Gulf regional guidelines for managing diabetic foot ulcers: assessment, treatment and prevention of recurrence.

Abstract

Background: Diabetic foot ulcers (DFUs) represent a major and growing complication of diabetes in the Gulf and wider Middle East and North Africa (MENA) region, which has the world's highest diabetes prevalence at approximately 17.6% of adults. DFUs carry a high burden of morbidity, mortality and economic cost, and their complex multifactorial aetiology, encompassing peripheral neuropathy, ischaemia, deformity and infection, is compounded by region-specific cultural, climatic and healthcare factors.

Aims: To develop evidence-based, Gulf-specific clinical guidelines on the assessment, management and prevention of recurrence of DFUs, applicable across varying levels of healthcare infrastructure and sensitive to the cultural context of the Gulf region.

Method: An international panel of diabetes and wound care experts from the Gulf region and beyond reviewed current international evidence and guidelines and applied it to Gulf-specific practice contexts. Consensus-based recommendations were formulated across the DFU care pathway through a structured expert panel process.

Findings: The guidelines provide recommendations across five domains: (1) causes and complications, including overlapping aetiological pathways, comorbidities, infection risk, chronicity and psychosocial impact; (2) holistic patient assessment encompassing wound, vascular, neurological, biomechanical, dermatological and footwear evaluation with clear red-flag escalation pathways; (3) management, covering offloading, wound bed preparation, comorbidity optimisation and multidisciplinary collaboration; (4) prevention of recurrence through risk-stratified surveillance, patient education and lifestyle modification; and (5) regional recommendations addressing Gulf-specific clinical, cultural and infrastructural considerations throughout.

Conclusion: Effective management of DFUs in the Gulf and MENA region requires a comprehensive, integrated, multidisciplinary approach grounded in international evidence and calibrated to regional context. These guidelines aim to standardise clinical practice, reduce variation in care and improve outcomes for patients across the region.