背景:糖尿病相关的足部疾病(DFD)-足部溃疡,感染,缺血-是住院的主要原因,残疾,以及澳大利亚的医疗费用。以前的2011年澳大利亚DFD指南已经过时。我们通过使用NHMRC推荐的ADAPTE和GRADE方法,系统地将合适的国际指南调整为澳大利亚环境,开发了新的澳大利亚基于证据的DFD指南。
结论:本文总结了针对普通医学受众的六项新指南中提出的98项建议中最相关的建议,包括:预防-筛查,教育,自我照顾,鞋类,和预防DFD的治疗方法;溃疡的分类-分类系统,感染,缺血和审计;外周动脉疾病(PAD)-检查和成像诊断,严重性分类,和治疗;感染-检查,文化,用于诊断的成像和炎症标志物,严重性分类,和治疗;卸载-不同溃疡类型和位置的压力卸载治疗;和伤口愈合-清创,伤口敷料的选择原则和不愈合溃疡的伤口治疗。
■对于没有DFD的人,主要变化包括使用新的风险分层系统进行筛查,对风险进行分类并管理DFD风险增加的人员。对于那些被归类为DFD风险增加的人,更具体的自我监控,鞋类处方,手术治疗,和活动管理实践,以防止DFD已被推荐。对于有DFD的人,关键的变化包括使用新的溃疡,用于评估的感染和PAD分类系统,记录和传达DFD严重性。这些系统还通知更具体的PAD,感染,压力卸载,和伤口愈合管理建议,以解决DFD。
Diabetes-related foot disease (DFD) - foot ulcers, infection, ischaemia - is a leading cause of hospitalisation, disability, and health care costs in Australia. The previous 2011 Australian
guideline for DFD was outdated. We developed new Australian evidence-based
guidelines for DFD by systematically adapting suitable international
guidelines to the Australian context using the ADAPTE and GRADE approaches recommended by the NHMRC.
This article summarises the most relevant of the 98 recommendations made across six new
guidelines for the general medical audience, including: prevention - screening, education, self-care, footwear, and treatments to prevent DFD; classification - classifications systems for ulcers, infection, ischaemia and auditing; peripheral artery disease (PAD) - examinations and imaging for diagnosis, severity classification, and treatments; infection - examinations, cultures, imaging and inflammatory markers for diagnosis, severity classification, and treatments; offloading - pressure offloading treatments for different ulcer types and locations; and wound healing - debridement, wound dressing selection principles and wound treatments for non-healing ulcers.
For people without DFD, key changes include using a new risk stratification system for screening, categorising risk and managing people at increased risk of DFD. For those categorised at increased risk of DFD, more specific self-monitoring, footwear prescription, surgical treatments, and activity management practices to prevent DFD have been recommended. For people with DFD, key changes include using new ulcer, infection and PAD classification systems for assessing, documenting and communicating DFD severity. These systems also inform more specific PAD, infection, pressure offloading, and wound healing management recommendations to resolve DFD.