The 46 global experts invited to write the 2019 international diabetic foot guidelines have just been announced, and this time four Australians are amongst them. With only one Australian previously invited onto the last 2015 international guidelines, this announcement recognises that Australia is fast becoming a leading global nation when it comes to expertise in managing diabetic foot disease.
The International Working Group on the Diabetic Foot (IWGDF) is the peak global body for all things diabetic foot. As part of this role the IWGDF publishes the international guidelines that outlines the most up-to-date robust global recommendations for assessing and managing diabetic foot disease. These guidelines are recognised as the global gold standard and are launched every four years at the ‘Olympics of the diabetic foot’ conference, the International Symposium of the Diabetic Foot (ISDF).
To develop these international guidelines, the IWGDF selects and invites leading global experts to write the international diabetic foot guidelines. To be eligible to be invited, experts must have authored leading research in a key field of diabetic foot disease in the last 4 years. For the 2019 guidelines the IWGDF has recognised four such experts from Australia, inviting:
- Professor Rob Fitridge for the field of peripheral artery disease (PAD) (re-invited from 2015)
- Dr Anita Raspovic for the field of prevention
- Dr Matthew Malone for the field of infection &
- Dr Pete Lazzarini for the field of offloading.
The overall IWGDF guidelines are led and coordinated by an Editorial Board comprising the world’s leading ‘expert experts’ in diabetic foot disease. The editorial board for 2019 is made up of:
- Prof Nicolaas Schaper from The Netherlands (Chair)
- Dr Jaap van Netten from The Netherlands (Secretary)
- Prof Ben Lipsky from the United States
- Prof Jan Apelqvist from Sweden
- Prof Robert Hinchliffe from the United Kingdom &
- Dr Sicco Bus from The Netherlands.
Many of these names will be very familiar to Australians and in particular those that have lectured at events in Australia over the last 12 months. For example:
- Prof Schaper headlined the Diabetes Feet Australia (DFA) 2017 Conference
- Dr Bus has headlined several DFA ‘What’s New in DFU’ 2017 events &
- Dr ‘Aussie’ Jaap van Netten is very well-known as the DFA Scientific Director.
The guidelines are divided up by the editorial board into multiple chapters covering key diabetic foot fields. In 2015, there were five chapters covering the fields of prevention, offloading, PAD, infection and wound healing. And in 2019, there will be six chapters, updating the same five chapters from 2015 and adding an additional chapter on diabetic foot ulcer assessment and classification.
Each chapter is developed by a working group of 6-12 experts. To be eligible to be invited onto a working group, an expert has to have authored leading research in the field of the chapter concerned in the last 4 years. Each working group then develops their particular chapter, which includes:
- formulating the key clinical questions for the chapter
- undertaking systematic reviews of the evidence to answer those clinical questions
- drafting the key clinical recommendations to manage diabetic foot disease for that chapter &
- finally drafting the full chapter and systematic reviews that goes into the final guidelines.
Each step of each chapter is carefully checked and approved by the editorial board before all chapters are brought together into the final guidelines to be published in the Diabetes Metabolism Research and Reviews journal and launched at ISDF; this time at The Hague in The Netherlands in May 2019.
Overall, there are thousands and thousands of hours of work from dozens of global experts pouring over thousands and thousands of papers and carefully coming to a final consensus conclusion for every recommendation that forms these guidelines. These guidelines then form the global gold standard for managing diabetic foot disease.
This recent IWGDF announcement of the expert authors to undertake this new guideline process highlights how far Australia has come in the world of diabetic foot disease. With Australia now providing nearly 10% of the global experts covering 75% of the chapters, and with Australia’s close ties with at least 50% of the IWGDF guideline editorial board, this announcement recognises the great progress the Australian diabetic foot community has made together over the last 4 years.
With the ongoing clinical and research collaboration of the Australian diabetic foot community, it is envisaged that many more Australians will be recognised for their global diabetic foot expertise in the 2023 international guidelines. And in turn Australia will begin to achieve one of its goals of being a recognised leading diabetic foot nation at the 2023 ‘Olympics of the diabetic foot conference’.
With more Australians with more global diabetic foot expertise this can only move us closer to our ultimate national goal of ending avoidable amputations in a generation.