Timely identification and proper treatment of nail disease is of great significance to the prevention of foot ulcer in diabetes. However, insufficient understanding of nail disease is highly prevalent in clinical workers. What's more, there is a lack of a summary of the best evidence about clinical management of nail diseases in diabetes in China.
To comprehensively retrieve and analyze evidence about the management of nail disease in diabetes, and give a summary of the best evidence.
We searched databases of BMJ Best Practice, UpToDate, WHO, Guidelines International Network, NICE, National Guideline Clearinghouse, RNAO, Scottish Intercollegiate Guidelines Network, New Zealand Guidelines Group, Yimaitong, JBI, PubMed, Embase, CINAHL, CNKI and Wanfang Data for clinical decisions, guidelines, systematic reviews and expert consensuses regarding the management of nail diseases in diabetes included as of December 6, 2021. Then we evaluated the quality of the evidence, and rated it according to the 2016 Supporting Document for the Joanna Briggs Institute Levels of Evidence and Grades of Recommendation, and summarized the best evidence.
A total of 8 studies were enrolled, including 1 about clinical decisions, 4 guidelines and 3 expert consensuses. The clinical decisions was from the UpToDate and directly included. Two guidelines were rated B, and the other 2 were rated A, all of which were allowed to be included. All the expert consensuses showed a high level of quality, and were allowed to be included. Finally, 9 items of best evidence regarding nail disease assessment, handling and health education were summarized, including 5 A-level recommendations and 4 B-level recommendations.
This study searched the clinical decisions, guidelines and expert consensus related to the management of patients with diabetes mellitus, and summarized the best evidence of the management of patients with diabetes mellitus. The evidence involves three aspects: nail disease assessment, handling and health education were summarized, and the levels were A-level recommendation and B-level recommendation. Our summary of the best evidence could be used as evidence-based basis for early clinical assessment and treatment of nail disease in diabetes.
Local wound management is a key part in the management of diabetic foot ulcers (DFUs), and dressings are one major tool. There are no specific guidelines on dressing selection for DFUs, and it is urgently needed to integrate relevant contents scattered in major comprehensive guidelines.
Practice guidelines related to the management of diabetic foot were searched and reviewed, and entries related to dressing selection or application were extracted for evidence synthesis to inform clinical interventions.
Published clinical practice guidelines about diabetes management were searched from diabetes websites and electronic literature databases, the search period was from January 2012 to November 2021, and screened according to inclusion and exclusion criteria, then their methodological quality was evaluated, and evidence related to dressing selection and application in which was translated, extracted and synthesized.
Ten guidelines published between 2012 and 2020 were included, with overall high quality and high consistency between reviewers. Then a table of recommendations for selection and application of wound dressings for diabetic foot disease was developed by comprehensively summarizing relevant evidence extracted from the guidelines (evidence from eight guidelines in foreign languages was first translated into Chinese before being extracted) .
The evidence selected from the guidelines involves wound characteristics, moisture healing, periwound skin management, patient preference, and cost. Among them, wound characteristics should be seriously considered in the selection of dressings for DFUs. Most of the recommendations are about the treatment of wound exudate condition and the presence or absence of infection. However, there are fewer recommendations for basal tissue types, especially gangrene wounds.
