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Meta-Analysis
. 2024 Dec;61(12):1517-1526.
doi: 10.1007/s00592-024-02320-2. Epub 2024 Jun 12.

Effectiveness of different advanced wound dressings versus standard of care for the management of diabetic foot ulcers: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome

Matteo Monami  1   2 , Benedetta Ragghianti  3 , Alessia Scatena  4 , Cesare Miranda  5 , Luca Monge  6 , Luigi Uccioli  7 , Laura Stefanon  8 , Cristina Cappella  9 , Antonio Silverii  3 , Cristiana Vermigli  9 ; Panel of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome and on behalf of SID and AMD
Affiliations
Meta-Analysis

Effectiveness of different advanced wound dressings versus standard of care for the management of diabetic foot ulcers: a meta-analysis of randomized controlled trials for the development of the Italian guidelines for the treatment of diabetic foot syndrome

Matteo Monami et al. Acta Diabetol. 2024 Dec.

Abstract

Aim: to assess the effects of advanced wound dressings (AWD) commonly used in the treatment of predominantly neuropathic diabetic foot ulcers (DFU) The present meta-analysis was designed to support the development of the Italian Guidelines for the Treatment of Diabetic Foot Syndrome (DFS).

Methods: A Medline and Embase search were performed up to April 1st, 2024 collecting all RCTs including diabetic patients or reporting subgroup analyses on diabetic patients with DFU comparing AWD with placebo/standard of care (SoC), with a duration of at least 12 weeks. Prespecified endpoints were: ulcer healing (principal), time-to-healing, frequency of dressings change, major and minor amputation, pain, and all-cause mortality. AWD assessed were: alginates; foam, hydrocolloids, hydrogels, hyaluronic acid, hemoglobin spray, silver-impregnated, sucrose octasulfate-impregnated, honey-impregnated, micro-organism-binding, and protease-modulating matrix dressings. Mantel-Haenzel Odds ratios and 95% confidence intervals (MH-OR, 95% CIs) were either calculated or extracted directly from the publications. Weighted mean differences (WMD) and 95% CIs were calculated for continuous variables.

Results: Fifteen studies fulfilled all inclusion criteria. Participants treated with AWD had a significantly higher ulcer healing rate and shorter time-to-healing in comparison with SoC/placebo (MH-OR 1.50 [0.80, 2.79], p = 0.20 and WMD:: - 24.38 [- 42.90, - 5.86] days, p = 0.010). No other significant effect on the above reported prespecified endpoints were observed. For the primary endpoint, the quality of evidence was rated as "moderate".

Conclusions: In conclusion, AWD, particularly sucrose-octasulfate, hydrogels, hyaluronic acid, and honey dressings, can actively promote wound healing and shortening time-to-healing in patients with DFU.

Keywords: Advanced wound dressings; Diabetic foot ulcers; Guidelines; Meta-analysis; Ulcer healing.

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Conflict of interest statement

Declarations. Conflicts of interest: MM received speaking fees from Zuccato S.r.l. and Athena. The other authors do not have any direct relevant conflicts of interest to disclose. Research involving human participants and/or animals: This article contains no studies with human participants or animals performed by any of the authors. Informed consent: No informed consent is needed.

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