The outcome of ulcers of the foot in diabetes is generally poor with around 1 in 10 resulting in the loss of a limb. There is an urgent need for the development of interventions to improve the outcome for patients. To date, however, the evidence base to support many of the interventions in common use, including wound dressings, is poor.
This article summarizes the findings of systematic reviews of the subject published between 2006 and 2014 and covers all relevant articles in any language, as well as comments on certain newer publications.
The 3 consecutive systematic reviews selected a total of 207 articles that met the predefined criteria from a total of 5,632 identified. These included articles on a very wide range of interventions designed to be applied to ulcers of the foot in diabetes to promote wound healing.
The available data suggest that although some newer therapies show promise, few published studies were of high quality, and the majority were susceptible to bias. More work is needed to substantiate the role of available dressings and wound care products in day-to-day clinical practice. Future work will require studies to be performed to a higher standard than many of those reviewed here and should establish not just clinical effectiveness but cost-effectiveness. The conclusions drawn from the studies of diabetic foot ulcers (DFUs) might apply to the management of other types of chronic wounds.
Derby and Nottingham, United Kingdom
From the Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS Foundation Trust; and Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust.
Received for publication March 7, 2016; accepted June 13, 2016.
Disclosure: The authors have no financial interest in any of the products, devices, or drugs mentioned in this article.
Frances L. Game, FRCP, Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS Foundation Trust, Uttoxeter Road, Derby DE22 3NE, United Kingdom, firstname.lastname@example.org