Abstract
Aims/hypothesisFoot ulcers in people with diabetes are a common and serious global health issue. Dressings form a key part of ulcer treatment. Existing systematic reviews are limited by the lack of head-to-head comparisons of alternative dressings in a field where there are several different dressing options. We aimed to determine the relative effects of alternative wound dressings on the healing of diabetic foot ulcers.MethodsThis study was a systematic review involving Bayesian mixed treatment comparison. We included randomised controlled trials evaluating the effects on diabetic foot ulcer healing of one or more wound dressings. There were no restrictions based on language or publication status.ResultsFifteen eligible studies, evaluating nine dressing types, were included. Ten direct treatment comparisons were made. Whilst there was increased healing associated with hydrogel and foam dressings compared with basic wound contact materials, these findings were based on data from small studies at unclear or high risk of bias. The mixed treatment comparison suggested that hydrocolloid-matrix dressings were associated with higher odds of ulcer healing than all other dressing types; there was a high degree of uncertainty around these estimates, which were deemed to be of very low quality.Conclusions/interpretationThese findings summarise all available trial evidence regarding the use of dressings to heal diabetic foot ulcers. More expensive dressings may offer no advantages in terms of healing than cheaper basic dressings. In addition, evidence pointing to a difference in favour of ‘advanced’ dressing types over basic wound contact materials is of low or very low quality.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-012-2558-5) contains peer-reviewed but unedited supplementary material, which is available to authorised users.
Highlights
Foot ulcers in people with diabetes are a common, serious and costly global health issue [1]
Conclusions/interpretation These findings summarise all available trial evidence regarding the use of dressings to heal diabetic foot ulcers
Evidence pointing to a difference in favour of ‘advanced’ dressing types over basic wound contact materials is of low or very low quality
Summary
Foot ulcers in people with diabetes are a common, serious and costly global health issue [1]. In 2007, the mean total reimbursement cost for a US Medicare patient with a Diabetologia (2012) 55:1902–1910 diabetic foot ulcer was $33,000 (for all Medicare services) [2]. Dressings form a key part of ulcer treatment, with clinicians having many different types to choose from. As dressing types grow in number and complexity, and with claims of promoting healing, expenditure increases. Drugs and devices prescribed in the UK National Health Service (NHS) are listed in the British National Formulary (BNF) [3] and the costs of non-hospital prescriptions in England are recorded by the NHS. Of the 201 BNF categories in 2010, the community prescription cost of the ‘wound management and other dressings’ section was £136 million [4], making it the 17th most costly section (the most costly section is ‘drugs for diabetes’ at over £700 million)
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