Offloading systems for the treatment of neuropathic foot ulcers in patients with diabetes mellitus: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome. in Acta diabetologica / Acta Diabetol. 2024 Jun;61(6):693-703. doi: 10.1007/s00592-024-02262-9. Epub 2024 Mar 15.

2024
ASL Torino 5
ASL Città di Torino

Tipo pubblicazione

Review

Autori/Collaboratori (13)Vedi tutti...

Monge L
AMD-Italian Association of Clinical Diabetologists, Rome, Italy.
Bandini G
Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy.
Monami M
Azienda Ospedaliero Universitaria Careggi and University of Florence, Florence, Italy.

et alii...

Abstract

AIM: To compare the effectiveness of commonly used offloading devices for the treatment of neuropathic foot ulcers in patients with diabetes mellitus. This meta-analysis (MA) has been performed for giving an answer to clinical questions on this topic of the Italian guideline on diabetic foot syndrome. METHODS: The present MA includes randomized controlled studies (duration?>?12 weeks) comparing, in patients with diabetes mellitus and non-infected neuropathic foot ulcer: any offloading device vs either no offloading device or conventional footwear; removable versus non-removable offloading devices; surgical procedure vs other offloading approaches. The primary endpoint was ulcer healing. RESULTS: A total of 184 studies were identified, and 18 were considered eligible for the analysis. We found that: any plantar off-loading, when compared to the absence of plantar offloading device, is associated with a higher ulcer healing (MH-OR: 3.13 [1.08, 9.11], p?=?0.04, I(2)?=?0%); total contact cast or nonremovable knee-high walker, compared to other offloading devices, had a higher ulcer healing rate (MH-OR: 2.64 [1.43, 4.89], p?=?0.002, I(2)?=?51%); surgical offloading for active ulcers in combination with post-surgery offloading achieves higher ulcer healing rate when compared to offloading devices alone (MH-OR: 6.77 [1.64, 27.93], p?=?0.008, I(2)?=?0%). CONCLUSIONS: Any plantar offloading, compared to the absence of plantar offloading device, is associated with a higher ulcer healing rate. Total contact cast or nonremovable knee-high walker, compared to other offloading devices, is preferable. Surgical offloading for active ulcers, in combination with post-surgery offloading devices, achieves a higher ulcer healing rate when compared to other offloading devices alone. Further studies with a larger cohort of patients with diabetic neuropathic foot ulcers and extended follow-up periods are necessary.

Accesso banca dati bibliografica

PMID : 38489054

DOI : 10.1007/s00592-024-02262-9

Keywords

Offloading; Diabetes mellitus; Neuropathic foot ulcer; Weight-Bearing; Shoes; Treatment Outcome; Italy; Wound Healing; Practice Guidelines as Topic; Diabetic Foot/therapy/surgery; Casts, Surgical; Randomized Controlled Trials as Topic; Humans;