In 2020, under the auspices of Diabetes Feet Australia and the Australian Diabetes Society, a national multi-disciplinary expert Australian DFD Guidelines working group was established with the aim of developing new Australian guidelines on managing diabetes-related foot disease. The working group developed methodology, based on NHMRC recommendations, to adapt suitable international DFD guidelines to the Australian context and established six national multi-disciplinary expert panels to enact the methodology and develop six individual Australian DFD guidelines (or chapters).

Following much work from the panels, the consultation drafts of the six new chapter guidelines have recently been completed and are now open for public consultation. These include chapter guidelines on prevention, offloading, infection, PAD, wound healing and wound classification.

We encourage all Australian health professionals, researchers and peak bodies with an interest in DFD to read the following consultation chapter guideline drafts and complete the below consultation surveys. Public consultation for each chapter guideline is open for a minimum of 4 weeks with opening and closing dates listed below. Once closed, we will provide the aggregated non-identifiable survey feedback to the panel to consider, address, improve and finalise the new Australian DFD guidelines for launch in mid-2021.

Public Consultation Prevention FB
Public Consultation Offloading FB
Public Consultation Infection FB
Public Consultation PAD FB
Public Consultation WHI FB
Public Consultation WC FB

In 2020, under the auspices of Diabetes Feet Australia and the Australian Diabetes Society, a national multi-disciplinary expert Australian DFD Guidelines working group was established with the aim of developing new Australian guidelines on managing diabetes-related foot disease. The working group developed methodology, based on NHMRC recommendations, to adapt suitable international DFD guidelines to the Australian context and established six national multi-disciplinary expert panels to enact the methodology and develop six individual Australian DFD guidelines (or chapters).

Following much work from the panels, the consultation drafts of the six new chapter guidelines have recently been completed and are now open for public consultation. These include chapter guidelines on prevention, offloading, infection, PAD, wound healing and wound classification.

We encourage all Australian health professionals, researchers and peak bodies with an interest in DFD to read the following consultation chapter guideline drafts and complete the below consultation surveys. Public consultation for each chapter guideline is open for 4 weeks with opening and closing dates listed below. Once closed, we will provide the aggregated non-identifiable survey feedback to the panel to consider, address, improve and finalise the new Australian DFD guidelines for launch in mid-2021.

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HEALTHCARE PROFESSIONALS

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RESEARCHERS

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ORGANISATIONS & PEAK BODIES

About the Guidelines

Australian experts
DFD Chapter
Groups
DFD recommendations
screened and reviewed

National Health and Medical Research Council recommendations for adapting suitable international guidelines were followed for this project. We systematically searched for international DFD guideline records. Search results were independently screened, and eligible full-text guidelines assessed for suitability using AGREE II and NHMRC instruments. Those scoring at least moderate quality, suitability and currency were included and had all recommendations extracted into six sub-fields: prevention, offloading, peripheral artery disease, infection, wound classification and wound healing interventions.

Six national expert panels, each comprising 6-8 (inter)national DFD multi-disciplinary clinical, research, consumer and Aboriginal and Torres Strait Islander experts, screened all recommendations within their sub-field for acceptability and applicability in the Australian context, using a customised ADAPTE evaluation form. Where panels were unsure of any acceptability and applicability items, full assessments were undertaken using a customised GRADE Evidence to Decision tool. Recommendations were adopted, adapted or excluded based on the level of agreement between the panel’s and original guideline’s judgements. Each panel developed subfield guideline manuscripts, outlining the recommendation, decision rationale, justifications and implementation considerations for each recommendation, with public consultation now underway.

PREVENTION

In Australia, it is estimated that 50,000 people are living with diabetes-related foot ulcers (DFU), while 300,000 people are considered at-risk of DFU. Aboriginal and Torres Strait Islander Australians have up to a 38-fold elevated risk of developing DFD, including diabetes-related peripheral neuropathy, DFU and amputation. DFU recurrence is common, with 40% of patients re-ulcerating within one year, and 65% within three years.

Implementing strategies for the prevention of DFU is critical to all Australians and will likely contribute to lowering the national health care burden. Addressing the DFU health disparities experienced by Aboriginal and Torres Strait Islander Australians is also paramount.

Interventions aimed at the prevention of DFU have been found to have contrasting benefits and risks, varying levels of evidence to support their benefits and risks, and global differences in their feasibility and clinical uptake. In order to interpret these benefits and risks, the quality of the supporting evidence, and the acceptability and feasibility of these interventions, evidence-based prevention guidelines have been developed to guide optimal care for people at-risk of DFU.

MEET THE PREVENTION CHAPTER GUIDELINE GROUP

Anita-Raspovic
M Kaminski Profile
Jon About Us
J Lasschuit profile
karl Schott Profile
James Charles Profile
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OFFLOADING

Pressure offloading management is critical for healing diabetes-related foot ulcers (DFU). Evidence-based guidelines have been developed over the years to weigh up the benefits, risks, quality of evidence and feasibility of different pressure offloading treatments to provide health professionals with best practice recommendations on how to provide optimal offloading treatment to people with DFU.

The current 2011 Australian evidence-based DFD guidelines are now outdated and substantial new offloading evidence has been published over the last decade. Many international evidence-based DFD guidelines have taken this new evidence into account and recently been published, but their applicability to the Australian context is unclear. Here, we aim to systematically adapt suitable international guidelines to the Australian context to become the new Australian evidence-based guideline on offloading management for people with DFU.

MEET THE OFFLOADING CHAPTER GUIDELINE GROUP

Pete Lazzarini About Us
Mal Fernando Profile
VNube Profile
Brian Martin Profile
Sara Jones profile
M Horsley Profile
James Charles Profile
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INFECTION

Diabetes-related foot infections cause substantial morbidity and mortality, with an increasingly large economic impact, both directly through patient management and indirectly through patient disability. Diabetes-related foot ulcers (DFU) currently affect around 50,000 Australians, and up to 40% of these individuals can expect to have an associated infection in the first year after presentation.

Risk of complications are further increased in Aboriginal and Torres Strait Islander peoples and addressing these risks are needed to successfully achieve key outcomes identified in the 2020 Closing the Gap in Partnership agreement.

Evidence-based guidelines are vital to ensure optimal multi-disciplinary management and outcomes of patients with diabetes-related foot infections. The current guidelines aimed to identify and adapt high quality international guidelines to the Australian context to become the new Australian multi-disciplinary evidence-based guidelines for people with a diabetes-related foot infection.

MEET THE INFECTION CHAPTER GUIDELINE GROUP

RobCommons
Sarah Lynar Profile
Matt Malone About Us
Ed Raby Profile
James Charles Profile
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PERIPHERAL ARTERY DISEASE

Diabetes-related peripheral artery disease (PAD) is implicated in up to 50% of diabetes-related foot ulcers (DFU) and significantly contributes to morbidity and mortality in this population.

Peripheral artery disease (PAD) is estimated to affect up to 12% of all adults. Despite the severity of the outcomes of PAD in people with diabetes, and particularly in those with DFU, there are limited data to determine best practice treatments for this specific population.

In Australia, national evidence-based guidelines for the assessment and management of DFD have not been published since 2011. Several international evidence-based DFD guidelines have been published recently. However, parts of these guidelines may not be appropriate or applicable in an Australian clinical setting due to the unique geographical and health care system differences between Australia and other parts of the world.

To develop a suitable national guideline for the assessment of management of PAD in people with DFU, we aimed to systematically identify and adapt suitable international guidelines.

MEET THE PAD CHAPTER GUIDELINE GROUP

Rob Fitridge About Us
V Chuter
C Ritter
Patrik
Frank Quigley
James Charles Profile
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WOUND HEALING INTERVENTIONS

In 2011, the peak International (IWGDF) DFD Guidelines reported that poor study design and reporting were a key limitation in the evidence base of interventions to enhance healing of DFU. However, with the subsequent 2016 IWGDF international reporting standards for DFU studies published, several well-designed clinical trials involving interventions to enhance DFU wound healing have since been published.

The last national evidence-based guideline in Australia published in 2011 urgently needs updating. Experts suggest there is a ‘renaissance in DFU wound healing intervention studies’ that have provided considerable new robust evidence to support different wound healing interventions that have significantly improved outcomes for people with DFU since 2011

This is a timely opportunity to adapt the 2019 IWGDF Guideline to the Australian context to become the new Australian guideline on wound healing interventions and in turn guide health professionals to address the large national DFU burden and mitigate existing inequalities amongst Australians living with DFU.

MEET THE WOUND HEALING INTERVENTIONS CHAPTER GUIDELINE GROUP

Jenny Prentice About Us
Pam Chen
K Carville
Terry Swanson
Pete Lazzarini About Us
James Charles Profile
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WOUND CLASSIFICATION

The annual burden of DFD in Australia is high with an estimated 27,600 public hospitalisations, 4,400 lower limb amputations, 1,700 deaths, and health system costs of $1.6 billion each year. Management of DFD by interdisciplinary high risk foot services (iHRFS) has been shown to increase the percentage of healed DFU, and reduce DFU healing times, amputations and hospitalisations.

Effective assessment, documentation and communication of clinical information and audit of patient outcomes is central to achieving optimal outcomes for patients living with DFD. National evidence-based Australian guidelines for prevention, identification and management of foot complications in diabetes were last published in 2011 and are now outdated. As there are existing international DFD guidelines that were recently updated and suitable for adaptation to an Australian context, here we present the new Australian evidence-based guideline for wound classification in people with DFU, adapted from recent 2019 IWGDF guidelines.

MEET THE WOUND CLASSIFICATION CHAPTER GUIDELINE GROUP

Stephen Twigg About Us
Emma Hamilton
Hayley Ryan
Jo
Byron Perrin
James Charles Profile
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MEET THE GUIDELINES WORKING GROUP

Pete Lazzarini About Us
Stephen Twigg About Us
Anita-Raspovic
Jenny Prentice About Us
Rob Fitridge About Us
RobCommons
James Charles Profile
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