Hyperbaric Oxygen Therapy as Adjunctive Treatment for Diabetic Foot Ulcers.

Hyperbaric oxygen therapy (HBOT) has been suggested to improve healing of hard-to-heal diabetic foot ulcers. Although the wide use of HBOT as a treatment for diabetic foot ulcers has been founded on weak scientific ground, 2 well-designed randomized, double-blind, placebo-controlled studies have in recent years put HBOT on firmer ground as treatment for diabetic patients with chronic foot ulcers. The recognition of inclusion criteria in these studies may help identify a select group of diabetic patients with hard-to-heal ulcers who might benefit from HBOT. In this review, we discuss the rationale behind the use of HBOT, its clinical application, and possible treatment complications

Hyperbaric Oxygen Therapy as adjunctive treatment of chronic diabetic foot ulcers

Chronic diabetic foot ulcers are a source of major concern for both patients and health care systems. Oxygen deficiency plays a major role in the pathogenesis of these ulcers. Hyperbaric oxygen therapy (HBOT) has been proposed as a medical treatment for diabetic foot ulcers, but the clinical utility has not been established. Hyperbaric Oxygen in Diabetic patients with chronic Foot Ulcer (HODFU) study is a prospective, randomized, placebo-controlled, double-blinded study, evaluating the effect of HBOT on ulcer healing in diabetic patients with chronic foot ulcers. Ninety four patients were included, representing 74% of all patients fulfilling the medical inclusion criteria during the inclusion period. Adjunctive HBOT significantly improved foot ulcer healing at 9- and 12-months follow-ups as compared to placebo. Numbers-needed to treat to avert non-healing of a chronic foot ulcer was 3.1. Treatment was well-tolerated and frequencies of adverse events were low. TcPO2, but not toe-blood pressure or ankle-brachial index, was identified as prognostic marker for ulcer healing after HBOT. At one-year follow-up HBOT was associated with improved health related quality of life. Patients perceived HBOT as unproblematic but time-consuming. Evaluation of these patients cardiac function indicates that a chronic diabetic foot ulcer should be regarded as a marker of cardiac disease. Thus, pharmacological cardiovascular prevention ought to be considered in all patients with a chronic diabetic foot ulcer. In conclusion, this study supports the concept that adjunctive treatment with HBOT enhances foot ulcer healing in selected patients with diabetes

Hyperbaric oxygen therapy as treatment of diabetic foot ulcers

Hyperbaric oxygen therapy (HBO) could be described as a short-term, high-dose oxygen inhalation and diffusion therapy, delivered systemically through airways and blood, achieved by having the patient breathing concentrated oxygen at a pressure higher than 1 absolute atmosphere. In clinical practice, monoplace or multiplace hyperbaric chambers are used to achieve this. Treatment is usually given as daily 90- to 120-min-long HBO sessions at pressures between 2.0 and 2.5 absolute atmosphere, aiming for 3040 treatment sessions. The use of HBO as treatment of diabetic foot ulcers has been founded on weak scientific ground, although the outcomes from previous studies are in concert with the conclusions from preclinical studies and supports the theoretical framework of HBO reversing hypoxia-induced pathology. Two well-designed randomized double-blind trials have put HBO on firmer ground and may justify adjunctive HBO treatment to a selected group of patients with nonhealing diabetic foot ulcers. Some health economic studies suggest potential cost effectiveness, but these studies are limited by deficient primary clinical data and should be interpreted with caution. Several issues remain to be addressed, such as developing robust criteria to improve treatment protocols, determining which patients are likely to benefit, and when to start and stop treatment. Copyright (C) 2012 John Wiley & Sons, Ltd

Hyperbaric oxygen therapy as adjunctive treatment of diabetic foot ulcers.

Hyperbaric oxygen therapy (HBO) is a short-term, high-dose oxygen inhalation and diffusion therapy, delivered systemically through airways and blood under high pressure using hyperbaric chambers. HBO stimulates angiogenesis, reduces edema, augments granulation tissue formation by enhancing fibroblasts, and improves leukocyte function by elevating the partial pressure of oxygen in tissue. The number of clinical trials evaluating the effect of HBO on the healing of diabetic foot ulcers is increasing, and to date two double-blind randomized controlled trials have been published, both showing improved long-term healing after HBO

The impact of metabolic control and QTc prolongation on all-cause mortality in patients with type 2 diabetes and foot ulcers.

AIMS/HYPOTHESIS: The increased all-cause mortality in patients with chronic diabetic foot ulcers cannot fully be explained by traditional cardiovascular risk factors. The significance of heart-rate-corrected QT (QTc) prolongation, a finding often seen in these patients, is unknown. Recently, the importance of metabolic control and hypoglycaemia has been discussed. The aim of this study was to evaluate the impact of different HbA(1c) levels and QTc prolongation on all-cause mortality in the high-risk population of patients with type 2 diabetes mellitus and foot ulcers. METHODS: All patients with type 2 diabetes, younger than 80 years, visiting our diabetes foot unit, with a foot ulcer duration >4 weeks, were screened for participation. Patients on dialysis were excluded. Patients were grouped according to HbA(1c) level and QTc time ≤ or > 440 ms. RESULTS: Patients (n = 214, median age 69.1 years) were grouped according to HbA(1c) level (HbA(1c) 8.9% [>74 mmol/mol] n = 63). Baseline characteristics, including use of potential hypoglycaemic drugs, were similar between groups. During the 8 years of follow-up 151 patients died (70.6%) and HbA(1c) < 7.5% (<58 mmol/mol) was strongly associated with increased mortality. The highest mortality was seen in patients with a combination of HbA(1c) < 7.5% (<58 mmol/mol) and QTc prolongation, with an 8 year mortality of 92.1% as compared with 48.8% in those with HbA(1c) < 7.5% (<58 mmol/mol) but without QTc prolongation. CONCLUSION/INTERPRETATIONS: HbA(1c) < 7.5% (<58 mmol/mol) in a high-risk population of patients with type 2 diabetes and foot ulcers is associated with a significantly higher mortality, particularly in patients with QTc prolongation

Treatment with oral anticoagulant drugs restrained from patients with atrial fibrillation : An assessment in a geographically well-defined catchment area

BACKGROUND: Atrial fibrillation (AF) affects about 3.2% of the adult population in the western world and incurs an annual stroke risk of 4.5%. The use of oral anticoagulant (OAC) drugs significantly reduces this risk. OAC drugs seem to be under-utilized, but little is known about why their use is restrained in routine clinical management. The aim of this study was to assess this issue and, from these data, to estimate the proportion of patients with AF in a general population who were eligible for treatment with OAC drugs.DESIGN: Retrospective study of medical records.METHODS: The study included all identified patients with AF in a well-defined catchment area of 65,532 people, among whom 1616 (3.2%) had documented AF. Of the patients with AF, 588 (36%) were originally reported not to be receiving OAC drugs. The patient-responsible physicians (n = 24) were requested to complete a standardized questionnaire to assess the reason for restraining the use of OAC drugs for each individual patient.RESULTS: Of the 588 patients originally reported not to be receiving OAC drugs, eight were shown to be using OAC drugs and seven were lost to follow up. Thus the reason for restraining OAC drugs was finally assessed in 573 patients. The primary reasons were: lack of indication, 26%; declined general condition, 14%; a history of bleeding, 12%; assumed poor compliance, 11%; repeated falls, 6%; and reason unknown, 9%.CONCLUSIONS: This is, to our knowledge, the first study to assess the reasons for restraining the use of OAC drugs in a geographically well-defined population including all hospital-based and non-hospital-based healthcare. Applying CHA2DS2-VASc and new strategies for OAC drugs to our study data indicated that between 72 and 88% of all patients with AF are eligible for treatment with OAC drugs