Evolving spectrum of diabetic wound: Mechanistic insights and therapeutic targets

Abstract

Diabetes mellitus is a chronic metabolic disorder resulting in an increased blood glucose level and prolonged hyperglycemia, causes long term health conse-quences. Chronic wound is frequently occurring in diabetes patients due to compromised wound healing capability. Management of wounds in diabetic patients remains a clinical challenge despite many advancements in the field of science and technology. Increasing evidence indicates that alteration of the biochemical milieu resulting from alteration in inflammatory cytokines and matrix metalloproteinase, decrease in fibroblast and keratinocyte functioning, neuropathy, altered leukocyte functioning, infection, etc. , plays a significant role in impaired wound healing in diabetic people. Apart from the current pharmacotherapy, different other approaches like the use of conventional drugs, antidiabetic medication, antibiotics, debridement, offloading, platelet-rich plasma, growth factor, oxygen therapy, negative pressure wound therapy, low-level laser, extracorporeal shock wave bioengineered substitute can be considered in the management of diabetic wounds. Drugs/therapeutic strategy that induce angiogenesis and collagen synthesis, inhibition of MMPs, reduction of oxidative stress, controlling hyperglycemia, increase growth factors, regulate inflammatory cytokines, cause NO induction, induce fibroblast and keratinocyte proliferation, control microbial infections are considered important in controlling diabetic wound. Further, medicinal plants and/or phytoconstituents also offer a viable alternative in the treatment of diabetic wound. The focus of the present review is to highlight the molecular and cellular mechanisms, and discuss the drug targets and treatment strategies involved in the diabetic wound.

Nanozymes for the Therapeutic Treatment of Diabetic Foot Ulcers

“…Staphylococci and streptococci were most abundant in wounds with mild infections, where penicillins can be the first choice. In more severe cases, bacterial diversity is higher and Gram-negative bacteria are common, aminoglycosides (e.g., amikacin, gentamicin), tertiary cephalosporins (e.g., ceftazidime), and carbapenems (e.g., imipenem) may be chosen . However, frequent use of antibiotics will be more likely to induce the growth of drug-resistant bacteria, reduce the efficacy of antibiotics, and may also trigger adverse reactions in organs such as the liver and kidneys, so the use of antibiotics needs to be strictly controlled and promptly adjusted .…”

Electrospinning Nanofibers as a Dressing to Treat Diabetic Wounds

“…As a result of diabetic peripheral neuropathy, wound healing is delayed due to sensory, motor, and autonomic dysfunction. Sensory neuropathy leads to a loss or absence of pain sensation, while autonomic neuropathy affects skin temperature, sweat production, and blood flow in the foot [30,31].…”

Advances in the Preparation of Nanofiber Dressings by Electrospinning for Promoting Diabetic Wound Healing

“…Symptoms such as hyperalgesia and autonomic movement disorders may occur during the onset, resulting in abnormal biomechanical changes during the patient’s walking. Autonomic neuropathy can cause a decrease or loss of skin temperature regulation, sweat regulation and blood flow regulation, a decrease in the flexibility of the foot tissue, and the formation of thick calluses, and thick calluses are prone to breakage and cracking, which subsequently increases the risk of infection [ 34 , 35 ].…”