In this blog, we discuss diabetic wounds, their causes, symptoms, and various treatment options to prevent severe health complications. We explain that diabetic wounds, also known as diabetic ulcers, are chronic sores frequently occurring in people with diabetes due to nerve damage and weakened immune systems. The blog covers traditional treatment methods for diabetic ulcers, including wound cleaning, debridement, dressing changes, offloading pressure, and antibiotic therapy. We also highlight the use of placental grafts, specifically Human Amnion/chorion Membrane (HAM) grafts, as a groundbreaking treatment option for diabetic ulcers. Lastly, we emphasize the importance of early detection and prompt treatment of diabetic wounds to reduce the risk of complications, such as infection, gangrene, and amputation, and improve patients' overall quality of life.
Learn about the factors causing diabetic wounds, their causes and symptoms, and various treatment options to prevent serious health conditions
[1]. According to Elaine Stritch, "Trying to manage diabetes is hard because if you don't, there are consequences you'll have to deal with later in life."
Diabetic wounds—also termed diabetic ulcers—are chronic sores frequently occurring in people with diabetes due to nerve damage (diabetic neuropathy) and debilitated immune systems. According to the American Pediatric Medical Association, about 15% of patients with diabetes develop a foot ulcer during their lifetime [2]. These wounds or ulcers primarily impact the feet and lower extremities, making walking or standing hard for the affected patients. As a result, their overall quality of life is adversely affected [3].
The formation of diabetic ulcers can be attributed to a combination of many factors. Poor blood circulation —a typical issue in diabetic patients—results from high sugar levels in the blood that damage blood vessels and reduce blood flow to the extremities [4][5]. Consequently, a limited blood supply impairs the body's natural wound-healing process, making it hard for wounds to close and heal appropriately.
Figure 1: Different grades of diabetes ulcers.
Neuropathy—or nerve damage—is another significant factor contributing to developing diabetic ulcers [6]. High blood sugar levels can harm nerves—particularly in the feet—leading to a loss of sensation. As a result, patients may not notice any minor injuries, which can subsequently develop into ulcers. In addition, increased pressure on certain body areas, such as pressure points or bony prominences, can cause the skin to split and create non-healing ulcers. This situation is further exacerbated by the inability of the weakened immune system to repel infections in these open wounds essentially [7].
The symptoms of diabetic wounds can vary depending on their severity and location. However, there are some typical signs that patients and healthcare professionals should know to identify and tackle these wounds promptly. According to the World Health Organization (WHO), over 422 million people worldwide have diabetes, with diabetic foot ulcers as a major complication affecting them [8].
Persistent pain or discomfort in the affected body areas is one of the major symptoms of diabetic ulcers. The pain severity can range from mild to debilitating, making it hard for the patient to walk or stand. Other typical signs of diabetic ulcers include swelling, redness, and warmth around the wound, which may signify inflammation or infection.
Another sign of diabetic ulcers is a foul-smelling discharge from the wound, which indicates the presence of bacteria or other pathogens. In a study published in the Journal of Diabetes and Its Complications, the authors reported that more than 50% of diabetic foot ulcers might be infected [9]. Therefore, any signs of infection, such as pus, enhanced redness, and a foul odor, must be taken seriously and tackled promptly by a healthcare professional.
Figure 2: Diabetes can have severe effects on various body functions.
In many severe cases, patients may experience numbness or tingling sensations in the impacted body region, which could indicate nerve damage or worsening of the ulcer. These sensory variations can be particularly concerning, as they can make it challenging for the patient to feel pain or other injury signs, increasing the risk of creating more severe ulcers.
By knowing the symptoms and signs of diabetic wounds, patients with diabetes and their caregivers can work together to specify and treat these ulcers at an early stage, thereby reducing the risk of complications and improving patient outcomes.
Managing diabetic wounds is multifaceted, focusing on eliminating infection, promoting healing, and preventing further complications. A study published in the International Wound Journal revealed that 34.6% of patients with diabetes would develop a diabetic foot ulcer during their lifetime, emphasizing the significance of effective treatment plans [10].
Traditionally, wound cleaning is a critical first step in treating diabetic wounds. The process involves the elimination of debris and contaminants from the wound bed by utilizing saline solution or wound cleansers with antimicrobial properties. In addition, regular wound cleaning helps minimize the infection risk and reinforces the body's natural healing processes.
Figure 3: Diabetes treatment plan.
Debridement—removing dead, damaged, or infected tissues from the wound bed—is another essential step of the diabetic wound management process. A study in the Journal of the American Podiatric Medical Association states that sharp debridement is the most effective method for accelerating wound healing and reducing infection risks [11]. Other debridement methods include enzymatic, autolytic, and mechanical techniques, which can be chosen based on the patient's and the wound's specific requirements.
Furthermore, dressing changes and offloading pressure from the wounded area are vital in treating diabetic ulcers. Dressing materials—such as hydrocolloid, hydrogel, alginate, or foam dressings—maintain a moist environment and protect the wound from any external contaminants. A study published in Advances in Wound Care demonstrated that diabetic ulcers treated with moist dressings had a significantly higher healing rate than those treated with traditional dry dressings.
Offloading pressure from the ulcer is imperative to prevent further tissue damage and support the healing process. It can be accomplished through specialized footwear, orthotic devices, or total contact casting. A Cochrane Review illustrated that offloading interventions substantially improved ulcer healing rates in patients with diabetes [12].
Healthcare professionals prescribe antibiotics to treat any underlying infection, which is particularly important in managing diabetic wounds, as conditions can lead to severe complications. Typically, the choice of antibiotic is guided by the specific pathogens identified through wound cultures and customized to the individual patient's requirements and other health conditions.
Traditional treatments for diabetic ulcers involve a comprehensive approach, including wound cleaning, debridement, dressing changes, offloading pressure, and antibiotic therapy if necessary. These techniques, supported by robust medical evidence, improve patient outcomes and minimize the risk of advanced complications associated with diabetic wounds.
Placental grafts—particularly those derived from Human Amnion/chorion Membrane (HAM)—have emerged as a groundbreaking treatment option for diabetic ulcers. According to a study published in the International Wound Journal, HAM grafts have shown significant clinical improvements in the healing process of diabetic ulcers compared to standard wound care treatment [13].
Figure 4: Treatment of diabetes with Placental grafts.
Placental grafts contain a rich array of biologically active growth factors, such as Vascular Endothelial Growth Factor (VEGF), Platelet-Derived Growth Factor (PDGF), and Epidermal Growth Factor (EGF), which are significant in promoting wound healing. Moreover, HAM grafts also contain important regulatory factors that stimulate the migration, proliferation, and cytokine expression of diabetic adipose-derived stem cells, thereby accelerating the healing process.
Using placental grafts in diabetic wound management provides several benefits. For example, in a randomized controlled trial published in Wound Repair & Regeneration, patients treated with HAM grafts experienced a 62% wound closure rate within 12 weeks, compared to a 32% closure rate in the control group receiving standard wound care treatment. This substantial improvement underscores the massive potential of placental grafts as an effective treatment option for diabetic ulcers.
Moreover, applying placental grafts in diabetic wound treatment has reduced the risk of advanced complications, such as infection and amputation. By facilitating quicker wound closure and cultivating a healthier wound environment, placental grafts can improve patient outcomes and better life quality for patients with diabetic wounds.
In conclusion, placental grafts, particularly those derived from HAM, have demonstrated promising results in managing diabetic wounds. Substantiated by robust scientific evidence, these innovative grafts can substantially accelerate wound healing and minimize the complication risks, making them a significant addition to the treatment options available for diabetic patients.
Untreated diabetic wounds can have dire consequences, leading to severe complications such as infection, gangrene, and amputation. According to the World Health Organization, diabetic foot ulcers precede more than 80% of non-traumatic lower extremity amputations among diabetic patients. This alarming statistic underscores the significance of early detection and appropriate treatment of diabetic ulcers to prevent such outcomes [14].
Figure 5: Complications due to diabetes.
In some cases, these complications might even become life-threatening. For example, untreated infections can spread throughout the body, leading to severe and potentially fatal sepsis. Furthermore, the longer a diabetic wound remains untreated, the higher the risk of developing serious health conditions that can significantly affect an individual's life quality.
The Centers for Disease Control and Prevention (CDC) estimates that in the United States alone, approximately 108,000 non-traumatic lower-limb amputations were conducted on adult patients with diagnosed diabetes in 2014. It signifies the critical necessity for timely intervention and comprehensive wound care management to reduce the risk of amputation and other complications from untreated diabetic ulcers.
Neglecting to treat diabetic ulcers might have severe consequences, ranging from infection and gangrene to amputation and even life-threatening situations. Therefore, early detection and prompt treatment are vital in preventing these patient outcomes and ensuring the best possible quality of life for individuals with diabetes.
When diabetic ulcers receive prompt and effective treatment, patients can expect significant improvement in wound healing rates and a reduced risk of complications. Research indicates that comprehensive care can reduce lower-extremity amputations among patients with diabetes by 45% to 85%. It demonstrates the significant impact of appropriate treatment on preventing infection, minimizing the risks of amputation, and ultimately improving the overall quality of life for diabetic patients. Therefore, diabetes patients must remain proactive in their wound care management [15].
Regularly monitoring their feet, retaining good blood sugar control, and seeking medical support at the first sign of a developing wound or ulcer can significantly improve healing outcomes. As a result, patients can savor an improved quality of life, better mobility, and a lower risk of experiencing serious complications originating from untreated diabetic ulcers.
In conclusion, proper treatment of diabetic wounds can lead to improved healing, reduced risks of infection and amputation, and better quality of life for diabetic patients. In addition, by remaining proactive in their self-care and seeking medical help, patients can significantly enhance their overall well-being and reduce the adverse effects of diabetic ulcers on their lives.
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