In the past ten years, global diabetes burden has increased rapidly. Since 1980, the number of patients with diabetes has increased tripled, and the severity of complications related to diabetes has attracted more and more attention. For example, diabetic feet are one of the main causes of non -traumatic amputation. Since 1999, the Diabetes Football International Working Group (IWGDF) has been formulating a guide to preventing and managing diabetic foot disease based on evidence. At the beginning of 2020, iWGDF updated the relevant content of diabetic foot diagnosis, and sorted out the relevant content for your reference.
1 Regardless of whether there are foot ulcers in diabetic patients, peripheral arterial disease (PAD) is performed every year, including related medical history collection and foot arteries. (Grade evaluation system: strong; evidence quality: low)
Compared with patients with diabetes, the characteristics of PAD patients with diabetes are as follows: 1) more common, 2) also affect young individuals, 3) often occurs with bilateral or multiple lesions, 4) remote affected, 5) The degree of calcification in the vascular vascular is higher, 6) faster progress, and higher amputation risk.
2 Based on the relevant history and backpills of the foot arteries, all diabetic patients and patients with foot ulcers are clinically examined to determine whether it has PAD. (Strong; low)
3 For those who are accompanied by foot ulcer with most diabetic patients, the use of clinical examinations cannot completely exclude PAD. The Doppler arterial waveforms need to be performed. He toes (TBI). There is no single way to prove that it is optimal, and there is no determined threshold that can be used to reliably eliminate PAD. However, the ABI index range is between 0.9-1.3; TBI ≥ 0.75; and the shape of the hoeing of the foot of the foot can be eliminated when the three-phase wave can be eliminated. (Strong; low)
4 Perform the following bedside testing, at least one item, any one can help doctors increase the probability of predicting ulcer cure by 25%. These tests include skin irrigation pressure ≥40mmHg, toe pressure ≥30 mmHg or oxygen oxygen. Pressure (TCPO2) ≥25mmHg. (Strong; middle)
5 The hierarchy, local ischemia, and foot infection (WIFI) classification systems with diabetic foot ulcers and PADs can benefit amputation risk management and blood transportation reconstruction. (Strong; middle)
6 Always consider the ankle pressure to be <50mmHg, ABI <0.5, and toe pressure <30mmHg or TCPO2 <25mmHg diabetes foot ulcer patients for emergency vascular imaging and blood transportation. (Strong; low)
7 Regardless of the results of the bed examination, if ulcer patients are given good care treatment, but when they are still unable to cure within 4-6 weeks, vascular imaging needs to be considered in a timely manner. (Strong; low)
8 Regardless of the results of the bed examination, if the ulcer patients are given the best treatment, the ulcers have not healed within 4-6 weeks, and they need to consider timely reconstruction of patients with diabetic foot. (Strong; low)
9 Diabetes microvascular lesions should not be regarded as the cause of poor healing of patients with diabetic foot ulcers. It is necessary to consider other possibilities that may cause adverse healing. (Strong; low)
10 When the lower limb vascular reconstruction is needed, any of the following methods can be used to obtain the patient’s anatomical information: color Doppler ultrasound, computer fault scanning blood vessel angiography, magnetic resonance angiography, or digital reduction of vascular angiography in the arteries. The entire lower limb arterial circulation needs to be evaluated, and the evaluation of the front and rear sides and the ankle arteries under the knee and ankle should be particularly detailed. (Strong; low)
11 When blood transportation was reconstructed for patients with diabetic foot ulcers, it aims to restore at least one foot blood vessels, and give priority to choosing to directly supply arteries in the blood flow of arterial ulcers. After surgery, evaluate its effectiveness and objectively measure the amount of irrigation. (Strong; low)
12 Open type or more hybrid reconstruction technology is superior. There is no sufficient evidence to confirm which method of blood transport reconstruction is more advantageous. Based on the degree of PAD, the availability of autologous veins, the patient’s complication, and the professional knowledge level of the local doctor. Considering. (Strong; low)
13 Any center of the treatment of diabetic foot ulcers should have corresponding professionals. These personnel need to have the professional knowledge required for diagnosis and can diagnose and treat PAD in time, which can perform intravascular technology and surgery bypass surgery. (Strong; low)
14 Ensure patients with diabetic foot ulcers who have undergone blood transport reconstruction surgery. (Strong; low)
15 Emergency assessment and treatment patients with the following symptoms or signs: PAD and patients with signs of foot infection, because their amputation risk is high. (Strong; medium)
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16 For patients with poor risk/benefit ratio and low probability of success, patients should be avoided by patients with blood transportation. (Strong; low)
17 Patients with diabetes and ischemic ulcers should be managed by positive cardiovascular risk factors, including smoking quit, antihypertensive and prescriptions, and small doses aspirin or clopidogre. (Strong; low)
