{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T15:38:25Z","timestamp":1792165105133,"version":"4.4.0"},"reference-count":36,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T00:00:00Z","timestamp":1584316800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Metabolism Res"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The International Working Group on the Diabetic Foot (IWGDF) has been publishing evidence\u2010based guidelines on the prevention and management of diabetic foot disease since 1999. This publication represents a new guideline addressing the use of classifications of diabetic foot ulcers in routine clinical practice and reviews those which have been published. We only consider systems of classification used for active diabetic foot ulcers and do not include those that might be used to define risk of future ulceration.<\/jats:p>\n                  <jats:p>The guidelines are based on a review of the available literature and on expert opinion leading to the identification of eight key factors judged to contribute most to clinical outcomes. Classifications are graded on the number of key factors included as well as on internal and external validation and the use for which a classification is intended.<\/jats:p>\n                  <jats:p>\n                    Key factors judged to contribute to the scoring of classifications are of three types:\n                    <jats:italic>patient related<\/jats:italic>\n                    (end\u2010stage renal failure),\n                    <jats:italic>limb\u2010related<\/jats:italic>\n                    (peripheral artery disease and loss of protective sensation), and\n                    <jats:italic>ulcer\u2010related<\/jats:italic>\n                    (area, depth, site, single, or multiple and infection). Particular systems considered for each of the following five clinical situations: (a) communication among health professionals, (b) predicting the outcome of an individual ulcer, (c) as an aid to clinical decision\u2010making for an individual case, (d) assessment of a wound, with\/without infection, and peripheral artery disease (assessment of perfusion and potential benefit from revascularisation), and (d) audit of outcome in local, regional, or national populations.\n                  <\/jats:p>\n                  <jats:p>We recommend: (a) for communication among health professionals the use of the SINBAD system (that includes Site, Ischaemia, Neuropathy, Bacterial Infection and Depth); (b) no existing classification for predicting outcome of an individual ulcer; (c) the Infectious Diseases Society of America\/IWGDF (IDSA\/IWGDF) classification for assessment of infection; (d) the WIfI (Wound, Ischemia, and foot Infection) system for the assessment of perfusion and the likely benefit of revascularisation; and (e) the SINBAD classification for the audit of outcome of populations.<\/jats:p>","DOI":"10.1002\/dmrr.3273","type":"journal-article","created":{"date-parts":[[2020,3,16]],"date-time":"2020-03-16T09:07:41Z","timestamp":1584349661000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":198,"title":["Guidelines on the classification of diabetic foot ulcers (IWGDF 2019)"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8357-9163","authenticated-orcid":false,"given":"Matilde","family":"Monteiro\u2010Soares","sequence":"first","affiliation":[{"name":"Departamento de Medicina da Comunidade, Informa\u00e7\u00e3o e Decis\u00e3o em Sa\u00fade Faculdade de Medicina da Universidade do Porto  Oporto Portugal"},{"name":"Center for Health Technology and Services Research (CINTESIS) Faculdade de Medicina da Universidade do Porto  Oporto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery Leeds Teaching Hospitals NHS Trust  Leeds United Kingdom"},{"name":"Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"Boyko","sequence":"additional","affiliation":[{"name":"VA Puget Sound Health Care System  Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Jeffcoate","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology Nottingham University Hospitals NHS Trust\u2014City Campus  Nottingham United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph L.","family":"Mills","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Morbach","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Angiology Marienkrankenhaus gGmbH  Soest Germany"},{"name":"Institute for Health Services Research and Health Economics Services Research and Health Economics, Faculty of Medicine, Heinrich\u2010Heine\u2010 University  D\u00fcsseldorf Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fran","family":"Game","sequence":"additional","affiliation":[{"name":"Department of Diabetes and Endocrinology University Hospitals of Derby and Burton NHS Foundation Trust  Derby United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the International Working Group on the Diabetic Foot (IWGDF)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,16]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"World Health Organization. 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