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Negative pressure wound therapy for treating foot wounds in people with diabetes mellitus

Diabetes mellitus is a common condition that leads to high blood glucose concentrations, with around 2.8 million people affected in the UK (approximately 4.3% of the population). Some people with diabetes can develop ulcers on their feet. These wounds can take a long time to heal, be painful and become infected. Ulceration of the foot in people with diabetes can also lead to a higher risk of amputation of parts of the foot or leg. Generally, people with diabetes are at a higher risk of lower‐limb amputation than people without diabetes. Negative pressure wound therapy is a wound treatment which involves applying suction to a wound; it is used increasingly around the world but it is not clear how effective it is. It also expensive compared with treatments such as dressings. We found five randomised controlled trials that compared negative pressure wound therapy with other treatments. We found some preliminary evidence that negative pressure wound therapy increases the healing of foot wounds on people with diabetes compared with other treatments. However, the findings are not conclusive and more, better quality randomised controlled trials are required.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Educating people with diabetes about foot care to help reduce foot ulcers and amputations

Foot ulcers (open sores) are common in people with diabetes, especially those with problems in the nerves (peripheral neuropathy), the blood supply to their legs (peripheral vascular disease (PVD)), or both. People with ulcers due to diabetes sometimes need an amputation (surgical removal of part of the limb). Foot ulcers not only lead to physical disability and loss of quality of life but also to economic burden (healthcare costs, industrial disability). The aim is therefore to prevent foot ulcers occurring. This review of high‐level studies found that educating people with diabetes about the need to look after their feet seems to improve people's foot care knowledge and behaviour in the short term. There is insufficient evidence that education alone, without any additional preventive measures, will effectively reduce the occurrence of ulcers and amputations.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Combined strategies to avoid foot ulcers in patients with diabetes

Foot ulcers (open sores) are common in people with diabetes mellitus (type 1 and type 2), especially those with problems in the nerves (peripheral neuropathy), the blood supply to their legs (peripheral vascular disease) or both. People with ulcers due to diabetes will sometimes need an amputation (surgical removal of part of the limb). Foot ulcers not only lead to physical disability and loss of quality of life, but also to economic burden (healthcare costs, industrial disability). The aim is therefore to prevent foot ulcers occurring, for example, by showing patients with diabetes how to look after their feet or by prompting doctors to check their patients' feet more often. The results of single prevention strategies alone have so far been disappointing, therefore in clinical practice, preventive interventions directed at patients, healthcare providers and/or the structure of health care are often combined. In this review of trials of complex, preventive interventions, we found insufficient evidence that these combined approaches can be effective in reducing foot problems.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Ozone therapy as a treatment for foot ulcers in people with diabetes

Diabetes mellitus (DM) is a common condition that leads to high sugar concentrations in the blood. People who have had diabetes for a long time often suffer from foot ulcers. Nearly 35% of all hospital admissions from diabetes clinics are due to them, as are nearly 80% of all non‐traumatic amputations of the leg and foot.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Granulocyte‐colony stimulating factor, a growth factor, which can be added to usual therapy for treating foot infections in people with diabetes

People with diabetes can develop foot infections which can be difficult to treat, and treatment failure can result in lower extremity amputation. We found five trials which included a total of 167 people. The trials showed that adding G‐CSF to usual therapy did not significantly affect the likelihood of the infection resolving or the improved healing of foot wounds, nor did it reduce the period of treatment with oral antibiotics. However, G‐CSF does appear to reduce the need for surgical interventions, especially amputations, and the number of days spent in hospital. There are limitations to this analysis related to the variations in the people included in the studies (e.g. the severity of infection, the timing of the clinical assessment, the use of different G‐CSF preparations, and for different lengths of time). Therefore caution is required in the interpretation of the findings.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Dressings to treat foot ulcers in people with diabetes

Diabetes mellitus (generally known as 'diabetes'), when untreated, causes a rise in the sugar (glucose) levels in the blood. It is a serious health issue that affects millions of people around the world (e.g., almost two million people in the UK and 24 million people in the USA). Foot ulcers are a common problem for people with diabetes; at least 15% of people with diabetes have foot ulcers at some time during their lives. Wound dressings are used extensively in the care of these ulcers. There are many different types of dressings available, from basic wound contact dressings to more advanced gels, films, and specialist dressings that may be saturated with ingredients that exhibit particular properties (e.g. antimicrobial activity). Given this wide choice, a clear and up‐to‐date overview of the available research evidence is needed to help clinicians/practitioners to decide which type of dressing to use.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Silver based wound dressings and topical agents containing silver for treating diabetic foot ulcers

People with diabetes can develop foot ulcers. These are often due to reduced blood supply, reduced sensation, a change in the amount of movement in the lower leg, a foot deformity or the presence of some trauma. Therapies for foot ulcers include pressure reducing or relieving footwear and wound care through frequent dressing changes. Healing the wound can be delayed by poor control of blood sugar levels, compliance with therapies and the amount of bacteria on the wound surface. Foot ulcers in people with diabetes frequently become infected. Silver is an antimicrobial and dressings which contain silver have been developed. The authors of this Cochrane review wanted to find evidence on whether silver based dressings reduced infection and encouraged wound healing. They searched the medical literature for randomised and controlled clinical trials but found no studies which were eligible for inclusion in the review. We therefore do not know if silver containing dressings and topical agents containing silver are beneficial to diabetic foot ulcer healing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Skin grafting and tissue replacement for treating foot ulcers in people with diabetes

Foot ulceration is a major problem in people with diabetes and is the leading cause of hospital admissions and limb amputations. Despite the current variety of strategies available for the treatment of foot ulcers in people with diabetes, not all ulcers heal completely. Additional treatments with skin grafts and tissue replacement products have been developed to help complete wound closure.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Antibiotics to treat foot infections in people with diabetes

We reviewed the effects on resolution of infection and safety of antibiotics given orally or intravenously (directly into the blood system) in people with diabetes that have a foot infection.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Behavioral Programs To Help Manage Type 1 Diabetes: A Review of the Research for Children, Teens, and Adults

This summary is for you if your health care professional has said you have (or your child has) type 1 diabetes. This summary will tell you what researchers have found about behavioral programs to help manage type 1 diabetes. It does not cover specific treatments for diabetes.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 29, 2016

Behavioral Programs To Help Manage Type 2 Diabetes: A Review of the Research for Adults

This summary is for you if your health care professional has said you have type 2 diabetes. This summary will tell you what researchers have found about behavioral programs to help manage type 2 diabetes. It does not cover specific treatments for diabetes.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: November 29, 2016

Type 2 diabetes: Overview

Being diagnosed with type 2 diabetes can come as a real surprise. High blood sugar levels are often first detected during a routine examination. Some people just have to make a few changes in their routines after being diagnosed, while others need permanent medication.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 4, 2014

Controlling blood glucose in treating diabetic foot ulcers (sores)

Background: People with diabetes can develop foot ulcers (sores) for a number of reasons. This includes nerve damage and reduced blood flow to the feet and legs. Having high blood glucose may affect the ability of foot ulcers to heal and therefore intensively controlling blood glucose may be beneficial.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Growth factors for treating diabetic foot ulcers

People who suffer from diabetes mellitus (usually referred to as ‘diabetes’) can develop wounds (ulcers) on their feet and ankles. These diabetic foot ulcers can take a long time to heal, and affect quality of life for people with diabetes. In some people, failure of these ulcers to heal can contribute to the need for some level of amputation on the foot. Any treatments that encourage diabetic foot ulcers to heal will be valuable.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Surgical and non‐surgical methods of cleaning and removing dead tissue from sores on the feet of people with diabetes.

People with diabetes often develop foot ulcers (open sores on the feet that go through the skin), which are a serious complication and can themselves result in serious consequences such as amputation. Cleaning and removing dead tissue and callus from the ulcers is a common procedure also know as "debridement" and can be done in several ways, including surgery and special dressings and gels (such as hydrogels). The review found that hydrogel results in faster healing than gauze or standard care. The evidence for other debriding strategies is unclear.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Medicines for Type 2 Diabetes: A Review of the Research for Adults

This summary covers the research on the benefits and possible side effects of medicines to lower or control your blood sugar. It will help you talk with your doctor or other health care professional to decide which medicines are best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: June 30, 2011

Autologous platelet‐rich plasma (PRP) for chronic wounds

Chronic wounds (or ulcers) are breaks in the skin that do not heal, or require a long time to heal, and frequently recur. Chronic wounds include pressure ulcers, venous leg ulcers, arterial ulcers, neurotrophic ulcers, and foot ulcers in people with diabetes. Autologous platelet‐rich plasma (PRP) is a potential wound healing treatment because it has components such as fibrin (a substance produced in the liver that makes the blood clot) and high concentrations of growth factors that are thought to help healing. We reviewed the evidence on the effect of autologous PRP on wound healing in people aged 18 years or older with chronic wounds from any cause (such as pressure ulcers, arterial ulcers, venous ulcers). We also included patients with wounds of mixed aetiology e.g. mixed arterial‐venous ulcers.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2016

Erysipelas and cellulitis: Overview

Erysipelas or cellulitis can develop if bacteria enter the skin through cuts or sores. Both infections make your skin swell and become red, warm and tender. Provided the right treatment is started early enough, these bacterial skin infections usually clear up without any lasting effects.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 3, 2015

What are the treatment options for chronic wounds?

At first, chronic wounds are regularly cleaned and covered using wound dressings and bandages. If a wound still has not healed after a long time, special treatments such as vacuum-assisted closure or skin grafts are used.If someone has a wound for a long time without any signs of healing, it is considered to be a chronic wound. Chronic wounds usually arise as a result of poor blood circulation, diabetes or a weak immune system.As well as tending to the wound, pain relief is important. Some people with complex, poorly healing wounds find psychological support helpful too.

Informed Health Online [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 23, 2015

Late Effects of Treatment for Childhood Cancer (PDQ®): Patient Version

Expert-reviewed information summary about the health problems that continue or appear after cancer treatment has ended.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: August 11, 2016

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