The management of chronic diabetic foot ulcers

News release from NETSCC, HTA

03 December 2009

There is no ‘clinical’ difference when comparing dressings for treating chronic diabetic foot ulcers, according to new research published by the National Institute for Health Research Health Technology Assessment (NIHR, HTA) programme. Statistically, however, the costs associated with the provision of dressings could result in savings to the NHS of around £2 million pounds per year.

Up to 15 per cent of all people with diabetes will suffer with an ulcer of the foot at some stage of their lives. Healing of these ulcers is slow and uncertain with only a third healing within three months, and only half in six months. There are a large number of dressing products available, ranging from the relatively simple and inexpensive ones, to those which are more sophisticated, and expensive.

The clinical trial, led by Professor William J Jeffcoate of Nottingham University Hospitals Trust, compared the effectiveness of three different types of dressings; a simple dry dressing, a dressing which is impregnated with iodine, and a modern hydrofibre dressing. Three hundred and seventeen patients with uninfected ulcers which had been present for at least six weeks were recruited from one of nine expert centres around the UK and randomised to receive one of these treatments. Each ulcer was managed with one of the three dressings for six months (or until they healed). The researchers then compared the number of ulcers which healed in the time period to measure their effectiveness.

The results showed that a greater proportion of smaller ulcers healed within the specified time. There was, however, no difference between the three dressings in terms of the number of ulcers which healed in the timeframe, the time to healing, any adverse events and health-related quality of life.

“We have found no evidence to suggest any difference in the effectiveness, safety or health-related quality of life between these dressings” says Professor Jeffcoate. “Until further trial evidence is available, we therefore believe that clinicians should select the cheapest and most convenient product available for treatment.” To view the full project details visit: http://www.hta.ac.uk/1357
Other research looking into dressings for treating ulcers assessed the cost-effectiveness of using antimicrobial silver-donating dressings beneath compression therapy to treat venous leg ulcers. This study suggested that there were no significant differences when it came to healing rates and quality of life. However, the economic analysis showed a significantly higher cost for those treated with antimicrobial dressings with there being no difference in clinical outcomes.

"A great variety of different dressings are used to treat venous leg ulcers, but quality evidence for the benefits of specific dressings is sparse”, says lead researcher Professor Michaels of the University of Sheffield. “Systematic reviews have shown no statistically significant difference in the number of ulcers healed between any of the dressing types”.

To view the full project details visit: http://www.hta.ac.uk/1380 These results also published in the British Journal of Surgery. For full details visit: http://www3.interscience.wiley.com/cgi-bin/fulltext/122611290/HTMLSTART?CRETRY=1&SRETRY=0

Notes for editors

 1. The National Institute for Health Research Health Technology Assessment (NIHR HTA) programme commissions research about the effectiveness, costs, and broader impact of health technologies for those who use, manage and provide care in the NHS. It is the largest NIHR programme and publishes the results of its research in the Health Technology Assessment journal, with over 530 issues published to date. The journal’s 2009 Impact Factor (4.197) ranked it in the top 10% of medical and health-related journals. All issues are available for download free of charge from the website, www.hta.ac.uk

2. The National Institute for Health Research provides the framework through which the research staff and research infrastructure of the NHS in England is positioned, maintained and managed as a national research facility. The NIHR provides the NHS with the support and infrastructure it needs to conduct first-class research funded by the Government and its partners alongside high-quality patient care, education and training. Its aim is to support outstanding individuals (both leaders and collaborators), working in world class facilities (both NHS and university), conducting leading edge research focused on the needs of patients. www.nihr.ac.uk

Contact details

Naomi Williams, Programme Manager (Communications)
Telephone: 02380 595 646, Email: N.E.Williams@southampton.ac.uk

Emma Sunderland, Assistant Programme Manager (Communications)
Telephone: 02380 599 094, Email: E.Sunderland@southampton.ac.uk

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