Why Medihoney Is Not Recommended for Diabetic Foot Ulcers
The International Working Group on the Diabetic Foot (IWGDF) provides a strong recommendation against using honey or bee-related products, including Medihoney, for wound healing in diabetic foot ulcers due to low-quality evidence and lack of demonstrated benefit on critical outcomes. 1, 2
The Evidence Problem
The prohibition against honey-based dressings stems from fundamental flaws in the research base:
All clinical trials evaluating honey for diabetic foot ulcers were rated at moderate to high risk of bias, meaning the study designs were flawed and results cannot be trusted 1
No two studies evaluated the same honey product, creating significant heterogeneity that prevents drawing reliable conclusions about any specific formulation 1
Critical outcomes were not improved: Studies failed to demonstrate differences in amputation rates, mortality, quality of life, new infection rates, or resource utilization 1
While some older research suggested honey might shorten healing time 3, 4, these findings came from low-quality studies that the IWGDF deemed insufficient to support clinical use 1
Why Guidelines Prioritize Quality Over Promising Results
The 2024 IWGDF guidelines explicitly acknowledge that some trials showed "positive effects on wound healing" with honey, but the certainty of evidence was so low that any apparent benefits "should be interpreted cautiously" 1. This represents a critical distinction in evidence-based medicine: promising results from poorly designed studies cannot override the need for high-quality evidence when making treatment recommendations.
The guideline authors note that adherence to standard of care was unclear in many honey studies, and there was significant heterogeneity in ulcer types and patient populations studied 1. Without knowing whether patients received proper debridement, offloading, and infection control—the true cornerstones of diabetic foot ulcer management—any apparent benefit from honey cannot be attributed to the dressing itself.
What Actually Matters in Diabetic Foot Ulcer Management
Dressing selection should be based primarily on exudate control, comfort, and cost—not on claims of accelerated healing 2. The evidence hierarchy for diabetic foot ulcers prioritizes:
- Sharp debridement performed regularly based on clinical need 2, 5
- Proper offloading of the ulcer, which is more critical than any dressing choice 2
- Basic wound contact dressings (simple gauze or non-adherent dressings) that perform equally well as expensive specialized products 2
- Infection control when clinically indicated 1
The Cost-Effectiveness Concern
Beyond the quality-of-evidence issue, no cost-effectiveness data exists for honey-based products in diabetic foot ulcers 1. Given that basic wound contact dressings are equally effective and substantially less expensive 2, using honey products diverts resources without demonstrated benefit on patient-centered outcomes like amputation prevention or mortality reduction.
Common Pitfall to Avoid
Do not select dressings based on marketing claims about antimicrobial properties or accelerated healing—these have not been shown to improve outcomes in diabetic foot ulcers 2. The antimicrobial properties of honey, while real in laboratory settings, have not translated to clinically meaningful improvements in infection rates or healing in properly conducted trials 1.
When Standard Care Fails
For non-healing ulcers that show insufficient improvement with best standard care (including appropriate debridement and offloading), consider sucrose-octasulfate impregnated dressing for non-infected, neuro-ischemic ulcers (Conditional recommendation; Moderate certainty) 2, 6. This represents a second-line option with better-quality evidence than honey products.