A clinician’s guide to the treatment of foot burns occurring in diabetic patients Larry M. Jones a, *, Rebecca Coffey a , Sorabh Khandelwal b , Said Atway c , Gayle Gordillo d , Claire Murphy e , Jody A. Fries f , Kathleen Dungan g a Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA b Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA c Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA d Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA e Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA f Department of Rehabilitation Services – Acute Care, The Ohio State University Wexner Medical Center, Columbus, OH, USA g Department of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, Columbus, OH, USA b u r n s x x x ( 2 0 1 4 ) x x x – x x x a r t i c l e i n f o Article history: Accepted 28 January 2014 Keywords: Diabetes Burns Hyperbaric oxygen Foot a b s t r a c t Introduction: Diabetes mellitus affects 25.8 million Americans and is predicted to almost double by 2050. The presence of diabetes complicates hospital courses because of the microvascular complications associated with disease progression. Patients with diabetes represent 18.3% of annual burn admissions to our unit and 27% have burns to the feet. The purpose of this project was to develop an evidence-based guideline for care of the patient with diabetes and foot burns. Methods: A multidisciplinary group was charged with developing an evidence-based guide- line for the treatment of foot burns in patients with diabetes. Evidence was evaluated in the areas of diabetes, burn care, hyperbaric medicine, care of diabetic foot wounds and physical therapy. After guideline development and approval, key aspects were incorporated into order sets. Results: Key aspects of this guideline are the ability to identify patients with undiagnosed diabetes, assess diabetic control, optimize glycemic and metabolic control, optimize burn wound management, treat microvascular disease, and provide education and a discharge plan. Evaluated outcomes are glycemic control, length of stay, complication rates, amputa- tion rates, infection rates and the use of hyperbaric oxygen. Conclusions: Best outcomes for this high risk population will be attainable with an evidence based guideline. # 2014 Elsevier Ltd and ISBI. All rights reserved. * Corresponding author at: The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N748 Doan Hall, Columbus, OH 43210, USA. Tel.: +1 614 293 5710; fax: +1 614 293 3425. E-mail address: Larry.jones@osumc.edu (L.M. Jones). JBUR-4292; No. of Pages 6 Please cite this article in press as: Jones LM, et al. A clinician’s guide to the treatment of foot burns occurring in diabetic patients. Burns (2014), http://dx.doi.org/10.1016/j.burns.2014.01.026 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/burns http://dx.doi.org/10.1016/j.burns.2014.01.026 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.