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).