Patients with inadequately controlled diabetes have too much glucose (sugar) in their bloodstream due to dysfunctional insulin production/utilization. Over time, this excessive amount of sugar can damage nerves and blood vessels, which can constrict blood flow. The pain associated with damaged nerves is called neuropathy and it can be severe enough to create mobility issues in the affected areas, which may further decrease circulation. In cases of diabetes, most patients experience neuropathy and decreased circulation in their extremities; this is due to how far away these areas are from the heart. Some patients with advanced diabetes experience injuries to their extremities, usually in the feet, resulting in open wounds or ulcers. With insufficient blood flow to the injury, it can become very difficult or impossible for the body to heal itself. The inflammatory process will be triggered but may not be followed up with the necessary responses from the immune system to repair the injured tissue. Diabetic ulcers can last for years and continue to worsen over time. These non-healing wounds are the main cause of foot and hand amputations for diabetic patients.
Diabetic ulcers and other non-healing wounds are some of the most studied conditions for hyperbaric oxygen therapy. Hyperbaric therapy can help push blood and oxygen much deeper into the body, even through areas that are damaged and inflamed. By flooding the ulcer with oxygen, the body can quickly initiate its healing response and fight to restore the injured tissue. Multiple studies and anecdotes have shown complete recovery from mild ulcers and injuries as well as ones that have progressed into severe infections and for patients who were scheduled for amputation. Hyperbaric therapy has also been proven to create new blood vessels, a process called angiogenesis. For diabetic patients, this can result in brand new routes for improved circulation to extremeties. This means that patients may be able to utilize hyperbaric therapy to prevent ulcers as well as to treat them. The mechanism of action for healing diabetic ulcers may also work to heal damaged nerves and end the painful symptoms of diabetic neuropathy.
Adjunctive HBO therapy can be valuable for treating selected cases of hypoxic diabetic foot ulcers. It seems to accelerate the rate of healing, reduce the need for amputation, and increase the number of wounds that are completely healed on long-term follow-up. Additional studies are needed to further define the role of HBO, as part of a multidisciplinary program, to preserve a functional extremity, and reduce the short- and long-term costs of amputation and disability.
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Results: Complete DFU closure was achieved in 5 patients (25%) in the HBOT group (n = 20) versus 1 participant (5.5%) in the routine care group (n = 18) (P = .001). The amputation rate was 5% for the HBOT group and 11% for the routine care group (χ = 15.204, P = .010). The HBOT group showed statistically significant improvements in inflammation index, blood flow, and health-related quality of life from pretreatment to 2 weeks after the last therapy ended (P < .05). Hemoglobin A1c was significantly lower in the HBOT group following treatment (P < .05) but not in the routine care group.
Conclusions: Adjunctive HBOT improved wound healing in persons with DFU. Therapy also reduced the risk of amputation of the affected limb. We assert that at least 20 HBOT sessions are required to be effective.
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For the past two decades, HBOT has been used in wound-repair mostly for the treatment of foot ulcers associated with diabetes (Mason et al., 1999). In line with these results, we present evidence that the wound-healing time was less when diabetic individuals were subjected to HBOT than when no treatment was given. Furthermore, diabetic mice subjected to the combined-treatment improved faster than those under other treatments. Specifically, the wounds of the diabetic mice subjected to HBOT plus WJ-MSC seeded scaffolds recovered significantly faster and with fewer sessions than the sham control group. Most likely, HBOT increased the tissue oxygen content and improved collagen synthesis, angiogenesis, and epithelization in the wound bed. See study here.
Farmer with diabetic ulcers finds healing with HBOT
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