Is insulin dressing effective for treating bedsores (pressure ulcers)?

Insulin Dressings for Bedsore Treatment

Topical insulin dressings are effective for treating pressure ulcers (bedsores) compared to normal saline dressings, showing significant reduction in wound size and improved healing scores. 1

Evidence for Insulin Dressings in Pressure Ulcer Treatment

• A randomized controlled trial demonstrated that topical insulin (1 U/cm² wound area) applied twice daily for 7 days significantly reduced pressure ulcer size from 9.61 cm² to 6.24 cm² compared to minimal change in the saline group (11.79 cm² to 11.43 cm²) 1
• Pressure Ulcer Scale for Healing (PUSH) scores improved significantly in the insulin treatment group (from 10.28 to 8.52) compared to minimal improvement in the saline control group (10.52 to 10.36) 1
• Insulin complexed with hydroxypropyl-beta-cyclodextrin (HPβCD) in gel form showed promising results in clinical studies for wound healing in patients with pressure ulcers 2
• No significant decrease in blood glucose levels was observed before and after insulin application, indicating the safety of topical insulin treatment 1

Standard Treatment Options for Pressure Ulcers

• The American College of Physicians (ACP) recommends hydrocolloid dressings for reducing wound size in pressure ulcers (weak recommendation, low-quality evidence) 3, 4
• Hydrocolloid dressings are superior to gauze dressings for reducing wound size and equivalent to foam dressings for complete wound healing 5, 4
• Protein or amino acid supplementation is recommended to reduce wound size (weak recommendation, low-quality evidence) 4, 5
• Electrical stimulation is recommended as adjunctive therapy to accelerate wound healing (weak recommendation, moderate-quality evidence) 4, 5

Treatment Algorithm for Pressure Ulcers

1. Initial wound management:

   • Clean the wound regularly with water or saline 4
   • Control exudate to maintain a moist wound environment 4
   • Regular debridement of non-viable tissue 4, 6

2. Dressing selection:

   • For standard care: Use hydrocolloid or foam dressings (established options with moderate evidence) 3, 5
   • For enhanced healing: Consider topical insulin dressings (1 U/cm² wound area) applied twice daily 1
   • For wounds with heavy exudate: Use appropriate absorbent dressings to control moisture 4

3. Adjunctive therapies:

   • Provide nutritional supplementation with protein or amino acids 4, 5
   • Consider electrical stimulation therapy to accelerate healing (use with caution in frail elderly patients) 4, 5
   • For severe ulcers, platelet-derived growth factor may improve healing compared to placebo 5

Considerations and Precautions

• Insulin dressings were studied in patients without diabetes mellitus, immunodeficiency, pregnancy, osteomyelitis, or peripheral vascular illness 1
• Monitor blood glucose levels when using topical insulin (10 minutes before and 1 hour after application) to ensure safety, although studies show no significant changes in glucose levels 1
• The most common adverse effects for local wound applications include skin irritation, inflammation, tissue damage, and maceration 5
• Frail elderly patients may be more susceptible to adverse events associated with electrical stimulation 5

Limitations of Current Evidence

• The Cochrane review of dressings for pressure ulcers found that most evidence is of low or very low certainty due to risk of bias and imprecision 7
• Many studies assess reduction in wound size or rate of healing rather than complete wound healing 4
• The relationship between reduction in wound size and eventual complete healing has not been well-defined 4, 5
• While insulin dressings show promise, larger studies with longer follow-up periods are needed to establish their long-term efficacy 1