AN UPTO DATE REVIEW: IN SIGHTS OF DIABETIC WOUND HEALING
Main Article Content
Keywords
diabetes mellitus, diabetic wounds, hyperglycemia, impaired wound healing, pathophysiology.
Abstract
Diabetes mellitus is a chronic metabolic condition characterized by persistent hyperglycemia, which has a detrimental impact on long-term health. The prevalence of diabetes mellitus is increasing, leading to a rise in the number of individuals experiencing impaired wound healing associated with this condition. Diabetic wounds often result in lower limb amputations, causing significant financial burden. The healing of these wounds is particularly challenging due to the hyperglycemic environment that promotes the growth of biofilms. This review provides an overview of recent advancements in the understanding of the pathophysiology of diabetic wounds, with a focus on neuropathy, impaired angiogenesis, compromised barrier function, and subsequent polymicrobial infections. The elucidation of these mechanisms contributes to a better understanding of the complexities involved in diabetic wound healing. Furthermore, this review discusses current treatment approaches as well as potential future strategies aimed at addressing the diverse pathologies associated with diabetic wounds. By targeting specific aspects of the wound healing process, these interventions aim to promote more efficient and effective healing, ultimately reducing the need for amputations and improving patient outcomes. Given the alarming increase in the prevalence of diabetes, it is crucial to stay updated on the advancements in our understanding of diabetic wound pathophysiology and the development of novel therapeutic approaches. Continued research and innovation in this field hold promise for improving the management and outcomes of individuals with diabetic wounds, thus alleviating the burden associated with this debilitating complication.
References
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1. Prentki M, Nolan CJ. Islet β cell failure in type 2 diabetes. The Journal of clinical investigation. 2006;116(7):1802-12.
2. Atlas D. International Diabetes Federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2015. Eur Respir J. 2006;27:188-207.
3. Karri V, Gowthamarajan K, Satish Kumar M, Rajkumar M. Multiple biological actions of curcumin in the management of diabetic foot ulcer complications: a systematic review. Trop Med Surg. 2015;3(179):2.
4. Yagihashi S, Mizukami H, Sugimoto K. Mechanism of diabetic neuropathy: where are we now and where to go? Journal of diabetes investigation. 2011;2(1):18-32.
5. Kant V, Gopal A, Pathak NN, Kumar P, Tandan SK, Kumar D. Antioxidant and anti-inflammatory potential of curcumin accelerated the cutaneous wound healing in streptozotocin-induced diabetic rats. International immunopharmacology. 2014;20(2):322-30.
6. Lipsky BA, Berendt AR, Cornia PB, Pile JC, Peters EJ, Armstrong DG, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clinical infectious diseases. 2012;54(12):e132-e73.
7. Demidova-Rice TN, Durham JT, Herman IM. Wound healing angiogenesis: innovations and challenges in acute and chronic wound healing. Advances in wound care. 2012;1(1):17-22.
8. Ryckman C, Gilbert C, de Médicis R, Lussier A, Vandal K, Tessier PA. Monosodium urate monohydrate crystals induce the release of the proinflammatory protein S100A8/A9 from neutrophils. Journal of leukocyte biology. 2004;76(2):433-40.
9. Busso N, So A. Gout. Mechanisms of inflammation in gout. Arthritis research & therapy. 2010;12(2):1-8.
10. Wang F, Huang D, Zhu W, Li S, Yan M, Wei M, et al. Selective inhibition of PKCβ2 preserves cardiac function after myocardial infarction and is associated with improved angiogenesis of ischemic myocardium in diabetic rats. International journal of molecular medicine. 2013;32(5):1037-46.
11. Huang D, Wang F-B, Guo M, Li S, Yan M-L, Yu T, et al. Effect of combined treatment with rosuvastatin and protein kinase Cβ2 inhibitor on angiogenesis following myocardial infarction in diabetic rats. International Journal of Molecular Medicine. 2015;35(3):829-38.
12. Gray RD, Lucas CD, MacKellar A, Li F, Hiersemenzel K, Haslett C, et al. Activation of conventional protein kinase C (PKC) is critical in the generation of human neutrophil extracellular traps. Journal of inflammation. 2013;10(1):1-8.
13. Fadini GP, Menegazzo L, Rigato M, Scattolini V, Poncina N, Bruttocao A, et al. NETosis delays diabetic wound healing in mice and humans. Diabetes. 2016;65(4):1061-71.
14. Hanefeld M, Duetting E, Bramlage P. Cardiac implications of hypoglycaemia in patients with diabetes–a systematic review. Cardiovascular diabetology. 2013;12:1-11.
15. Deng L, Du C, Song P, Chen T, Rui S, Armstrong DG, et al. The role of oxidative stress and antioxidants in diabetic wound healing. Oxidative medicine and cellular longevity. 2021;2021.
16. Barker AR, Rosson GD, Dellon AL. Wound healing in denervated tissue. Annals of plastic surgery. 2006;57(3):339-42.
17. Azhar A, Basheer M, Abdelgawad MS, Roshdi H, Kamel MF. Prevalence of peripheral arterial disease in diabetic foot ulcer patients and its impact in limb salvage. The International Journal of Lower Extremity Wounds. 2021:15347346211027063.
18. Gazzaruso C, Gallotti P, Pujia A, Montalcini T, Giustina A, Coppola A. Predictors of healing, ulcer recurrence and persistence, amputation and mortality in type 2 diabetic patients with diabetic foot: a 10-year retrospective cohort study. Endocrine. 2021;71:59-68.
19. Iacopi E, Coppelli A, Goretti C, Bargellini I, Cicorelli A, Cioni R, et al. Effect of direct endovascular revascularization based on the angiosome model on risk of major amputations and life expectancy in type 2 diabetic patients with critical limb ischemia and foot ulceration. Journal of the American Podiatric Medical Association. 2021;111(4).
20. Caetano AP, Conde Vasco I, Veloso Gomes F, Costa NV, Luz JH, Spaepen E, et al. Successful revascularization has a significant impact on limb salvage rate and wound healing for patients with diabetic foot ulcers: single-centre retrospective analysis with a multidisciplinary approach. CardioVascular and Interventional Radiology. 2020;43:1449-59.
21. Alexandrescu V-A, Brochier S, Limgba A, Balthazar S, Khelifa H, De Vreese P, et al. Healing of diabetic neuroischemic foot wounds with vs without wound-targeted revascularization: preliminary observations from an 8-year prospective dual-center registry. Journal of Endovascular Therapy. 2020;27(1):20-30.
22. Los-Stegienta A, Katarzynska J, Borkowska A, Marcinek A, Cypryk K, Gebicki J. Differentiation of diabetic foot ulcers based on stimulation of myogenic oscillations by transient ischemia. Vascular Health and Risk Management. 2021:145-52.
23. Shareef AM, Ahmedani MY, Waris N. Strong association of anemia in people with diabetic foot ulcers (DFUs): Study from a specialist foot care center. Pakistan Journal of Medical Sciences. 2019;35(5):1216.
24. Olgun ME, Altuntaş SÇ, Sert M, Tetiker T. Anemia in patients with diabetic foot ulcer: effects on diabetic microvascular complications and related conditions. Endocrine, Metabolic & Immune Disorders-Drug Targets (Formerly Current Drug Targets-Immune, Endocrine & Metabolic Disorders). 2019;19(7):985-90.
25. Idris I, Tohid H, Muhammad NA, Rashid MRA, Ahad AM, Ali N, et al. Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study. BMJ open. 2018;8(12):e025125.
26. Alsayegh F, Waheedi M, Bayoud T, Al Hubail A, Al-Refaei F, Sharma P. Anemia in diabetes: experience of a single treatment center in Kuwait. Primary care diabetes. 2017;11(4):383-8.
27. Wright J, Oddy M, Richards T. Presence and characterisation of anaemia in diabetic foot ulceration. Anemia. 2014;2014.
28. Almoznino-Sarafian D, Shteinshnaider M, Tzur I, Bar-Chaim A, Iskhakov E, Berman S, et al. Anemia in diabetic patients at an internal medicine ward: clinical correlates and prognostic significance. European journal of internal medicine. 2010;21(2):91-6.
29. Yammine K, Hayek F, Assi C. Is there an association between anemia and diabetic foot ulcers? A systematic review and meta‐analysis. Wound Repair and Regeneration. 2021;29(3):432-42.
30. Boireau‐Adamezyk E, Baillet‐Guffroy A, Stamatas GN. The stratum corneum water content and natural moisturization factor composition evolve with age and depend on body site. Wiley Online Library; 2021.
31. Rigal A, Michael‐Jubeli R, Nkengne A, Baillet‐Guffroy A, Bigouret A, Tfayli A. Raman confocal microscopy and biophysics multiparametric characterization of the skin barrier evolution with age. Journal of Biophotonics. 2021;14(9):e202100107.
32. Park HY, Kim JH, Jung M, Chung CH, Hasham R, Park CS, et al. A long‐standing hyperglycaemic condition impairs skin barrier by accelerating skin ageing process. Experimental dermatology. 2011;20(12):969-74.
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Aug 12, 2023
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VISHESH KUMAR MAURYA, Shweta Rawat, Ravinder Pal Singh, Abhilasha Mittal, & Sanjesh Kumar. (2023). AN UPTO DATE REVIEW: IN SIGHTS OF DIABETIC WOUND HEALING. Journal of Population Therapeutics and Clinical Pharmacology, 30(16), 586–598. https://doi.org/10.53555/jptcp.v30i16.2143
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Author Biographies
VISHESH KUMAR MAURYA
Assistant Professor, Rakshpal Bahadur, College of Pharmacy, Near Doordarshan Kendra/ITBP, Badaun Road, Bareilly, India
Shweta Rawat
Department of Pharmacology, NIMS Institute of Pharmacy, NIMS University Rajasthan, Jaipur-303121
Ravinder Pal Singh
Department of Pharmaceutics, NIMS Institute of Pharmacy, NIMS University Rajasthan, Jaipur- 303121
Abhilasha Mittal
Department of Pharmaceutical Chemistry, NIMS Institute of Pharmacy, NIMS University Rajasthan, Jaipur-303121.
Sanjesh Kumar
Assistant Professor, Rakshpal Bahadur, College of Pharmacy, Near Doordarshan Kendra/ITBP, Badaun Road, Bareilly, India