Introduction
According to Haryanto et al., (2016), in 2013, about 415 million people in the world had diabetes. The report by Haryanto et al., (2016) also projected that by 2035 about 595 million individuals in the world would have diabetes. Researchers have indicated that diabetes affects people from both developed and developing countries. This finding is supported by the data from the center for disease control and prevention (CDC), which indicated that approximately 29.1 million (9.3%) U.S population is diabetic (2014). The report also noted that diabetes was common among individuals who were aged 20 years and above. Nevertheless, people who were above the age of 65 were found to be prone to diabetes. Among this category of individuals, men (25.9%) were more likely to develop diabetes (CDC, 2014). Haryanto et al., (2016) reported that about 15-25% of diabetic patients would end up developing foot ulcers at some point.
Typically, foot ulceration is common among diabetic patients. If a patient has diabetes, wound healing is a slow process, and the condition may even get worse. This implies that for such patients it is important for medics to monitor patients’ wounds closely. Haryanto et al., (2016), defined wound healing as changes that takes place around a wounded area. Various factors can affect the healing the healing process of wounds. These are fibroblast dysfunction, immune system deficiency, and hypoxia among others. First, t his paper will discuss the effect of systemic insulin in regards to diabetic foot ulcer. Second, it will elaborate the impact that combining cell therapy has on non-healing wounds among diabetic patient with PAD. Finally, this article will discuss the role that maceration plays on wound healing in pertinent to diabetic foot ulcer.
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Vatankhah et al., (2017) carried out a study to examine the effects of insulin on the wound healing process among diabetic patients who have developed foot ulceration. The study used 85 participants who were seeking treatment for diabetic foot ulcer in a vascular surgery clinic. The researchers collected the participants regarding medical history, present medication, imaging data and characteristics of the foot ulcers from the medical records of the patients. The patients’ data was collected and recorded the prescriptions given by the physicians in the primary care. The outcomes from the study were categorized into four groups namely wound healing, chronic wounds, minor or major amputations. Chi and Fischer's tests were used to analyze the collected data. Besides, the researchers used a both the univariate and multivariate regression models to examine the relationship between insulin treatments and wound healing among diabetic patients with foot ulcers. The results of the study indicated that twenty (30.3%) patients who were provided with insulin therapy fully recovered when compared to four (9.8%) who were under oral medication or those who were not provided with diabetic treatment (p=0.013). This result shows that insulin treatment influences the wound healing process positively among diabetic individuals. Various medications that are used in lowering the levels of plasma glucose can help in hastening the process of wound healing since they contribute to reducing the rates of inflammation thereby promoting healing. Nevertheless, those medications that are orally taken may have little effects when compared to the ones that are directly introduced into the circulatory system. As such, systemic insulin therapy has the potential of enhancing the wound healing process among diabetic patients who have developed foot ulcerations. Besides, studies have also indicated that a combination of cell therapy plays a role in healing non-healing wounds among diabetic patients with peripheral arterial disease (PAD).
Viswannathan et al., (2013) carried out research to establish the role that combining cell therapy have in non-healing wounds among diabetic patients diagnosed with peripheral arterial disease (PAD). Precisely, the study examined the impact that combining allogeneic stem cells (UCMSC+CD34+) among diabetic patients with PAD. Besides, the article aimed at evaluating the effects that neonatal fibroblasts had on non-healing wounds when applied directly. The study used five diabetic patients who had been diagnosed with severe PAD. Notably, the only option that had been left for these patients was amputation. The patients were injected with mesenchymal stem cells that had been derived from the Umbilical Cord Matrix (UCMSC) as well as the Haematopoietic Stem Cells (HSCs CD34+). Blood from the human umbilical cord was used to source the HSCs CD34+ that were employed in the experiment. Both the UCMSC and HSCs CD34+) were injected into the lower limbs of the affected participants. On the other hand, allogeneic neonatal fibroblasts were applied directly on the non-healing wounds in diabetic foot ulcers. The researchers calculated the ankle brachial indices (ABI) before and after the initiation of the procedure. In addition, wound closure, scores in pain improvement, and prevention of amputation were used as the indicators of success. The results from ABI measurements showed that there was a significant improvement 0.2 to 0.45 with no instances of limb amputation. It was also apparent that the wounds healed completely after three months among the participants. Besides, there were no cases of ulcers reoccurrence during this time. Fourteen months after the process, one of the patients voluntarily reported a sustained improvement. There was also a reduction in pain as per the results of this study. Concisely, these results indicate that combining cell therapy aids in preventing limb loss among patients with severe PAD and non-healing wounds. Researchers have also suggested that maceration plays a role in determining the rate of healing among diabetic patients who are victims of foot ulcers.
Haryanto et al., (2016), conducted a study to establish the correlation between maceration and wound healing. The study used a prospective cohort design. The study was conducted among patients who were diagnosed with diabetes mellitus type 2. Notably, these were patients who had sought medical attention at Kitamura Wound Care Clinic for their medical conditions. The researchers used a probability sample technique to ensure that all the patients have equal chances of participating in the study. Besides, the researchers ensured that the participants met their inclusion criteria. As such, the participants were supposed to be over 21 years of age and must have been diagnosed with diabetes mellitus type 2 adhering to the 2013 guidelines provided in American Diabetes Association . Essentially, the researchers compiled with research ethics by informing the patients and their family members about their intentions prior to starting their research. Sixty-two participants (70 wounds) were used in this research. Their wounds were grouped into two categories namely non-maceration (52) and Maceration (18). The groups were examined weekly. In week two, three, and four, two, six, and two wounds were healed in the non-maceration category of patients respectively. Under the maceration category, only one wound was healed among the patients. In conclusion, this data showed that there is a correlation between maceration and wound healing. It is apparent that non-macerated wounds healed faster compared to macerated wounds. Maceration delays the healing process and makes the wound to enlarge.
In conclusion, this paper has shown that there are three ways in which wound healing process among diabetic patients can be enhanced. First, this article has indicated that administration of systematic injection of insulin among diabetic patients with foot ulcers would help in improving the healing process. Secondly, the paper has demonstrated that combining cell therapy aids in preventing limb loss among patients with severe PAD and non-healing wounds . Finally, this report has indicated that non-macerated of diabetic foot ulcers healed faster when compared to macerated wounds.
References
Centers for Disease Control and Prevention (2014). National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014 . Atlanta, GA: U.S. Department of Health and Human Services.
Haryanto, H., Arisandi, D., Suriadi, S., Imran, I., Ogai, K., Sanada, H., Okuwa, M., & Sugama. J. (2016). Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study . Int Wound J 2016; doi: 10.1111/iwj.12638
Vatankhah, N., Jahangiri, Y., Landry, G.J., Moneta, G.L. & Azarbal, A.F. (2017). Wound Repair and Regeneration.
Viswannathan, C. et al. (2013). Role of combination cell therapy in non-healing diabetic ulcers in patients with servere peripheral arterial disease- a preliminary report on five cases. The journal of diabetic Foot complications , 5(1):1-14.
