Epidermal Growth Factor is Effective in the Treatment of Diabetic Foot Ulcers: Meta-Analysis and Systematic Review

Thien Quoc Bui,Patricia Sarlós,Andrea Párniczky,Zsolt Szakács,Péter Hegyi,Barbara Tóth,Dávid Németh,Gabriella Emri,Orsolya Varga,Quoc Van Phu Bui,Zoltán Rumbus

doi:10.3390/ijerph16142584

Abstract

Diabetic foot ulcers (DFUs) are one the common complications of diabetes mellitus. Many trials were performed to evaluate the effect of recombinant human epidermal growth factor (rhEGF) in healing DFUs. This meta-analysis was performed to synthesize the evidence of rhEGF treatment in DFUs in comparison to placebo. Databases included for the search were PubMed, EMBASE, the Cochrane Library, Web of Science, EBSCOhost, ScienceDirect, and Scopus (up to January 2019). The outcome of interest was the complete healing rate of DFUs. We performed random effects meta-analysis stratified by the types of administration route (intralesional injection and topical apply) by calculating the odds ratios (OR) and 95% confidence interval (95% CI). A total of six studies involving 530 patients were eligible for analysis. The combined OR (intralesional injection and topical apply) was 4.005 (95% CI: (2.248; 7.135), p < 0.001). The ORs for intralesional injection and topical application were 3.599 (95% CI: (1.213; 10.677), p = 0.021) and 4.176 (95% CI: (2.112; 8.256), p < 0.001), respectively. Statistical heterogeneity might not be important in overall treatment (I2 = 15.17, p = 0.317) and both of the subgroups (I2: 24.56, p = 0.25 and I2: 33.26, p = 0.213, respectively). Our results support the use of rhEGF in the treatment of DFUs.

Highlights

Diabetes mellitus (DM) is caused by a deficiency of either insulin production or insulin function.Untreated or inadequately treated DM results in many complications, such as micro-vasculopathy and macro-vasculopathy [1]
Seven studies were found to be eligible for qualitative analysis [11,12,13,14,15,16,17] and six of those were included in the quantitative synthesis
Our results indicate that the use recombinant human epidermal growth factor (rhEGF) together and these studies were pooled into our meta-analysis

Summary

Introduction

Diabetes mellitus (DM) is caused by a deficiency of either insulin production or insulin function. Untreated or inadequately treated DM results in many complications, such as micro-vasculopathy (including retinopathy, nephropathy, and neuropathy) and macro-vasculopathy (including cardiovascular disease and insufficient blood flow to lower limbs) [1]. Neuropathy is the main etiology of diabetic foot ulcers (DFUs). The mechanism of this includes direct damage to the nerve. Res. Public Health 2019, 16, 2584; doi:10.3390/ijerph16142584 www.mdpi.com/journal/ijerph

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Conclusion