国际糖尿病足工作组和中华医学会糖尿病学分会糖尿病足诊治指南的解读与比较

Interpretation and comparison of guidelines for diagnosis and treatment of diabetic foot between International Working Group on Diabetic Foot and Chinese Diabetes Society

为寻找糖尿病足诊疗规律,本文对比研究了国内外糖尿病足指南。本文从指南制定使用的方法学、内容划分、高危足预防、糖尿病足溃疡减压、糖尿病足溃疡周围血管病变、糖尿病足感染、糖尿病足溃疡愈合、糖尿病足溃疡分类这几个部分,比较了国际糖尿病足工作组2019年糖尿病足指南和中华医学会糖尿病学分会2019年糖尿病足指南。糖尿病足预防非常重要,溃疡减压以不可拆卸支具为主;存在外周动脉疾病时,要掌握手术适应证并采取合理治疗方法;有感染时,要根据严重程度不同选择不同的抗感染方法(含手术清创)。促进创面愈合的方法很多,但证据等级多不高;溃疡分类多,但无一能涵盖诊治全部需求。我国医护人员应当将国内外指南与当地医疗条件相结合、规范化地诊治糖尿病足。

This exploratory study attempted to establish the rules in diagnosis and treatment of diabetic foot,through interpretation and comparison of the guidelines for diabetic foot from domestic with international ones.The document provided comparison between Guidelines of International Working Group on Diabetic Foot(IWGDF)and Chinese Diabetes Society(CDS)in 2019,related to diabetic foot disease on:methodology,content,prevention,offloading,peripheral artery disease(PAD),infection,wound healing interventions,and classification of diabetic foot ulcers.Prevention of ulcers in persons with diabetes foot is very important,and a non-removable offloading device is the first-choice of offloading treatment;Surgical indications and reasonable treatment should be mastered in PAD;Different anti-infection treatments,including surgical debridement,should be used base on the severity of foot infection;There are lots of treatments to improve healing,however the Grand Standard of medical evidence is not very high;There are a larger number of proposed classifications and scoring systems for diabetic foot,but none of them could cover all the needs of diagnosis and treatment.Thus,the principles outlined have to be adapted or modified by our health care professionals,based on local circumstances,to develop a standardizated procedure in diagnosis and treatment of diabetic foot.