Healing Of Diabetic Foot Wounds Research Articles

Maggot debridement therapy stimulates wound healing by altering macrophage activation.

The purpose of this study is to determine the impact of maggot debridement therapy (MDT) on macrophages during the healing process of diabetic foot ulcers (DFU). The activation phenotype of macrophages during wound healing following MDT was evaluated using double staining immunohistochemistry (IHC). In addition, markers associated with macrophage activation were discovered using immunoblotting and real-time polymerase chain reaction (PCR). During the process of diabetic wound healing following MDT, the presence and over-expression of M2 macrophages were observed, while the under-expression of M1 macrophages was noted. In addition, the activation markers of macrophages exhibited a correlation with the indicated Th1/Th2 cytokines. MDT interventions have the potential to modulate macrophage activity, thereby aiding in the healing of diabetic foot wounds.

Function and mechanism of mesenchymal stem cells in the healing of diabetic foot wounds.

Diabetes has become a global public health problem. Diabetic foot is one of the most severe complications of diabetes, which often places a heavy economic burden on patients and seriously affects their quality of life. The current conventional treatment for the diabetic foot can only relieve the symptoms or delay the progression of the disease but cannot repair damaged blood vessels and nerves. An increasing number of studies have shown that mesenchymal stem cells (MSCs) can promote angiogenesis and re-epithelialization, participate in immune regulation, reduce inflammation, and finally repair diabetic foot ulcer (DFU), rendering it an effective means of treating diabetic foot disease. Currently, stem cells used in the treatment of diabetic foot are divided into two categories: autologous and allogeneic. They are mainly derived from the bone marrow, umbilical cord, adipose tissue, and placenta. MSCs from different sources have similar characteristics and subtle differences. Mastering their features to better select and use MSCs is the premise of improving the therapeutic effect of DFU. This article reviews the types and characteristics of MSCs and their molecular mechanisms and functions in treating DFU to provide innovative ideas for using MSCs to treat diabetic foot and promote wound healing.

Exploring the mechanism by which aqueous Gynura divaricata inhibits diabetic foot based on network pharmacology, molecular docking and experimental verification

BackgroundTo predict and validate the potential mechanism by which Gynura divaricata (GD) functions in the treatment of diabetic foot (DF).MethodsThe main chemical constituents of GD were identified by reviewing the literature, the traditional Chinese medicine database platform (TCMIP) and the BATMAN-TCM platform. DF disease targets were identified with the GeneCards database, and the compound-target network was constructed by using the intersection of drugs and disease. The STRING platform was used to construct the protein–protein interaction (PPI) network, and Cytoscape 3.7.2 software was used to visualize the results. Moreover, the Metascape database was used for Gene Ontology (GO) enrichment analyses and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Molecular docking of the active ingredients of GD and core protein targets of DF was performed using AutoDock software. Finally, the predicted results were preliminarily verified with experiments.ResultsA total of 140 potential targets of GD were identified and associated with DF. According to the PPI network analysis, GD accelerated DF wound healing, and the mechanism may be related to proteins such as AKT1, TP53, IL6, CASP3, TNF, and VEGFA. GO and KEGG enrichment analyses indicated that GD may play a role in the treatment of diabetic foot by affecting various signaling pathways. Molecular docking results showed that the proteins AKT1, TP53, IL6, CASP3, TNF, and VEGFA were closely associated with the components of GD. The animal experiments showed that GD reduced the levels of IL-6 and TNF-α and increased the mRNA and protein expression of VEGFA in rats with DF.ConclusionsGD regulates multiple targets and multiple pathways to promote wound healing in DF.

Nutritional supplementation on wound healing in diabetic foot: What is known and what is new?

Non-healing diabetic foot ulcers (DFU) are the most notable and striking complications of diabetes mellitus. More than 25% of nonhealing DFU can ultimately lead to amputation of the lower extremity within 6-18 mo after the first manifestation of the wound. Although wound healing is complex, nutritional status is crucial in soft tissue repair. Malnutrition is highly prevalent and overlooked in patients with diabetes and chronic wounds. Moreover, to date, we do not have clear recommendations or evidence about the use of nutritional supplements for improving wound healing in patients with DFU. In this article the authors briefly analyzed the current evidence on the use of nutritional supplements of proteins or amino acids, fatty acids, probiotics, vitamins, and trace elements in the wound healing process in patients with DFU.

To Evaluate the Effect of Collagen Dressing in Diabetic Foot Ulcer Patients

Aim: To assess the outcome of collagen dressing in the treatment of diabetic foot ulcers.Materials & methods: 100 patients who presented with diabetic foot ulcers were included as study group. Patients with diabetic foot ulcers who were known cases of carcinomas and connective tissue disorders were excluded from the present study. Pre-treatment dimensions were recorded. Collagen dressing was applied at regular follow-ups and subsequent examination of the lesion was done.Results: Mean wound area before dressing as 41.3 mm2, while mean wound area second weak after dressing was 18.9 mm2. Significant results were obtained while comparing the mean wound area before dressing and second week after dressing.Conclusion: Diabetic foot ulcers treated with collagen dressing are efficacious in terms of reduction in wound area resulting in early wound healing. Collagen-based wound dressings can be an effective tool in the healing of diabetic foot wounds.

Negative Pressure Wound Therapy Promotes Wound Healing by Inhibiting Inflammation in Diabetic Foot Wounds: A Role for NOD1 Receptor.

Aims: Diabetic foot results in frequent amputation and quality-of-life reduction in diabetes population. These lesions are featured by a prolonged and exaggerated inflammation with a significant impairment in local bacterial invasion. Negative pressure wound therapy (NPWT) attenuates hyperinflammation in the healing of diabetic foot wounds, but the potential mechanism of NPWT down-regulated inflammatory reaction still remains elusive. This study aims to explore the inflammatory signaling involved in the effect of NPWT on diabetic ulcer. Methods: Thirty patients with diabetic foot ulceration were divided into NPWT group (treated with NPWT, n = 10), NPWT + FK565 group (treated with NPWT combined with FK565 which is NOD1 receptor ligand, n = 10) and control group (n = 10). After two weeks treatment, samples were harvested and analyzed by histochemistry for infiltration of inflammatory cells, immunofluorescence stain for NOD1, western blotting for NOD1, RIP2 (Receptor interacting protein 2), IL-1β, TAK1 (Transforming growth factor-β-activated kinase1), p65 and real time-PCR for expression of NOD1 and RIP2. Results: NPWT could notably accelerate the diabetic wound healing through alleviating inflammatory reaction. The immunofluorescence analysis results revealed that NOD1 was mainly expressed in the cytoplasm and noticeably decreased after the NPWT treatment. And NPWT obviously decreased both the mRNA and protein level of NOD1 and RIP2. Moreover, The protein expression of IL-1β, TAK1 and p65 in the NPWT-group were significant decreased. Conclusion: NPWT effectively promotes wound healing by suppressing the wound inflammation in diabetic foot, which is mediated at least in part by suppression of NOD1 receptor.

Knowledge of Using Vacuums in the Treatment of Resistance Diabetic Foot Ulcers among Medical Students at King Faisal University, Saudi Arabia

Negative pressure therapy is used in diabetic foot cases to be healing of diabetic foot wounds by suctioning and vacuuming negative partial air from the wound, which helps in the formation and promotion of new tissues that are healthy and rich in capillaries. The aim of the study is to assess medical students’ knowledge about using negative pressure therapy in healing resistance diabetic foot wounds and ulcers. This is a cross-sectional study, depending on the online questionnaire that was used for data collection using social media platforms. 63.2% of participants answered “for 1-3 weeks” or “for 3-6 weeks” when they asked what is the duration of negative pressure wound therapy, while those who answered “for 6-9 weeks” were 29.4%, and about 7.5% answered “for 9-12 weeks.” About 43.5% of the participants only heard about the vacuum treatment. Also, only 23.6% of the participants had seen the negative pressure wound therapy instrument, and the remaining 76.4% did not see it. when asked about thinking that negative pressure wound therapy impacted the quality of patient care, about 54.5% of the participants indicated that it impacted the better quality of care, and only 9.5% indicated that it is the same quality of care, while about 30.8% of them indicated that it impacted relative better but highly expensive, and only 5.2% indicated that it is the worse quality of care. Medical students need to be aware of negative pressure therapy to take care of the well-being of resistance wounds of diabetic patients.

Transverse Tibial Bone Transport Enhances Distraction Osteogenesis and Vascularization in the Treatment of Diabetic Foot.

ObjectiveTo investigate the effect of transverse tibial bone transport on the treatment of Wagner Stage 4 diabetic foot.MethodsFrom January 2017 to October 2019, a total of 19 patients with Wagner Stage 4 diabetic foot ulcers were recruited. All patients were treated with transverse tibial bone transport. A detailed follow‐up was carried out at 1 week, 1 month, 3 months, 6 months, and 1 year after surgery. The wound healing rate and the limb salvage rate at 1 year after the surgery were evaluated. Preoperative and 3‐month postoperative digital subtraction angiography (DSA) were obtained. The level of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF) and platelet‐derived growth factor (PDGF) before surgery and on 1st, 4th, 11th, 18th, 28th, and 35th days after surgery were measured. Operation time, intraoperative blood loss, postoperative complications, visual analog scale (VAS) pain score, skin temperature, Semmes‐weinstein monofilament (SWM), and ankle brachial index (ABI) were also assessed.ResultsThe wound healing rate and the limb salvage rate were both 94.74% in the patients at 1 year after the surgery. DSA showed the thickening of the calf and foot arteries, clear visualization, and a rich vascular network. The levels of VEGF, bFGF, and PDGF on the 11th, 18th, 28th, and 35th days after surgery were significantly higher than those before surgery (p < 0.05). The EGF level on the 18th, 28th, and 35th days after surgery was significantly higher than that before surgery (p < 0.05). Superficial wound complications occurred in one patient during the hospitalization. There was no movement area infection, skin flap necrosis, tibial fracture, loosening of the external fixator, or rupture in study.ConclusionTransverse tibial bone transport can improve the blood circulation of the affected limbs, promote the healing of diabetic foot wounds, and reduce the amputation rate of the affected limbs. Transverse tibial bone transport can promote the healing of Wagner Stage 4 diabetic foot.

Effect of Chinese herbal medicine Shuanghuangdan dressing combined with silver ion dressing change in improving the healing of diabetic foot wounds

Effect of Chinese herbal medicine Shuanghuangdan dressing combined with silver ion dressing change in improving the healing of diabetic foot wounds

Proteomics changes after negative pressure wound therapy in diabetic foot ulcers.

Label-free quantitative mass spectrometry was used to analyze the differences in the granulation tissue protein expression profiles of patients with diabetic foot ulcers (DFUs) before and after negative-pressure wound therapy (NPWT) to understand how NPWT promotes the healing of diabetic foot wounds. A total of three patients with DFUs hospitalized for Wagner grade 3 were enrolled. The patients received NPWT for one week. The granulation tissue samples of the patients prior to and following NPWT for one week were collected. The protein expression profiles were analyzed with label-free quantitative mass spectrometry and the differentially expressed proteins (DEPs) in the DFU patients prior to and following NPWT for one week were identified. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses were conducted to annotate the DEPs and DEP-associated signaling pathways. Western blotting and ELISA were performed to validate the results. By comparing the differences in the protein profiles of granulation tissue samples prior to and following NPWT for one week, 36 proteins with significant differences were identified (P<0.05); 33 of these proteins were upregulated and three proteins were downregulated. NPWT altered proteins mainly associated with antioxidation and detoxification, the cytoskeleton, regulation of the inflammatory response, complement and coagulation cascades and lipid metabolism. The functional validation of the DEPs demonstrated that the levels of cathepsin S in peripheral blood and granulation tissue were significantly lower than those prior to NPWT (P<0.05), while the levels of protein S isoform 1, inter α-trypsin inhibitor heavy chain H4 and peroxiredoxin-2 in peripheral blood and granulation tissue were significantly higher than those prior to NPWT (P<0.05). The present study identified multiple novel proteins altered by NPWT and laid a foundation for further studies investigating the mechanism of action of NPWT.

Highly absorptive dressing composed of natural latex loaded with alginate for exudate control and healing of diabetic wounds

Wounds can take longer to heal in diabetic patients, increasing the risk of infections and other complications. The most common wounds in diabetic patients are diabetic foot ulcers, a severe complication associated with diabetes mellitus. The United States alone spends $18.7 billion annually on care for these wounds including pain and infection management. If improperly managed, infected lesions may require amputation. The enormous cost associated with wound care and the dire consequences if not cared for properly, emphasize the need to develop strategies to accelerate the healing of diabetic foot wounds. Natural rubber latex (NRL), extracted from Hevea brasiliensis (the rubber tree), has been widely applied as a carrier system for several pharmacologically active compounds. Furthermore, it has been shown to encourage angiogenesis, facilitate cell adhesion, and accelerate wound healing. When NRL dressings are applied to wounds of diabetic patients, exudate release is upregulated. The production of exudate is essential to wound healing as it provides the nutrients, proteins, cells, and environment required for regeneration. Despite its benefits, it is necessary to control excess exudate to avoid prolonged healing resulting from dermatitis, maceration of the wound edges, and lesion growth. In order to solve the problem of excessive exudate release induced by NRL membrane application, we aimed to regulate humidity by absorbing excess exudate and increase water vapor transmission. We developed a highly absorptive, permeable, alginate loaded NRL dressing. Adding alginate to NRL membranes, swelling was increased up to 80-fold, absorbing 4.80 g of water per gram of dry membrane. Moreover, water vapor transmission was improved drastically as the material transmitted 480% more water vapor than pure NRL membranes. Furthermore, in vitro tests demonstrated not only that the membranes are biocompatible, but that they also enhance cell proliferation. Through a cell proliferation assay, we observed that fibroblast proliferation was improved by the presence of NRL while the keratinocytes benefit from the presence of alginate. The NRL-alginate dressings have great potential to improve diabetic wound care by accelerating the healing process.

Prospective observational study evaluating the predictive value of ankle branchial pressure index on the outcomes of diabetic foot ulcers

Background: The study was conducted to determine the diagnostic accuracy of ankle branchial pressure index (ABPI) in predicting major amputation and duration of wound healing in diabetic foot ulcers.Methods: 105 participants (30-85 years) admitted in general surgery inpatient with diabetic foot ulcers during 18 months were enrolled in the present prospective observational study. Institutional ethics committee approved the study and written informed consent was obtained from all study participants. Data was analyzed using R and the tests of significance were chi square test and ANOVA. Area under curve (AUC) of receiver operator characteristic (ROC) was used to describe the diagnostic accuracy of ABPI. P&lt;0.05 was considered statistically significant.Results: The mean ABPI of study participants was 0.7 with 23.8% participants having normal ABPI. Lower ABPI was associated with longer duration of ulcer healing (p=0.003). All participants with ABPI &lt;0.3 required more than 120 days for wound healing (p&lt;0.001) and required above knee amputation (p&lt;0.001). AUC ROC of ABPI and major amputation is 0.987 with 92.9% sensitivity and 98.9% specificity. Significantly higher proportion of participants with ABPI ≤0.48 underwent major amputation. The AUC of ROC of ABPI on duration of wound healing was 0.953 with 84.9% sensitivity and 98.1% specificity. Conclusions: ABPI can be used as a routine tool in all patients with diabetic foot ulcers for screening peripheral arterial disease so that the decision for amputation can be made early during diabetic foot ulcers.

593-P: Cold Atmospheric Pressure Plasma for Accelerated Wound Healing in Diabetic Foot: The Prospective, Randomized, Placebo-Controlled KPW-Trial

Diabetic foot is a common complication of diabetes mellitus and requires specialized treatment. Cold plasma has demonstrated beneficial effects on wound infection and healing in case reports. The “Kaltplasma Wund (KPW)-Trial” aimed to analyse whether the application of cold plasma accelerates wound healing in diabetic foot compared to standard care therapy. It was a prospective, randomized, placebo-controlled, patient-blinded, bi-center trial. People with diabetes mellitus and diabetic foot WA 1B or 2B were eligible. Each wound was randomized separately. Wounds were treated additionally with cold plasma generated from inert argon gas in an atmospheric pressure plasma jet or placebo. Primary endpoints were reduction in wound size, in clinical infection and microbial load compared to beginning. Important secondary endpoints were time to significant wound reduction (&amp;gt;10%), and to reduction of infection. Ad hoc we analysed the time to 20% wound reduction. In addition, wound dressings from 15 patients per group were analysed for expression of VEGF via ELISA. In total 65 cases were included in the study and 62 were considerable for final evaluation. Plasma therapy yielded in a significant increase of wound healing, both in total area reduction (-26.31±11.72, p=0.0248 vs. placebo) as well as time to significant wound area reduction (10% from baseline, -1.60±0.58, p=0.0085 vs. placebo). The effect was even more significant, if the reduction level was set to 20% (p&amp;lt;0.0001). Reduction of infection and microbial load was not significantly pronounced in plasma therapy. Regarding the expression of VEGF wounds in the plasma group presented throughout the study with at most visits significant higher levels of baseline corrected VEGF than wounds randomized to placebo therapy. Cold plasma therapy revealed beneficial effects in chronic wound treatment in terms of wound surface reduction and time to wound closure independent from background infection. Disclosure B. Stratmann: Speaker’s Bureau; Self; AstraZeneca, Neoplas Tools GmbH. T. Costea: Other Relationship; Self; Merck Sharp &amp; Dohme Corp. C. Nolte: None. J. Hiller: None. J. Schmidt: None. J. Reindel: None. K. Masur: None. W.H. Motz: None. J. Timm: None. W. Kerner: None. D. Tschoepe: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH. Research Support; Self; AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Neoplas tools GmbH.

Effect of transverse tibial bone transport on expression of serum angiogenesis-related growth factors

To investigate the effect of transverse tibial bone transport on the expression of angiogenesis-related growth factors in the serum of diabetic foot patients. Between January 2018 and December 2018, 10 patients who suffered from diabetes mellitus accompanied with Wagner stage 4 diabetic foot underwent transverse tibial bone transport. There were 5 males and 5 females with an average age of 59.2 years (range, 51-70 years). The duration of diabetes was 2-60 months, with an average of 24.2 months. The duration of diabetic foot was 30-120 days, with an average of 54.1 days. Peripheral venous blood was taken at 1 day before operation and at 1, 4, 11, 18, 28, and 35 days after operation. The serum was centrifuged and subjected to ELISA test to detect the expression levels of serum vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), and platelet-derived growth factor (PDGF). The levels of serum VEGF, bFGF, and EGF increased rapidly at 11 days after operation, and the expression levels of the factors at 11, 18, 28, and 35 days were significantly higher than those before operation ( P<0.05). The expression level of PDGF increased suddenly at 18 days after operation, and the expression level of PDGF at 18, 28, and 35 days was significantly higher than that before operation ( P<0.05). Transverse tibial bone transport for the treatment of diabetic foot can significantly increase the expression of serum angiogenesis-related growth factors in early stage, which may be the mechanism of promoting the healing of diabetic foot wounds.

Cold Plasma Therapy for Acceleration of Wound Healing in Diabetic Foot

Cold Plasma Therapy for Acceleration of Wound Healing in Diabetic Foot

THE EFFECT OF INFRARED RAY AND COUNSELING ON DIABETIC FOOT ULCER HEALING PROCESS

Background: Diabetic foot ulcer is one of the chronic complications of diabetes mellitus caused by neuropathy, angiopathy and decreased endurance. The risk of amputation in patient with diabetes mellitus fifteen times greater compared to non-diabetic. Various efforts on diabetic foot wound care have been carried out but the results are still far from satisfactory. Until now, infrared and counseling effect on wound healing in diabetic foot cannot be explained.Objective: The purpose of this study was to examine the effect of infrared ray and counseling on diabetic foot ulcer healing process.Method: The research design was quasi-experimental design with posttest control group design, the population in this study were patients with grade 3 diabetic foot wounds, blood sugar 100-200 g/ dl, BMI 18.5 to 24.9, aged 35-55 years. Large sample in this study as many as 20 were divided into two groups, the control random sampling. The collection of data for the dependent variable using the observation sheet after the tenth day of treatment, which consists of the rate of growth of granulation, ankle brachial index and capillary refill time. Furthermore, the data were processed using non-parametric statistical significance level &lt; 0.05.Result: The results showed that the infrared and counseling effect on the growth of granulation with a significance level (p = 0.0003), infrared and counseling influence ankle brachial index (p = 0.024), infrared and counseling effect on capillary and counseling effect on capillary refill time (p = 0.024).Conclusion: It can be concluded from this study that applying infrared and counseling has any impact on healing in diabetic foot ulcer, on the growth of granulation and improved blood in diabetic foot ulcers. Key words: Infrared Ray, Counseling, Foot Ulcer Healing.

Effect of Hemoglobin A1C on Wound Healing in Diabetic Foot Ulcers Treated with Hyperbaric Oxygen Therapy

Husain, Sharmeen MD; Shoucair, Sami MD; Blitzer, David MD; Martin, David Z. MD, FACS Author Information

Negative pressure wound therapy promoted wound healing by suppressing inflammation via down-regulating MAPK-JNK signaling pathway in diabetic foot patients

AimsNegative pressure wound therapy displayed significant clinical benefits in the healing of diabetic foot wounds. In the present study, we investigated the mechanism of regulation of MAPK-JNK (Mitogen-activated protein kinase- c-Jun N-terminal kinase) signaling pathway by negative pressure wound therapy on these wounds. MethodsTwenty-six type 2 diabetes patients with foot ulceration were randomly assigned to the two groups, thirteen treated with negative pressure wound therapy and the others treated with traditional debridement therapy. Skin samples were harvested and histologically and immunohistochemical analyzed in both groups. Immunofluorescence stain, Enzyme-linked immunosorbent assay and Western blotting were performed for inducible nitric oxide synthase, inter leukin-6, tumor necrosis factor-α, P-c-Jun N-terminal kinase and c-Jun N-terminal kinase. Real time-polymerase chain reaction was performed to evaluate expression of c-Jun N-terminal kinase, extracellular signal regulated kinase1/2 and p38. ResultsNegative pressure wound therapy could effectively alleviate inflammatory reaction and reduce inter leukin-6 and inducible nitric oxide synthase production after 7 days treatment. The level of tumor necrosis factor-α, inter leukin-6 and P-c-Jun N-terminal kinase were significantly decreased. However, there was no statistical difference in messenger ribonucleic acid expression of p38, extracellular signal regulated kinase1 and 2. ConclusionsNegative pressure wound therapy possibly suppress the wound inflammation by inhibiting inter leukin-6, tumor necrosis factor-α and inducible nitric oxide synthase in diabetic foot patients. This effect is maybe mediated at least in part by suppression of Mitogen-activated protein kinase- c-Jun N-terminal kinase signaling pathway.

Association Between Cigarette Smoking and Diabetic Foot Healing: A Systematic Review and Meta-Analysis.

The role of smoking for wound healing in patients with diabetic foot has been unclear. This meta-analysis examined the relationship between cigarette smoking and diabetic foot wound healing. Observational studies for the association between smoking and diabetic foot wound healing of patients were systematically searched through PubMed and Wanfang Data, published up to June 2018. Healing rates of wounds were recognized as outcomes. Meta-analysis models were chosen by heterogeneity. A total of 3388 eligible studies were identified, of which 18 met all our inclusion criteria. In the smoking group, healing rate had an average of 62.1%, ranging from 20.0% to 89.6%; in the nonsmoking group, healing rate had an average of 71.5%, ranging from 40.2% to 93.8%. A significant association was found between smoking and the healing of diabetic foot wounds ( z = 3.08; P = .002), with an odds ratio (OR) of 0.70 (95% CI = 0.56-0.88), based on a random-effects model. Meta-regression analyses indicated that the heterogeneity did not come from publication year ( t = -0.50, P = .622) or overall healing rate ( t = 0.16, P = .872). The leave-one-out sensitivity analysis was robust; sensitivity analysis for pooled estimate of adjusted ORs had an OR of 0.20 (95% CI = 0.07-0.56; z = 3.08; P = .002). Subgroup analysis had an OR of 0.62 (95% CI = 0.41-0.95; z = 2.21; P = .027) in retrospective cohort studies and had an OR of 0.75 (95% CI = 0.57-0.99; z = 2.02; P = .043) in prospective cohort studies. Our meta-analysis indicated that smoking had an overall negative effect on the wound healing of diabetic foot individuals. This study provides evidence for the harm of smoking to diabetic foot and may help reduce the medical and economic burden on poor healing of diabetic foot.

Diabetes Foot Wound Healing—A Collaborative Approach

There exists limited data demonstrating that glycemic control can improve healing of diabetic foot wounds. From March through December 2017, patients followed in the Foot Wound Clinic of a large urban safety net health system were concurrently seen by diabetes specialists to determine whether improving glycemic control via an integrated treatment approach impacted wound healing. This pilot study is the first to examine the effect of diabetes specialty co-management with podiatric care of diabetic foot wounds. Sixty patients were included in the analysis of this pilot program and were followed for an average of 220 days. Patients were classified as having either improved glycemic control (IGC) or non-improved glycemic control (NIGC) defined as &amp;lt; 1% HbA1c change at study end. Cohort characteristics and outcomes are summarized in Table 1. All patients had aggressive diabetic foot care including wound debridement and appropriate antibiotic therapy as determined by their podiatrist. Ulcers worsened in 47% of NIGC patients compared to 13% of IGC patients with IGC patients having an average HbA1c reduction of 2%. With both NIGC and IGC groups receiving similar wound management, 63% of NIGC patients had decreased ulcer volume compared to 87% of IGC patients, suggesting that improving glycemic control, in collaboration with diabetes specialist co-management, contributes to improved wound healing and a trend for decreased resource utilization.Table 1. Cohort characteristics and study outcomesIGCNIGCp-valueTotal No. of patients3030Total No. of ulcers3641Median ulcer size (mm3)BaselineStudy End170010040Patients with improved ulcer healing, n (%)26 (87)19 (63)0.04HbA1c, mg/dLBaselineStudy End10.68.210.211.10.47&amp;lt;0.005Hypertension, n (%)Pre-existingControlled at baselineControlled at study end25 (83)19 (63)19 (63)24 (80)16 (53)21 (70)ED visitsTotal visitsAverage No. of visits per patientFoot relatedDiabetes related351.9104502.32620.190.020.38Average number of podiatric appointments570.92No. of patients seen by Diabetes specialistAverage No. of specialist visits per patientNo. of patients seen in co-management visitNo. seen in sporadic visitNo visits252.32505242.81686Lost to follow-up with diabetes specialist, n (%)13 (43)15 (50) Disclosure J.N. McNulty: None. B.J. Lewis: None. J. La Fontaine: None. A. Rose: None. M. Gomez: None. L. Meneghini: Advisory Panel; Self; Novo Nordisk Inc., Sanofi US. Consultant; Self; Sanofi US, Novo Nordisk Inc.. Advisory Panel; Self; Intarcia Therapeutics, Inc.. Other Relationship; Self; American Diabetes Association. U. Gunasekaran: None. M.S. Ruiz: None.