Healing of Diabetic Wounds using Hyperbaric Oxygen Therapy in Morris County, New Jersey

Around 463 million people worldwide have diabetes, with three-quarters (76.2%) living in middle-income nations and only a handful (3.13%) in low-income countries.

According to the International Diabetes Federation, the number of diabetic patients would reach 700 million by 2045. (Reference)

Surprisingly, over half of adult patients with type 2 diabetes (DM2) are completely ignorant that they have the illness.

Furthermore, 185.8 million people with diabetes go undiagnosed in middle-income nations.

Type 2 diabetes is frequently asymptomatic for lengthy periods of time, and by the time a patient is recognized, problems such as neuropathy, retinopathy, metabolic abnormalities, and diabetic foot ulcers (DFUs) may have occurred, making treatment difficult.

In a diabetic patient, a diabetic foot ulcer is described as an ulcer in the lower leg that is accompanied with neuropathy and/or peripheral artery disease.

Infected DFUs with multidrug resistance (MDR) eventually become non-healing, contributing considerably to amputations and mortality, particularly in developing countries.

Every 30 seconds, a lower limb is amputated, which is a common diabetic complication.

The incidence rate of DFU in diabetic patients is 2% (9.26 million), and the risk of DFU increases 17–60% if the patient has had DFU in the previous three years; also, half (4.63 million) of diabetic individuals have lower limb amputation at some point in their lives.

Furthermore, after the initial amputation, 28–51 percent of DFU patients had an increased chance of having a second amputation within five years.

Furthermore, diabetic patients with DFU had a higher rate of death (28–77%) between 90 days and 5 years following amputation, as well as a drop in survival rate after five years of up to 55 percent and 34.4 percent after minor and major amputations, respectively.

DFUs and subsequent amputations have been shown to reduce quality of life, raise the financial burden on families and the health-care system, and increase the chance of early death.

Diabetic foot ulcers continue to be a significant concern for both patients and healthcare providers, owing to disparities in health-care facilities, a lack of knowledge, delayed referral, and a shortage of specialized healthcare workers.

Different modalities are offered in the line of standard treatment (ST) for DFUs, including pressure relief, surgical debridement, antibiotics for infection, and blood sugar control.

The majority of the time, diabetic foot ulcers are infected with polymicrobial agents that are immune to the body’s immune system, resulting in a high risk of antibiotic resistance and non-healing ulcers.

Importantly, chronic non-healing ulcers may not respond to standard treatment, and not every patient with DFUs can be treated with surgical debridement, necessitating the use of other treatment options.

Hyperbaric oxygen treatment (HBOT) is an additional therapy that has been utilized to treat complex DFUs for decades.

A chronic wound’s affected tissues become hypoxic, preventing ulcer repair; thus, oxygen plays an important role in chronic wound healing.

For a better therapeutic outcome, the patient is kept in a chamber with 100% breathing oxygen at a higher atmospheric pressure than sea level (typically at 1.4 atmosphere absolute).

Patients who had HBOT saw a variety of beneficial physiological changes, including increased angiogenesis, enhanced collagen deposition, increased leukocyte activity, and reduced edema.

HBOT helps to increase oxygen levels in tissues, which speeds up the healing process of ulcers and prevents amputations.

Despite these benefits and their possible applicability for non-healing DFUs, HBOT has remained a controversial therapy that should only be used as a last resort when treating DFUs.

In 2015, a Cochrane analysis led by Kranke found that patients treated with HBOT had a significant improvement in wound healing. (Reference)

In contrast, Brouwer reported in a recent systematic review (SR) and meta-analysis (MA) that HBOT reduces major amputation rate but is ineffective in wound healing; however, these researchers failed to include five RCTs, so the conclusions drawn in these reviews are not based on all available evidence and may be weak.

Furthermore, because the quality of evidence in these evaluations was incorrectly appraised, the conclusions drawn concerning the efficacy of HBOT in the treatment of non-healing DFUs may be incomplete.

Keeping in mind the methodological flaws of earlier reviews, the current methodologically sound SR&MA was designed to provide the most solid data about the efficacy of HBOT as an adjuvant therapy for the treatment of DFUs, which included all new and old RCTs and CCTs.