Diabetes is a disease in which patients have high level of sugar in blood. It is a disease in which the body’s ability to produce or respond to the hormone insulin is impaired, resulting in abnormal metabolism of carbohydrates and elevated levels of glucose in the blood. High blood glucose levels can damage organs, blood vessels, and nerves. For several reasons, people with diabetes are especially susceptible to lower limb and foot wounds that do not heal. People with diabetes may also experience peripheral artery disease, which can cause a hardening and obstruction of blood vessels in the lower leg and foot. It is estimated that about 15% to 25% of people with diabetes develop a foot ulcer in their lifetime. These wounds are often resistant to treatment and difficult to heal; therefore, people with diabetes experience lower limb amputation at about 20 times the rate of people without diabetes.
When a foot ulcer does not heal despite standard wound care, patients may try additional treatments such as hyperbaric oxygen therapy. In hyperbaric oxygen therapy, a patient enters a chamber that fits a single or multiple individuals and is exposed to 100% oxygen while the atmospheric pressure is increased.
In HBOT, 100% oxygen is administered to the patient at an increased atmospheric pressure; this is the technology being evaluated in this health technology assessment. Wound healing occurs through various phases of regeneration, and oxygen is an integral part of this process
This report was developed by a multidisciplinary team from Health Quality Ontario
They performed a review of the clinical and economic literature for the effectiveness and cost effectiveness of hyperbaric oxygen therapy, as well as the budget impact of HBOT from the perspective of the Ministry of Health and Long-Term Care. Seven randomized controlled trials and one nonrandomized controlled trial met the inclusion criteria
Patients reported very high satisfaction with HBOT treatment
Their analysis showed that standard wound care plus hyperbaric oxygen therapy results in an improvement in ulcer healing compared with standard wound care alone. The studies we reviewed found that standard wound care plus hyperbaric oxygen is as safe as standard wound care alone.
The evidence makes it difficult to draw any definitive conclusions on the clinical and cost effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers.
Authors Health Quality Ontario
Newspaper Ont Health Technol Assess Ser. 2017; 17(5): 1–142.