Hyperbaric Oxygen Therapy Facilitates Healing of Chronic Foot Ulcers in Patients With Diabetes

TLDR

Chronic diabetic foot ulcers pose a significant burden to patients and health care systems. The study aimed to assess the effect of hyperbaric oxygen therapy on chronic diabetic foot ulcers. In a randomized, double‑blind, placebo‑controlled trial, 94 patients with Wagner grade 2–4 ulcers received 40 daily 85‑minute hyperbaric oxygen sessions over eight weeks in an ambulatory setting, compared to hyperbaric air. At one year, 52 % of HBOT patients achieved complete ulcer healing versus 29 % of placebo (P = 0.03), and among those completing >35 sessions, 61 % healed versus 27 % (P = 0.009), with few adverse events, indicating HBOT improves healing.

Abstract

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.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.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.The HODFU study showed that adjunctive treatment with HBOT facilitates healing of chronic foot ulcers in selected patients with diabetes.