{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T22:39:02Z","timestamp":1791499142826,"version":"4.3.4"},"reference-count":40,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,5,14]],"date-time":"2023-05-14T00:00:00Z","timestamp":1684022400000},"content-version":"vor","delay-in-days":0,"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":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This publication represents a scheduled update of the 2019 guidelines of the International Working Group of the Diabetic Foot (IWGDF) addressing the use of systems to classify foot ulcers in people with diabetes in routine clinical practice. The guidelines are based on a systematic review of the available literature that identified 28 classifications addressed in 149 articles and, subsequently, expert opinion using the GRADE methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      First, we have developed a list of classification systems considered as being potentially adequate for use in a clinical setting, through the summary of judgements for diagnostic tests, focussing on the usability, accuracy and reliability of each system to predict ulcer\u2010related complications as well as use of resources. Second, we have determined, following group debate and consensus, which of them should be used in specific clinical scenarios. Following this process, in a person with diabetes and a foot ulcer we recommend:\n                      <jats:list list-type=\"explicit-label\">\n                        <jats:list-item>\n                          <jats:p>for communication among healthcare professionals: to use the SINBAD (Site, Ischaemia, Bacterial infection, Area and Depth) system\u00a0(first option) or consider using WIfI (Wound, Ischaemia, foot Infection) system (alternative option, when the required equipment and level of expertise is available and it is considered feasible) and in each case the individual variables that compose the systems should be described rather than a total score;<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>for predicting the outcome of an ulcer in a specific individual: no existing system could be recommended;<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>for characterising a person with an infected ulcer: the use of the IDSA\/IWGDF classification (first option) or consider using the WIfI system (alternative option, when the required equipment and level of expertise is available and it is considered as feasible);<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>for characterising a person with peripheral artery disease: consider using the WIfI system as a means to stratify healing likelihood and amputation risk;<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>for the audit of outcome(s) of populations: the use of the SINBAD score.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>For all recommendations made using GRADE, the certainty of evidence was judged, at best, as being low. Nevertheless, based on the rational application of current data this approach allowed the proposal of recommendations, which are likely to have clinical utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/dmrr.3648","type":"journal-article","created":{"date-parts":[[2023,5,14]],"date-time":"2023-05-14T07:59:55Z","timestamp":1684051195000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":135,"title":["Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update)"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-2910","authenticated-orcid":false,"given":"Matilde","family":"Monteiro\u2010Soares","sequence":"first","affiliation":[{"name":"Portuguese Red Cross School of Health\u2014Lisbon  Lisbon Portugal"},{"name":"MEDCIDS\u2014Departamento de Medicina da Comunidade Informa\u00e7\u00e3o e Decis\u00e3o em Sa\u00fade Faculty of Medicine of the University of Porto  Porto Portugal"},{"name":"RISE@ CINTESIS Faculty of Medicine Oporto University  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Diabetes Fiona Stanley Hospital  Murdoch Australia"},{"name":"University of Western Australia Medical School Fiona Stanley Hospital  Murdoch Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Russell","sequence":"additional","affiliation":[{"name":"Leeds Institute of Clinical Trials Research University of Leeds  Leeds UK"},{"name":"Leeds Vascular Institute Leeds Teaching Hospitals NHS Trust  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gulapar","family":"Srisawasdi","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine Sirindhorn School of Prosthetics Orthotics  Bangkok Thailand"},{"name":"Faculty of Medicine Siriraj Hospital Mahidol University  Bangkok Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-192X","authenticated-orcid":false,"given":"Edward J.","family":"Boyko","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Washington  Seattle Washington USA"},{"name":"Veterans Affairs Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph L.","family":"Mills","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine Michael E. 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