What is the International Working Group on the Diabetic Foot (IWGDF)?

What is the International Working Group on the Diabetic Foot (IWGDF)?

The International Working Group on the Diabetic Foot (IWGDF) is a global multidisciplinary organization that develops and publishes evidence-based guidelines for the prevention and management of diabetic foot disease, serving as the primary international authority for standardizing diabetic foot care worldwide. 1, 2

Organizational Structure and Mission

The IWGDF was founded in 1996 and became a Consultative Section of the International Diabetes Federation (IDF) in 2000, later integrating as part of the IDF programme as the IDF Diabetic Foot Programme in 2010. 2 The organization's core objective is to reduce the global burden of diabetic foot disease through cost-effective, quality healthcare based on evidence-based medicine principles. 2

Global Reach and Implementation

• The IWGDF currently has representatives from more than 100 countries worldwide, ensuring global implementation and adaptation of guidelines to local contexts. 2
• Guidelines have been translated into 26 languages and distributed in over 80,000 copies globally, with current translations serving approximately 2.9 billion people in their native languages. 2, 3
• The organization recruits local champions as members to facilitate implementation of the International Consensus in their respective regions. 2

Guideline Development Process

The IWGDF has published comprehensive evidence-based guidelines since 1999, with systematic updates every 4 years. 2, 3, 4 The most recent update was published in 2023. 5, 4

The guideline development follows rigorous methodology:

• Working groups of independent multidisciplinary experts conduct systematic reviews of medical literature. 2
• Since 2023, the IWGDF uses the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) framework to formulate clinical questions in PICO/PACO format and develop recommendations. 5, 6
• Recommendations are based on evidence quality, expert opinion when evidence is lacking, and consideration of benefits versus harms, patient preferences, feasibility, applicability, and costs. 5, 7
• All recommendations undergo thorough review by IWGDF representatives globally before endorsement. 2

Scope of Guidelines

The 2023 IWGDF Guidelines cover seven major topics: 4

1. Prevention of foot ulcers
2. Classification of diabetic foot ulcers
3. Offloading interventions
4. Peripheral artery disease (developed in collaboration with European Society for Vascular Surgery and Society for Vascular Surgery) 6
5. Infection management
6. Wound healing interventions
7. Acute Charcot neuro-osteoarthropathy (new guideline added in 2023) 5, 4

Clinical Impact and Significance

Every 30 seconds, a lower limb is lost to diabetes somewhere in the world, with more than 1 million people with diabetes losing a leg annually. 2 The IWGDF addresses this devastating burden by:

• Providing standardized approaches to foot ulcer evaluation and treatment that have been associated with decreased amputation rates globally. 1, 4
• Establishing five key prevention elements: identification of at-risk feet, regular inspection, education, appropriate footwear, and treatment of pre-ulcerative signs. 1
• Defining seven key ulcer treatment elements: pressure relief, perfusion restoration, infection treatment, metabolic control, local wound care, education, and recurrence prevention. 1

Resource Requirements and Volunteer Effort

The 2023 guideline update required an estimated 10 years of full-time work from over 100 experts across more than 60 countries, representing approximately 2 million euros in volunteer time if financially compensated. 3 This demonstrates the extraordinary commitment of the international diabetic foot community to advancing evidence-based care.

Practical Implementation Tools

The IWGDF provides practical implementation resources including:

• Risk stratification systems with specific examination frequencies (ranging from annual for very low risk to every 1-3 months for high risk patients). 8
• Standardized definitions and criteria for diabetes-related foot disease to facilitate clear communication between disciplines and countries. 9
• Classification systems for different clinical purposes, including the SINBAD system for communication and the IDSA/IWGDF classification for infection assessment. 10