Therahoney is NOT Contraindicated in T2DM—This is a Misconception
Honey-based wound dressings like Therahoney are explicitly contraindicated for diabetic foot ulcers regardless of diabetes type, but this is NOT because the patient has diabetes—it's because honey lacks evidence for improving wound healing outcomes and may delay appropriate care. 1
The Actual Contraindication
The International Working Group of the Diabetic Foot provides a strong recommendation against using honey or bee-related products for wound healing purposes in diabetic foot ulcers (Strong recommendation; Low certainty). 1 This contraindication applies to:
- All diabetic foot ulcers (not just T2DM specifically)
- Honey used for wound healing acceleration (not for infection control)
- Any bee-related topical products 1
Why Honey is Contraindicated in Diabetic Wounds
The contraindication exists because:
- Lack of evidence for healing benefit: Honey has not demonstrated improved wound healing outcomes in diabetic foot ulcers compared to standard care 1
- Delays appropriate treatment: Using honey may postpone evidence-based interventions that actually work (sharp debridement, proper offloading, moisture-retentive dressings) 1, 2
- Diverts from standard of care: The only debridement method with strong evidence is sharp debridement, and basic moisture-absorbing dressings are preferred over specialty products 2, 3
What Should Be Used Instead
For diabetic foot ulcers in T2DM patients, the evidence-based approach includes:
- Sharp debridement to remove necrotic tissue and callus (the only strongly supported method) 2, 3
- Simple moisture-absorbing dressings that maintain moist wound environment, selected based on exudate level 2
- Non-removable knee-high offloading devices for plantar ulcers 2, 3
- Avoid topical antiseptic/antimicrobial dressings unless treating active infection 1, 3
Common Misconception to Avoid
The critical pitfall is assuming honey is contraindicated because of the diabetes itself (e.g., concerns about sugar content affecting glycemic control). This is incorrect. The contraindication is based on lack of efficacy evidence for wound healing, not metabolic concerns. 1
If the wound shows insufficient improvement after 2 weeks of optimized standard care, consider evidence-based adjunctive therapies like sucrose-octasulfate dressings (for neuro-ischemic ulcers) or autologous leucocyte-platelet-fibrin patches—but never honey. 2, 3