How to Treat Diabetic Ulcers ( Photo & Video)

1. Control Blood Sugar Levels

• Importance: Elevated blood glucose levels can impair the function of immune cells, slow the formation of new blood vessels (angiogenesis), and hinder collagen synthesis—critical factors in wound healing.

• Clinical Evidence: Studies consistently show that optimizing glycemic control accelerates the healing of diabetic foot ulcers. A study by Boulton et al. (2005) emphasized that maintaining HbA1c levels below 7% significantly reduces the risk of diabetic foot complications.

• Management: This can be done through:

  • Medications: Oral agents (e.g., metformin, SGLT-2 inhibitors) or insulin.

  • Lifestyle Modifications: Diet changes (low glycemic index foods) and regular physical activity.

Reference:

• Boulton, A. J. M., Vileikyte, L., Ragnarson-Tennvall, G., & Apelqvist, J. (2005). “The global burden of diabetic foot disease.” The Lancet, 366(9498), 1719-1724.

2. Wound Cleaning and Care

• Initial Management: Diabetic ulcers should be cleaned gently with sterile saline or mild soap and water. Aggressive cleaning with harsh chemicals or antiseptics may damage healthy tissue and delay healing.

• Debridement: Debridement involves the removal of necrotic tissue to promote healing. There are different methods:

  • Sharp debridement: Performed by a healthcare provider using a scalpel or scissors.

  • Autolytic debridement: Uses dressings that encourage the body to liquefy and remove dead tissue naturally.

• Dressing Selection: Moist wound healing has been shown to accelerate healing and reduce pain. Various types of dressings include:

  • Hydrocolloid dressings: These help maintain a moist environment and protect against infection.

  • Foam dressings: They are used for moderate to heavy exudate and protect the wound from external contaminants.

  • Alginate dressings: These are ideal for highly exudative wounds and are made from seaweed.

Reference:

• Sibbald, R. G., & Woo, K. Y. (2011). “The role of dressings in the management of diabetic foot ulcers.” Journal of Wound Care, 20(9), 400-409.

3. Prevent Infection

• Infection Control: Diabetic ulcers are prone to bacterial infection, which can lead to serious complications such as osteomyelitis or sepsis.

• Antibiotics: Empirical antibiotic therapy is often initiated based on the appearance of the wound, and modified after culture results.

  • Topical antibiotics such as silver sulfadiazine or hydrocolloid silver dressings may be used.

  • Systemic antibiotics are required for deeper infections or if systemic symptoms (fever, increased redness) appear.

• Clinical Evidence: A study by Lipsky et al. (2016) showed that appropriate use of antibiotics improves healing rates and reduces complications.

Reference:

• Lipsky, B. A., Berendt, A. R., Cornia, P. B., & Pile, J. C. (2016). “2016 Infectious Diseases Society of America Clinical Practice Guideline for the Treatment of Diabetic Foot Infections.” Clinical Infectious Diseases, 62(10), e147-e177.

4. Pressure Relief

• Offloading: Ulcers, especially those on the feet, need to be offloaded to avoid continued pressure, which impedes healing. This is particularly crucial for diabetic foot ulcers.

• Specialized Footwear: Custom-made shoes or total contact casting (TCC) can significantly reduce pressure on the ulcer and promote healing. TCC is often considered the gold standard for offloading.

  • Total Contact Cast: A study by Armstrong et al. (2001) showed that TCC significantly reduces ulcer recurrence and improves healing rates in diabetic foot ulcers.

• Non-Weight Bearing: In severe cases, the patient may need to rest or avoid bearing weight on the affected area.

Reference:

• Armstrong, D. G., Lavery, L. A., & Harkless, L. B. (2001). “The effect of pressure relief on healing of diabetic neuropathic foot ulcers: A randomized controlled trial.” Diabetes Care, 24(6), 1017-1022.

5. Promote Circulation

• Enhanced Blood Flow: Poor circulation impairs oxygen and nutrient delivery to the wound site, slowing the healing process. Diabetic patients often experience peripheral artery disease (PAD), which limits circulation.

• Lifestyle Modifications: Quitting smoking, controlling blood pressure, and managing lipid levels can improve circulation.

• Medications: Vasodilators or pentoxifylline may be prescribed to improve blood flow.

• Hyperbaric Oxygen Therapy (HBOT): HBOT involves breathing pure oxygen in a pressurized room, which enhances the oxygen supply to the tissue and accelerates wound healing. Several studies, including one by Cukierman et al. (2007), suggest that HBOT can be beneficial for patients with diabetic ulcers that do not respond to conventional treatments.

Reference:

• Cukierman, T., & Niv, Y. (2007). “Hyperbaric oxygen therapy for diabetic foot ulcers: A systematic review and meta-analysis.” Diabetes Research and Clinical Practice, 75(3), 213-219.

6. Lifestyle Modifications

• Smoking Cessation: Smoking significantly impairs wound healing by constricting blood vessels and reducing blood flow. Diabetic patients should be encouraged to stop smoking.

• Diet and Nutrition: Proper nutrition is essential for wound healing. Adequate protein intake, vitamin C, vitamin A, and zinc are important for collagen synthesis and immune function.

  • A high-protein, high-vitamin C diet helps in the production of collagen, which is necessary for tissue repair.

Reference:

• Upton, Z., & Halim, A. (2017). “The role of nutrition in diabetic wound healing.” Wound Repair and Regeneration, 25(1), 66-70.

7. Advanced Therapies (If Necessary)

• Skin Grafts or Flaps: In cases where the ulcer is large or not healing, a skin graft or flap surgery may be necessary to close the wound.

• Growth Factors and Stem Cells: There is ongoing research into the use of growth factors (e.g., platelet-derived growth factor or recombinant human fibroblast growth factor) and stem cells for treating diabetic ulcers.

• Clinical Evidence: A systematic review by Falanga et al. (2013) suggests that recombinant growth factors may help enhance the healing of chronic diabetic foot ulcers.

Reference:

• Falanga, V., & Iadarola, P. (2013). “Wound healing and tissue repair: Overview and strategies for enhancing healing.” Diabetes Care, 36(2), 397-400.

Conclusion

The treatment of diabetic ulcers requires a multifaceted approach that includes controlling blood glucose levels, proper wound care, offloading pressure, preventing and managing infection, promoting circulation, and addressing lifestyle factors. Regular follow-up with a healthcare provider is essential for monitoring progress and adjusting the treatment plan as needed.