Diabetic Foot Screening: A Systematic Review of Global Guidelines and Questionnaire-Based Tools

Abstract

Diabetic foot ulcers are a significant complication of diabetes mellitus, contributing to high morbidity, prolonged hospitalisations, and increased healthcare costs. Early detection through diabetic foot screening (DFS) and preventive management strategies are therefore crucial in reducing the incidence of diabetic foot ulcers and improving patient outcomes. Hence, this study aims to review and summarise the current practices in DFS and risk stratification to aid subsequent clinical management. A systematic search of PubMed and Embase was conducted to identify articles relevant to DFS guidelines and questionnaire-based screening tools. Of 1761 studies screened, 15 met the inclusion criteria. While national and international guidelines provide comprehensive protocols for DFS with similarities in screening components, differences exist in risk stratification approaches, frequency of assessments, and integration of questionnaire-based tools such as Q-DFD, Thai Q-DFD, DFSQ-UMA and MNSI. Analysis of DFS guidelines identified three key components: neuropathy assessment, vascular assessment, and visual inspection. The screening methods include monofilament testing, vibration perception, and pedal pulse palpation with additional tools such as ankle-brachial index being used in some of the guidelines. These can be performed by various healthcare providers, including general practitioners, diabetes nurses, and podiatrists, ensuring accessibility across different healthcare settings. Risk stratification models classify patients into low-, moderate-, or high-risk categories, guiding screening frequency which varies from annual to quarterly assessments depending on risk level. Effective DFS, based on standardised guidelines and risk stratification models, is essential for preventing diabetic foot ulcers. The integration of DFS into routine clinical practice, supported by tools such as validated questionnaires, can significantly improve outcomes for diabetic patients.