Growth factors for treating diabetic foot ulcers.
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ABSTRACT:
SUBMITTER: Marti-Carvajal AJ
PROVIDER: S-EPMC8665376 | biostudies-literature | 2015 Oct
REPOSITORIES: biostudies-literature
Publications
Growth factors for treating diabetic foot ulcers.
Martí-Carvajal Arturo J AJ Gluud Christian C Nicola Susana S Simancas-Racines Daniel D Reveiz Ludovic L Oliva Patricio P Cedeño-Taborda Jorge J
The Cochrane database of systematic reviews 20151028 10
<h4>Background</h4>Foot ulcers are a major complication of diabetes mellitus, often leading to amputation. Growth factors derived from blood platelets, endothelium, or macrophages could potentially be an important treatment for these wounds but they may also confer risks.<h4>Objectives</h4>To assess the benefits and harms of growth factors for foot ulcers in patients with type 1 or type 2 diabetes mellitus.<h4>Search methods</h4>In March 2015 we searched the Cochrane Wounds Group Specialised Reg ...[more]
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Project description:AimsTopical growth factors accelerate wound healing in patients with diabetic foot ulcers (DFU). Due to the absence of head-to-head comparisons, we carried out Bayesian network meta-analysis to compare the efficacy and safety of growth factors.MethodsUsing an appropriate search strategy, randomized controlled trials on topical growth factors compared with standard of care in patients with DFU, were included. Proportion of patients with complete healing was the primary outcome. Odds ratio (95% confidence interval) was used as the effect estimate and random effects model was used for both direct and indirect comparisons. Markov Chain Monte Carlo simulation was used to obtain pooled estimates. Rankogram was generated based on surface under the cumulative ranking curve (SUCRA).ResultsA total of 26 studies with 2088 participants and 1018 events were included. The pooled estimates for recombinant epidermal growth factor (rhEGF), autologous platelet rich plasma (PRP), recombinant human platelet-derived growth factor (rhPDGF) were 5.72 [3.34, 10.37], 2.65 [1.60, 4.54] and 1.97 [1.54, 2.55] respectively. SUCRA for rhEGF was 0.95. Sensitivity analyses did not reveal significant changes from the pooled estimates and rankogram. No differences were observed in the overall risk of adverse events between the growth factors. However, the growth factors were observed to lower the risk of lower limb amputation compared to standard of care.ConclusionTo conclude, rhEGF, rhPDGF and autologous PRP significantly improved the healing rate when used as adjuvants to standard of care, of which rhEGF may perform better than other growth factors. The strength of most of the outcomes assessed was low and the findings may not be applicable for DFU with infection or osteomyelitis. The findings of this study needs to be considered with caution as the results might change with findings from head-to-head studies.
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Project description:Diabetic foot ulcers (DFUs) are a devastating complication of diabetes. In order to identify systemic and local factors associated with DFU healing, we examined the cellular landscape of DFUs by single-cell RNA-seq analysis of foot and forearm skin specimens, as well as PBMC samples, from 10 non-diabetic subjects, and 17 diabetic patients, 11 with, and 6 without DFU. Our analysis shows enrichment of a unique inflammatory fibroblast population in DFU patients with healing wounds. The patients with healing DFUs also depicted enrichment of macrophages with M1 polarization, as opposed to more M2 macrophages in non-healing wounds. These findings were verified using Immunohistochemistry and Spatial Transcriptomics.
2021-11-01 | GSE165816 | GEO
Project description:Diabetic foot ulcers (DFUs) are a serious complication from diabetes mellitus, with a huge economic, social and psychological impact on the patients' life. One of the main reasons why DFUs are so difficult to heal is related to the presence of biofilms. Biofilms promote wound inflammation and a remarkable lack of response to host defences/treatment options, which can lead to disease progression and chronicity. In fact, appropriate treatment for the elimination of these microbial communities can prevent the disease evolution and, in some cases, even avoid more serious outcomes, such as amputation or death. However, the detection of biofilm-associated DFUs is difficult due to the lack of methods for diagnostics in clinical settings. In this review, the current knowledge on the involvement of biofilms in DFUs is discussed, as well as how the surrounding environment influences biofilm formation and regulation, along with its clinical implications. A special focus is also given to biofilm-associated DFU diagnosis and therapeutic strategies. An overview on promising alternative therapeutics is provided and an algorithm considering biofilm detection and treatment is proposed.
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Project description:BackgroundDiabetic foot ulcers are a major complication of diabetes mellitus (DM), when heparin and heparin related substances may be potentially used as an adjuvant treatment. We aimed to evaluate the efficacy and safety of heparin and heparin related substances for the treatment of diabetic foot ulcers.MethodsWe searched up to March 2021 in the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; EBSCO CINAHL; VIP Chinese Science and Technique Journals Database; China National Knowledge Infrastructure (CNKI) Database and Wan Fang Database investigating heparin or heparin-related substances in patients with diabetic foot ulcers. The primary outcomes included proportion of ulcers completely healed and time to complete ulcer healing. We assessed each included study with the Cochrane 'Risk of bias' tool and used the GRADE approach to assess the overall quality of the evidence.ResultsWe included nine randomized studies involving 620 participants in the meta-analysis, involving two different heparin and heparin-related substances, low molecular weight heparin (LMWH) and hyaluronic acid. Our study did not show the benefits from LMWH on increasing chance of the ulcer healing (RR: 1.26; 95% CI: 0.78 to 2.04; P=0.35; very low) or shortening the time to complete ulcer healing (SMD: 0.13 d; 95% CI: -0.29 to 0.56; P=0.54; very low). Hyaluronic acid may improve the complete ulcer healing (RR: 1.57; 95% CI: 1.29 to 1.91; P˂0.00001; very low) and shorten the time to complete ulcer healing (SMD -0.84, 95% CI -1.15 to -0.53; P<0.00001; low). Hyaluronic acid and LMWH were generally well tolerated for treating diabetic foot ulcers in this review.ConclusionHyaluronic acid may improve diabetic foot ulcer with very low quality evidence but not LMWH. However, the benefits and harms need further validation in larger trials with different population.Systematic review registration[https://www.crd.york.ac.uk/prospero/], identifier [PROSPERO, CRD42021269212].
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Project description:BackgroundDiabetic foot ulcers (DFUs) are prevalent among individuals with poorly controlled diabetes, and severe cases can result in increased morbidity and a poor quality of life. This study aimed to identify the factors that affect the severity of DFUs, offering insights into potential interventions that could enhance patient outcomes.MethodologyA prospective cross-sectional study was conducted from August 2023 to March 2024 at Muhimbili National Hospital in Tanzania, involving 177 consecutively selected patients with DFUs. The primary outcome variable was the severity of DFUs, which was assessed using the Meggitt-Wagner severity score. Both socio-demographic and clinical characteristics were evaluated to determine their association with the outcome variable using multivariate ordinal logistic regression analysis.ResultsThe median age of the study participants was 60 years (IQR = 52-68), with a male-to-female ratio of 2 to 1. Notably, Wagner grades 4 and 5 accounted for 57.6% of the participants. Factors associated with increased severity of DFUs included age over 60 years (aOR = 1.83, 95% CI 1.05-3.23, p = 0.035) and poor adherence to diabetes medications (aOR = 2.62, 95% CI 1.36-5.09, p = 0.004). Conversely, having health insurance coverage was linked to better outcomes (aOR = 0.51, 95% CI 0.27-0.96, p = 0.036).ConclusionThe study highlights factors that can enhance comprehensive care for diabetic patients, especially elderly individuals. Key measures include implementing educational programs to encourage medication adherence, improving healthcare access, particularly for uninsured individuals, promoting insurance coverage, and making diabetes treatments more affordable.
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Project description:To investigate the expression of miRNAs in C57 diabetic ulcer mice by Small RNA sequencing
2024-08-31 | GSE275847 | GEO
Project description:Diabetic foot ulcers (DFUs) are a serious complication of diabetes that results in significant morbidity and mortality. Mortality rates associated with the development of a DFU are estimated to be 5% in the first 12 months, and 5-year morality rates have been estimated at 42%. The standard practices in DFU management include surgical debridement, dressings to facilitate a moist wound environment and exudate control, wound off-loading, vascular assessment, and infection and glycemic control. These practices are best coordinated by a multidisciplinary diabetic foot wound clinic. Even with this comprehensive approach, there is still room for improvement in DFU outcomes. Several adjuvant therapies have been studied to reduce DFU healing times and amputation rates. We reviewed the rationale and guidelines for current standard of care practices and reviewed the evidence for the efficacy of adjuvant agents. The adjuvant therapies reviewed include the following categories: nonsurgical debridement agents, dressings and topical agents, oxygen therapies, negative pressure wound therapy, acellular bioproducts, human growth factors, energy-based therapies, and systemic therapies. Many of these agents have been found to be beneficial in improving wound healing rates, although a large proportion of the data are small, randomized controlled trials with high risks of bias.
| S-EPMC5793889 | biostudies-other
Project description:AimsDiabetic foot ulcers have caused significant medical, economic and social consequences for patients, families and society. With appropriate treatment, many diabetic foot ulcers can heal, temporarily avoiding possible amputation. Unfortunately, even if foot ulcers subside, recurrence is still common. The recurrence of ulcer has brought another physical and psychological trauma to diabetic foot patients who yearn for a better life. Therefore, it may be more useful to evaluate the factors associated with ulcer recurrence in diabetic foot ulcer patients.MethodsThe PubMed, Web of Science, Embase and China National Knowledge Infrastructure databases were comprehensively searched for prospective or retrospective studies published up to February 1, 2024. All English or Chinese language studies on diabetic foot ulcer patients who experience recurrence were included, and RevMan 5.3 software was used to analyze the data.ResultsA total of 22 studies meeting the eligibility criteria were ultimately included in this meta-analysis. 1861 of 5252 diabetic foot ulcer patients experienced recurrence during follow-up. The following variables were associated with an increased risk of ulcer recurrence: male (OR = 1.26, 95% CI = 1.10 ~ 1.44, P = 0.0009), smoking history (OR = 1.18, 95% CI = 1.04 ~ 1.35, P = 0.01), living alone (OR = 1.86, 95% CI = 1.21 ~ 2.86, P = 0.004), plantar ulcers (OR = 2.44, 95% CI = 1.41 ~ 4.23, P = 0.001), diabetic retinopathy (OR = 1.59, 95% CI = 1.35 ~ 1.88, P < 0.00001), diabetic nephropathy (OR = 1.37, 95% CI = 1.12 ~ 1.68, P = 0.002), diabetic peripheral neuropathy (OR = 1.78, 95% CI = 1.45 ~ 2.19, P < 0.00001), foot deformity (OR = 2.51, 95% CI = 1.85 ~ 3.40 P < 0.00001) and peripheral arterial disease (OR = 3.10, 95% CI = 2.43 ~ 3.95 P < 0.00001). However, hypertension (OR = 1.16, 95% CI = 0.96 ~ 1.40, P = 0.13) and body mass index (MD = 0.20, 95% CI = -0.12 ~ 0.53, P = 0.22) were not associated with diabetic foot ulcer recurrence.ConclusionsOur meta-analysis identified the following important risk factors for diabetic foot ulcer recurrence: male sex, smoking history, living alone, plantar ulcer, diabetic retinopathy, diabetic nephropathy, diabetic peripheral neuropathy, foot deformity, and peripheral arterial disease. Understanding these factors and their impact on ulcer recurrence is crucial for multidisciplinary teams to develop management and treatment plans for diabetic foot ulcer patients.
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