SVS Guidelines Bundle

Management of Diabetic Foot

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2 Key Points ➤ Diabetes is one of the leading causes of chronic disease and limb loss worldwide, currently affecting 382 million people. ➤ Every year, >1 million people with diabetes suffer limb loss as a result of diabetes. ➤ Approximately 80% of diabetes-related lower extremity amputations are preceded by a foot ulcer. ➤ This progression from foot ulcer to amputation lends to several possible steps where intervention based on evidence-based guidelines may prevent major amputation. Prevention Prevention of Diabetic Foot Ulceration ➤ We recommend that patients with diabetes undergo annual interval foot inspections by physicians (MD, DO, DPM) or advanced practice providers with training in foot care (1C). ➤ We recommend that foot examination include testing for peripheral neuropathy using the Semmes-Weinstein test (1B). ➤ We recommend education of the patients and their families about preventive foot care (1C). Therapeutic Footwear: • We suggest against the routine use of specialized therapeutic footwear in average- risk diabetic patients (2C). • We recommend using custom therapeutic footwear in high-risk diabetic patients, including those with significant neuropathy, foot deformities, or previous amputation (1B). ➤ We suggest adequate glycemic control (hemoglobin A1c <7% with strategies to minimize hypoglycemia) to reduce the incidence of diabetic foot ulcers (DFUs) and infections, with subsequent risk of amputation (2B). ➤ We recommend against prophylactic arterial revascularization to prevent DFU (1C).

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