Quality of Clinical Practice Guidelines for Diabetic Foot Management: A Systematic Review Using the AGREE II and...

Area of Science:

• Medical Guidelines
• Diabetology
• Wound Care

Background:

• Diabetic foot ulcers (DFUs) represent a significant complication of diabetes, necessitating high-quality clinical practice guidelines (CPGs) for effective management.
• Evaluating the methodological rigor and recommendation quality of existing DFU CPGs is crucial for optimizing patient care and guiding future guideline development.

Purpose of the Study:

• To assess the methodological quality of DFU management CPGs using the AGREE II and AGREE-REX instruments.
• To evaluate the excellence and synthesize clinical treatment recommendations within these DFU CPGs.
• To grade the evidence supporting synthesized DFU treatment recommendations using the OCEBM system.

Main Methods:

• A systematic literature search identified DFU CPGs published between January 1, 2015, and May 1, 2025.
• Guideline quality was appraised using the AGREE II and AGREE-REX tools by independent reviewers.
• Clinical treatment recommendations were synthesized and evidence graded using the Oxford Centre for Evidence-Based Medicine (OCEBM) system.

Main Results:

• Fifteen CPGs were included, categorized as 6 high-quality and 9 moderate-quality.
• Highest AGREE II scores were for Editorial Independence and Scope and Purpose; lowest was Applicability.
• AGREE-REX showed lowest scores for Values and Preferences, while Clinical Applicability and Implementability scored well.
• Seventeen key DFU treatment recommendations were synthesized, predominantly Grade B, supported by moderate-quality evidence.

Conclusions:

• DFU CPGs are generally developed systematically but exhibit limitations in applicability, stakeholder involvement, and rigor.
• The quality of recommendations is inconsistent, particularly concerning the consideration of patient values and preferences.
• Future guideline development should prioritize enhancing applicability, stakeholder engagement, rigor, and the quality of underlying evidence to improve DFU management strategies.