Diabetic foot ulcers continue to be a major cause of morbidity and mortality in patients with diabetes despite several standard of care options. A paper published in the American Journal of Clinical Dermatology highlights new trends in the management of diabetic foot ulcers, including the use of adjunctive therapies.
Pressure relief, debridement, infection management, and revascularization comprise the current gold standard of care for diabetic foot ulcers. Despite the potential benefit of each component, this regimen alone may not be sufficient for the prevention and management of foot ulcers in patients with diabetes. Although prevention is key, new trends in diabetes foot ulcer management have been shown to greatly improve treatment beyond current standard of care.
For ulcers that persist beyond the 4-week standard of care treatment recommendation, adjunctive approaches may be an option. Negative pressure wound therapy, for instance, may potentially assist in promoting wound healing via the application of intermittent or continuous negative pressure to a wound. Hyperbaric oxygen therapy is another adjunctive approach that has been suggested for diabetic foot ulcers; however, the efficacy of this strategy is considered controversial, according to the published literature.
There is an increasing trend toward the use of bioengineered skin substitutes as adjunct therapy for treating and closing diabetic foot ulcer wounds. Skin substitutes used for diabetic foot ulcers include dermal substitutes consisting of either acellular or cellular extracellular matrix and composite substitutes of dermal and epidermal components. In addition, a growing trend has been observed in the use of topical growth factors for diabetic foot ulcers.
There is currently only 1 topical recombinant human platelet-derived growth factor approved by the US Food and Drug Administration for the treatment of foot ulcers in patients with diabetes. The product may be more cost effective compared with standard of care alone. Although promising, high doses of this adjunctive approach have been linked to an increased risk for cancer.
Electrical stimulation is another emerging technologic approach for treatment of hard to treat foot ulcer wounds. Evidence to support this strategy is mostly found in individual case reports and small studies. The newest trend in diabetic foot ulcer adjunctive therapy — pressure and temperature feedback devices — is increasingly used in foot ulcer prevention strategies in patients with diabetic peripheral neuropathy.
Although many of the emerging approaches are novel and most lack sufficient evidence to support their clinical efficacy, the investigators wrote that the new standard of care for the management of diabetic foot ulcers “should integrate a multimodal approach that addresses the many factors that contribute to ulcer development as well as those that promote wound healing.”
Aldana PC, Khachemoune A. Diabetic foot ulcers: appraising standard of care and reviewing new trends in management [published online December 17, 2019]. Am J Clin Dermatol. doi:10.1007/s40257-019-00495-x