DM Full Guideline (2010) - VA/DoD Clinical Practice Guidelines Home

Version 4.0
EVIDENCE
- Take Charge of Your Diabetes: Prevent Foot Problems
- Taking Care of Your Feet
- Tips on Good Foot Care: from Feet Can Last a Lifetime
VA/DoD Clinical Practice Guideline
for the Management of Diabetes Mellitus
Recommendation Sources LE QE SR
1 Patient education on specific
aspects of care.
ADA, 2002
Litzelman et al., 1993
III
I
Fair
B
Young et al., 1992
III
2 Patient instruction on self-foot
care.
Ahroni, 1993
Barth et al., 1991
III
II
Fair
B
Fain & Melkus, 1994
II
Feste, 1991
III
Mayfield et al., 1998 [SR]
II
Weir et al., 1994
III
QE = Quality of Evidence; R = Recommendation; SR = Systematic Review (see Appendix A).
I. Perform Visual Inspection and Peripheral Sensation Evaluation At Each Routine Primary Care
Visit
OBJECTIVE
Ensure ongoing screening to identify patients at risk for LE ulcers and amputation.
RECOMMENDATIONS
1. Visual inspection and peripheral sensation testing in high-risk patient should be performed at each routine
primary care visit for all patients (see Annotation A).
J. Perform Wound Assessment
OBJECTIVE
Determine the character and nature of the wound.
RECOMMENDATIONS
1. Patients with diabetes with minor wounds or foot lesions should have a wound assessment.
2. The wound assessment includes:
• A review of anatomic, physical, and lesion characteristics including determination of circumference,
depth, and involvement of deep structures.
• Assessment for signs of infection including necrosis, sinus tracts, exudate, odor, presence of fibrin, and
healthy granulation tissue.
• Assessment of surrounding areas for signs of edema, cellulitis, or abscess.
Module F – Foot Care Page 103