Diabetes mellitus type 1 is a metabolic disease in which the body has difficulty producing insulin. This leads to high blood glucose levels, which 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. About 15% to 25% of people with diabetes will develop a foot ulcer. These wounds are often resistant to healing; therefore, people with diabetes experience lower limb amputation at about 20 times the rate of people without diabetes. If an ulcer does not heal with standard wound care, other therapeutic interventions are offered, one of which is hyperbaric oxygen therapy (HBOT).
Hyperbaric oxygen therapy (HBOT) has been promoted as an effective treatment for diabetic foot wounds, and the first controlled trial for this indication was reported (in Diabetes Care) over 20 years ago.
A Cochrane database systematic review published in 2004 concluded, based on results from a number of clinical trials that “HBOT significantly reduced the risk of major amputation and may improve the chance of healing at 1 year” and a more recent systematic review and meta-analysis that included 10 studies concluded that HBOT reduces the risk of amputation.
As recently as November 2017, the German Federal Government covers HBOT for diabetic foot syndrome under public health insurance for public and private centres.
How HBOT can help it?
The use of HBOT by diabetics can be grouped into three categories:
1. As an adjunct to help prevent diabetic complications such as:
- Numbness and tingling
- Wounds occurring
2. As an adjunct to help improvements in cardiovascular complications and reduce insulin requirements.
Kakhnovskii et al., 1980, noted improvement in cardiovascular complications by using HBOT and later reported HBOT as an adjunct to diet and insulin in the treatment of moderately severe diabetes in 130 patients. The dosage of insulin was reduced by 4-38 units in 62.3% of the patients after treatment. The authors concluded that the hypoglycaemic effect of HBOT is due to inhibition of the effect of anti-insulin hormones by HBOT .
3. Wound Healing
- After 30 days of standard treatment when a diabetic wound has not healed satisfactory, HBOT is used as a standard protocol in America and is paid for by American health insurers.
4. Stem Cell Production
How Many Treatments?
A course of 40 HBOT treatments in a concentrated block according to Dr Paul Harsh MD in his book Oxygen Revolution, where he says:
‘…in cases of chronic wounding, 40 HBOT’s in a concentrated block of treatments is necessary to achieve permanent improvement….’
The US Government medical system of Medicare and Medicad, federal and state respectively, managed programs reimburse towards the cost of HBOT treatments prescribed a doctor for any FDA approved treatments which includes DFU’s as listed on their site as “Enhanced healing of selected problem wounds” .