A Critical Evaluation of Existing Diabetic Foot Screening Guidelines.

NewsBot · Nov 24, 2024

Effectiveness of screening for foot complications in people with diabetes – A systematic review
Aleksandra Staniszewska et al
Journal of Diabetes and its Complications; Volume 38, Issue 11, November 2024, 108865

Highlights
•
People with diabetes have a six-fold risk of limb loss compared to the general population
•
Annual foot checks are offered in England and Scotland to reduce the risk of limb loss
•
Only five recent studies assessed the effectiveness of structured foot screening
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The low number and quality of studies has resulted in variable effect of screening on clinical outcomes
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New robust evidence is needed to justify population-based foot screening in people with diabetes to guide use of resources
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Background
A quarter of people with diabetes develop foot ulcer in their lifetime and are six times more likely to require a major lower limb amputation compared to the general population. Risk stratification tools can reliably identify those at the highest risk of ulceration, but it remains unclear if screening for foot complications can prevent limb loss in people with diabetes.
Aims
The aim of this systematic review was to determine whether population-based foot screening in people with diabetes reduces lower limb complications as assessed by development of foot ulceration, minor and major lower limb amputations, hospitalisation, or death.
Methods
MEDLINE, Embase, Emcare and CINAHL databases were searched to identify randomised and non-randomised controlled trials and observational studies (cohort, case-control and cross-sectional surveys). The screening process, study quality assessment and data extraction were performed by two independent reviewers.
Results
Following abstract screening and assessment for eligibility, five out of 10,771 identified studies were included in the analysis. Of these studies, one demonstrated 24 % reduction in development of new ulceration following introduction of screening. Major amputations decreased by between 17 and 96 % in three studies. Hospitalisation rates were contradictory, with one study showing doubling in hospital admissions and another one reduction by 33 %. One study demonstrated no impact of screening on minor or major amputation rates. None of the studies addressed the effect of foot screening on all-cause mortality.
Conclusions
The number and quality of studies to support population-based foot screening to prevent lower limb complications in people with diabetes is low. Current evidence suggests variable impact of screening on important clinical outcomes.
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NewsBot · Nov 25, 2024

Diabetic Foot Ulcer beyond Wound Closure: Clinical Practice Guideline
Deborah M Wendland et al
Phys Ther. 2024 Nov 22

A total of 37.3 million Americans have diabetes, and 96 million more have prediabetes. Hyperglycemia, the hallmark of diabetes, increases the risk for diabetes-related complications, including skin breakdown and cardiovascular disease. Many clinical practice guidelines exist, but there are gaps regarding the best approaches to assess physical fitness and mobility in adults with diabetes; incorporate exercise into the care plan; and reload the diabetic foot after ulcer closure has occurred to avoid ulcer reoccurrence. The purpose of this clinical practice guideline was to review and assess previously published guidelines and address gaps within the guidelines specific to the following: best screening tools/tests and interventions to prevent a future reulceration, best screening tools and interventions to assess and address mobility impairments, best tools to measure and interventions to address reduced physical fitness and activity, best approach to reloading the foot after ulceration closure and, finally, whether improvement in physical fitness will positively change quality of life and health care costs. The Guidelines Development Group performed a systematic literature search and review of the literature. A total of 701 studies were identified. Following duplicate removal and exclusion for irrelevance, 125 studies underwent full-text review and 38 studies were included. Recommendations were developed using a software assistant created specifically for guideline recommendation development. Recommendations resulted for physical fitness and activity inclusion and measurement for adults with diabetes and with or without foot ulceration. Exercise and physical activity should be prescribed according to the physiologic response of an adult with diabetes to exercise and preferences for optimizing long-term quality of life and reduce health care costs. Reloading following diabetic foot ulcer closure should include maximal offloading, especially during the first 3 months; loading should be titrated using a footwear schedule. Further research is necessary in the areas of exercise in the wound healing process and the assessment of methods to reload a newly reepithelialized ulcer to prevent recurrence.
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NewsBot · Feb 16, 2025

Implementation of evidence-based foot screening in people with diabetes: A scoping review
Jemma M Houghton et al
J Diabetes Complications. 2025 Feb 12;39(3):108972.

Background: Recommendations to prevent diabetes ulceration and amputation include an annual foot check, primarily screening for sensation and circulation. Using these simple, evidence-based components is vital to identifying complications early, assessing risk, and managing care to prevent or delay amputations. However, routine implementation of these assessments is suboptimal and approaches to their integration remain poorly understood.

Aim: We aimed to identify and synthesize information on the factors affecting implementation of simple evidence-based diabetes foot screening.

Methods: We reviewed published and grey literature using a blinded two-stage process by two independent reviewers. Included studies were primary research that implemented or improved foot screening for adults with type 1 or 2 diabetes, assessing at least one of the following: 10-g monofilament sensitivity, pedal pulse palpation, or history of ulceration or amputation. A thematic synthesis approach was used.

Results: We screened 5133 titles and abstracts, reviewed 102 full-text articles, and included 26 studies in the final analysis. We identified four key themes: (1) Existing diabetes screening (i.e. retinal screening) or treatment interventions (i.e. medication collection) provide opportunities for synergistic integration; (2) Annual event-based foot screening (e.g. on World Diabetes Day) in lower resource settings provides community-focused preventative care; (3) Further opportunities to increase access to foot screening include self-administered screening and screening in complex residential settings; (4) Healthcare provider champions are essential for local foot screening implementation in primary and secondary care.

Conclusion: Further research should evaluate the issues identified in these four themes, in different contexts, and with support of implementation frameworks.
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NewsBot · May 25, 2025

Evaluating and mapping the evidence that screening for diabetic foot disease meets the criteria for population-wide screening: a scoping review
Jennifer A Pallin et al
BMJ Public Health. 2024 Jul 3;2(1):e000561.

Objective: To evaluate and map the evidence around diabetes-related foot screening using the World Health Organisation screening principles, which set the gold standard for determining the appropriateness of introducing population-wide screening programmes internationally.

Design: A scoping review methodology in line with Arksey and O'Malley and the Joanna Briggs Institute.

Data sources: Medline (EBSCO), Scopus, ScienceDirect and EMBASE between 24 May 2022 and 12 July 2022. Reference lists of the selected studies, and 'Google' and 'Google Scholar' were also searched.

Eligibility criteria: Inclusion criteria were informed by the principles of screening. Articles, published in English since 2000, reporting on the impact of the diabetes-related foot ulcers, effectiveness of treatment available for those identified as being at risk, reliability of screening tests for screening for the at-risk foot and the effectiveness, cost-effectiveness, safety and ethics of diabetes-related foot screening programmes were included.

Data extraction and synthesis: Data were extracted by one reviewer, with data extraction headings relating to the principles of screening. A narrative synthesis approach was used to report the information from included studies.

Results: 46 articles were deemed eligible for inclusion. Diabetes-related foot ulcers are an important health condition associated with increased risk of mortality and poorer quality of life. However, there is insufficient evidence on the effectiveness of treatments to prevent disease development. Moreover, while consensus exists on what screening tools should be used to screen for risk factors, there is no agreement on threshold values. Finally, there is no available information on the potential budgetary, organisational or societal implications of a whole-population diabetes-related foot screening programme.

Conclusion: Existing evidence does not support the introduction of an organised population-wide screening programme in the context of World Health Organisation screening principles. Further research on treatment and management strategies for the at-risk foot and of whole-population screening programmes is required.
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NewsBot · Sep 8, 2025

Prevalence, Screening Practices and Risk
Stratification for Diabetic Foot Complications in
Primary Healthcare Clinics: A Cross-Sectional Study
in Gauteng Province, South Africa
Simiso Ntuli
Source

Background/Objective: The incidence of diabetic foot complications has been increasing in South
Africa. While foot screening at the primary healthcare level is crucial for preventing these
complications, the growing number of cases in hospitals indicates that patients with diabetes are not
undergoing routine screening in primary healthcare settings. Method: This cross-sectional
descriptive observational study was conducted at five community healthcare centres, one in each
municipality in Gauteng. Participants included patients with diabetes who presented at these
facilities for their routine diabetes care. Data were collected, which included patient demographics, a
history of screening, risk factors for diabetic foot, and an assessment of diabetic foot was conducted
for each participant. Results: A total of 597 diabetic patients volunteered for this study. Only 10%
(n=60) had received a diabetic foot assessment. No patient had been risk-stratified; the results showed
that 30% (n=178) were very low risk and 17% (101) were at high risk. Active ulcers were recorded in
19% (116), and 18% (106) were in remission. Neuropathy was recorded in 33% (1498), peripheral
arterial disease in 22% (131), and a history of amputation was recorded in 17% (103). Conclusion:
Implementing routine diabetic foot assessment and risk stratification at the PHC level could be key
in preventing diabetic-related complications.
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NewsBot · Oct 1, 2025

Establishing guidelines-based multidisciplinary diabetic limb salvage programme: A 100-day review of clinical characteristics and outcomes
Jaime Hui Xian Lin et al
SAGE Open Med . 2025 Sep 27:13:20503121251368698.

Objectives: A newly established hospital in Singapore has introduced a pioneering multidisciplinary diabetic foot programme to provide comprehensive care for patients with diabetic foot ulcers. This study evaluates the early outcomes of a multidisciplinary diabetic limb salvage programme. Over the first 100 days of operation, the diabetic foot programme managed 106 patients.

Methods: A descriptive statistical analysis was conducted to evaluate clinical characteristics and outcomes at 100 days of follow-up.

Results: The majority of patients were Malay (46.2%) and male (61.3%), with a median age of 63.5 years. Most patients had long-standing diabetes and poor glycaemic control (77.8%), leading to high rates of diabetes-related complications. A total of 18.3% of patients had osteomyelitis, and 11.7% had gangrene. Of the 106 patients, 61.3% required inpatient management, 25.5% underwent revascularisation, and 34.9% had diabetic foot ulcer-related surgeries. According to Wound, Ischaemia and Foot Infection 12-month risk stratification, nearly 30% of patients were at medium to high risk of major lower extremity amputation. Minor lower extremity amputation occurred in 15.1% of patients and 4.7% required major lower extremity amputation. The 30-day mortality rate was 3.8%, and the average length of stay was 15.7 days. The time from admission to revascularisation was 4.4 days, and the time to diabetic foot ulcer-related surgery was 4.2 days. Wound healing was documented in 34.8% of patients at 100 days of follow-up, with a healing time of 63.2 days.

Conclusion: Our guidelines based, multidisciplinary diabetic limb salvage programme demonstrated favourable limb salvage outcomes despite high predicted amputation risks. The early outcomes of this programme highlight the effectiveness of early medical optimisation, infection control, revascularisation and active wound care.
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NewsBot · Oct 29, 2025

Diabetic Foot Screening: A Systematic Review of Global Guidelines and Questionnaire-Based Tools
Glenys Shu Wei Quak et al
Source

Diabetic foot ulcers are a significant complication of diabetes mellitus, contributing to high morbidity, prolonged hospitalisations, and increased healthcare costs. Early detection through diabetic foot screening (DFS) and preventive management strategies are therefore crucial in reducing the incidence of diabetic foot ulcers and improving patient outcomes. Hence, this study aims to review and summarise the current practices in DFS and risk stratification to aid subsequent clinical management. A systematic search of PubMed and Embase was conducted to identify articles relevant to DFS guidelines and questionnaire-based screening tools. Of 1761 studies screened, 15 met the inclusion criteria. While national and international guidelines provide comprehensive protocols for DFS with similarities in screening components, differences exist in risk stratification approaches, frequency of assessments, and integration of questionnaire-based tools such as Q-DFD, Thai Q-DFD, DFSQ-UMA and MNSI. Analysis of DFS guidelines identified three key components: neuropathy assessment, vascular assessment, and visual inspection. The screening methods include monofilament testing, vibration perception, and pedal pulse palpation with additional tools such as ankle-brachial index being used in some of the guidelines. These can be performed by various healthcare providers, including general practitioners, diabetes nurses, and podiatrists, ensuring accessibility across different healthcare settings. Risk stratification models classify patients into low-, moderate-, or high-risk categories, guiding screening frequency which varies from annual to quarterly assessments depending on risk level. Effective DFS, based on standardised guidelines and risk stratification models, is essential for preventing diabetic foot ulcers. The integration of DFS into routine clinical practice, supported by tools such as validated questionnaires, can significantly improve outcomes for diabetic patients.
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NewsBot · Dec 30, 2025

Exploring diabetic foot screening programs with integrated consolidated framework for implementation: Rapid review protocol
Virginie Blanchette et al
HRB Open Res. 2025 Apr 4:8:49.

Background: Diabetic foot ulcers (DFU)s pose significant challenges for individuals with diabetes, leading to severe consequences, such as lower extremity amputations (LEA)s, reduced quality of life, and increased mortality. Disorganized diabetic foot care services contribute to health inequities worldwide, highlighting the need for structured preventive measures, which require an understanding of organizational and systemic components of the implementation of foot screening programs or initiatives, including equity factors. Thus, the Consolidated Framework for Implementation Research (CFIR) is one of the most widely used frameworks for assessing these factors and contexts. This helps to reduce the risk of failure of implementation efforts in the real world and can help to support the scaling up of preventative measures. This review aims to analyze foot screening programs or initiatives for individuals at risk of DFUs and LEAs, define their key components and implementation determinants, identify barriers and facilitators, and describe effective implementation strategies in primary care with CFIR.

Methods: A rapid review will be conducted following the Canadian method by Dobbins (2017) and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. The research question is defined using the PICO framework. A systematic search will be conducted in MEDLINE, CINAHL, and EMBASE. Primary studies in English or French, including both primary study designs and knowledge syntheses, will be screened according to the defined eligibility criteria via Covidence. Study quality will be appraised using the Mixed Methods Appraisal Tool and data will be synthesized guided by the CFIR. Data synthesis will focus on implementation determinants, including barriers, facilitators, and implementation strategies.

Discussion: Findings will inform policy, practice and decision making regarding the implementation of screening programs. This can promote the development of screening programs for diabetic foot complications across Canada or in other countries.
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NewsBot · Mar 26, 2026

Quality of Clinical Practice Guidelines for Diabetic
Foot Management: A Systematic Review Using the
AGREE II and AGREE-REX Instruments
Yu Song et al
Source

Objective: To evaluate the methodological quality and the excellence of recommendations in clinical practice guidelines (CPGs) for
diabetic foot ulcer (DFU) management, and to synthesize their clinical treatment recommendations.
Methods: A systematic search of PubMed, EMBASE, Web of Science, and guideline databases was conducted to identify DFU
guidelines published between January 1, 2015, and May 1, 2025. The quality of included guidelines was appraised by reviewers using
the AGREE II and AGREE-REX instruments. Domain scores are presented as median (interquartile range). Recommendations for
DFU clinical treatment were synthesized, and the supporting evidence was graded using the OCEBM system.
Results: Fifteen CPGs were included (6high-quality, 9moderate-quality). The highest AGREE II domain score was for Editorial
Independence (100.00% [97.22–100.00%]), followed by Scope and Purpose (96.30% [88.89–100.00%]), Clarity of Presentation
(96.30% [92.59–100.00%]), Rigor of Development (75.69% [41.67–93.06%]), and Stakeholder Involvement (74.07% [62.96–-
83.33%]). The lowest scoring domain was Applicability (52.78% [36.11–59.72%]). The lowest AGREE-REX score was for Values
and Preferences (47.22% [43.06–52.78%]), while Clinical Applicability (79.63% [66.67–81.48%]) and Implementability (77.78%
[72.22–80.56%]) scored respectably. Seventeen key DFU treatment recommendations were synthesized, mostly Grade
B recommendations supported by moderate-quality evidence.
Conclusion: Existing DFU guidelines are developed using systematic methods but show limitations in applicability, stakeholder
involvement, and rigor of development. The quality of recommendations is inconsistent, with notably low scores in the domain of
values and preferences. Enhancing these aspects and improving the underlying evidence quality are crucial strategies for future
guideline development and implementation.
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NewsBot · May 29, 2026

Diabetic foot screening programs through an implementation science lens: A rapid review
Maya Fakhfakh et al
Int J Nurs Stud. 2026 May 19:182:105582.

Background: Diabetes-related foot conditions drive amputations and premature mortality worldwide. Although international guidelines recommend annual foot screening based on risk, implementation remains insufficient and inequitable. This rapid review synthesized evidence on primary-care diabetic foot screening programs, examined barriers and facilitators using the Consolidated Framework for Implementation Research, and mapped strategies with an equity lens.

Methods: A rapid review following Dobbins (2017) was reported according to PRISMA guidelines. MEDLINE, EMBASE, and CINAHL were searched from inception to October 2025, supplemented by citation tracking. Data extraction focused on study and participant characteristics, program components, PROGRESS+ equity factors, and Consolidated Framework for Implementation Research determinants. Narrative synthesis included descriptive overview of program components and Consolidated Framework for Implementation Research-based analysis of barriers, facilitators, and strategies mapped to Expert Recommendations for Implementing Change.

Results: 44 studies from 16 countries were included, most (73%) from high-income settings with contributions from upper-middle-income (11%) and low- and middle-income countries (16%). Programs frequently integrated screening into routine workflows, incorporated risk stratification, and were delivered by multidisciplinary teams. Facilitators included validated guidelines, electronic health records templates and prompts, cultural and linguistic adaptation, leadership commitment, and coalition-building. Barriers included resource constraints, staff turnover, fragmented care, and economic barriers to access. Expert Recommendations for Implementing Change reported strategies included cyclical small tests of change, audit and feedback, educational meetings and materials, coalition-building and infrastructure changes. Equity tailoring was described but inconsistently applied, with no study systematically stratifying outcomes by sociodemographic subgroups.

Conclusion: Diabetic foot screening programs share common components but face barriers to equity and sustainability. Implementation informed by Consolidated Framework for Implementation Research analysis and grounded in equity can reduce avoidable amputations globally.
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NewsBot · Jul 13, 2026

Integrated care pathway for the management of diabetic foot disease: a position statement from the Italian Diabetic Foot Study Group
Laura Giurato et al
Acta Diabetol. 2026 Jul 13.

Diabetic foot is one of the most serious chronic complications of diabetes mellitus and reflects the systemic burden of the disease. Preventive strategies and structured management pathways are therefore essential elements of diabetes care. Lifetime occurrence of foot ulceration has been reported in nearly one-third of individuals with diabetes, and these lesions account for most non-traumatic lower-extremity amputations. Furthermore, the estimated five-year mortality following ulceration is 30%. This document aims to ensure an appropriate, multidisciplinary care pathway for patients with diabetic foot, tailored to clinical complexity and aligned with the different levels of care of Italian diabetes centers. The integrated model of diabetic foot care is based on the level of care that diabetes centers (local and hospital) can provide, including available personnel, expertise, and diagnostic and therapeutic resources to manage varying degrees of clinical complexity. Accordingly, three levels of care complexity, low, medium, and high, have been defined, with corresponding key diagnostic and therapeutic activities and healthcare professionals involved.
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A Critical Evaluation of Existing Diabetic Foot Screening Guidelines.

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Critical Thinking

Iatrogenic injury and critical limb iscahemia

“Switch” Critical to Wound Healing

Critical limb ischemia

Critical limb ischemia criteria are not applicable to diabetic foot

'Time critical' rapid amputation using fire service hydraulic cutting equipment

Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis--critical appr

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A Critical Evaluation of Existing Diabetic Foot Screening Guidelines.

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NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

NewsBot The Admin that posts the news.

Critical Thinking

Iatrogenic injury and critical limb iscahemia

“Switch” Critical to Wound Healing

Critical limb ischemia

Critical limb ischemia criteria are not applicable to diabetic foot

'Time critical' rapid amputation using fire service hydraulic cutting equipment

Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis--critical appr

Share This Page

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