DIABETIC FOOT SYNDROME

Diabetes mellitus

Diabetes mellitus (DM) is defined as a group of metabolic diseases characterized by chronic hyperglycemia caused by a secretion disorder or the effect of insulin or a combination thereof. DM is a chronic disease that after longer period causes irreversible changes leading to the damage of the tissues of the body.

HBOT is a valuable complementary method of treating diabetic changes in the skin of the lower limbs, caused by the deterioration of blood supply in damaged small vessels and capillaries.

• Accelerates healing
• Reduces the risk of high amputation by 60%
• Increases the number of completely healed diabetic wounds in the long term

It is shown that in patients with diabetic foot syndrome, HBOT significantly reduces the risk of amputation by up to 50% and may shorten treatment time.

The study, which included 28 patients with chronic neuropathic nonischemic defects with severity of I-III grade according to Wagner, clearly showed reduction of the defect by 41%. After HBO treatment, two patients completely recovered within four weeks.

Out of 68 patients with Wagner II-IV diabetic foot syndrome, 35 patients underwent exposure to the hyperbaric chamber. 33 patients enrolled in the control group without hyperbaric oxygen therapy. The HBO group had a demonstrable lower risk of amputation. A detailed analysis showed the greatest positive effect of HBO in reducing amputation in the most severe defects – level IV according to Wagner (2/22 HBO vs. 11/20 control group).

In Slovakia, 337 187 diabetics are registered as of 31 December 2009, of which type 2 diabetics there are 303 265. 25% of diabetics have a serious lesion of the lower limb, a complication of diabetes – 4,292 patient per year undergo amputation of lower limb.

Adequate supply of oxygen is the key factor in the control of infection and wounds healing. Breathing pure 100% oxygen under heightened pressure (than atmospheric pressure) has beneficial effect on curing of diabetic wounds (ulcers).

What do experts say?

There are numbers of medical studies that demonstrate therapeutic and economic effects of using HBO with diabetic foot syndrome.
 
ABIDIA 2000

Research has been done in a prospective study of 18 patients, suffering from ischemic defects, Wagner score II.

HBO was administered 1 x daily for 90 minutes at a pressure of 2.5 ATA total of 30 sessions. After six weeks,in the HBO group, 5 out of 8 patients were healed versus the control group in which 1 out of 8 patients healed.

Abidia A, Laden G, Kuthan G. et al:
The role of hyperbaric oxygen therapy in ischaemic diabetic lower extremity ulcers:
and a double-blind randomized control trial.
Eur J Vasc Endovasc Surg, 25, 2003: 513 – 518

 
KESSLER 2003

The study involved 28 patients with neuropathy defects with Wagner scores I-III.

The HBO group (14 patients) was treated twice daily for 90 minutes at 2.5 ATA for 2 weeks, 5 times a week. The control group (13 patients) was treated with standard therapy. Result: In the second week of the study, the reduction in defect size was clearly greater (41%) in the HBO group versus the control group. After 4 weeks, 2 patients from the HBO group were completely cured. There was no one cured in the control group.

Kessler L, Bilbault P, Ortega F et al:
Hyperbaric oxygenation accelerates the healing rate of nonischemic chronic diabetic foot ulcers.
Diab Care, 26, 2003: 2378 – 2382

Hyperbaric chamber treatment is not only effective but also economical

The HBO effectiveness in the treatment of diabetic foot was the topic at the IV. European Consensus Conference held in London in 1998 and the VIII. European Consensus Conference held in 2006 in Raven. The importance of using HBO in the diabetic foot is also part of the meta-analysis within the recognized Cochrane Review system. The conclusion is that in patients with HBV ulceration it significantly reduces the high risk of amputation with a great chance of healing within one year. In many studies, the cost of treatment and follow-up care for patients with diabetic foot was evaluated. The latest study published in the International Journal of Technology Assessment in Health Care presents results from Canada, where treatment costs were evaluated over a twelve year period in patients with and without hyperbaric oxygen therapy. Cost savings for HBO patients amounted to 10,000 Canadian dollars.