Although 37.3 million Americans have diabetes and 96 million more have prediabetes, there have been gaps in best practices for managing the condition in these adults — particularly in assessing physical fitness and mobility, incorporating exercise into the plan of care, and reloading the diabetic foot after an ulcer has closed to avoid a recurrence. Thanks to a newly published clinical practice guideline, or CPG, the physical therapy profession now has in-depth guidance on best practices to optimize long-term quality of life for adults with diabetes.

APTA Clinical Electro & Wound Management has released a new CPG, developed with funding from APTA. Titled "Diabetic Foot Ulcer Beyond Wound Closure: Clinical Practice Guideline," the CPG has been published in PTJ: Physical Therapy & Rehabilitation Journal, APTA's scientific journal. APTA members have full-text access to all PTJ content for free as a member benefit; to help disseminate the recommendations as quickly as possible, APTA made the CPG available to all.

The CPG includes five recommendations for physical fitness and activity inclusion and measurement for adults with diabetes, with or without foot ulceration. Specific areas include:

• Best screening tools/tests and interventions to prevent a future re-ulceration.
• Best screening tools and interventions to assess and address mobility impairments.
• Best tools to measure, and interventions to address, reduced physical fitness and activity.
• Best approach to reloading the foot after ulceration closure.
• Whether improvement in physical fitness will positively change quality of life and health care costs.

Overall, it recommends that exercise, along with physical activity, should be "prescribed according to the individual's current condition, physiologic response to exercise, and preference to optimize long-term quality of life and reduce health care costs." To further the CPG’s practical use, a supplemental checklist that can be used for patient intake includes skin assessment, range of motion, monofilament testing, readiness to change assessment, and diabetes management, such as knowledge, control, and footwear.

The recommendations are the result of a systemic search for literature and review of the existing literature. Over 700 studies were identified, eventually winnowed down to 125 following removals for duplicates and irrelevance. After full-text review, 38 studies ultimately met the criteria for inclusion.

The CPG development group was led by APTA members Deborah M. Wendland, PT, DPT, PhD, Elizabeth A. Altenburger, PT, MSPT, and Jaimee D. Haan, PT, MBA; and Shelley B. Swen, PT, DPT. Altenburger, Haan, and Swen are American Board of Wound Management-Certified Wound Specialists.