A multidisciplinary expert consensus framework for diabetic foot disease management in the Gulf Cooperation Council: A modified Delphi study.

BACKGROUND

The Gulf Cooperation Council (GCC) countries face an escalating epi-demic of diabetes, with prevalence rates substantially exceeding global averages and projections indicating a 96% increase by 2035. Diabetic Foot Disease (DFD) represents one of the most serious and costly complications of diabetes, yet regionally adapted clinical guidance is absent across all six GCC nations.

METHODS

A modified Delphi study incorporating elements of the RAND/UCLA Appropriateness Method was conducted with an expert panel of 18 multidisciplinary clinicians from all six GCC countries (United Arab Emirates, Kingdom of Saudi Arabia, Qatar, Bahrain, Kuwait, and Oman). Panelists rated consensus statements using a 5-point Likert scale over two anonymous voting rounds, with an 80% agreement threshold defining consensus. Statements not achieving consensus were revised following structured group discussion.

RESULTS

The panel generated consensus recommendations across seven domains: prevention and screening, risk assessment and classification, vascular assessment and management, wound management, infection and osteomyelitis, Charcot neuroarthropathy, and follow-up and recurrence prevention. Recommendations encompass GCC-specific adaptations addressing cultural practices, regional microbiology, climatic factors, healthcare system organization, and resource constraints.

CONCLUSIONS

This consensus provides the first evidence-informed, regionally adapted framework for DFD management in the GCC. Implementation requires coordinated investment in multidisciplinary care models, workforce development, patient education programmes tailored to regional contexts, and robust data systems to monitor outcomes and guide continuous quality improvement.