2015 Reflection: Diabetic Foot Ulcer Treatments and Trends
by Michel H.E. Hermans, MD
At the beginning of a new year, many look back at the previous one in an attempt to analyze what happened, whether it was good or bad or perhaps even special.
Wound Care Advancements in Thinking
From a chronic or acute wound healing point of view, 2015 was not particularly special. Yes, a number of new dressings and techniques were launched at the different conferences, but none of them really established a breakthrough with regard to new clinical data or a totally new approach to many of the still unsolved problems that exist in healing wounds.
For example, there was no breakthrough on biofilm treatment (though it is better recognized now that prevention through proper debridement plays a key role) or on the problem of infections in general. Sadly, trials with an initially quite promising new compound for the treatment of diabetic foot ulcers were discontinued. During the phase I and II trials, the compound generated a great deal of interest, but it seems that positive results could not be repeated at the phase III level.
One positive thing about the year was the fact that wound debridement is (finally) recognized as, perhaps, the most crucial step in topical wound treatment, as reflected in the DIME acronym (where the "D" stands for debridement) versus the TIME acronym (where the "T" stands for tissue).
Another piece of very good news was the announcement by the Centers for Disease Control and Prevention (CDC) that the number of new diabetes mellitus cases in the US has decreased over the last couple of years.
Forecast: Diabetes and Foot Ulcer Prevention
From 1991 to 2009, the number of new cases in people between 18 and 80 years old grew more than threefold to more than 1.7 million. However, from 2009 to 2014, the number of new cases decreased significantly to approximately 1.4 million new cases per year. One of the reasons quoted in the CDC report is decreased sugar intake and, perhaps, a stabilization of weight increase and the percentage of obese Americans. Indeed, a 10-year study in Diabetoligia (July 2015, Issue 7) by O’Connor et al. showed that, in the United Kingdom, substituting one serving per day of water or unsweetened tea/coffee for soft drinks and for sweetened-milk beverages reduced the incidence of developing diabetes by 14-25%. If sweet beverage consumers reduced sugar intake to below 2% of their total energy intake, 15% of incident diabetes might be prevented.
If sugar consumption could be limited, other life style changes could be implemented, and a country wide foot ulcer prevention program could be started (as exists in some other modern countries), the prevalence and incidence of diabetic foot ulcers could no doubt be lowered dramatically. The morbidity and mortality related to diabetic foot ulcers could also be lowered as well. This would be a very positive development for 2016 and the following years.
On the treatment of diabetic foot ulcers, a new approach using a specific MMP-9 inhibitor in a diabetic mice model was very encouraging and the compound is now being trialed in humans.
Who knows whether this is a breakthrough and who knows what 2016 will bring (after all, the world is in turmoil) but, perhaps and hopefully, the outlook for better wound care is positive.
I wish you a good and healthy 2016.
About the Author
Michel H.E. Hermans, MD, is an expert in wound care and related topics, trained in general surgery, trauma care and burn care in the Netherlands. He has more than 25 years of senior management experience in the wound care industry. He has conducted a large number of clinical trials relating to devices and drugs aimed at wound care and related indications and diseases. Dr. Hermans speaks internationally and has authored many published works relating to wound management.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.