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Dietary supplements for the treatment of foot ulcers in people with diabetes.

Dietary Supplements for the Treatment of Foot Ulcers in People with Diabetes Mellitus.

We wanted to find out if dietary supplements or special diets are effective in treating foot ulcers in people with diabetes. Cochrane researchers collected and analyzed all relevant studies (randomized controlled trials (RCTs)) to answer this question, and found nine studies to be included. RCTs are medical studies in which the treatment or care that people receive is randomly determined.

This type of trial provides the most reliable medical evidence on whether results differ with different treatment or care approaches or not..

Key information.

Eight of the nine studies that we identified reported results that we are interested in primarily on the effect on ulcer healing. Results from five studies showed very low certainty about the effect of oral nutritional supplements in tablet form on the healing of leg ulcers in people with diabetes. Besides the fact that the number of participants was insufficient, these studies did not assess the healing process in such a way that we can be sure of the effects.

Results from three other studies also showed very low certainty about whether other forms of nutritional supplementation had any effect on ulcer healing. Two of these studies showed very low certainty about whether supplemented beverages affect other outcomes, such as death, the likelihood of amputation, fewer new ulcers, or people’s quality of life. We cannot be sure of the results of these studies, as they were not properly conducted and had an insufficient number of participants..

What was studied in the review?

Foot ulcers may develop in people with diabetes. This is often due to decreased blood supply, decreased sensation, foot deformity, trauma, or a combination of all or some of these causes. Foot ulcers are a serious complication of diabetes and can lead to serious consequences such as amputation..

Leg ulcers, like other wounds, are believed to heal better and faster if people eat well. Supplements containing certain vitamins and protein can be given to people with foot ulcers and diabetes to help treat them.

What are the main findings of this review?

We found nine relevant studies from 2004 to 2019, involving 629 people, 72% of whom were men, with a median age of 59.2 years. Most of the studies were conducted in outpatient clinics. Three studies looked at another drink with nutritional supplements and compared it to a drink that looked the same but did not contain any additives. Five studies examined the effects of different types of pill supplements and compared them to pills that did not contain any active substance or dietary supplement.

One study compared two different doses of vitamin D injections. None of the studies reported any of the outcomes of interest to this review.

Two studies were carried out with financial support from food supplement manufacturers, five studies were funded by Iranian universities.

From eight studies, it is not clear whether dietary interventions improve foot ulcer healing in people with diabetes versus no nutritional supplementation or other supplementation doses. One study reported adverse events and two reported the number of amputations. It is not clear in the results whether there is a difference in the number of amputations or deaths between the use of supplements and no supplements.

It is also unclear if there is a difference in health-related quality of life or the number of recurrent ulcers



between supplements and no supplements..

Overall, we found that the certainty of the evidence was very low. None of the studies had enough participants, five did not measure outcomes in a way that we could be sure of the results, and the studies were not conducted properly, so we are not very confident about the results. More studies with low risk of bias (bias) and with high certainty of results are needed so that we can clarify the role of dietary interventions in treating foot ulcers in people with diabetes..

How relevant is this review?

We searched for studies published as of March 2020.

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