{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:11:30Z","timestamp":1792782690354,"version":"4.5.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e0 degli Studi di Roma Tor Vergata","id":[{"id":"https:\/\/ror.org\/02p77k626","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Acta Diabetol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Diabetic foot is one of the most serious chronic complications of diabetes mellitus and reflects the systemic burden of the disease. Preventive strategies and structured management pathways are therefore essential elements of diabetes care. Lifetime occurrence of foot ulceration has been reported in nearly one-third of individuals with diabetes, and these lesions account for most non-traumatic lower-extremity amputations. Furthermore, the estimated five-year mortality following ulceration is 30%. This document aims to ensure an appropriate, multidisciplinary care pathway for patients with diabetic foot, tailored to clinical complexity and aligned with the different levels of care of Italian diabetes centers. The integrated model of diabetic foot care is based on the level of care that diabetes centers (local and hospital) can provide, including available personnel, expertise, and diagnostic and therapeutic resources to manage varying degrees of clinical complexity. Accordingly, three levels of care complexity, low, medium, and high, have been defined, with corresponding key diagnostic and therapeutic activities and healthcare professionals involved.<\/jats:p>","DOI":"10.1007\/s00592-026-02741-1","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T09:56:22Z","timestamp":1783936582000},"page":"1685-1695","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrated care pathway for the management of diabetic foot disease: a position statement from the Italian Diabetic Foot Study Group"],"prefix":"10.1007","volume":"63","author":[{"given":"Laura","family":"Giurato","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3789-9622","authenticated-orcid":false,"given":"Marco","family":"Meloni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessia","family":"Scatena","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"De Giglio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Murdolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Mastinu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Gicchino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desiree","family":"Gabriele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Anichini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesare","family":"Miranda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Uccioli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"SID-AMD Diabetic Foot Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"issue":"1","key":"2741_CR1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.2337\/dci22-0043","volume":"46","author":"M Katherine McDermott","year":"2023","unstructured":"Katherine McDermott M, Fang, Andrew JM, Boulton E, Selvin, Caitlin W, Hicks (2023) Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers. Diabetes Care 46(1):209\u2013221. https:\/\/doi.org\/10.2337\/dci22-0043","journal-title":"Diabetes Care"},{"issue":"1","key":"2741_CR2","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1001\/jama.2023.10578","volume":"03","author":"G David","year":"2023","unstructured":"David G, Armstrong T-W, Tan, Andrew JM, Boulton, Sicco A, Bus (2023) Diabetic Foot Ulcers: A Review. JAMA July 03(1):62\u201375. https:\/\/doi.org\/10.1001\/jama.2023.10578","journal-title":"JAMA July"},{"issue":"3","key":"2741_CR3","doi-asserted-by":"publisher","first-page":"e3657","DOI":"10.1002\/dmrr.3657","volume":"40","author":"NC Schaper","year":"2024","unstructured":"Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Fitridge R, Game F, Monteiro-Soares M, Senneville E, IWGDF Editorial Board (2024) Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev Mar 40(3):e3657. https:\/\/doi.org\/10.1002\/dmrr.3657","journal-title":"Diabetes Metab Res Rev Mar"},{"issue":"5","key":"2741_CR4","doi-asserted-by":"publisher","first-page":"964","DOI":"10.2337\/dc19-1614","volume":"43","author":"Y Zhang","year":"2020","unstructured":"Zhang Y, Lazzarini PA, McPhail SM, van Netten JJ, Armstrong DG, Pacella RE (2020) Global disability burdens of diabetes-related lower-extremity complications in 1990 and 2016. Diabetes Care 43(5):964\u2013974. https:\/\/doi.org\/10.2337\/dc19-1614","journal-title":"Diabetes Care"},{"issue":"1","key":"2741_CR5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s13047-020-00383-2","volume":"13","author":"DG Armstrong","year":"2020","unstructured":"Armstrong DG, Swerdlow MA, Armstrong AA, Conte MS, Padula WV, Bus SA (2020) Five-year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer. J Foot Ankle Res 13(1):16. https:\/\/doi.org\/10.1186\/s13047-020-00383-2","journal-title":"J Foot Ankle Res"},{"key":"2741_CR6","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.jcot.2021.01.017","volume":"17","author":"M Edmonds","year":"2021","unstructured":"Edmonds M, Manu C, Prashanth Vas (2021) The current burden of diabetic foot disease. J Clin Orthop Trauma 17:88\u201393. https:\/\/doi.org\/10.1016\/j.jcot.2021.01.017","journal-title":"J Clin Orthop Trauma"},{"issue":"24","key":"2741_CR7","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.1056\/NEJMra1615439","volume":"376","author":"DG Armstrong","year":"2017","unstructured":"Armstrong DG, Boulton AJM, Bus SA (2017) Diabetic Foot Ulcers and Their Recurrence. N Engl J Med 376(24):2367\u20132375. https:\/\/doi.org\/10.1056\/NEJMra1615439","journal-title":"N Engl J Med"},{"key":"2741_CR8","doi-asserted-by":"publisher","first-page":"1697","DOI":"10.2337\/dc13-2470","volume":"37","author":"R Waaujman","year":"2014","unstructured":"Waaujman R, de Haart M, Arts MLJ, Wever D, Verlouw Anke JWE, Nollet F, Bus SA (2014) Risk Factors for Plantar Foot Ulcers Recurrence in Neuropathic Diabetic Patients. Diabetes Care 37:1697\u20131705. https:\/\/doi.org\/10.2337\/dc13-2470","journal-title":"Diabetes Care"},{"key":"2741_CR9","doi-asserted-by":"publisher","unstructured":"Sicco A, Bus, Isabel CN, Sacco M, Monteiro-Soares A, Raspovic J, Paton A, Rasmussen LA, Lavery, Jaap J, van Netten Guidelines on the prevention of foot ulcers in persons with diabetes (IWGDF 2023 update) (2024) Diabetes Metab Res Rev. Mar;40(3):e3651. https:\/\/doi.org\/10.1002\/dmrr.3651","DOI":"10.1002\/dmrr.3651"},{"key":"2741_CR10","doi-asserted-by":"publisher","first-page":"e3270","DOI":"10.1002\/dmrr.3270","volume":"36","author":"JJ Netten","year":"2020","unstructured":"Netten JJ, Raspovic A, Lavery LA et al (2020) Prevention of foot ulcers in the at-risk patient with diabetes: a systematic review. Diabetes Metab Res Rev 36:e3270. https:\/\/doi.org\/10.1002\/dmrr.3270","journal-title":"Diabetes Metab Res Rev"},{"issue":"Suppl 1","key":"2741_CR11","doi-asserted-by":"publisher","first-page":"S84","DOI":"10.1002\/1520-7560(200009\/10)16:1","volume":"16","author":"J Apelqvist","year":"2000","unstructured":"Apelqvist J, Bakker K, van Houtum WH, Nabuurs-Franssen MH, Schaper NC (2000) International consensus and practical guidelines on the management and prevention of the diabetic foot. International Working Group on the Diabetic Foot. Diabetes Metab Res Rev 16(Suppl 1):S84\u201392. https:\/\/doi.org\/10.1002\/1520-7560(200009\/10)16:1","journal-title":"Diabetes Metab Res Rev"},{"key":"2741_CR12","unstructured":"Ministry of Health \u2013 Directorate General for Health Planning National Plan on Diabetes, State-Regions Conference 2012\u20132013, available online: https:\/\/www.epicentro.iss.it\/igea\/strumenti\/documentiMinistero"},{"issue":"3","key":"2741_CR13","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1016\/j.numecd.2020.10.010","volume":"10","author":"M Meloni","year":"2021","unstructured":"Meloni M, Acquati S, Licciardello C, Ludovico O, Sepe M, Vermigli C, Da Ros R (2021) Barriers to diabetic foot management in Italy: A multicentre survey in diabetic foot centres of the Diabetic Foot Study Group of the Italian Society of Diabetes (SID) and Association of Medical Diabetologists (AMD). Nutr Metab Cardiovasc Dis Mar 10(3):776\u2013781. https:\/\/doi.org\/10.1016\/j.numecd.2020.10.010","journal-title":"Nutr Metab Cardiovasc Dis Mar"},{"key":"2741_CR14","unstructured":"Italian Association of Diabetes Specialists (AMD) AMD Annals 2025, available online: https:\/\/aemmedi.it\/annali-amd"},{"key":"2741_CR15","doi-asserted-by":"publisher","unstructured":"Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky B, IWGDF Editorial Board (2019) Practical Guidelines on the prevention and management of diabetic foot disease (IWGDF 2019 update). Diabetes Metab Res Rev 2020 Mar:36 Suppl 1e3266. https:\/\/doi.org\/10.1002\/dmrr.3266","DOI":"10.1002\/dmrr.3266"},{"issue":"3","key":"2741_CR16","doi-asserted-by":"publisher","first-page":"e3648","DOI":"10.1002\/dmrr.3648","volume":"40","author":"M Monteiro-Soares","year":"2024","unstructured":"Monteiro-Soares M, Hamilton EJ, Russell DA, Srisawasdi G, Boyko EJ, Mills JL, Jeffcoate W, Game F (2024) Guidelines on the classification of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev Mar 40(3):e3648. https:\/\/doi.org\/10.1002\/dmrr.3648","journal-title":"Diabetes Metab Res Rev Mar"},{"key":"2741_CR17","doi-asserted-by":"publisher","unstructured":"\u00c9ric Senneville Z, Albalawi SA, van Asten ZG, Abbas G, Allison J, Arag\u00f3n-S\u00e1nchez JM, Embil LA, Lavery M, Alhasan Z-R, Xu, Edgar JG, Peters (2024) IWGDF\/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections (IWGDF\/IDSA 2023). Diabetes Metab Res Rev. Mar;40(3):e3687. https:\/\/doi.org\/10.1002\/dmrr.3687","DOI":"10.1002\/dmrr.3687"},{"issue":"4","key":"2741_CR18","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1016\/j.numecd.2013.12.007","volume":"24","author":"A Aiello","year":"2014","unstructured":"Aiello A, Anichini R, Brocco E, Caravaggi C, Chiavetta A, Cioni R, Da Ros R, De Feo E, Ferraresi R, Florio F, Gargiulo M, Galzerano G, Gandini R, Giurato L, Graziani L, Mancini L, Manzi M, Modugno P, Setacci C, Uccioli L, Italian Society of Diabetes; Italian Society of Radiology; Italian Society of Vascular Endovascular Surgery (2014) Treatment of peripheral arterial disease in diabetes: a consensus of the Italian Societies of Diabetes (SID, AMD), Radiology (SIRM) and Vascular Endovascular Surgery (SICVE). Nutr Metab Cardiovasc Dis Apr 24(4):355\u2013369. https:\/\/doi.org\/10.1016\/j.numecd.2013.12.007","journal-title":"Nutr Metab Cardiovasc Dis Apr"},{"issue":"5","key":"2741_CR19","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1007\/s00592-024-02393-z","volume":"62","author":"A Scatena","year":"2025","unstructured":"Scatena A, Apicella M, Mantuano M et al (2025) Autologous cell therapy for ischemic diabetic foot: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 62(5):743\u2013752. https:\/\/doi.org\/10.1007\/s00592-024-02393-z","journal-title":"Acta Diabetol"},{"key":"2741_CR20","doi-asserted-by":"publisher","unstructured":"Monami M, Scatena A, Ragghianti B, Miranda C, Monge L, Silverii A, Uccioli L, Vermigli C, AMD (2025) For the Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome \u00b7 on behalf of SID and Effectiveness of most common adjuvant wound treatments (skin substitutes, negative pressure wound therapy, hyperbaric oxygen therapy, platelet-rich plasma\/fibrin, and growth factors) for the management of hard-to-heal diabetic foot ulcers: a meta-analysis of randomized controlled trials for the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrom. Acta Diabetologica 62:1081\u20131095. https:\/\/doi.org\/10.1007\/s00592-024-02426-7","DOI":"10.1007\/s00592-024-02426-7"},{"key":"2741_CR21","doi-asserted-by":"publisher","unstructured":"Anichini R, Brocco E, Caravaggi CM, Da Ros R, Giurato L, Izzo V, Meloni M, Ucciol L, SID\/AMD Diabetic Foot Study Group (2020). Physician experts in diabetes are natural team leaders for managing diabetic patients with foot complications. A position statement from the Italian diabetic foot study group. Nutr Metab Cardiovasc Dis. Feb 10;30(2):167\u2013178. https:\/\/doi.org\/10.1016\/j.numecd.2019.11.009","DOI":"10.1016\/j.numecd.2019.11.009"},{"issue":"41","key":"2741_CR22","doi-asserted-by":"publisher","first-page":"e00132","DOI":"10.1002\/edm2.132","volume":"Apr 11","author":"R Collings","year":"2020","unstructured":"Collings R, Freeman J, Latour JM, Paton J (2020) Footwear and insole design features for offloading the diabetic at risk foot. A systematic review and meta-analyses. Endocrinol Diabetes Metab Apr 11(41):e00132. https:\/\/doi.org\/10.1002\/edm2.132","journal-title":"Endocrinol Diabetes Metab"},{"key":"2741_CR23","doi-asserted-by":"publisher","unstructured":"L\u00f3pez-Moral M, L\u00e1zaro-Mart\u00ednez JL, Garc\u00eda-Morales E, Garc\u00eda-\u00c1lvarez Y, \u00c1lvaro-Afonso FJ, Molines-Barroso RJ (2019) Clinical efficacy of therapeutic footwear with a rigid rocker sole in the prevention of recurrence in patients with diabetes mellitus and diabetic polineuropathy: A randomized clinical trial. PLoS One. Jul 11;14(7):e0219537. https:\/\/doi.org\/10.1371\/journal.pone.0219537","DOI":"10.1371\/journal.pone.0219537"},{"key":"2741_CR24","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1007\/s00592-024-02353-7","volume":"61","author":"R Da Ros","year":"2024","unstructured":"Da Ros R, Volpe A, Bordieri C, Tramonta R, Bernetti A, Scatena A, Monge L, Ragghianti B, Silverii A, Uccioli L, Vermigli C, Monami M, Miranda C (2024) Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome and on behalf of SID and AMD. Prevention of foot ulcers recurrence in patients with diabetes: a systematic review and meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 61:1363\u20131373. https:\/\/doi.org\/10.1007\/s00592-024-02353-7","journal-title":"Acta Diabetol"},{"key":"2741_CR25","doi-asserted-by":"publisher","unstructured":"Meloni M, Giurato L, Monge L, Miranda C, Scatena A, Ragghianti B, Silverii GA, Vermigli C, De Cassai A, Volpe A, Tramonta R, Medea G, Bordieri C, Falcone M, Stefanon L, Bernetti A, Cappella C, Gargiulo M, Lorenzoni V, Scevola G, Stabile E, Da Ros R, Murdolo G, Bianchini E, Gaggia F, Gauna C, Romeo F, Apicella M, Mantuano M, Monami M L. Uccioli. For the Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome, and on behalf of SID and AMD. (2024) Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol. May;61(5):543\u2013553. https:\/\/doi.org\/10.1007\/s00592-024-02246-9","DOI":"10.1007\/s00592-024-02246-9"},{"key":"2741_CR26","doi-asserted-by":"publisher","unstructured":"Bouillet B, Ahluwalia R, Iacopi E, Garcia-Klepzig Jl, L\u00fcdemann C, Manu C, Meloni M, Rodriguez Saenz De Buruaga V, Vouillarmet J, Petit JM, Van Acker K, L\u00e1zaro-Mart\u00ednez JL (2021) Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays. J Wound Care. Oct 2;30(10):804\u2013808. https:\/\/doi.org\/10.12968\/jowc.2021.30.10.804","DOI":"10.12968\/jowc.2021.30.10.804"}],"container-title":["Acta Diabetologica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-026-02741-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00592-026-02741-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00592-026-02741-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T07:32:58Z","timestamp":1792567978000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00592-026-02741-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":26,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10]]}},"alternative-id":["2741"],"URL":"https:\/\/doi.org\/10.1007\/s00592-026-02741-1","relation":{},"ISSN":["1432-5233"],"issn-type":[{"value":"1432-5233","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]},"assertion":[{"value":"24 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors have no conflicts of interest to declare that are relevant to the content of this article.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}}]}}