BACKGROUND: Individuals with diabetes may develop diabetic foot ulcers due to diabetic peripheral neuropathy. Multiple factors influence the ulcer healing process; oxygen helps in facilitating the different stages of wound healing. OBJECTIVE: The objective of this systematic review was to analyze the different levels of evidence available in the application of topical oxygen therapy, warm oxygen therapy, or other modes of topical oxygen delivery in the healing dynamics of diabetic foot ulcers. METHODS: Databases searched included Pubmed/Medline, Science Direct, Web of Science, Scopus, Cochrane, and CINAHL. The eligibility criteria of studies included participants ≥18 years with chronic non-healing diabetic foot ulcer (duration ≥3 months) receiving warm oxygen or topical oxygen therapy (TOT), and other modes of topical oxygen administration, which were compared with standard care group. Randomized and non-randomized studies were included. The primary outcome measure assessed was the rate of wound healing or wound closure. RESULTS: The review included 5 studies which used different modes of topical oxygen administration. The healing trajectory of the wounds was completely achieved in low-grade ulcers (grade 1), whereas all highgrade ulcers (grades 2, 3, and above) showed either 100% or 50% healing with a reduction in ulcer size and ulcer tissue depth. CONCLUSION: Topical oxygen therapy facilitates wound healing dynamics among individuals with chronic diabetic foot ulcers.
Background: Diabetes and associated diabetic foot ulcers require coordinated management, including several health care providers (HCPs). Therefore, an interprofessional (IP) team-based approach is essential for effectively managing and educating the population on diabetic foot self-management strategies. However, the perceptions of the HCPs related to the importance of IP teamwork in diabetic foot care and their readiness to work in an IP team are less explored.Methods: The present qualitative study aimed to investigate HCPs' readiness to work as part of a well-motivated IP team and its use in teaching patients effective diabetic foot self-management techniques. The study includes HCPs involved in diabetic foot management patient education and treatment. The seven HCPs were an Anatomist engaged in health professions education, a Medical doctor, an Endocrinologist, Surgeon, Physiotherapist, Nutritionist, and a Nurse who volunteered to be part of the IP team. They were interviewed in-depth using an interview guide, and a thematic analysis of the interview transcripts was undertaken. Results: Every participant was strongly motivated to be an IP team member. The following themes were identified that supported IP team-based approach in diabetic foot-care: 'patient-centric practices,' 'comprehensive care,' 'teamwork and coordination for improved patient outcome,' 'integrated approach,' 'professional knowledge amalgamation,' 'time-management,' 'education in a favorable environment,' and 'constant motivation and support through educational modules.' Conclusion: The HCPs' expressed their willingness to work as part of an IP team and also suggested appropriate teaching methods for diabetic foot self-management.
Background Prolonged and overlapping phases of wound healing in diabetes are mainly due to the redox imbalance resulting in the chronicity of the wound. Photobiomodulation therapy works on the principle of absorption of photon energy and its transduction into a biological response in the living tissue. It alleviates the cellular responses, thereby improving the mechanism of wound healing in diabetes. Objective To find out the effect of photobiomodulation therapy of dosage 4 J/cm2 in the healing dynamics of diabetic neuropathic wounds in Wistar rats and its relation with oxidative stress markers. Methodology Diabetes was induced using Streptozotocin of 60 mg/kg of body weight to eighteen female Wistar rats. Neuropathy was induced by the sciatic nerve crush injury followed by an excisional wound of 2 cm2 on the back of the animal. Experimental group animals were treated with dosage 4 J/cm2 of wavelength 655 and 808 nm, and control group animals were kept unirradiated. The biomechanical, histopathological, and biochemical changes were analysed in both groups. Results There was a reduction in mean wound healing time and an increased rate of wound contraction in the experimental group animals compared to its control group. The experimental group showed improved redox status, and histopathological findings revealed better proliferative cells, keratinisation, and epithelialization than un-irradiated controls. Conclusions Photobiomodulation therapy of dosage 4 J/cm2 enhanced the overall wound healing dynamics of the diabetes-induced neuropathic wound and optimised the oxidative status of the wound, thereby facilitating a faster healing process.
Individuals with diabetic foot ulcers have overlapped the inflammatory, proliferative and remodeling phase, making the tissue vulnerable to delayed healing responses. We aimed to establish the dose–response relationship of photobiomodulation therapy of different doses and matrix metalloproteinases in the healing dynamics of diabetic neuropathic ulcers. Diabetes was induced in 126 Albino Wistar rats, and neuropathy was induced to the hind paw by a sciatic nerve injury method. An excisional wound was created on the neuropathy‐induced leg. Photobiomodulation therapy of dosages 4, 6, 8, 10, 12 and 15 J cm−2 and wavelength 655 nm and 808 nm was irradiated. Photobiomodulation therapy of dosages 4, 6 and 8 J cm−2 showed better wound healing properties with optimized levels of matrix metalloproteinases‐1 and 8. We observed a strong dose response in the experimental group treated with 6 and 8 J cm−2. The findings from the present study conclude that photobiomodulation therapy of dosages 4, 6 and 8 J cm−2 is suggestive of usefulness in diabetic neuropathic ulcer healing. Markers like matrix metalloproteinases may give a clear direction on response to the therapy. Based on the findings from the present study, we recommend to validate the findings for safety and efficacy in future through human prospective randomized controlled clinical trials.
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