Diabetic foot (DF) is a prevalent and significant complication of diabetes mellitus. The primary factors that contribute to amputation and mortality in DF patients are multifaceted and include foot deformities, ulcers, ischemia, and potential concurrent infections. To further standardize DF prevention and treatment in China, improve consistency in DF diagnosis and treatment, and promote the development of a specialized tiered care system, the Chinese Burn Association, the Yangtze River Delta Integrated Diabetic Foot Alliance, and the Editorial Committee of the Chinese Journal of Burns and Wound Repair established a multidisciplinary expert team. The team identified clinical issues concerning the diagnosis, treatment, and prevention of DF via the population, interventions, comparisons, outcomes framework, assessed the quality of relevant evidence using the Grading of Recommendations Assessment, Development and Evaluation system, and ultimately formulated a consensus titled “Practical Guidelines for the Prevention and Management of Diabetic Foot Disease in China.” The guidelines include 46 recommendations that address comprehensive medical assessment; internal medical treatments, including treatments related to blood glucose, blood pressure, and blood lipid control; antithrombotic and anti-infection therapy; perioperative risk assessment and management; surgical interventions, such as debridement, vascular reconstruction, and tissue repair; foot disease prevention; multidisciplinary collaboration; and the establishment of a hierarchical diagnosis and treatment system, with the objective of guiding clinical practice for managing DF in China.

Diabetes mellitus is a group of chronic metabolic diseases worldwide that seriously threaten human health and increases the social and economic burden; underlying drivers of impaired healing include uncontrolled inflammation, repeated ischemia reperfusion injury, and neuropathy alongside infection risks. Macrophages orchestrate standard repair, exhibit sustained classical pro-inflammatory activation in diabetes, disrupting growth factor secretion, angiogenesis, and matrix regulation. Hyperglycemia mediated advanced glycation end products and reactive oxygen species heighten pattern recognition receptor stimulation, causing reduced alternative macrophage differentiation. Promising immunomodulation approaches redirecting their phenotypes to resolve inflammation and stimulate regeneration provides optimism. We discuss macrophage origination, polarization dynamics, diabetic wounds phenotypic imbalance, and critical microenvironmental disruptions perpetuating pathological function. Elucidating specific regulatory nodes upholding their activation states will inform intelligent targeting opportunities. Overall, infiltrating macrophages constitute indispensable yet amenable diabetic wound healing coordinators.