Efficacy of hyperbaric oxygen therapy for diabetic foot ulcer, a systematic review and meta-analysis of controlled clinical trials

• Published in: Scientific reports 2021-01, Vol.11 (1), p.2189-2189, Article 2189
• Main Authors: Sharma, Rakesh, Sharma, Suresh K., Mudgal, Shiv Kumar, Jelly, Prasuna, Thakur, Kalpana
• Format: Article
• Language: English
• Subjects: 631/80; 692/163; 692/308; Adverse events; Amputation; Amputation, Surgical; Clinical trials; Controlled Clinical Trials as Topic; Diabetes; Diabetes mellitus; Diabetic Foot - mortality; Diabetic Foot - pathology; Diabetic Foot - therapy; Feet; Foot diseases; Humanities and Social Sciences; Humans; Hyperbaric oxygen therapy; Hyperbaric Oxygenation - adverse effects; Leg ulcers; Meta-analysis; Mortality; multidisciplinary; Oxygen; Oxygen therapy; Publication Bias; Risk; Science; Science (multidisciplinary); Treatment Outcome; Ulcers; Wound Healing
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-81886-1

Studies have suggested that hyperbaric oxygen therapy (HBOT) is effective in the healing of diabetic foot ulcer (DFU); however, there is a lack of consensus. Therefore, to assess the efficacy of HBOT on diabetic foot ulcer among diabetic patients, controlled clinical trials were searched through PubMed, EMBASE, Clinical key, Ovid Discovery, ERMED, Clinical Trials.gov databases for randomized controlled trials (RCTs) and other sources until 15 September 2020. Studies that evaluated the effect of HBOT on diabetic foot ulcer, complete healing, amputation, adverse events, ulcer reduction area, and mortality rate were included. Of 1984 study records screened, 14 studies (768 participants) including twelve RCTs, and two CCTs were included as per inclusion criteria. The results with pooled analysis have shown that HBOT was significantly effective in complete healing of diabetic foot ulcer (OR = 0.29; 95% CI 0.14–0.61; I 2  = 62%) and reduction of major amputation (RR = 0.60; 95% CI 0.39–0.92; I 2  = 24%). Although, it was not effective for minor amputations (RR = 0.82; 95% CI 0.34–1.97; I 2  = 79%); however, less adverse events were reported in standard treatment group (RR = 1.68; 95% CI 1.07–2.65; I 2  = 0%). Nevertheless, reduction in mean percentage of ulcer area and mortality rate did not differ in HBOT and control groups. This review provides an evidence that hyperbaric oxygen therapy is effective as an adjunct treatment measure for the diabetes foot ulcers. These findings could be generalized cautiously by considering methodological flaws within all studies.