What is the best treatment for diabetic foot ulcers?

What is the best treatment for diabetic foot ulcers?

Centers for Disease and Control and Prevention 2019 show that about thirty-four million Americans have diabetes. Similarly, data from World Health Organization 2018 shows that the number of people having diabetes worldwide has risen for one hundred and eight million to four hundred and twenty million from 1980 to 2014, with the global prevalence rising from 4.7% to 8.5% within the same period. Diabetes, when combined with decreased blood flow to various extremities, nerve damages in the feet increases the probability of foot ulcers, fatal infection, gangrene, and necessitates limb amputations. According to Nain et al. 2011, diabetic foot ulcers are the top reasons for admissions among diabetic patients, and worse; they are associated with the most extended length of hospitalization since they require many surgical procedures. Boulton et al. 2018 show that diabetic patients make more than half of the patients that are admitted to hospitals for amputation. In the United Kingdom, for instance, diabetic patients account for nearly forty percent of hospitalization for severe amputations and about seventy-three present to emergency rooms for minor amputations.

American College of Surgeons 2018 shows that more than a quarter of diabetic patients will develop diabetic foot or foot ulcers in their lifespan and experience remission after three years. Liu et al. 2017 points that diabetic foot ulcer is attributed to the loss of a lower limb every thirty seconds worldwide with the probability of losing the remaining legs rising to fifty percent after three years, lead to over eighty-five percent of the non-traumatic lower-limb amputations, about seventeen percent mortality rate. The speed at which untreated diabetic foot ulcer becomes infected when left untreated is fatal, and the result is amputations (Meloni et al., 2015). As shown, the impact of a diabetic foot ulcer is big, and the need for an intervention that is effective, cost-effective, patient-friendly, and scientifically supported and evidence-based was inevitable.

Review

Aimed to determine the efficacy of negative pressure wound therapy in promoting diabetic wound healing. Search method: The review searched CINAHL, Proquest, Medline and manual search for other studies which might have been unpublished or sponsored by the government and non-governmental organization, the reference lists of incorporated studies, reviewed on NPWT, meta-analysis and other health technology reports which led to the identification of additional studies. The review experienced no language barrier nor study setting and identified seven more studies for inclusion into the review, as shown in the reference list. All the studies’ conceptual framework and scope of practice were relevant to the study question.

Study design: the review used published and unpublished randomized controlled trials within ten years (2010-2020) that evaluated the effectiveness of NPWT in treating diabetic foot ulcers regardless of the study setting, authors, and language of publication (as long as translation can be accessed).

Search outcomes: the review of these studies including statistics show how fatal diabetic foot ulcer and then an inevitable need for an outlined, evidence-based and effective therapy of diabetic foot ulcer to lessen complications such as infections, gangrene, and amputations as well as save patients the stress and the expenses that they have to incur to cater for their management (Borys et al., 2019). Most of these studies also showed that optimal remedy for diabetic foot ulcers is still ill-defined. Healthcare providers initially were using saline-moisturized gauzes as the standard method of care, which could not keep the diabetic wound moist with saline-moistened gauzes. Meloni et al. (2015) and Borys et al. (2019) revealed a gap; they showed that previous interventions of diabetic wound healing are more expensive, not adequately ineffective, and some lack sufficient scientific evidence to support their efficacy. The studies showed that NPWT could fill this gap because it is scientifically supported, efficient, and cost-effective. NPWT utilizes well-controlled negative pressure via a vacuum-assisted closure device to improve foot ulcer healing draining fluid from the wound via a sealed dressing or some foam dressing and a tube joined to a collection container. Ramanujam, Stapleton & Zgonis (2013) show that NPWT exploits sub-atmospheric pressure dressing, which is often readily available as a VAC device, thus accelerating diabetic wound healing. A study involving patients diagnosed with diabetic foot ulcers between 2019 November to 2020 November shows that NPWT has reduced the number of subsequent amputations according to the six follow-up periods, which shows how effective this method if in the management of diabetic foot ulcers and preventing its complications. The study adds that NPWT provides an excellent environment that accelerates re-epithelialization, actions of growth factors, angiogenesis, as well as facilitating granulations. Borys et al. 2019 provide that NPWT reduces edema, which in turn lessens interstitial pressure, thus promotes wound vessel formation and improves blood circulation and lymphatic drainage in the wound, nutrients availability, and oxygen supply and antibiotic therapy. Numerous studies have confirmed that NPWT enhances the balance between enzyme proteases and their inhibitors while influencing cytokine modulation resulting in a positive wound environment. Besides, Liu et al. 2017 reveal that NPWT takes a short time to complete healing of diabetic foot ulcers matched to other standard treatments. Similarly, Liu et al. 2017 while recommends the use of NPWT for diabetic ulcers, points out that it is more expensive than standard moist wound therapy. However, Guffanti (2014) refutes this claim and shows that though it appears the VAC is costly, it is ultimately cost-effective for patients than the standard moist wound therapy since it increases healing rate, thus ensuring overall reduction in healing time.

Database

Currently, the internet is flooded with a lot of information that it becomes hard to differentiate, which is reliable. Similarly, most websites and pages post outdated and untrue information. CINAHL is a different tool that considers reliability, evidenced-based, and validity of the information it avails through its CINAHL Complete. It is a preferred definitive research tool that provides the most recent, reliable, and validated as well as evidence-based nursing and allied health journal which are crucial in this research. The source of its information is essential and well-reviewed.

Apart from its efficiency in availing credible information, Proquest provides single sources of a peer-reviewed scholarly journal which are easily accessible and navigable. Its renowned abstracting and indexing simplify research management and sharing. The health research premium collection allows access to the latest health and medical information, which are crucial for this research. Medline provides a variety of information and research to choose from and has over twelve million journals and peer-reviewed researches. Similarly, with Medline, it is easy to go back in history and learn the trends to reflect on the invention that has taken place over time. Its authoritative abilities make it attractive and can evaluate the authors of researches, results, and the objectives of the researchers. Manual research is crucial at identifying fact sheets, particularly the updates from World Health Organizations, to get insight into the prevalence and fatality of a problem or a disease.

Limits

The speed at which the field and the subject matters change is the determinant of how many years a researcher can go into history to seek information. Health is a first paced field, and going too much into history may prove irrelevant. For instance, over the past years, numerous inventions have occurred regarding the treatment of diabetic foot ulcers. Some of these inventions are no longer relevant in nursing or health. Therefore, staying within the range (10 years) helps get adequate information and relate the recent and past information to determine the future of the field or the topic.

Is it treatment change?

Negative pressure wound therapy is not a therapy change but an improvement in the remedy of diabetic foot ulcers. It takes into consideration the patient, economy, quality of life, and many other factors to provide care that is not the only disease-oriented but also patient-effective.

Inclusion/exclusion

Any study that was published or authored between 2010 and 2020, whose scope and conceptual framework was relevant to review’s PICO question, was included in the review regardless of the study setting, authors, and language of publication (as long as translation can be accessed). Studies published or authored earlier than 2010, whose scope and conceptual framework not related to the review’s PICO question were excluded.

Keywords

The review used keywords and exploited Boolean operators such as ‘AND,’ and ‘OR’ to combine keywords and improve effective search, narrow search (VAC AND NPWT), and connect two synonyms (diabetic foot ulcer OR foot ulcer) during the search for information as shown Diabetic foot* AND foot* ulcer, diabetic) OR (negative- pressure wound therapy* AND vacuum-assisted closure AND topical negative pressure therapy AND negative pressure dressing* AND Vac AND Npwt AND Tnpt)

Truncation

Most of the keywords were as well used as truncates. For instance, the review could search VAC, which produced NPWT, TNPT, diabetes, diabetic foot ulcer, among others that were relevant to the review’s PICO question. Also, foot ulcers produced NPWT, diabetic foot ulcer management, VAC, review of foot ulcer management, and other relevant and non-relevant sources.

Quality Appraisal

Initial the review used CINAHL, Proquest, Medline, and manual search for other studies to identify a total of 53 articles using the search strategy. Later, the review re-evaluated the articles removed duplicated and retained 18 articles based on the inclusion and exclusion criteria. Due to the need for more information, the review later using the search engine added seven articles that met the inclusion criteria bringing the total articles to 25.

Data abstraction and synthesis

After the selection and identification of the studies, I gathered data from the studies. I re-evaluated them to makes sure that I only had the essential information for the review’s PICO question. The review also employed meta-analysis of the obtained data to enables pulling of the data from these different sources to achieve a cleaner answer to the review’s PICO question.