RT Journal Article
T1 Review and Evaluation of European National Clinical Practice Guidelines for the Treatment and Management of Active Charcot Neuro‐Osteoarthropathy in Diabetes Using the AGREE‐II Tool Identifies an Absence of Evidence‐Based Recommendations
A1 Renwick, Nichola
A1 Pallin, Jennifer
A1 Bo Jansen, Rasmus
A1 Gooday, Catherine
A1 Tardaguila García, Aroa
A1 Sanz Corbalán, Irene
A1 Tentolouris, Anastasios
A1 Jirkovská, Alexandra
A1 Koller, Armin
A1 Korzon Burakowska, Anna
A1 Petrova, Nina
A1 Game, Frances
AB BackgroundCharcot neuro-osteoarthropathy (CNO) is a rare but devastating complication of diabetes associated with high rates of morbidity; yet, many nonfoot specialists are unaware of it, resulting in missed and delayed diagnosis. Clinical practice guidelines (CPGs) have proven useful in improving quality of care and standardizing practice in diabetes and diabetic foot care. However, little is known about the consistency in recommendations for identification and management of active CNO.AimThe aim of this study is to review European national diabetes CPGs for the diagnosis and management of active CNO and to assess their methodological rigor and transparency.Methods A systematic search was performed to identify diabetes national CPGs across Europe. Guidelines in any language were reviewed to explore whether they provided a definition for active CNO and recommendations for diagnosis, monitoring, and management. Methodological rigor and transparency were assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) tool, which comprises 23 key items organized within six domains with an overall guideline assessment score of ≥ 60% considered to be of adequate quality to recommend use. Each guideline was assessed by two reviewers, and inter-rater agreement (Kendall’s W) was calculated for AGREE-II scores.Results Seventeen CPGs met the inclusion criteria. Breadth of CNO content varied across guidelines (median (IQR) word count: 327; Q1 = 151; Q3 = 790), and 53% provided a definition for active CNO. Recommendations for diagnosis and monitoring were provided by 82% and 53%, respectively, with offloading being the most common management recommendation (88%). Four guidelines (24%) reached threshold for recommendation for use in clinical practice (≥ 60%) with the scope and purpose domain scoring highest (mean (SD): 67%, ± 23%). The remaining domains had average scores ranging between 19% and 53%. Inter-rater agreement was strong (W = 0.882; p < 0.001).Conclusions: European national CPGs for diabetes provide limited recommendations on active CNO. All guidelines showcased deficits in their methodology, suggesting that more rigorous methods should be employed for diabetes CPG development across Europe.
PB John Wiley and Sons
SN 2314-6745
YR 2024
FD 2024-06-09
LK https://hdl.handle.net/20.500.14352/125068
UL https://hdl.handle.net/20.500.14352/125068
LA eng
NO Renwick, Nichola, et al. «Review and Evaluation of European National Clinical Practice Guidelines for the Treatment and Management of Active Charcot Neuro-Osteoarthropathy in Diabetes Using the AGREE-II Tool Identifies an Absence of Evidence-Based Recommendations». Journal of Diabetes Research, vol. 2024, 2024, https://doi.org/10.1155/2024/7533891
NO Diabetic Foot Research Group (DFSG)
DS Docta Complutense
RD 19 oct 2025