What is the treatment for diabetic foot ulcers?

From the Guidelines

The treatment for diabetic foot ulcers should prioritize sharp debridement, basic wound dressings, and offloading, with consideration of adjunctive treatments such as sucrose-octasulfate impregnated dressings or hyperbaric oxygen therapy in specific situations, as recommended by the most recent guidelines 1.

Key Components of Treatment

• Sharp debridement to remove dead tissue, as it is preferred over other methods 1
• Basic wound dressings to absorb exudate and maintain a moist wound healing environment, with selection based on exudate control, comfort, and cost 1
• Offloading to reduce pressure on the wound, which is crucial for healing, particularly in neuropathic ulcers 1

Adjunctive Treatments

• Consideration of sucrose-octasulfate impregnated dressings for non-infected, neuro-ischaemic diabetic foot ulcers that have had insufficient change in ulcer area with best standard of care, including appropriate off-loading for at least 2 weeks 1
• Hyperbaric oxygen therapy as an adjunctive treatment in neuro-ischaemic or ischaemic diabetes-related foot ulcers where standard of care alone has failed and resources exist to support this intervention 1

Infection Control and Blood Sugar Management

• Antibiotics for infected ulcers, with oral options including amoxicillin-clavulanate, clindamycin, or trimethoprim-sulfamethoxazole, and intravenous antibiotics for severe infections
• Blood glucose management to maintain levels between 80-130 mg/dL before meals and below 180 mg/dL after meals

Important Considerations

• Regular vascular assessment to identify patients who may need revascularization procedures
• A collaborative team approach, including different specialties and an engaged and empowered patient, to effectively manage diabetic foot ulcers 1

From the FDA Drug Label

REGRANEX is indicated for the treatment of lower extremity diabetic neuropathic ulcers that extend into the subcutaneous tissue or beyond and have an adequate blood supply, when used as an adjunct to, and not a substitute for, good ulcer care practices including initial sharp debridement, pressure relief and infection control REGRANEX is a prescription medicine that is used with good ulcer care practice for the treatment of diabetic sores (ulcers) of your legs or feet that are deeper than just your skin, in people who have good blood supply to the legs and feet.

The treatment for diabetic foot ulcers is REGRANEX (becaplermin), which is used as an adjunct to good ulcer care practices, including:

• Initial sharp debridement
• Pressure relief
• Infection control
• Non-weight-bearing regimen
• Moist saline dressings changed twice a day
• Additional debridement as necessary

Key points:

• REGRANEX is used for diabetic neuropathic ulcers that extend into the subcutaneous tissue or beyond
• It is not intended to be used in wounds that close by primary intention
• The efficacy of REGRANEX has not been established for the treatment of pressure ulcers and venous stasis ulcers
• REGRANEX should be used with caution in patients with cancer, as it may increase the risk of cancer 2

From the Research

Treatment for Diabetic Foot Ulcers

The treatment for diabetic foot ulcers involves a multidisciplinary approach, including:

• Assessing the ulcer grade classification
• Surgical debridement
• Dressing to facilitate wound healing
• Off-loading
• Vascular assessment and possible interventional vascular correction
• Infection and glycemic control 3
• Pressure relief
• Debridement
• Infection management
• Revascularization when indicated 4

Standard Care and Adjunctive Therapies

Standard care for diabetic foot ulcers includes:

• Off-loading
• Debridement
• Infection control
• Adequate perfusion Adjunctive therapies that may be used in addition to standard care include:
• Negative pressure wound therapy
• Hyperbaric oxygen therapy
• Bioengineered skin substitutes
• Growth factors
• Shockwave therapy 4, 5

Role of Antibiotics

Antibiotics are only required for clinically infected wounds, not for uninfected ulcers 6. The use of antibiotics should be judicious and based on the presence of infection, as overuse can lead to antibiotic resistance.

Evidence-Based Treatment Update

Recent evidence-based evaluations of diabetic foot ulcer therapies suggest that:

• Multidisciplinary management, patient education, glucose control, debridement, offloading, infection control, and adequate perfusion are the mainstays of standard care
• Adjunctive therapies, such as negative pressure wound therapy and bioengineered skin substitutes, may be useful in certain cases, but the evidence is limited 5
• Newer wound care therapies, such as advanced dressings, off-loading shoes, and bioengineered skin constructs, may also be effective in reducing healing times 7