Treatment of diabetic foot ulcers

NewsBot · Aug 13, 2025

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Comparison of the efficacy of 12 interventions in the treatment of diabetic foot ulcers: a network meta-analysis.
Hu X, Meng H, Liang J, An H, Zhou J, Gao Y, You C, Zhang Z, Gong X, Liu Y. 2025.
PeerJ 13:e19809 https://doi.org/10.7717/peerj.19809

Objective

This study aimed to comprehensively compare the efficacy of 12 interventions for diabetic foot ulcer (DFU) using a network meta-analysis (NMA).
Methods

The NMA was conducted by PRISMA guidelines, and the protocol was registered in PROSPERO (CRD42023461811). PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched from inception to September 2023. Randomized controlled trials (RCTs) enrolling patients with DFU were included if they compared epidermal growth factor (EGF), platelet-derived growth factor (PDGF), platelet-rich plasma (PRP), stem cells (SC), low-frequency ultrasound (LFU), negative pressure wound therapy (NPWT), low-level laser therapy (LLLT), electric stimulation (ES), extracorporeal shockwave therapy (ESWT), amniotic membrane therapy (AMT), hyperbaric oxygen therapy (HBOT), and topical oxygen therapy (TOT) against standard of care (SOC) or placebo. The primary endpoint assessed was the wound healing rate. Secondary endpoints comprised wound healing time, percentage area reduction (PAR), and amputation rate. The surface under the cumulative ranking curve (SUCRA) was calculated to rank the efficacy of interventions.
Results

A total of 99 RCTs involving 7,356 patients were included. Among the 12 interventions analyzed, only LFU (OR = 2.20; 95% CI [0.99–4.91]) and ES (OR = 1.88; 95% CI [0.87–4.05]) did not demonstrate statistically significant improvements in ulcer healing rate compared with SOC. Based on SUCRA rankings, SC (SUCRA = 89.7%; OR = 5.71; 95% CI [2.64–12.34]) and AMT (SUCRA = 89.2%; OR = 5.11; 95% CI [3.12–8.37]) ranked highest in promoting ulcer healing, while LFU (29.4%) and SOC (10.4%) ranked lowest. Regarding wound healing time, AMT (MD = –26.91 days; 95% CI [−44.27 to −9.55]), PRP (MD = –21.65 days; 95% CI [−33.61 to −9.69]), and NPWT (MD = −16.79 days; 95% CI [−31.12 to −2.26]) significantly reduced healing durations compared to SOC. SUCRA rankings indicated that AMT (84.7%) and PRP (74.6%) ranked highest, while LFU (29.4%) and SOC (10.4%) remained lowest. Concerning PAR, LLLT (MD = 34.27; 95% CI [17.35–51.20]) and ESWT (MD = 27.50; 95% CI [11.00–44.00]) showed significant improvements over SOC, with LLLT (SUCRA = 93.9%) and ESWT (SUCRA = 84.0%) ranking highest, while SOC (21.0%) and TOT (18.3%) ranked lowest. For amputation rate, SC (OR = 0.12; 95% CI [0.03–0.55]) and HBOT (OR = 0.35; 95% CI [0.16–0.78]) significantly lowered the risk compared to SOC, with SUCRA rankings placing SC (79.9%) and PRP (73.2%) as most effective, while NPWT (26.4%) and SOC (9.9%) were least effective.
Conclusions

SC and AMT emerged as highly effective, demonstrating superior efficacy in improving healing rate compared to PDGF, ES, and HBOT. AMT also showed significant effects in shortening ulcer healing time. LLLT exhibited considerable effectiveness in reducing ulcer areas, and SC therapy was associated with reduced amputation rate.
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NewsBot · Aug 13, 2025

The impact of an aggressive clinic-based diabetic foot protocol: a single-center case series
Qing Jia et al
Wounds. 2025 Jul;37(7):269-274.

Background: The considerable health and economic burden of hard-to-heal wounds has become increasingly prominent. Diabetic foot ulcers (DFUs), as a representative type of these wounds, pose substantial challenges for health care professionals in both treatment and long-term management.

Objective: To evaluate the efficacy of a standardized wound hygiene protocol in promoting healing outcomes for DFUs and to provide supplementary clinical evidence to inform wound care practices.

Materials and methods: Diabetic foot care specialists administered a wound hygiene protocol to 20 patients with DFUs. The protocol comprised 4 key components: cleansing, debridement, wound edge refashioning, and dressing coverage. Wound healing progress was monitored and documented over a 12-week observation period.

Results: After 12 weeks of treatment with the wound hygiene protocol in the multidisciplinary diabetic foot clinic, 16 of the 20 patients achieved complete wound healing, while the remaining 4 patients showed significant wound improvement, resulting in a healing rate of 80%. Wound area, exudate level, and pain scores all showed significant improvement compared to baseline, with statistically significant differences (P < .001). The overall mean (SD) wound area reduction rate was 95.11% (10.46%), with a mean healing rate of 1.32 (0.36) cm² per week. The average healing time for patients with complete healing was 56.44 (25.12) days.

Conclusion: This case series demonstrates that the implementation of a wound hygiene protocol significantly enhances healing outcomes in patients with DFUs. These findings provide critical insights for the management of diverse hard-to-heal wounds in clinical practice.
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NewsBot · Aug 20, 2025

Management of Diabetic Wounds: Expert Panel Consensus Statement
Henry C Hsia et al
Adv Wound Care (New Rochelle). 2025 Aug 20.

Significance: The Wound Healing Foundation recognized the need for consensus-based unbiased recommendations for the treatment of wounds. Consensus statements on the treatment of chronic wounds and acute wounds have been developed and published previously. The current publication on diabetic wounds represents the next step in this process. Diabetic wounds constitute a major problem. Population-based and meta-analytic studies indicate that the presence of foot wounds in patients with diabetes increases their mortality risk by more than twofold. The management of diabetic wounds requires consistent and evidence-driven intervention to achieve optimal clinical outcomes. This consensus statement provides the clinician with the necessary foundational approaches to the causes, diagnosis, and therapeutic management of diabetic wounds. Presented in a structured format, this is a useful guide for clinicians and learners in all patient care settings. Recent Advances: Continuous glucose monitoring and other new tools have facilitated better diabetes management and the management of associated wounds. Diabetic limb salvage should focus on achieving and optimizing function for the patient with diabetes rather than preserving limb tissue at all costs. Critical Issues: Successful management of diabetic wounds requires a multidisciplinary approach encompassing comprehensive assessment, timely intervention, and collaborative care by the wound clinician with providers who can address critical aspects to achieve healing, including careful management of blood glucose levels, optimization of off-loading and physical therapy, assessment and treatment of limb ischemia, control and prevention of wound infection, and optimal pain management. Future Directions: Emerging treatments offer hope and promise, but the heterogenicity of diabetic wounds poses a challenge to performing good studies, which will be necessary to advance new treatments for diabetic wounds.
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NewsBot · Aug 27, 2025

A Multifaceted Approach to Diabetic Foot Ulcer Healing Beyond HbA1c: A Prospective Observational Study in a Tertiary Care Hospital in Chennai
Mughilan Selvaraj et al
Cureus. 2025 Jul 17;17(7):e88136.

Background: Diabetic foot ulcers (DFUs) are among the most debilitating complications of diabetes mellitus, often leading to delayed healing, infections, and potential limb loss. While glycemic control, typically measured by HbA1c, has been a primary focus in DFU management, recent evidence suggests that healing outcomes are influenced by a broader range of factors.

Objective: To evaluate the predictive role of clinical, biochemical, and inflammatory parameters beyond HbA1c in the healing of DFUs.

Methodology: This longitudinal observational study included 220 patients with DFUs treated at a tertiary care hospital in Chennai. Data were collected on demographics, ulcer severity (Wagner Grade), glycemic status (HbA1c), biochemical markers (C-reactive protein [CRP], interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-α], and serum albumin), and clinical outcomes. Statistical analyses were performed using regression and correlation models to assess associations with time to ulcer healing.

Results: HbA1c showed a significant correlation with Wagner Grade but did not independently predict healing time. Serum albumin and Wagner Grade emerged as significant predictors of healing duration (P < 0.05). Although inflammatory markers such as CRP, IL-6, and TNF-α were elevated in many patients, they did not show a statistically significant correlation with healing outcomes.

Conclusions: DFU healing is a multifactorial process influenced by nutritional status and ulcer severity in addition to glycemic control. Integrating assessments such as Wagner Grade and serum albumin with traditional glycemic markers can enhance the prediction of healing outcomes and guide more effective management strategies.
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NewsBot · Nov 3, 2025

Implementation of Evidence-Based Practice in Diabetic Foot Ulcer Care in Healthcare Settings: A Systematic Review
V Lokeesan et al
Int J Nurs Pract. 2025 Dec;31(6):e70080.

Aim: To evaluate the evidence for implementation strategies for evidence-based diabetic foot ulcer care in healthcare settings.

Background: Evidence-based practice in diabetic foot ulcer care improves healing rates and reduces complications. However, facilitating the uptake of evidence-based practice is challenging. To overcome this, a number of different strategies are used. However, there is little literature to support which strategies are effective in implementing evidence-based practice in diabetic foot ulcer care in healthcare settings.

Method: A systematic search was undertaken of Medline, PubMed, CINAHL, Cochrane Library databases, APA Psych INFO, Health & Medical Collection, India Database, Nursing & Allied Health Database and Google Scholar from 24 March 2010 to 01 May 2023. Original, English language, peer-reviewed research articles and systematic reviews that relate to the implementation of diabetic foot ulcer care in any healthcare settings with healthcare professionals were included in the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-P) 2015 guided the reporting of this review.

Results: A total of 42 articles were included in the final analysis. Implementation strategies such as educational workshops, educational resources, creating champions, audit and feedback, reminders, creating networks and tools were determined to support the implementation of evidence-based strategies for diabetic foot ulcer care.

Conclusions: The use of multiple implementation strategies aids in the successful implementation of evidence-based diabetic foot ulcer care in healthcare settings.
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NewsBot · Nov 3, 2025

A Bayesian hierarchical meta-analysis of CAMPS versus standard of care for diabetic foot ulcers: systematic review of evidence from Medicare’s 2024 final Local Coverage Determinations
Zwelithini Tunyiswa , Robert Frykberg
Source

Aims: To quantify the treatment effects of cellular, acellular and matrix-like products (CAMPs) on diabetic foot ulcer (DFU) healing, based on the 35 randomized controlled trials (RCTs) cited in Medicare’s 2024 Local Coverage Determinations (LCDs).

Methods: We extracted healing outcome data from all 35 RCTs and applied a Bayesian hierarchical beta-binomial model to estimate product-specific and pooled healing probabilities, and risk ratios. We used posterior prediction to account for heterogeneity and to impute missing standard of care (SOC) comparators. Predicted outcomes were standardized to a 12-week follow-up and a hypothetical trial size of 100 participants (50 per arm), ensuring comparability across heterogeneous study designs.

Results: All CAMPs showed improved healing relative to SOC. The pooled posterior mean risk ratio was 2.0 (95% credible interval (Crl)): 1.69–2.38), indicating a doubling of healing likelihood. Product-specific risk ratios ranged from 1.74 to 2.30, with minimal posterior probability near the null, supporting consistent treatment benefit across products.

Conclusions: CAMPs consistently show superior healing outcomes compared to SOC in promoting DFU healing. This quantitative synthesis clarifies the evidence underpinning Medicare’s coverage decisions and provides a statistical benchmark for clinicians, sponsors, and payers in evaluating CAMPs-based therapies.
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NewsBot · Dec 2, 2025

Evidence-based management of diabetic foot problems
Andrew James Michael Boulton et al
Source

At present we are experiencing a rapid rise in the global prevalence of diabetes and unfortunately, this is associated with an increase in many of the late complications of diabetes, particularly diabetic foot ulcers which have a significant impairment on quality of life as well as being associated with increased morbidity and mortality. The potential for preventing first and recurrent foot ulcers is reviewed particularly related to recent developments in smart technology and remote monitoring of foot temperature and pressures under high-risk feet. Recent trials on both these areas are reviewed and show promise for the future. Pharmacological approaches to reduce the incidence of foot ulcers are then considered and the small section on the potential role of fibrates which certainly demands further investigation. With respect to treatment of complex foot ulcers, a number of recent evidence-based therapies are described including sucrose octasulfate dressings, negative pressure wound therapy and topical wound oxygen therapy. Lastly, appropriate care and management of infected DFUs is considered particularly focusing on the area of osteomyelitis. A number of excellent recent Guidelines and related reviews are then listed to help readers further understand this rapidly developing and complex area.
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NewsBot · Jun 29, 2026

Meta-analysis on the safety and efficacy of different dressings in the treatment of diabetic foot ulcers
Xinxin Huang, Xubiao Meng
Open Med (Wars). 2026 Jun 26;21(1):20261459.

Introduction: Diabetic foot ulcers (DFU) are a common and severe complication of diabetes, associated with high morbidity, infection risk, and amputation rates. Various dressings have been applied in clinical practice, yet their comparative safety and efficacy remain unclear. This study aimed to systematically evaluate different dressings for DFU treatment through meta-analysis.

Content: Relevant studies from Chinese and English databases were retrieved and analyzed. A total of 25 studies involving 2,421 patients were included. Dichotomous data analysis showed that the experimental group had a significantly higher complete wound healing rate than the control group (OR=4.62, 95 % CI: 3.10-6.90, p<0.01), a significantly lower incidence of wound infection (OR=0.63, 95 % CI: 0.43-0.93, p=0.02), and no significant difference in amputation rate (OR=0.62, 95 % CI: 0.34-1.14, p=0.12). Continuous data analysis indicated that the experimental group had higher wound healing scores (MD=25.77, 95 % CI: 2.33-49.20, p=0.03), greater ulcer area reduction (MD=27.96, 95 % CI: 21.93-34.00, p<0.01), and shorter healing time (MD=-11.41, 95 % CI: -14.35 to -8.47, p<0.01). Meta-regression analysis suggested that publication year, blinding, and outcome indicators contributed to heterogeneity (p<0.05).

Summary: Activated carbon cloth (ACC), negative pressure wound therapy (NPWT), and olive oil dressings demonstrated favorable safety and efficacy, although each has distinct advantages. Clinical selection should therefore be individualized according to patient conditions and wound characteristics.

Outlook: Future studies with larger sample sizes and higher methodological quality are needed to further validate these findings and reduce heterogeneity, thereby providing more robust evidence for clinical decision-making.
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NewsBot · Jul 11, 2026

Comparative Certainty of Evidence for Diabetic Foot Ulcer Therapies: A Narrative Synthesis
Stephanie M. Mueller et al
Diabetology 2026, 7(7), 131; https://doi.org/10.3390/diabetology7070131

Background: Diabetic foot ulcers (DFUs) are a major cause of morbidity and lower extremity amputation. Numerous advanced wound therapies with various mechanisms of action have been developed to improve healing outcomes; however, the comparative certainty of evidence supporting these interventions remains unclear. This study evaluates randomized controlled trials (RCTs) of DFU therapies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Methods: A narrative synthesis of RCTs published between January 2016-January 2026 evaluating therapies for DFUs was performed. For studies that reported 12–week healing outcomes, risk of bias was assessed using the Cochrane Risk of Bias 2 tool and certainty of evidence for each therapy subgroup was evaluated using the GRADE framework. Results: A total of 143 RCTs were included with 45 RCTs undergoing GRADE assessment. The proportion of studies demonstrating statistically significant improvements in 12-week healing rates relative to controls varied and was not reflected in the GRADE assessment. Moderate-certainty evidence was assigned to the hyperbaric oxygen therapy subgroup. Low-certainty evidence was assigned to silver dressings, biosynthetic scaffolds, stem cell therapy, and negative pressure wound therapy. Very low-certainty evidence was assigned to topical oxygen, synthetic structural scaffolds, moisture-retaining dressings, local antimicrobial delivery, placental-derived skin substitutes, platelet-rich plasma, acellular dermal matrices, allografts/xenografts, and off-loading devices. No therapy subgroup was assigned high-certainty evidence. Conclusions: The certainty of evidence supporting DFU therapies varies substantially across intervention categories. These findings highlight the need for larger, methodologically rigorous comparative trials to clarify the effectiveness of DFU therapies and guide evidence-based wound care.
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NewsBot · Aug 15, 2026 at 5:06 AM

Association of structured out-of-hospital continuity of care with wound healing and quality of life in severe diabetic foot ulcer: a retrospective exploratory study
Wei Wei, Lan Yi & Shi Zhao
BMC Endocrine Disorders

Background

To evaluate the association of a structured out-of-hospital continuity of care intervention with diabetic ulcer healing and patient-reported outcomes in individuals with severe diabetic foot ulcers (DFUs), and to identify prognostic factors influencing healing.
Methods

This retrospective comparative study included 91 inpatients with severe DFUs (Wagner grades 4–5). The intervention group (n = 45) received a structured out-of-hospital care protocol comprising domiciliary visits, remote monitoring, and access to specialized care as needed. The control group (n = 46) was provided with standard post-discharge follow-up. Outcomes included ulcer healing status, time to complete wound closure, and health-related quality of life (HRQoL). Factors related to wound healing were assessed using Fine-Gray competing risks regression, with major amputation and death treated as competing events.
Results

Over a mean follow-up of 10.74 ± 9.05 months, the intervention group showed a higher ulcer healing rate compared to the control group (82.22% vs. 63.04%; difference 19.20%, 95% CI: 0.80% − 37.50%, p = 0.060). In the Fine-Gray competing risks analysis, the intervention group was associated with a significantly higher probability of healing (subdistribution hazard ratio = 1.74, 95% CI: 1.08–2.83, p = 0.024). Regarding HRQoL, a transient between-group difference in EQ-5D-5L was observed at 6 months (p = 0.029), but the group-by-time interaction was not significant (p = 0.220), indicating no sustained improvement.
Conclusion

In this exploratory retrospective study, structured out-of-hospital continuity of care was associated with a statistically non-significant increase in crude healing rates. After accounting for competing risks, a significant association was observed in the primary analysis. However, this effect was attenuated and no longer significant in additional baseline severity factors (ABI and ulcer location). A transient improvement in quality of life at 6 months was not sustained. Ulcer severity and peripheral artery disease were identified as independent prognostic factors. Larger prospective studies are needed to confirm these exploratory findings.
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NewsBot · Aug 16, 2026 at 2:37 AM

Adjunctive therapies added to standard of care for diabetic foot ulcers: a systematic review and network meta-analysis with pairwise comparisons
Wenquan Luo et al
Source

Background: Diabetic foot ulcers (DFUs) remain one of the most disabling and costly complications of diabetes. Although standard of care (SOC) is the foundation of DFU management, many ulcers fail to heal adequately, prompting increasing use of adjunctive therapies. However, the comparative effectiveness of different adjunctive strategies remains uncertain.

Objective: To evaluate and compare the efficacy and safety of adjunctive therapies added to SOC for patients with DFUs using systematic review, pairwise meta-analysis, and network meta-analysis.

Methods: PubMed, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, WHO ICTRP, and ChiCTR were searched from inception to February 18, 2026. Randomized controlled trials evaluating adjunctive therapies plus SOC for DFUs were included. Interventions were classified into eight clinically interpretable categories: oxygen-based therapies, device-based and physical wound therapies, growth factor and blood-derived therapies, placental and perinatal tissue-derived products, acellular matrix/skin substitute/scaffold products, cell-based and adipose-derived therapies, topical pharmacologic and bioactive agents, and nanotechnology-based, natural product, and bioactive dressing therapies. Outcomes included ulcer area reduction, complete healing, time to healing, adverse events, and amputation.

Results: Eighty-four randomized controlled trials involving 7,232 participants were included. Compared with SOC alone, several adjunctive therapies improved healing-related outcomes. Device-based therapies, placental products, growth factor/blood-derived therapies, matrix/skin substitute products, and oxygen-based therapies were associated with greater ulcer area reduction. Oxygen-based therapies, matrix/skin substitute products, device-based therapies, placental products, topical pharmacologic/bioactive agents, and growth factor/blood-derived therapies increased the likelihood of complete healing. Cell-based/adipose-derived therapies, growth factor/blood-derived therapies, and matrix/skin substitute products shortened time to healing. Most adjunctive therapies did not increase adverse events, while placental products were associated with a lower risk of adverse events. Oxygen-based and growth factor/blood-derived therapies showed potential reductions in amputation risk, although the evidence was limited.

Conclusions: Adjunctive therapies added to SOC may improve healing outcomes in patients with DFUs, but their benefits vary across clinical endpoints. Oxygen-based therapies, device-based therapies, placental products, growth factor/blood-derived therapies, and matrix/skin substitute products showed the most consistent potential benefits. Nevertheless, heterogeneity, sparse networks, variable certainty of evidence, and limited direct comparisons preclude a definitive treatment hierarchy. High-quality randomized trials with standardized outcome definitions and adequate follow-up are needed to clarify the optimal use of adjunctive therapies in DFU management.
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Treatment of diabetic foot ulcers

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Treatment of diabetic foot ulcers

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Comprehensive Therapy vs. Standard Treatment in Diabetic Foot Ulcer Healing

Healing of diabetic neuropathic foot ulcers receiving standard treatment

Nanozymes for the Treatment of Diabetic Foot Ulcers

Rapha® device for the treatment of diabetic foot ulcers

Cytoreg for the treatment of diabetic foot disease

Diabetic foot treatment in a country without podiatrists

The Efficacy of Diabetic Foot Treatment in a "TOSF" Pattern

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