A Novel Diagnostic Test for End-Stage Sensory Failure Associated With Diabetic Foot Ulceration: Proof-of-Principle Study

Trial of a Trivial Quantitative Heat-Pain Stimulus for Detecting Severe Loss of Nociception

BACKGROUND

Loss of nociception (LON) at the feet of persons with diabetes mellitus develops gradually over years and remains asymptomatic until the first painless diabetic foot ulceration (DFU). Severe LON with pain insensitivity can be diagnosed with a mechanical (pinprick) pain stimulus of 512-mN force. A comparable "suprathreshold" heat-pain stimulus may have the same potential.

OBJECTIVE

A six-second, 51°C heat-pain stimulus delivered on a 38.5-mm² spot by a commercial medical device (bite away®, to treat insect bites) was explored in a prospective cross-sectional diagnostic accuracy study to detect DFU-related LON.

METHODS

Seventy-two participants were studied: 12 with and 30 without diabetic neuropathy according to the conventional criteria, and 30 patients with a history of painless DFU (indicative of end-stage LON, reference standard). The feet were stimulated at the plantar and dorsal sides. A palmar surface was stimulated for control purposes. Participants scored stimulated pain intensity 0 to 10 on a numerical rating scale.

RESULTS

At hands, pain intensity was rated six on average by all participants. Persons without neuropathy scored 7 (0-10), median (range), at the plantar side and 8.5 (2-10) at the dorsal side of the foot, while those with DFU scored 0 (0-8) and 0 (0-10), respectively. A pain response of 0 at the foot dorsum detected DFU-related LON with a sensitivity of 65% (specificity, 100%; positive and negative predictive values, 100% and 96%, respectively).

CONCLUSIONS

Due to its high specificity, the test seems advantageous for diagnostic purposes, complementary to current screening tests.

Short-term effect of dressing with Dermaheal ointment in the treatment of diabetic foot ulcer: A double-blinded randomized controlled clinical trial

Background and Aims

Diabetic foot ulcers, a major cause of amputations in diabetics, could benefit from natural products as adjuncts to standard care, given the costs and adverse effects of typical therapies. This study aims to evaluate the short-term effects of dressing with Dermaheal ointment in the treatment of DFUs through a double-blinded randomized controlled clinical trial.

Methods

This double-blinded, placebo-controlled trial included 50 patients with Wagner's ulcer grade I or II, randomly assigned to Dermaheal and placebo groups (received standard treatment and placebo ointment). The ulcer site was dressed daily for four consecutive weeks with either Dermaheal or placebo ointment. Ulcer healing score (using DFU healing checklist), ulcer size with transparent ruler and largest dimension of ulcer, and pain severity using numerical pain rating score (were recorded at five-time points, including baseline, and on weeks 1, 2, 3, and 4). Also, ulcer healing status was investigated at the trial ended in November 2021.

Results

Both groups showed significant improvement in ulcer healing over 4 weeks (p time < 0.001), with more remarkable progress in the Dermaheal group (p group = 0.03). At the trial end, complete ulcer healing was also significantly higher in the Dermaheal group compared to the placebo group (56% vs. 12%, p = 0.002). Both groups exhibited a decrease in ulcer size (p time < 0.001). Considering the baseline ulcer size as a covariate, substantial changes in mean ulcer size were noted in the initial (p = 0.01), second (p = 0.001), third (p = 0.002), and fourth (p = 0.002) weeks of the intervention, showing a preference for the Dermaheal group. However, no significant between-group difference was observed in pain severity levels.

Conclusion

Dressing with Dermaheal as a topical treatment shows promise in improving healing and reducing the size of diabetic foot ulcers. Further research is needed to confirm these findings' long-term efficacy.

Early detection to prevent foot ulceration among type 2 diabetes mellitus patient: A multi-intervention review

Foot ulceration is one of the biggest complications experienced by type 2 diabetes patients. The severity and prevention of new wounds can be overcome through early detection interventions. This systematic review aims to explain and provide a comparison of various interventions that have been developed to prevent the occurrence of Diabetes Foot Ulcers (DFU). We searched Scopus, Science Direct, PubMed, CINAHL, SAGE, and ProQuest for English, experimental studies, published between 2016-2021 that tested early detection for preventing diabetic foot ulcers in diabetic patients. The Joanna Briggs Institute guidelines were used to assess eligibility, and PRISMA quality and a checklist to guide this review. 25 studies were obtained that matched the specified inclusion criteria. The entire article has an experimental study design. Majority of respondents were type 2 diabetes patients who have not experienced ulceration. Based on the results of the review, there were 3 main types of interventions used in the early detection of DFU. The types of intervention used are 1) conventional intervention/physical assessment, 2) 3D thermal camera assessment system, and 3) DFU screening instrument. The three types of interventions have advantages and disadvantages, so their use needs to be adjusted to the conditions and needs of the patient. the development of DFU risk early detection intervention needs to be developed. Integration with modern technology can also be done to increase the accuracy of the results and the ease of examination procedures.