Hyperbaric Oxygen Therapy as adjunctive treatment of chronic diabetic foot ulcers

Magnus Löndahl

Hyperbaric Oxygen Therapy as adjunctive treatment of chronic diabetic foot ulcers

Medicin/akutsjukvård, Lund

Forskningsoutput: Avhandling › Doktorsavhandling (sammanläggning)

Sammanfattning

Popular Abstract in Swedish
Diabetes relaterade fotsår är en vanlig och allvarlig komplikation till diabetes. Orsaken till fotsår är mångfasetterad och inkluderar bland annat diabetesrelaterade nervskador och försämrad funktion i stora och små blodkärl. Vid förekomst av högt blodsocker fungerar immunförsvaret sämre och problematiska infektioner är vanligare vid diabetes. Sårläkning försämras vid låg vävnadskoncentration av syrgas, ett tillstånd som är vanligt förekommande då fotsår inte läker hos patienter med diabetes. Trots
ökad förekomst av sårläkning och minskande antal amputationer, är andelen
amputationer och oläkta sår fortfarande för hög, varför behov av nya
behandlingsmetoder fortsatt föreligger.
Hyperbar syrgasbehandling (HBOT) ökar vävnadskoncentrationen av syrgas och har visats förbättra sårläkning i såväl cell- som djurförsök. Ett flertal kliniska studier har utvärderat effekten av HBOT på läkning av diabetesrelaterade fotsår. Resultaten av dessa är positiva, men pga. metodologiska problem saknas ännu "bevis" för att kunna rekommendera HBOT vid behandling av diabetesrelaterade fotsår. Cochrane institutet har påpekat vikten av att stora randomiserade studier med kliniskt meningsfulla
uppföljningsparametrar genomförs.
Hyperbaric Oxygen therapy in Diabetic patients with chronic Foot Ulcer (HODFU) studien är en prospektiv (framåtblickande), dubbel-blindad (varken patient eller behandlare/utvärderar vet vilken behandlingen patienten har) randomiserad (patienterna har slumpvässigt tilldelats sin behandling) studie, som utvärderar effekten av 40 HBOT-behandlingar på läkning av kroniska fotsår hos patienter med diabetes.
Vid 9- och 12 månaders uppföljningar hade dubbelt så många sår läkt hos de patienter som erhållit HBOT jämfört med de som behandlats med placebo (icke aktiv behandling, i denna studie hyperbar luft). Vidare förbättrades HBOT patienternas hälso-relaterade livskvalité. HBOT tolererades väl och förekomsten av biverkningar var låg.
Studien visar även att vävnadstryck av syrgas i huden är en bättre prognostisk markör för sårläkning efter HBOT jämfört med arm/ankel blodtrycksindex och tåblodtryck (vanliga parametrar vid utredning av nedsatt cirkulation i benen). Studien ådagalägger även att förekomst av kroniskt diabetesrelaterat fotsår är starkt kopplat till försämrad hjärtfunktion. Förebyggande läkemedelsbehandling mot hjärt/kärl sjukdom bör därför övervägas hos alla patienter med diabetes och kronsikt
fotsår.

Originalspråk	engelska
Kvalifikation	Doktor
Tilldelande institution	Institutionen för kliniska vetenskaper, Lund
Handledare	Katzman, Per, handledare Apelqvist, Jan, handledare
Tilldelningsdatum	2010 sep. 3
Förlag	Lund University
ISBN (tryckt)	978-91-86443-94-8
Status	Published - 2010

Bibliografisk information

Defence details

Date: 2010-09-03
Time: 09:00
Place: Segerfalk salen, BMC, Lund

External reviewer(s)

Name: Gerok-Andersson, Kurt
Title: MD
Affiliation: Department of Medicine, Karolinska Institutet, Stockholm

---

Ämnesklassifikation (UKÄ)

Annan klinisk medicin

FN:s Globala mål

Denna forskningsoutput relaterar till följande Globala mål

4 Artikel i vetenskaplig tidskrift

Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes.
Löndahl, M., Katzman, P., Nilsson, A. & Hammarlund, C., 2010, I: Diabetes Care. 33, 5, s. 998-1003
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
Diabetic persons with foot ulcers and their perceptions of hyperbaric oxygen chamber therapy
Hjelm, K., Löndahl, M., Katzman, P. & Apelqvist, J., 2009, I: Journal of Clinical Nursing. 18, 14, s. 1975-1985
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review
Is chronic diabetic foot ulcer an indicator of cardiac disease?
Löndahl, M., Katzman, P., Fredholm, O., Nilsson, A. & Apelqvist, J., 2008, I: Journal of Wound Care. 17, 1, s. 12-16
Forskningsoutput: Tidskriftsbidrag › Artikel i vetenskaplig tidskrift › Peer review

Citera det här

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title = "Hyperbaric Oxygen Therapy as adjunctive treatment of chronic diabetic foot ulcers",

abstract = "Chronic diabetic foot ulcers are a source of major concern for both patients and health care systems. Oxygen deficiency plays a major role in the pathogenesis of these ulcers. Hyperbaric oxygen therapy (HBOT) has been proposed as a medical treatment for diabetic foot ulcers, but the clinical utility has not been established. Hyperbaric Oxygen in Diabetic patients with chronic Foot Ulcer (HODFU) study is a prospective, randomized, placebo-controlled, double-blinded study, evaluating the effect of HBOT on ulcer healing in diabetic patients with chronic foot ulcers. Ninety four patients were included, representing 74% of all patients fulfilling the medical inclusion criteria during the inclusion period. Adjunctive HBOT significantly improved foot ulcer healing at 9- and 12-months follow-ups as compared to placebo. Numbers-needed to treat to avert non-healing of a chronic foot ulcer was 3.1. Treatment was well-tolerated and frequencies of adverse events were low. TcPO2, but not toe-blood pressure or ankle-brachial index, was identified as prognostic marker for ulcer healing after HBOT. At one-year follow-up HBOT was associated with improved health related quality of life. Patients perceived HBOT as unproblematic but time-consuming. Evaluation of these patients cardiac function indicates that a chronic diabetic foot ulcer should be regarded as a marker of cardiac disease. Thus, pharmacological cardiovascular prevention ought to be considered in all patients with a chronic diabetic foot ulcer. In conclusion, this study supports the concept that adjunctive treatment with HBOT enhances foot ulcer healing in selected patients with diabetes.",

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AU - Löndahl, Magnus

N1 - Defence details Date: 2010-09-03 Time: 09:00 Place: Segerfalk salen, BMC, Lund External reviewer(s) Name: Gerok-Andersson, Kurt Title: MD Affiliation: Department of Medicine, Karolinska Institutet, Stockholm ---

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N2 - Chronic diabetic foot ulcers are a source of major concern for both patients and health care systems. Oxygen deficiency plays a major role in the pathogenesis of these ulcers. Hyperbaric oxygen therapy (HBOT) has been proposed as a medical treatment for diabetic foot ulcers, but the clinical utility has not been established. Hyperbaric Oxygen in Diabetic patients with chronic Foot Ulcer (HODFU) study is a prospective, randomized, placebo-controlled, double-blinded study, evaluating the effect of HBOT on ulcer healing in diabetic patients with chronic foot ulcers. Ninety four patients were included, representing 74% of all patients fulfilling the medical inclusion criteria during the inclusion period. Adjunctive HBOT significantly improved foot ulcer healing at 9- and 12-months follow-ups as compared to placebo. Numbers-needed to treat to avert non-healing of a chronic foot ulcer was 3.1. Treatment was well-tolerated and frequencies of adverse events were low. TcPO2, but not toe-blood pressure or ankle-brachial index, was identified as prognostic marker for ulcer healing after HBOT. At one-year follow-up HBOT was associated with improved health related quality of life. Patients perceived HBOT as unproblematic but time-consuming. Evaluation of these patients cardiac function indicates that a chronic diabetic foot ulcer should be regarded as a marker of cardiac disease. Thus, pharmacological cardiovascular prevention ought to be considered in all patients with a chronic diabetic foot ulcer. In conclusion, this study supports the concept that adjunctive treatment with HBOT enhances foot ulcer healing in selected patients with diabetes.

AB - Chronic diabetic foot ulcers are a source of major concern for both patients and health care systems. Oxygen deficiency plays a major role in the pathogenesis of these ulcers. Hyperbaric oxygen therapy (HBOT) has been proposed as a medical treatment for diabetic foot ulcers, but the clinical utility has not been established. Hyperbaric Oxygen in Diabetic patients with chronic Foot Ulcer (HODFU) study is a prospective, randomized, placebo-controlled, double-blinded study, evaluating the effect of HBOT on ulcer healing in diabetic patients with chronic foot ulcers. Ninety four patients were included, representing 74% of all patients fulfilling the medical inclusion criteria during the inclusion period. Adjunctive HBOT significantly improved foot ulcer healing at 9- and 12-months follow-ups as compared to placebo. Numbers-needed to treat to avert non-healing of a chronic foot ulcer was 3.1. Treatment was well-tolerated and frequencies of adverse events were low. TcPO2, but not toe-blood pressure or ankle-brachial index, was identified as prognostic marker for ulcer healing after HBOT. At one-year follow-up HBOT was associated with improved health related quality of life. Patients perceived HBOT as unproblematic but time-consuming. Evaluation of these patients cardiac function indicates that a chronic diabetic foot ulcer should be regarded as a marker of cardiac disease. Thus, pharmacological cardiovascular prevention ought to be considered in all patients with a chronic diabetic foot ulcer. In conclusion, this study supports the concept that adjunctive treatment with HBOT enhances foot ulcer healing in selected patients with diabetes.

KW - hyperbaric oxygen therapy

KW - Diabetes Mellitus

KW - foot ulcer

KW - HRQL

KW - cardiac function

M3 - Doctoral Thesis (compilation)

SN - 978-91-86443-94-8

T3 - Lund University Faculty of Medicine Doctoral Dissertation Series

PB - Lund University

ER -

Hyperbaric Oxygen Therapy as adjunctive treatment of chronic diabetic foot ulcers

Sammanfattning

Bibliografisk information

Ämnesklassifikation (UKÄ)

FN:s Globala mål

Fingeravtryck

Forskningsoutput

Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes.

Diabetic persons with foot ulcers and their perceptions of hyperbaric oxygen chamber therapy

Is chronic diabetic foot ulcer an indicator of cardiac disease?

Citera det här