Cilostazol prevents foot ulcers in diabetic patients with peripheral vascular disease

Abstract

Diabetic patients are at high risk of foot ulcerations that may lead to limb amputations with important socio-economic impact. Peripheral vascular disease may be frequently associated in diabetes mellitus type II with its main symptom, intermittent claudication. Many studies reported the known efficacy of cilostazol in treating vascular claudication. Metalloproteinase-9 (MMP-9) seems to be a biochemical marker implicated in chronic wounds and in particular in diabetic foot ulcers. Cilostazol appears to have a lowering effect on MMP-9 levels and this may suggest a beneficial effect in order to prevent or retard the onset of foot ulcer in diabetic patients. In our study, two groups of diabetic patients with peripheral vascular disease were divided into two groups according to the presence of claudication in order to receive cilostazol. Group A (31 patients without claudication) were not eligible to receive cilostazol whereas Group B (47 patients with claudication) received cilostazol administration for 24 weeks (100 mg orally twice daily). Median follow up was of 16 months. During the follow up, 4·25% of patients of Group B and 35·48% of patients of Group A (P < 0·01) showed onset of foot ulceration. Although further randomised and controlled studies are required cilostazol seems to show beneficial effects for primary prevention of diabetic foot ulcers.

Efficacy of cilostazol for the treatment of Raynaud’s phenomenon in systemic sclerosis patients

“…In the present study, the incidence of DUs was not compared with a control group; however, the result can be considered positive, as DUs generally affect more than half of the patients during the course of the disease and occur in about 30 % of the patients each year [7]. Our results are consistent with a recent study by De Franciscis et al [21] in which cilostazol treatment demonstrated to reduce significantly the incidence of new ulcers in diabetic patients with peripheral arterial disease and decrease MMP-9 plasma levels-a metalloproteinase that has been implicated in various pathologic conditions characterized by excessive fibrosis including SSc [22]. It is possible that a similar effect on MMP-9 also occurs in SSc patients and deserves to be investigated in future studies.…”

The use of Cilostazol in Diabetic Patients

“…Thus, cilostazol may increase skin oxygen supply assessed by transcutaneous oxygen pressure measurement, enhance collateral blood flow,* and promote angiogenesis** in diabetic patient with lower limb ischemia [6]. Additionally, cilostazol appears to have a lowering effect on MMP-9 levels (biochemical marker implicated in chronic wounds) and this may suggest a beneficial effect regarding the prevention or retardation of the onset of foot ulceration in diabetic patients [7]. Even in those patients undergoing lower limb revascularization, the use of cilostazol has improved 1-year freedom from lower limb amputation [8].…”

Cilostazol for Treatment of Patients With Diabetic Leg Ulcers

“…Own experience of using this preparation testifies about perspective of its application for patients with the diabetic leg ulcers [5,6]. Expediency of its application for patients with the diabetic leg ulcers needs profound confirmation, although there are reports that specify on credible potential of the use of preparation at treatment of this category of patients [7,8].…”