Dressings to treat foot ulcers in people with diabetes

Background

Diabetes mellitus (generally known as 'diabetes'), when untreated, causes a rise in the sugar (glucose) levels in the blood. It is a serious health issue that affects millions of people around the world (e.g., almost two million people in the UK and 24 million people in the USA). Foot ulcers are a common problem for people with diabetes; at least 15% of people with diabetes have foot ulcers at some time during their lives. Wound dressings are used extensively in the care of these ulcers. There are many different types of dressings available, from basic wound contact dressings to more advanced gels, films, and specialist dressings that may be saturated with ingredients that exhibit particular properties (e.g. antimicrobial activity). Given this wide choice, a clear and up-to-date overview of the available research evidence is needed to help clinicians/practitioners to decide which type of dressing to use.

Review question

What is the evidence that the type of wound dressing used for foot ulcers in people with diabetes affects healing?

What we found

This overview drew together and summarised evidence from 13 systematic reviews that contained 17 relevant randomised controlled trials (the best type of study for this type of question) published up to 2013. Collectively, these trials compared 10 different types of wound dressings against each other, making a total of 37 separate comparisons. The different ways in which dressing types were compared made it difficult to combine and analyse the results. Only four of the comparisons informed by direct data found evidence of a difference in ulcer healing between dressings, but these results were classed as low quality evidence.

There was no clear evidence that any of the 'advanced' wound dressings types were any better than basic wound contact dressings for healing foot ulcers. The overview findings were restricted by the small amount of information available (a limited number of trials involving small numbers of participants).

Until there is a clear answer about which type of dressing performs best for healing foot ulcers in people with diabetes, other factors, such as clinical management of the wound, cost, and patient preference and comfort, should influence the choice of dressing.

This plain language summary is up-to-date as of April 2015.

Authors' conclusions: 

There is currently no robust evidence for differences between wound dressings for any outcome in foot ulcers in people with diabetes (treated in any setting). Practitioners may want to consider the unit cost of dressings, their management properties and patient preference when choosing dressings.

Read the full abstract...
Background: 

Foot ulcers in people with diabetes mellitus are a common and serious global health issue. Dressings form a key part of ulcer treatment, with clinicians and patients having many different types to choose from. A clear and current overview of current evidence is required to facilitate decision-making regarding dressing use.

Objectives: 

To summarize data from systematic reviews of randomised controlled trial evidence on the effectiveness of dressings for healing foot ulcers in people with diabetes mellitus (DM).

Methods: 

We searched the following databases for relevant systematic reviews and associated analyses: the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library 2015, Issue 2); Database of Abstracts of Reviews of Effects (DARE; The Cochrane Library 2015, Issue 1); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, 14 April 2015); Ovid EMBASE (1980 to 14 April 2015). We also handsearched the Cochrane Wounds Group list of reviews. Two review authors independently performed study selection, risk of bias assessment and data extraction. Complete wound healing was the primary outcome assessed; secondary outcomes included health-related quality of life, adverse events, resource use and dressing performance.

Main results: 

We found 13 eligible systematic reviews relevant to this overview that contained a total of 17 relevant RCTs. One review reported the results of a network meta-analysis and so presented information on indirect, as well as direct, treatment effects. Collectively the reviews reported findings for 11 different comparisons supported by direct data and 26 comparisons supported by indirect data only. Only four comparisons informed by direct data found evidence of a difference in wound healing between dressing types, but the evidence was assessed as being of low or very low quality (in one case data could not be located and checked). There was also no robust evidence of a difference between dressing types for any secondary outcomes assessed.

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