J Korean Diabetes.  2024 Dec;25(4):230-235. 10.4093/jkd.2024.25.4.230.

Latest Approaches in the Treatment of Diabetic Foot Ulcers: An Integrative Analysis Based on the International Working Group on the Diabetic Foot (IWGDF) 2023 Guidelines

• Lee YN

• KMID: 2563241
• DOI: http://doi.org/10.4093/jkd.2024.25.4.230

Abstract

Diabetic foot ulcers are among the most severe complications in diabetes patients, often leading to life-threatening consequences if not treated appropriately. This study reviews the key treatment approaches outlined in the 2023 International Working Group on the Diabetic Foot (IWGDF) guidelines, focusing on wound debridement, dressing selection, and adjunctive therapies such as negative pressure wound therapy, leucocyte/platelet/fibrin patch, and hyperbaric oxygen therapy. The guidelines emphasize a multidisciplinary approach to accelerate wound healing and reduce recurrence and amputation rates. The findings suggest that integrating these advanced techniques with consistent patient monitoring and self-care education can improve clinical outcomes and prevent ulcer recurrence. This study concludes that further advancements in treatment and monitoring strategies will continue to enhance diabetic foot care, benefitting patient quality of life.

Keyword

Bandages; Diabetic foot; Wound healing; Wounds and injuries

Reference

1.Rice JB., Desai U., Cummings AK., Birnbaum HG., Skornic-ki M., Parsons NB. Burden of diabetic foot ulcers for medicare and private insurers. Diabetes Care. 2014. 37:651–8.

2.Schaper NC., van Netten JJ., Apelqvist J., Bus SA., Fitridge R., Game F, et al. IWGDF Editorial Board. Practical guidelines on the prevention and management of diabetes-related foot disease (IWGDF 2023 update). Diabetes Metab Res Rev. 2024. 40:e3657.

3.Chen P., Vilorio NC., Dhatariya K., Jeffcoate W., Lobmann R., McIntosh C, et al. Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: a systematic review. Diabetes Metab Res Rev. 2024. 40:e3786.

4.Nube VL., Alison JA., Twigg SM. Frequency of sharp wound debridement in the management of diabetes-related foot ulcers: exploring current practice. J Foot Ankle Res. 2021. 14:52.

5.Jeffcoate WJ., Price PE., Phillips CJ., Game FL., Mudge E., Davies S, et al. Randomised controlled trial of the use of three dressing preparations in the management of chronic ulceration of the foot in diabetes. Health Technol Assess. 2009. 13:1–86. iii-iv.

6.Nain PS., Uppal SK., Garg R., Bajaj K., Garg S. Role of negative pressure wound therapy in healing of diabetic foot ulcers. J Surg Tech Case Rep. 2011. 3:17–22.

7.Edmonds M., Lázaro-Martínez JL., Alfayate-García JM., Martini J., Petit JM., Rayman G, et al. Sucrose octasulfate dressing versus control dressing in patients with neu-roischaemic diabetic foot ulcers (Explorer): an international, multicentre, double-blind, randomised, controlled trial. Lancet Diabetes Endocrinol. 2018. 6:186–96.

8.Wen J., Jin X., Al Sayah F., Johnson JA., Paulden M., Ohinmaa A. Economic evaluation of sucrose octasulfate dressing for treatment of diabetic foot ulcers in patients with type 2 diabetes. Can J Diabetes. 2022. 46:126–33.

9.Yahia EA., El-Sharkawey AE., Bayoumi MM. Quantitative evaluation of diabetic foot wound healing using hydrogel composite nanosilver (AgNPs)—based dressing vs. traditional dressing: a prospective randomized control study. Pak J Med Health Sci. 2021. 15:2043–7.

10.Djavid GE., Tabaie SM., Tajali SB., Totounchi M., Farhoud A., Fateh M, et al. Application of a collagen matrix dressing on a neuropathic diabetic foot ulcer: a randomised control trial. J Wound Care. 2020. 29(Sup3):S13–8.

11.Lalau JD., Bresson R., Charpentier P., Coliche V., Erlher S., Ha Van G, et al. Efficacy and tolerance of calcium alginate versus vaseline gauze dressings in the treatment of diabetic foot lesions. Diabetes Metab. 2002. 28:223–9.

12.Bryant R., Nix D. Acute and chronic wounds: current management concepts. 5th ed.St. Louis: Elsevier;2015.

13.Bonham PA., Brunette G., Crestodina L., Droste LR., González A., Kelechi TJ, et al. 2021 Guideline for management of patients with lower-extremity wounds due to diabetes mellitus and/or neuropathic disease: an executive summary. J Wound Ostomy Continence Nurs. 2022. 49:267–85.

14.Nube VL., White JM., Brewer K., Veldhoen D., Meler C., Frank G, et al. A randomized trial comparing weekly with every second week sharp debridement in people with diabetes-related foot ulcers shows similar healing outcomes: potential benefit to resource utilization. Diabetes Care. 2021. 44:e203–5.

15.Jimenez JC., Agnew PS., Mayer P., Clements JR., Caporusso JM., Lange DL, et al. Enzymatic debridement of chronic nonischemic diabetic foot ulcers: results of a randomized, controlled trial. Wounds. 2017. 29:133–9.

16.Tallis A., Motley TA., Wunderlich RP., Dickerson JE Jr., Waycaster C., Slade HB; Collagenase Diabetic Foot Ulcer Study Group. Clinical and economic assessment of diabetic foot ulcer debridement with collagenase: results of a randomized controlled study. Clin Ther. 2013. 35:1805–20.

17.Michailidis L., Bergin SM., Haines TP., Williams CM. Healing rates in diabetes-related foot ulcers using low frequency ultrasonic debridement versus non-surgical sharps debridement: a randomised controlled trial. BMC Res Notes. 2018. 11:732.

18.Lázaro-Martínez JL., Álvaro-Afonso FJ., Sevillano-Fernández D., García-Álvarez Y., Sanz-Corbalan I., García-Morales E. Cellular proliferation, dermal repair, and microbio-logical effectiveness of ultrasound-assisted wound debridement (UAW) versus standard wound treatment in complicated diabetic foot ulcers (DFU): an open-label randomized controlled trial. J Clin Med. 2020. 9:4032.

19.Malekpour Alamdari N., Mehraneroodi B., Gholizadeh B., Zeinalpour A., Safe P., Besharat S. The efficacy of negative pressure wound therapy compared with conventional dressing in treating infected diabetic foot ulcers: a randomized controlled trial. Int J Diabetes Dev Ctries. 2021. 41:664–8.

20.Seidel D., Storck M., Lawall H., Wozniak G., Mauckner P., Hochlenert D, et al. Negative pressure wound therapy compared with standard moist wound care on diabetic foot ulcers in real-life clinical practice: results of the German DiaFu-RCT. BMJ Open. 2020. 10:e026345.

21.Singh SP., Kumar V., Pandey A., Pandey P., Gupta V., Verma R. Role of platelet-rich plasma in healing diabetic foot ulcers: a prospective study. J Wound Care. 2018. 27:550–6.

22.Jeong SH., Han SK., Kim WK. Treatment of diabetic foot ulcers using a blood bank platelet concentrate. Plast Reconstr Surg. 2010. 125:944–52.

23.Yarahmadi A., Saeed Modaghegh MH., Mostafavi-Pour Z., Azarpira N., Mousavian A., Bonakdaran S, et al. The effect of platelet-rich plasma-fibrin glue dressing in combination with oral vitamin E and C for treatment of non-healing diabetic foot ulcers: a randomized, double-blind, parallel-group, clinical trial. Expert Opin Biol Ther. 2021. 21:687–96.

24.Chen CY., Wu RW., Hsu MC., Hsieh CJ., Chou MC. Adjunctive hyperbaric oxygen therapy for healing of chronic diabetic foot ulcers: a randomized controlled trial. J Wound Ostomy Continence Nurs. 2017. 44:536–45.

25.Salama SE., Eldeeb AE., Elbarbary AH., Abdelghany SE. Adjuvant hyperbaric oxygen therapy enhances healing of nonischemic diabetic foot ulcers compared with standard wound care alone. Int J Low Extrem Wounds. 2019. 18:75–80.