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      Systematic review and meta‐analysis of clinical trials examining the effect of hyperbaric oxygen therapy in people with diabetes‐related lower limb ulcers

      1 , 2 , 3 , 1 , 2
      Diabetic Medicine
      Wiley

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          Current Challenges and Opportunities in the Prevention and Management of Diabetic Foot Ulcers.

          Diabetic foot ulcers remain a major health care problem. They are common, result in considerable suffering, frequently recur, and are associated with high mortality, as well as considerable health care costs. While national and international guidance exists, the evidence base for much of routine clinical care is thin. It follows that many aspects of the structure and delivery of care are susceptible to the beliefs and opinion of individuals. It is probable that this contributes to the geographic variation in outcome that has been documented in a number of countries. This article considers these issues in depth and emphasizes the urgent need to improve the design and conduct of clinical trials in this field, as well as to undertake systematic comparison of the results of routine care in different health economies. There is strong suggestive evidence to indicate that appropriate changes in the relevant care pathways can result in a prompt improvement in clinical outcomes.
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            Hyperbaric Oxygen Therapy Facilitates Healing of Chronic Foot Ulcers in Patients With Diabetes

            OBJECTIVE Chronic diabetic foot ulcers are a source of major concern for both patients and health care systems. The aim of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) in the management of chronic diabetic foot ulcers. RESEARCH DESIGN AND METHODS The Hyperbaric Oxygen Therapy in Diabetics with Chronic Foot Ulcers (HODFU) study was a randomized, single-center, double-blinded, placebo-controlled clinical trial. The outcomes for the group receiving HBOT were compared with those of the group receiving treatment with hyperbaric air. Treatments were given in a multi-place hyperbaric chamber for 85-min daily (session duration 95 min), five days a week for eight weeks (40 treatment sessions). The study was performed in an ambulatory setting. RESULTS Ninety-four patients with Wagner grade 2, 3, or 4 ulcers, which had been present for >3 months, were studied. In the intention-to-treat analysis, complete healing of the index ulcer was achieved in 37 patients at 1-year of follow-up: 25/48 (52%) in the HBOT group and 12/42 (29%) in the placebo group (P = 0.03). In a sub-analysis of those patients completing >35 HBOT sessions, healing of the index ulcer occurred in 23/38 (61%) in the HBOT group and 10/37 (27%) in the placebo group (P = 0.009). The frequency of adverse events was low. CONCLUSIONS The HODFU study showed that adjunctive treatment with HBOT facilitates healing of chronic foot ulcers in selected patients with diabetes.
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              Diabetes-related lower-extremity complications are a leading cause of the global burden of disability

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                Author and article information

                Journal
                Diabetic Medicine
                Diabet. Med.
                Wiley
                0742-3071
                1464-5491
                May 26 2019
                May 26 2019
                Affiliations
                [1 ]Queensland Research Centre for Peripheral Vascular Disease College of Medicine and Dentistry James Cook University Townsville QLD Australia
                [2 ]Department of Vascular and Endovascular Surgery Townsville Hospital Townsville QLD Australia
                [3 ]Australian Institute of Tropical Health and Medicine James Cook University Townsville QLD Australia
                Article
                10.1111/dme.13975
                31002414
                d5911c60-74e6-45a1-afe3-111c0dd20add
                © 2019

                http://doi.wiley.com/10.1002/tdm_license_1.1

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