Relationship between microbiota and healing status in diabetes-related foot ulcers treated with Trigona honey

Diabetes-related foot ulcers (DFUs) are a major complication of diabetes, and treatment with honey, which has antimicrobial properties, has been utilized in patients. However, the effects have been shown to vary, with the causes of these differences remaining unclear. Recently, microbiota has been reported to be associated with wound healing. Therefore, we hypothesized that differences in microbiota might explain the variations observed in response to honey. The present study aimed to investigate the relationship between the microbiota and the healing status in DFUs treated with Trigona honey.

A cohort study involving 12 DFUs categorized into healing and deteriorating groups was conducted. Wound and peri-wound microbiota observed at baseline and at 1 week later (after starting honey application) were investigated and then compared in the healing status.

Enterococcus was higher in the deteriorating group at baseline in the wound (p = 0.02), while Corynebacterium was higher in the healing group at 1 week later in the peri-wound skin (p = 0.02). Changes in the relative abundance of Prevotella and Brevundimonas in the peri-wound skin significantly differed based on the healing status.

The findings suggest that the honey's effects might differ based on the composition of the wound microbiota, and they highlight the bacterial interactions with the changes in the wound and peri-wound skin environment induced by the honey. These results also imply that honey therapy on its own may not be enough for treating DFUs. This study is limited by the small sample size and short follow-up period; further research will need to explore combined treatment strategies and long-term microbiota dynamics to improve DFU management.