Christina N Parker1,2, Jaap J Van Netten1,3,4, Tony J Parker1,5, Limin Jia6, Heidi Corcoran7, Michele Garrett8,9, Ching F Kwok10, Aziz Nather11, Ma Teresa Que12, Gulapar Srisawasdi13, Paul Wraight14, Peter A Lazzarini1,3,15. 1. Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia. 2. School of Nursing, Queensland University of Technology, Brisbane, Australia. 3. School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia. 4. Department of Rehabilitation Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands. 5. School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia. 6. Department of Endocrinology, Ningxia People's Hospital, Yinchuan, China. 7. Podiatry Department, Tuen Mun Hospital, New Territories West Cluster, Hong Kong Hospital Authority, Tuen Mun, Hong Kong. 8. Podiatry SIG, New Zealand Society for the Study of Diabetes, Auckland, New Zealand. 9. Diabetes Service, Waitemata District Health Board, Auckland, New Zealand. 10. Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital and National Yang Ming University, Taipei, Taiwan ROC. 11. Department of Orthopaedic Surgery, National University Hospital, Singapore. 12. Diabetes Foot Clinic, East Avenue Medical Center, Quezon City, Philippines. 13. Department of Rehabilitation Medicine, Siriraj Hospital, Bangkok, Thailand. 14. Diabetic Foot Unit, Royal Melbourne Hospital, Melbourne, Australia. 15. Allied Health Research Collaborative, Metro North Hospital and Health Service, Brisbane, Australia.
Abstract
AIM: No studies have investigated if national guidelines to manage diabetic foot disease differ from international guidelines. This study aimed to compare guidelines of Western Pacific nations with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. METHODS: The 77 recommendations in five chapters of the 2015 IWGDF guidance documents were used as the international gold standard reference. The IWGDF national representative(s) from 12 Western Pacific nations were invited to submit their nation's diabetic foot guideline(s). Four investigators rated information in the national guidelines as "similar," "partially similar," "not similar," or "different" when compared with IWGDF recommendations. National representative(s) reviewed findings. Disagreements in ratings were discussed until consensus agreement achieved. RESULTS: Eight of 12 nations (67%) responded: Australia, China, New Zealand, Taiwan, and Thailand provided national guidelines; Singapore provided the Association of Southeast Asian Nations guidelines; and Hong Kong and the Philippines advised no formal national diabetic foot guidelines existed. The six national guidelines included were 39% similar/partially similar, 58% not similar, and 2% different compared with the IWGDF recommendations. Within individual IWGDF chapters, the six national guidelines were similar/partially similar with 53% of recommendations for the IWGDF prevention chapter, 42% for wound healing, 40% for infection, 40% for peripheral artery disease, and 20% for offloading. CONCLUSIONS: National diabetic foot disease guidelines from a large and diverse region of the world showed limited similarity to recommendations made by international guidelines. Differences between recommendations may contribute to differences in national diabetic foot disease outcomes and burdens.
AIM: No studies have investigated if national guidelines to manage diabetic foot disease differ from international guidelines. This study aimed to compare guidelines of Western Pacific nations with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. METHODS: The 77 recommendations in five chapters of the 2015 IWGDF guidance documents were used as the international gold standard reference. The IWGDF national representative(s) from 12 Western Pacific nations were invited to submit their nation's diabetic foot guideline(s). Four investigators rated information in the national guidelines as "similar," "partially similar," "not similar," or "different" when compared with IWGDF recommendations. National representative(s) reviewed findings. Disagreements in ratings were discussed until consensus agreement achieved. RESULTS: Eight of 12 nations (67%) responded: Australia, China, New Zealand, Taiwan, and Thailand provided national guidelines; Singapore provided the Association of Southeast Asian Nations guidelines; and Hong Kong and the Philippines advised no formal national diabetic foot guidelines existed. The six national guidelines included were 39% similar/partially similar, 58% not similar, and 2% different compared with the IWGDF recommendations. Within individual IWGDF chapters, the six national guidelines were similar/partially similar with 53% of recommendations for the IWGDF prevention chapter, 42% for wound healing, 40% for infection, 40% for peripheral artery disease, and 20% for offloading. CONCLUSIONS: National diabetic foot disease guidelines from a large and diverse region of the world showed limited similarity to recommendations made by international guidelines. Differences between recommendations may contribute to differences in national diabetic foot disease outcomes and burdens.
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