Comparison of the International Working Group on Diabetic Foot (IWGDF) Guidelines: Review of Similarities and Differences Between the 2019 and 2023 Versions on the Prevention and Management of Diabetic Foot

Mahin  Nomali; Mahdi  Mazandarani; Narges  Lashkarbolouk; Mohammad Reza  Mohajeri Tehrani; Neda  Mehrdad; Keyvan  Salehi; Amir Mahdi  Raeisi; Orod  Jalali; Shiva Armani  Moghadam; Pedram  Pirmoradian; Mohammad Reza  Amini

doi:10.18502/ijdl.v26i2.21915

Mahin Nomali Department of Biostatistics and Epidemiology, School of Health, Mazandaran University of Medical Sciences, Sari, Mazandaran, Iran
Mahdi Mazandarani Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran
Narges Lashkarbolouk Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran
Mohammad Reza Mohajeri Tehrani Department of Internal Medicine, School of Medicine, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Neda Mehrdad Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Science, Tehran, Iran
Keyvan Salehi School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Amir Mahdi Raeisi School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Orod Jalali School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shiva Armani Moghadam School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Pedram Pirmoradian School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Mohammad Reza Amini Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijdl.v26i2.21915

Keywords: Guideline, International Working Group on the Diabetic Foot, Diabetes, Review

Abstract

Background: Since 1999, the International Working Group on the Diabetic Foot (IWGDF) has consistently provided evidence-based guidelines aimed at the prevention and management of diabetic foot (DF). The latest version of these guidelines was published in 2023. Despite similarities such as being compiled by a working group, based on systematic reviews, and using the GRADE methodology to grade recommendations, it has some differences from the 2019 version. Awareness of these similarities and differences facilitates the faster implementation of evidence into clinical practice. The aim was to compare the similarities and differences between the 2019 and 2023 versions of the IWGDF guidelines.

Methods: In this comparative review study, both guideline versions were reviewed as primary sources. Data were extracted in two domains: structural (methodology) and content (number of chapters and recommendations, and key points). A comparison was then conducted on the data both quantitatively and qualitatively, whereby the similarities and differences between the two versions were identified and analyzed by juxtaposing the extracted information.

Results: The 2019 version consists of six guidelines, while the 2023 version includes seven separate guidelines. Both versions contain individual guidelines for prevention of foot ulcers (14 recommendations in 2023 vs. 16 in 2019), classification of foot ulcers (5 recommendations in both versions), diagnosis and treatment of foot infections (26 recommendations in 2023 vs. 27 in 2019), diagnosis and treatment of peripheral artery disease (25 recommendations in 2023 vs. 17 in 2019), offloading interventions (12 recommendations in 2023 vs. 9 in 2019), and wound healing interventions (29 recommendations in 2023 vs. 9 in 2019). A significant difference in the 2023 version compared to 2019 is the addition of a guideline for the diagnosis and treatment of active Charcot neuro- osteoarthropathy, which includes 26 recommendations.

Conclusion: Despite content similarities, the 2023 version differs from the 2019 version in the number of recommendations, with the most notable difference being the inclusion of a guideline for the diagnosis and treatment of active Charcot neuro-osteoarthropathy