This may be the author’s version of a work that was submitted/accepted for publication in the following source:
Parker, Christina,Lazzarini, Peter A.,van Netten, Jaap J., &Parker, Tony J.
(2019)
Differences between the IWGDF guideline and national guidelines for the management of diabetic foot disease. In
Vietnam Wound Care Conference, 2018-05-18 - 2018-05-18. (Unpub-lished)
This file was downloaded from: https://eprints.qut.edu.au/132435/
c
2019 The Author(s)
This work is covered by copyright. Unless the document is being made available under a Creative Commons Licence, you must assume that re-use is limited to personal use and that permission from the copyright owner must be obtained for all other uses. If the docu-ment is available under a Creative Commons License (or other specified license) then refer to the Licence for details of permitted re-use. It is a condition of access that users recog-nise and abide by the legal requirements associated with these rights. If you believe that this work infringes copyright please provide details by email to [email protected]
Notice:Please note that this document may not be the Version of Record (i.e. published version) of the work. Author manuscript versions (as Sub-mitted for peer review or as Accepted for publication after peer review) can be identified by an absence of publisher branding and/or typeset appear-ance. If there is any doubt, please refer to the published source.
Differences between the IWGDF
guideline and national guidelines for the
management of diabetic foot disease
Dr Christina Parker
1,2Dr Peter Lazzarini1,3, Dr Jaap Van Netten1,3,5, Dr Tony Parker1,4
1Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT) 2School of Nursing, QUT
3School of Clinical Sciences, Faculty of Health, QUT 4School of Biomedical Sciences, Faculty of Health, QUT
5Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement
Background
Prevalence of diabetes:
9% of adult men
8% of adult women
Expected to rise by up to 70%
Background
Aim
To compare guidelines of Western Pacific nations with the International
Working Group on the Diabetic Foot (IWGDF) guidance documents
Methods
12 Nations invited to participate representing >30% of the worlds diabetes population
8 Nations responded
Australia
China
New Zealand
Taiwan
Thailand
Singapore
Hong Kong
Phillipines
Data extraction
Guidelines reviewed for :
Year of publication
Type of guideline
Development structure
Type of literature review performed
Data Analysis
Descriptive statistics for guideline recommendations were listed as:
Similar (over 80% matching)
Partially similar (20-80% matching)
Not similar / not present (<20% matching)
Different
Results
Methodology of national guidelines
Guideline Year of publication
Type of guideline Committee Structure
Type of review Structure of the guideline
ASEAN 2015 Standalone document Expert committee from 5 surgical and medical disciplines across 6 nations
Narrative reviews Four sections with multiple recommendations: prevention; assessment and investigation; medical treatment and surgical treatment.
Australia 2011 Part of overall set of guidelines for prevention, diagnosis and management of diabetes, but accessible as standalone document Expert committees of national and international clinicians from 8 surgical and medical disciplines
Systematic reviews, with expert opinion used where evidence was absent or unreliable
Multiple recommendations classified under headings of primary care settings (assessing and defining risk, frequency of risk assessment and prevention of foot complications), management of foot complications in primary care settings (predicting outcomes from foot ulcers, tools for grading foot ulcer severity and interventions for ulcer management) and relevance to specialist settings (management in specialist settings).
Chinese 2013 Part of guideline for Type II diabetes Expert committee of endocrinologists Expert opinion Guidance on chronic complications of diabetes including diabetic peripheral neuropathy, diabetic foot disease and lower extremity arterial disease.
Results
Methodology of national guidelines
Guideline Year of publication
Type of guideline Committee Structure Type of review Structure of the guideline
New
Zealand
2014 Part of a diabetes guideline to be used in conjunction with other national and
international documents
Expert team supported by an advisory group of diabetes specialists, dietitians and general practitioner
Narrative reviews Five topic groupings including multiple recommendations: basic care, self-management and education; management of glycaemia and cardiovascular risk for people with diabetes; management of diabetes complications; while in hospital; and special groups.
Thailand 2013 Standalone document Expert committee of national clinicians from 7 surgical, medical and rehab disciplines, physiotherapist and pedorthists
Systematic reviews, with expert opinion used where
evidence was absent or unreliable
Includes multiple recommendations for diabetes mellitus screening to prevent foot ulcers, prevention and
management of different types of diabetic foot ulcers, prevention of recurrent ulcer, proper shoes and orthoses for people with diabetes, roles of different levels of healthcare units and their key performance index.
Taiwan 2015 Part of a book on Clinical practice guidelines for diabetes care
The Diabetes Association of the Republic of China (Taiwan)
Expert opinion A chapter on diabetic foot with one recommendation noted.
Results
National guideline ratings
0
20
40
60
80
ASEAN Australia
China
New
Zealand
Taiwan
Thailand
Total
%
Prevention (13 recommendations)
Results
National guideline ratings
0
20
40
60
80
100
ASEAN Australia
China
New
Zealand
Taiwan
Thailand
Total
%
Offloading (13 recommendations)
Results
National guideline ratings
0
20
40
60
80
100
ASEAN Australia
China
New
Zealand
Taiwan
Thailand
Total
%
PAD (16 Recommendations)
Results
National guideline ratings
0
50
100
150
ASEAN Australia
China
New
Zealand
Taiwan
Thailand
Total
%
Infection (26 recommendations)
Results
National guideline ratings
0
20
40
60
80
100
ASEAN Australia
China
New
Zealand
Taiwan
Thailand
Total
%
Wound Healing (9 Recommendations)
Results
National guideline ratings
0
20
40
60
80
100
ASEAN
Australia
China
New
Zealand
Taiwan
Thailand
%
Total (77 Recommendations)
Discussion
First study to compare national guidelines with peak international guidance documents
Limited similarity to the recommendations
Higher level of similarity related to :
Rigorous methodologies
Involvement of multidisciplinary experts
Lower level of similarity related to:
Complex management
Conclusion
Scope to improve the development of national diabetic foot disease guidelines
Development of guidelines should include:
Robust methodology
Multidisciplinary experts
Specific
