Efficacy of hyperbaric oxygen therapy for diabetic foot

Studies have suggested that hyperbaric oxygen therapy (HBOT) is effective in the healing of diabetic foot ulcer (DFU); 

however, there is a lack of consensus. 

Studies that evaluated the effect of HBOT on diabetic foot ulcer, complete healing, amputation, adverse events, ulcer reduction area, and mortality rate were included. Of 1984 study records screened, 14 studies (768 participants) including twelve RCTs, and two CCTs were included as per inclusion criteria. 

The results with pooled analysis have shown that HBOT was significantly effective in complete healing of diabetic foot ulcer (OR = 0.29; 95% CI 0.14–0.61; I2 = 62%) 

Globally about 463 million people are living with diabetes, among them, three fourth (76.2%) are living in the middle, and a few (3.13%) are living in low-income countries. The International Diabetes Federation has anticipated the numbers of diabetes patients to raise to 700 million by 2045. Surprisingly, almost half of type-2 diabetes (DM2) adult patients are unaware that they are suffering from this disease. Moreover, 185.8 million undiagnosed diabetes are from middle-income countries1.

Most of the time DM2 remain completely asymptomatic for a long duration and by the time patient diagnoses they develop complications like neuropathy, retinopathy, metabolic disorders, diabetic foot ulcers (DFUs) which are later difficult to treat. 

Diabetic foot ulcer is defined as a presence of ulcer in the lower limb which is associated with neuropathy and/or peripheral arterial disease in a patient with diabetes2. Eventually, DFUs which are infected and multi-drug resistance (MDR), become non-healing and significantly contributes to amputations and mortality, specifically in the developing countries3,4.

Globally, every 30 s, a lower limb is lost, which is a major sequela of diabetes.

 The incidence rate of DFU in diabetes patient is 2%, (9.26 million) 

and this risk increases 17–60% with a previous history 

of DFU in next three years; also, among them, half (4.63 million) of diabetes patients undergo lower limb amputation at some stage of their life1. Additionally, 28–51% DFU patients after the first amputation will have a higher probability of the second amputation in within five years6. Furthermore, a higher rate (28–77%) of mortality was reported between 90 days to 5 years of post-amputation in diabetic patients7,8, as well as reduction of survival rate at five-years were up to 55%, 34.4% after minor and major amputations respectively in diabetes patients with DFU9

Ref

Sci Rep. 2021 Jan 26;11:2189. doi: 10.1038/s41598-021-81886-1

Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials

Rakesh Sharma 1, Suresh K Sharma 1, Shiv Kumar Mudgal 2, Prasuna Jelly 1,✉, Kalpana Thakur