Diabetic Foot Ulcer Healing with Nitric Oxide Treatment

Health Writer

One of the hallmarks of diabetes is poor circulation. High blood sugar levels can cause damage to your blood vessels and can prevent a cut or open wound from healing properly. Poor circulation means that someone with diabetes can quickly develop a foot ulcer – a situation that can escalate into gangrene and the need to amputate the extremity if wound care doesn’t resolve the foot ulcer. Treatment is often not effective, so it’s good news that a research team is looking to develop a quick, effective way to treat and heal foot ulcers in people with diabetes. In fact, diabetes foot ulcers are the most common foot injuries that lead to foot amputations.

On average, once a foot ulcer develops, it can take around to 130 days to completely heal. Efforts to improve or speed up healing time could dramatically improve a person’s quality of life and likely allow for a better outcome. The researchers experimented with human cells to try to find a way to harness the body’s own healing mechanism, amplifying levels of nitric oxide. Nitric acid levels are often impaired in patients with diabetes. In this case, utilizing bandages containing nitric oxide that release levels as needed to the damaged cells seems to have solved this challenging medical treatment issue. The 2018 study published in MDPI-Medical Sciences showed that when nitric oxide is introduced and monitored closely, foot ulcer wound healing in a person with diabetes can be incredibly rapid and complete.

To understand how this new procedure might cut healing time, you have to understand how wound healing occurs. Once you sustain an open wound in the skin, three types of cells step in to help with repair. Macrophages, arrive within 24 hours of the damage, helping to clear away debris. Fibroblasts are next on the scene, and they help to lay down the matrix necessary for the next cells to arrive. Those cells are keratinocytes and they are the cells that will do the actual rebuilding and repair or the wound, allowing it to ultimately close over time.

The role of nitric oxide, normally found in adequate levels in the body of a healthy person, is to set the rhythm or pace of the repair process by the different cells. It also helps to limit inflammation and induce cell proliferation and remodeling. It orchestrates a delicate balance, so the researchers anticipated that just flooding the wound with more nitric oxide would not likely yield optimal results. The researchers found that the levels of nitric oxide have to be closely monitored and adjusted, based on the appearance of each of the three cell categories involved in wound repair.

One of the crucial elements of the research was the finding that you have to directly measure nitric oxide levels in real time and not nitrite levels, though stable nitrite is easier to measure. The researchers found that nitrite levels do not perfectly reflect the nitric oxide levels in the presence of high blood sugar. So, though it added a burden to the process, they found that they had to track and adjust nitric oxide levels directly. This close monitoring and adjusting of the nitric oxide levels nudged very rapid wound healing. The previous older method of just adding nitric oxide to bandages and assuming it would hasten wound healing was not found to improve healing time significantly.

The research team plans to collaborate with a health system, in order to have access to more human cell samples. This next phase would allow them to test personalized bandages laden with specific amounts of nitric oxide, since there’s some variability of nitric oxide. They can then create bandages that hold the amounts of nitric oxide that will match and compensate for the levels needed by an individual patient. They anticipate having bandage prototypes in a few years. The nitric oxide-releasing bandage could be a game-changer in the diabetes world, lowering rates of amputations and ensuring better quality of life for individuals with diabetes.

Another 2018 study out of the UK used a special type of bandage on 148 people with diabetic foot ulcers. These bandages used technology that absorbed excess fluid while promoting a cushioned and moist healing environment and the production of higher levels of nitric acid. Outcomes included a higher rate of healed to completion foot ulcers and fewer hospitalizations associated with foot ulcer complications.

A cornerstone of diabetes is to prevent foot trauma and open wounds, in order to limit risk of a foot ulcer. Tips to do that include:

  • Use protective footwear like wool socks that are breathable, indoors and outdoors (indoors with rubber treads to prevent slipping).
  • Have a family member or friend help you to examine your feet regularly since diabetes-related nerve damage can result in skin numbness which may hinder your detection of a small abrasion or cut
  • Keep feet clean and dry
  • Have a health professional trim your toenails
  • Make sure you have your shoes measured to avoid shoes that are too tight or too loose
  • Check inside your shoes regularly to make sure they are not breaking down and developing sharp edges or seams
  • See a podiatrist regularly
  • If you do develop a wound or cut, seek medical attention immediately and comply with all wound care instructions
  • Closely monitor and manage blood sugar levels

See more helpful articles:

Hyperbaric Oxygen Therapy for Wound Care

FDA Approves Treatment for Diabetic Foot Ulcers

Speeding Up Wound Healing with Debridement