From prototype to implementation: Development of the DMIST scoring system for monitoring diabetic foot ulcers

Diabetic foot ulcers (DFUs) pose a significant health challenge, marked by high morbidity, mortality, and healthcare costs. Effective evaluation of the DFU healing process is crucial to prevent delays and enhance patient outcomes. Traditional wound healing scales like PUSH and DESIGN have proven suboptimal for DFUs, necessitating a disease-specific approach. This communication introduces a qualitative study, which served as the first step in developing the DMIST scale, a tool to monitor and assess DFUs over time. Using a morpho-qualitative analysis method, we examined 50 DFUs in 42 patients from a hospital in Tokyo, classifying ulcers by primary pathogenic factors and healing periods. Our analysis identified 8 categories and 33 sub-categories of morphological characteristics. Key findings included identification of features such as the "red ring", "hyperkeratosis", and "rolled wound edges", each affecting healing times. The DMIST scale integrates these visual signs, offering a practical tool for DFU management, particularly valuable in low-resource settings. This scale has undergone validation and refinement through international collaboration, with the aim to improve DFU patient outcomes globally. We hope the DMIST scale to be widely adapted and that our experience in its development will aid future development of wound assessment tools from various causes.