Quality of Clinical Practice Guidelines for Diabetic Foot Management: A Systematic Review Using the AGREE II and AGREE-REX Instruments
Summary: This systematic review assessed the methodological quality and recommendation excellence of 15 clinical practice guidelines (CPGs) for diabetic foot ulcer (DFU) management using AGREE II and AGREE-REX instruments. Six guidelines were rated high-quality and nine moderate-quality. Highest AGREE II domains were Editorial Independence, Scope and Purpose, and Clarity of Presentation. Lowest scores were in Applicability, Stakeholder Involvement, and Rigor of Development. AGREE-REX showed weaknesses in Values and Preferences. Seventeen key treatment recommendations were synthesized, mostly Grade B with moderate-quality evidence. The review concludes that while guidelines use systematic methods, gaps remain in applicability, stakeholder input, and implementation. Future guidelines should prioritize these areas and strengthen underlying evidence to improve clinical utility and patient outcomes.
Key Highlights:
- Variability in quality; strong in scope/clarity but weak in applicability and rigor
- Low scores in stakeholder involvement and values/preferences
- Recommendations mostly Grade B with moderate evidence
- Authors: Yu Song, Zhong-Fei Cui, Zhi-Qiang Wu, Xiao-Bo Liu, Wen-Jun Liu et al.
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Keywords: DFU guidelines, AGREE II, diabetic foot management, clinical practice guidelines, Yu Song