A Pilot Study of Short-Duration Hyperbaric Oxygen Therapy to Improve HbA1c, Leukocyte, and Serum Creatinine in Patients with Diabetic Foot Ulcer Wagner 3-4

Abstract

Objective To evaluate the short-duration hyperbaric oxygen therapy (HBOT) can improve HbA1c levels, leukocyte count, and serum creatinine levels in patients with diabetic foot ulcer (DFU) Wagner 3-4. Methods Blood samples from all DFU patients at Sanglah General Hospital, Denpasar, were taken for HbA1c, leukocyte, and serum creatinine test before debridement procedure, and the patients were then grouped into either standard therapy or standard therapy with HBOT for 10 sessions (combination therapy). At the end of therapy, all blood tests were resumed. Results Each group consisted of 15 patients. Results of laboratory analysis before and after treatment were significant regarding decrease of HbA1c levels in standard therapy (10.98 ± 2.37 % to 9.70 ± 2.46 %; p = 0.006), HbA1c levels in combination therapy (9.42 ± 1.96 % to 7.07 ± 1.16 %; p < 0.001), and leukocyte count in combination therapy (13.97 ± 6.24 x 103 cells/μL to 8.84 ± 2.88 x 103 cells/μL; p = 0.009). The HbA1c levels at the end of therapy were significantly different between groups (p = 0.001). Serum creatinine level was decreased only in combination therapy but it was not significant. The effect size of all variables was larger in the combination therapy, but it was not significant (p > 0.05). Conclusion The use of short-duration HBOT on DFU reduces HbA1c levels, leukocyte count, and serum creatinine levels better than standard therapy alone. This protocol would save time and effort in future HBOT implementation. This trial is registered with ClinicalTrials.gov Identifier: NCT03615755.

Evaluation of Oxidative Stress in Patients with Difficult-to-Heal Skin Wounds Treated with Hyperbaric Oxygen

“…Grimberg-Peters et al [ 40 ], among other groups, showed a supportive effect of HBO in an analysis of the effect of such a treatment aimed at reducing inflammation on the activity of neutrophils isolated from severely injured patients (days 1–2 after trauma). In turn, a statistically significant decrease in the number of leukocytes after therapy combined with HBO compared with baseline was observed by Irawan et al [ 41 ] in patients with a diabetic foot ulcer.…”

Hyperbaric Oxygen Therapy and Vascular Complications in Diabetes Mellitus

“…101 Also, HBOT decreases the level of inflammatory markers such as cytokines (interleukin 1 and tumor necrosis factor a), 113,105 C-reactive protein, 101,117 free fatty acid (FFA), and NO 101,102 in the blood of patients with DM. In addition, HBOT improves glucose metabolism in patients with DM and vascular complications, most probably by increasing insulin sensitivity [118][119][120] via upregulation of peroxisome proliferator-activated receptor gamma (PPAR-g) expression 121,122 as well as increase in adiponectin level, which further regulates the expression of glucose transporter 4 by Akt and mediate glucose uptake. 123 Hyperbaric oxygen therapy exerts a beneficial effect on glucose metabolism by reducing hypoxia and inflammation, known for the ability to synergistically inhibit the activity of molecules involved in the insulin signaling cascade.…”

The Role of VEGF and TNF-Alpha on Epithelialization of Diabetic Foot Ulcers after Hyperbaric Oxygen Therapy

“…An ulcer occurs because, at tissue damage or death, that associated with the degree of peripheral vascular disease in inferior limb and may be accompanied by infection [4], [5]. It is estimated 15-25% of DM patients will develop DFUs with high morbidity, 40-80% will have high infection risk, and 10-20% will require amputation [6].…”

“…The standard therapies of DFUs are to regulate normal blood sugar levels, antibiotics medication to prevent and treat infection, ulcer debridement, wound care, off-loading the affected limb, and to improve blood flow or revascularisation [2], [6], [7], [8], [9]. In addition to these standard therapies, there are many adjuvant therapies, such as hyperbaric oxygen therapy (HBOT), growth factor therapy, stem cells therapy [7], [10], autolytic debridement [4], and percutaneous transluminal angioplasty [11].…”