Improving wound-healing outcomes in diabetic foot ulcers

The prevalence of diabetes is increasing worldwide and has been forecasted to double in the next 20 years. The major increase in morbidity and mortality of diabetes is due to the development of both macro- and microvascular complications, including failure of the wound-healing process. Foot ulcers occur in 15% of all patients with diabetes and precede 84% of all lower-leg amputations. The essential components of diabetic foot ulcer treatment are to reduce foot bearing pressure (in neuropathic ulcers) and to increase blood supply (in the case of vascular ulcers). Antibacterial therapy is also important. Despite optimized treatment, for reasons not completely understood, some ulcers fail to heal. Previous research studies have shown clearly that failure of healing eventually leads to deep-seated infection and amputation. Therefore, impaired wound healing is the pivotal event responsible for most of the morbidity (and mortality) of diabetic foot disease. Improving wound healing in diabetes requires a multidisciplinary approach in terms of clinical management as well as an increased effort aimed at better understanding the pathogenesis of poor wound healing in diabetes. Consequently, a detailed understanding of the wound-healing process in diabetes and how it can be improved is of great importance. However, efforts to develop new therapies are hampered by a lack of knowledge of the molecular mechanisms responsible for the pathologies, as well as a lack of suitable models for the study of chronic wounds. Therefore, this review will address both clinical and biochemical aspects of wound healing in diabetes.