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Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis
Daria O'Reilly1, Anjori Pasricha, Kaitryn Campbell
1Programs for Assessment of Technology in Health (PATH) Research Institute/St. Joseph's Healthcare Hamilton, Canada.
Summary
Hyperbaric oxygen therapy (HBOT) may reduce major amputations in diabetic foot ulcers, but limited evidence prevents definitive conclusions. More research is needed to confirm HBOT
Area of Science:
- Diabetic foot ulceration
- Hyperbaric oxygen therapy (HBOT)
- Amputation risk reduction
Background:
- Diabetic foot ulcers affect 10-15% of individuals with diabetes.
- These ulcers precede 85% of lower limb amputations.
- Hyperbaric oxygen therapy (HBOT) is explored for its potential to promote ulcer healing.
Purpose of the Study:
- To systematically review the efficacy of systemic HBOT for nonhealing lower limb diabetic ulcers.
- To evaluate HBOT's impact on ulcer healing and amputation rates.
Main Methods:
- Systematic search of multiple databases (Medline, EMBASE, CINAHL, PubMed, Cochrane, Biosis).
- Inclusion of randomized controlled trials (RCTs) and observational studies.
- Pooled analysis of outcomes from twelve selected publications.
Main Results:
- Pooled data suggested HBOT reduced major amputation risk by 60-61% compared to standard care.
- RCT data indicated a relative risk of 0.54 for unhealed wounds with HBOT (p=0.10).
- Observational data showed a relative risk of 0.24 for unhealed wounds with HBOT (p<0.0001).
Conclusions:
- Limited RCT evidence precludes definitive conclusions on HBOT benefits and harms.
- RCTs found no significant effect of HBOT on amputation rates.
- High-quality studies showed no difference in outcomes with HBOT compared to standard care.
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