The Gulf Diabetic Foot Working Group (GDFWG) has published the first Gulf diabetic foot ulcer guidelines, covering the assessment, management and prevention of recurrence of diabetic foot ulcers (DFUs) and written specifically for the Gulf and the wider Middle East and North Africa. The international consensus document appeared as a free-access supplement to the Journal of Wound Care on 8 October.
Who wrote it
The panel is chaired by Dr Noor Janahi, consultant podiatrist at Awali Hospital, Bahrain. It includes a senior consultant podiatrist from Hamad Medical Corporation in Qatar, a diabetic foot and wound specialist from Oman’s Ministry of Health, an endocrinologist and a vascular surgeon from Oman, a plastic surgeon from Kuwait, a surgeon from Saudi Arabia and a UK foot and ankle surgeon. Two authors work for wound care company MiMedx. Publication was supported by Advanced Technology Company of Kuwait and Mölnlycke, and the authors declare no conflicts of interest.
What the Gulf diabetic foot ulcer guidelines cover
The guidelines apply international evidence to Gulf practice across five domains: causes and complications; holistic assessment, including wound, vascular, neurological, biomechanical, dermatological and footwear evaluation with red-flag escalation pathways; management, including offloading, wound bed preparation and multidisciplinary care; prevention of recurrence; and regional recommendations that run through every section.
The Gulf-specific recommendations
- Barefoot walking: described as a common cultural practice that needs particular attention, as it can make patients reluctant to wear protective footwear, especially at home.
- Climate: heat and humidity contribute to sweating and maceration. Total contact casts should be changed at intervals of up to a week, adjusted for climate and adherence, and offloading choices should reflect climate and footwear preferences.
- Wudhu: clinicians should routinely discuss ritual ablution with Muslim patients, stress drying between the toes after every wash, and explain that Islamic jurisprudence permits masah, wiping over a dressing rather than wetting it.
- Traditional remedies: use of herbal and traditional treatments can delay medical attention.
- Classification: the region should move from the Wagner system to WIfI “at the earliest opportunity”.
- Data: standardised assessment tools and key performance indicators across centres would create a shared inter-hospital dataset to fill the gap in regional health-economic evidence.
- Remote monitoring: smart insoles and sensors could support patients in rural or resource-limited settings.
The burden
The document notes that MENA has the world’s highest diabetes prevalence, at 17.6% of adults, with 85 million adults living with diabetes in 2024, a figure expected to reach 163 million by 2050. A meta-analysis of Middle Eastern studies put the pooled prevalence of DFU-related amputation at 33%, and in Oman almost half of all lower-limb amputations are linked to diabetes.
IMEA POD Perspective
The Gulf diabetic foot ulcer guidelines are a practical document written by clinicians who treat these patients, and it is notable that a podiatrist chairs the group. The wudhu guidance is a good example of what international guidelines miss: a practice performed five times a day that can either protect or endanger a neuropathic foot. The recommendations with the biggest system-level impact are the least glamorous: adopting WIfI and shared KPIs. Without common data, Gulf health systems cannot show whether programmes such as Saudi Arabia’s Walk Safe are reducing amputations. Readers should note that this is a consensus document, not a graded systematic review, that it received industry support, and that the IWGDF guidelines, due for update in 2027, remain the international reference. The Gulf diabetic foot ulcer guidelines give podiatrists biomechanical assessment, offloading, nail and skin care, and orthotists custom footwear. Many centres in the region still have neither, and the Omani review found no multidisciplinary foot teams outside Muscat. Guidelines will only change outcomes if the workforce exists to deliver them.
Sources and further reading
- Janahi N, al Mahrizi AS, ben Nakhi M, et al. Gulf regional guidelines for managing diabetic foot ulcers: assessment, treatment and prevention of recurrence. Journal of Wound Care 2026;35(Sup10C)
- Wounds International: Unmet needs in managing diabetic foot and its complications, recommendations for the Gulf region (2025)
- IMEA POD: Saudi Arabia launches Walk Safe national diabetic foot programme
- IMEA POD: Oman, diabetes behind 47% of amputations, foot review finds
- IMEA POD: IWGDF 2027 guidelines, what foot teams should expect