Comment on: Margolis et al. Lack of Effectiveness of Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcer and the Prevention of Amputation: A Cohort Study. Diabetes Care 2013;36:1961–1966

Abstract

The retrospective study recently published by Margolis et al. (1) raises many questions. First, it appears that the excluded cohort had a lower extremity amputation (LEA) rate of 4.5% in the first 28 days. This seems high. Previous studies have shown overall amputation rates (major and minor) after 1 year of 12.5–22.6% in two smaller cohort studies of sicker patients (2,3). Given that the excluded cohort was defined as having “adequate lower extremity arterial flow” (diagnostic method unknown), these results suggest that the excluded cohort was either at inherently higher risk for an LEA or that basic wound care was poorly conducted. Second, since the detailed selection criteria for hyperbaric oxygen …