Effect of systemic insulin treatment on diabetic wound healing

Abstract

This study investigates if different diabetic treatment regimens affects diabetic foot ulcer healing. From January 2013 to December 2014, 107 diabetic foot ulcers in 85 patients were followed until wound healing, amputation or development of a non-healing ulcer at the last follow-up visit. Demographic data, diabetic treatment regimens, presence of peripheral vascular disease, wound characteristics and outcome were collected. Non-healing wound was defined as major or minor amputation or those who didn’t have complete healing until the last observation. Median age was 60.0 years (range: 31.1–90.1) and 58 cases (68.2%) were males. Twenty-four cases reached a complete healing (healing rate: 22.4%). Median follow-up period in subjects with classified as having chronic wounds was 6.0 months (range: 0.7–21.8). Insulin treatment was a part of diabetes management in 52 (61.2%) cases. Insulin therapy significantly increased the wound healing rate (30.3% [20/66 ulcers] vs. 9.8% [4/41 ulcers]) (P=0.013). In multivariate random-effect logistic regression model, adjusting for age, gender, smoking status, type of diabetes, hypertension, chronic kidney disease, peripheral arterial disease, oral hypoglycemic use, wound infection, involved side, presence of Charcot’s deformity, gangrene, osteomyelitis on x-ray, and serum hemoglobin A1C levels, insulin treatment was associated with a higher chance of complete healing (beta±SE: 15.2±6.1, P=0.013). Systemic insulin treatment can improve wound healing in diabetic ulcers after adjusting for multiple confounding covariates.

Does intensive glycaemic control promote healing in diabetic foot ulcers? – a feasibility study

“…Over a similar timeframe, much lower healing rates have been reported with standard care (eg, 31% at 20 weeks in a meta-analysis30). Even when standard care included insulin, a retrospective cohort study found that only 30% of ulcers had healed after 1.1 month 31. The baseline mean HbA1c was lower in the participants of that study (7.9% or 63 mmol/mol) compared with our own (10.8% or 94 mmol/mol).…”

Update on management of diabetic foot ulcers

“…Systemic insulin use has been associated with a higher chance of complete wound healing when adjusted for multiple cofounders. 96,97 There has been growing interest in various vitamins and supplements and their impact on wound healing. In 2017, several RCTs evaluated the use of magnesium, omega-3 fatty acids, zinc sulfate, and vitamin D. [98][99][100][101] All of the aforementioned studies showed significant benefits in reduction in wound size when compared with placebo.…”

Human αβ and γδ T Cells in Skin Immunity and Disease

“…Obesity is a strong predictor for T2DM ( 155 ). Patients with T2DM exhibit a complex array of complications including a higher prevalence of chronic non-healing wounds, impaired leukocyte function, neuropathy, and vasculopathy ( 156 , 157 ).…”

“…Systemic insulin therapy has shown some success in improving wound healing in rats and humans ( 156 , 172 ). Insulin regulates glucose uptake, gene expression, and cell differentiation which all impact skin-resident T cells and wound repair.…”

“…Insulin regulates glucose uptake, gene expression, and cell differentiation which all impact skin-resident T cells and wound repair. Other studies show that topical insulin injections accelerate the healing of diabetic foot ulcers by stimulating the AKT and ERK pathways ( 156 ). A large multicenter clinical trial is needed to determine the level of effectiveness and mechanisms used by insulin to promote proper T cell function and wound healing in diabetic patients.…”