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Effectiveness of Topical Insulin Dressings in Management of Diabetic Foot Ulcers

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A Correction to this article was published on 10 April 2020

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Abstract

Background

Infected diabetic foot ulcers are always a problem for the surgeon, as well as, an economic burden upon the patient and state, in terms of increased hospital stay and cost of medications and dressings. Various methods have been devised for the treatment of infected wounds in history with varying results in different patients groups. The purpose of this study is to compare the effectiveness of topical insulin on the healing of diabetic foot ulcers with the conventional Pyodine® povidone iodine dressing. Our objective was to compare effectiveness of topical insulin with conventional Pyodine® povidone iodine dressings in frequency of healing of diabetic foot ulcers.

Materials and Methods

It was a quasi-experimental study done at Pakistan Institute of Medical Sciences Islamabad over a period of 20 months from January 2015 to September 2016. One hundred ten patients were included in the study. Sampling technique used was non-probability consecutive. Patients were assigned into two groups, group A receiving treatment with solution of 30 International Units Insulin Regular in 30 ml of normal saline and group B receiving conventional dressing with normal saline. The wound were compared for both groups at the days 7, 14 and 21 for wound healing. Complete healing time of diabetic foot ulcers was determined from patients’ followup visits in outpatient department. Data was by analyzed by SPSS 20.

Results

A total of 110 patients were enrolled in the study. Patients were divided equally into both control and experimental groups. The mean age of the patients was 53.23 ± 6.21 years. The mean pre-treatment wound diameter was 4.81 ± 0.85 cm in the placebo group, while it was 4.84 ± 0.81 cm in the topical insulin group (CI 0.29–0.35, P = 0.875). The mean post-treatment wound diameter was 3.90 ± 0.76 cm in the placebo group, while it was 2.46 ± 0.57 cm in the topical insulin group (CI 0.44–0.58, P = 0.022). The mean wound difference was 0.91 ± 0.25 cm in the placebo group, while it was 2.4 ± 0.34 cm in the topical insulin group (CI 0.40–0.20, P = 0.041). The mean percent reduction in wound diameter was 19.2 ± 4.6% in the placebo group, while it was 49.7 ± 5.2% cm in the topical insulin group (CI 10.6–6.1, P = 0.001).

Conclusion

There was significant contraction seen in the size of the ulcer in both the study groups depicting the healing process.

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Change history

  • 10 April 2020

    In the original article, Mehreen K. Bhettani’s last name and Mubarik Rehman’s first name are misspelled.

References

  1. Kharroubi AT, Darwish HM (2015) Diabetes mellitus: the epidemic of the century. World J Diabetes 6(6):850–867

    Article  Google Scholar 

  2. Ramarao K, Ramu L (2017) Comparative study between the effect of topical insulin and normal saline dressing in healing of diabetic foot ulcers. Int J Contemp Med Res 4(6):1337–1339

    Google Scholar 

  3. American Diabetes Association (2009) Diagnosis and classification of diabetes mellitus. Diabetes Care 32(Suppl 1):62–67. https://doi.org/10.2337/dc09-s062

    Article  Google Scholar 

  4. Dowd SE, Wolcott RD, Sun Y, McKeehan T, Smith E, Rhoads D (2008) Polymicrobial nature of chronic diabetic foot ulcer biofilm infections determined using bacterial tag encoded FLX amplicon pyrosequencing (bTEFAP). PLoS ONE 3(10):e3326. https://doi.org/10.1371/journal.pone.0003326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M (2012) Prediabetes: a high-risk state for diabetes development. The Lancet 379:2279–2290

    Article  Google Scholar 

  6. Lima MH, Caricilli AM, de Abreu LL et al (2012) Topical insulin accelerates wound healing in diabetes by enhancing the AKT and ERK pathways: a double-blind placebo-controlled clinical trial. PLoS ONE 7(5):e36974

    Article  CAS  Google Scholar 

  7. Emanuelli T, Burgeiro A, Carvalho E (2016) Effects of insulin on the skin: possible healing benefits for diabetic foot ulcers. Arch Dermatol Res 308(10):677–694

    Article  CAS  Google Scholar 

  8. Apikoglu-Rabus S, Izzettin FV, Turan P, Ercan F (2009) Effect of topical insulin on cutaneous wound healing in rats with or without acute diabetes. Clin Exp Dermatol 35:180–185

    Article  Google Scholar 

  9. Wilson JM, Baines R, Babu ED, Kelley CJ (2008) A role for topical insulin in the management problematic surgical wounds. Ann R Coll Surg Engl 90:160. https://doi.org/10.1308/003588408x261816

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Rezvani O, Shabbak E, Aslani A, Bidar R, Jafari M et al (2009) A randomized, double-blind, placebo-controlled trial to determine the effects of topical insulin on wound healing. Ostomy Wound Manag 55:22–28

    Google Scholar 

  11. Salahuddin O, Azhar M, Imtiaz A, Latif M (2013) A developing world experience with distal foot amputations for diabetic limb salvage. Diabet Foot Ankle. https://doi.org/10.3402/dfa.v4i0.22477

    Article  PubMed  PubMed Central  Google Scholar 

  12. Whiting DR, Guariguata L, Weil C, Shaw J (2011) IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 94:311–321

    Article  Google Scholar 

  13. Santos VP, Silveiria DR, Caffaro RA (2006) Risk factors for primary major amputations in diabetic patients. Sao Paulo Med J 124:66–70

    Article  Google Scholar 

  14. Goenka G, Athavale VS, Nirhale DS, Deshpande N, Agrawal K, Calcuttawala M (2014) Role of topical use of insulin in healing of chronic ulcer. Med J Dr DY Patil Univ 7(5):579–583

    Article  Google Scholar 

  15. Sureshbabu A, Okajima H, Yamanaka D, Shastri S, Tonner E, Rae C et al (2009) IGFBP-5 induces epithelial and fi broblast responses consistent with the fibrotic response. Biochem Soc Trans 37:882–885

    Article  CAS  Google Scholar 

  16. Stephen S, Agnihotri M, Kaur S (2016) A randomized, controlled trial to assess the effect of topical insulin versus normal saline in pressure ulcer healing. Ostomy Wound Manag 62(6):16–23

    Google Scholar 

  17. Kanth S, Bhat PR (2011) Wound dressing—topical insulin. J SWCR 4:11–14

    Google Scholar 

  18. Swaminathan R (2014) Effectiveness of topical insulin in management of chronic diabetic foot ulcers. Indian J Basic Appl Med Res 3(3):455–459

    Google Scholar 

  19. Zhang XJ, Wu X, Wolf SE, Hawkins HK, Chinkes DL, Wolfe RR (2007) How local insulin-zinc injection accelerates skin donor site wound healing? J Surg Res 14(2):90–96

    Article  Google Scholar 

  20. Zhang Z, Lv L (2016) Effect of local insulin injection on wound vascularization in patients with diabetic foot ulcer. Exp Ther Med 11(2):397–402. https://doi.org/10.3892/etm.2015.2917

    Article  CAS  PubMed  Google Scholar 

  21. Scherer SS, Tobalem M, Vigato E et al (2012) Nonactivated versus thrombin-activated platelets on wound healing and fibroblast- to-myofibroblast differentiation in vivo and in vitro. Plast Reconstr Surg 129:46e–54e

    Article  Google Scholar 

  22. Praveen JRA, Kumar PN (2017) Topical application of insulin in the diabetic wound ulcer of foot and its comparison with regular normal saline dressing. J Evol Med Dent Sci 6(95):7020–7025. https://doi.org/10.14260/jemds/2017/1523

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Pakistan Institute of Medical Sciences, Islamabad, 44000, Pakistan

    Mehreen K. Bhittani

  2. Shifa College of Medicine, Shifa Tameer-e-Millat University, Pitrus Bokhari Road H-8/4, Islamabad, 44000, Pakistan

    Mubarak Rehman & Humera N. Altaf

  3. Tehsil Headquarter Hospital Hazro, Hazro Tehsil, Attock District, 43440, Pakistan

    Omar S. Altaf

Authors
  1. Mehreen K. Bhittani
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  2. Mubarak Rehman
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  3. Humera N. Altaf
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  4. Omar S. Altaf
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Correspondence to Humera N. Altaf.

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Bhittani, M.K., Rehman, M., Altaf, H.N. et al. Effectiveness of Topical Insulin Dressings in Management of Diabetic Foot Ulcers. World J Surg 44, 2028–2033 (2020). https://doi.org/10.1007/s00268-019-05321-3

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