Here is the link to the guidelines for peripheral artery disease in people with diabetes.
Diabetes-related foot complications have become a major cause of morbidity and are implicated in
most major and minor amputations globally. Approximately 50% of people with diabetes and a foot
ulcer have peripheral artery disease (PAD) and the presence of PAD significantly increases the risk of
adverse limb and cardiovascular events.
The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based
guidelines on the management and prevention of diabetes-related foot complications since 1999. This
guideline is an update of the 2019 IWGDF guideline on the diagnosis, prognosis and management of
peripheral artery disease in people with diabetes mellitus and a foot ulcer. For this updated guideline the
IWGDF, the European Society for Vascular Surgery and the Society for Vascular Surgery decided to
collaborate to develop a consistent suite of recommendations relevant to clinicians in all countries.
This guideline is based on three new systematic reviews. Using the Grading of Recommendations,
Assessment, Development, and Evaluation (GRADE) framework clinically relevant questions were
formulated, and the literature was systematically reviewed. After assessing the certainty of the evidence,
recommendations were formulated which were weighed against the balance of benefits and harms,
patient values, feasibility, acceptability, equity, resources required, and when available, costs.
Through this process five recommendations were developed for diagnosing PAD in a person with
diabetes, with and without a foot ulcer or gangrene. Five recommendations were developed for
prognosis relating to estimating likelihood of healing and amputation outcomes in a person with diabetes
and a foot ulcer or gangrene. Fifteen recommendations were developed related to PAD treatment
encompassing prioritisation of people for revascularisation, the choice of a procedure and post-surgical
care. In addition, the Writing Committee has highlighted key research questions where current evidence
is lacking.
The Writing Committee believes that following these recommendations will help healthcare
professionals to provide better care and will reduce the burden of diabetes-related foot complications.
Here are some key points about the authors of the IWGDF PAD guideline:
- The guideline was developed jointly by the International Working Group on the Diabetic Foot (IWGDF), the European Society for Vascular Surgery (ESVS), and the Society for Vascular Surgery (SVS).
- The writing committee consisted of 18 members, 6 selected by each organization. This included experts in vascular surgery, angiology, interventional radiology, vascular medicine, endocrinology, epidemiology, and podiatry.
- The committee was co-chaired by Robert Hinchliffe (on behalf of ESVS), Joseph Mills (on behalf of SVS), and Robert Fitridge (on behalf of IWGDF).
- Nicolaas Schaper (on behalf of IWGDF) and Vivienne Chuter (as scientific secretary) also played key roles.
- The authors came from various countries including the USA, UK, Australia, Germany, Japan, and others. This provided an international perspective.
- All authors participated in reviewing evidence, formulating recommendations using the GRADE approach, and writing/reviewing the guideline text.
To summarize, this was an international, multidisciplinary group of experts in diabetic foot disease and vascular care that collaborated to develop the guideline.
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