Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials

Abstract

Studies have suggested that hyperbaric oxygen therapy (HBOT) is effective in the healing of diabetic foot ulcer (DFU); however, there is a lack of consensus. Therefore, to assess the efficacy of HBOT on diabetic foot ulcer among diabetic patients, controlled clinical trials were searched through PubMed, EMBASE, Clinical key, Ovid Discovery, ERMED, Clinical Trials.gov databases for randomized controlled trials (RCTs) and other sources until 15 September 2020. Studies that evaluated the effect of HBOT on diabetic foot ulcer, complete healing, amputation, adverse events, ulcer reduction area, and mortality rate were included. Of 1984 study records screened, 14 studies (768 participants) including twelve RCTs, and two CCTs were included as per inclusion criteria. The results with pooled analysis have shown that HBOT was significantly effective in complete healing of diabetic foot ulcer (OR = 0.29; 95% CI 0.14–0.61; I2 = 62%) and reduction of major amputation (RR = 0.60; 95% CI 0.39–0.92; I2 = 24%). Although, it was not effective for minor amputations (RR = 0.82; 95% CI 0.34–1.97; I2 = 79%); however, less adverse events were reported in standard treatment group (RR = 1.68; 95% CI 1.07–2.65; I2 = 0%). Nevertheless, reduction in mean percentage of ulcer area and mortality rate did not differ in HBOT and control groups. This review provides an evidence that hyperbaric oxygen therapy is effective as an adjunct treatment measure for the diabetes foot ulcers. These findings could be generalized cautiously by considering methodological flaws within all studies.

A General Overview on the Hyperbaric Oxygen Therapy: Applications, Mechanisms and Translational Opportunities

“…Furthermore, anaerobic infections have a lower occurrence and amputation rates immensely decrease [ 48 , 49 ]. Different systematic reviews support the adjuvant use of systemic but not topical HBOT in the wound healing of diabetic foot ulcers [ 50 , 51 ]. However, studies results are quite heterogeneous, and it is still necessary to define which group of patients may benefit most from this intervention [ 52 ].…”

Patients with Diabetes Complicated by Peripheral Artery Disease: the Current State of Knowledge on Physiotherapy Interventions

“…The last meta-analysis performed in January 2021 concludes that HBOT was associated with higher rates of diabetic foot ulcer healing and reduced rates of major amputation of the lower extremity. The authors suggest a great need for well-planned, sufficiently multicentric trials to assess the efficacy and safety of HBOT as an adjuvant treatment for diabetic foot ulcers [ 109 ].…”

Effect of Hydrogel Use on Healing Diabetic Foot Ulcers: Systematic Review

“…One of them is a dressing made from natural or synthetic materials, namely, hydrogel [10]. In addition to hydrogel, you can also use additional therapy, namely, Hyperbaric Oxygen Therapy [11]. The role of hyperbaric oxygen (HBO) is to improve the amount of oxygen delivered to the wound area, both bound to hemoglobin and dissolved in plasma [12].…”