Extracorporeal shock wave therapy safe and efficacious for Diabetic Foot Ulcers, reveals research

A new groundbreaking study revealed that extracorporeal shockwave therapy (ESWT) is safe, efficacious, and has shown favorable outcomes for the treatment of diabetic foot ulcers (DFU) as per a systematic review and meta-analysis published in the journal Diabetes Research and Clinical Practice.

Diabetes is a global pandemic affecting individuals of all age groups. DFU is one of the most prevalent and serious consequences of DM which does not heal quickly, leading to prolonged hospitalization, reduced quality of life, amputation, and worsened consequences. Glycemic control, infection management, appropriate orthotic shoe wear, offloading devices, debridement, and alternative therapies like hyperbaric oxygen therapy are some of the management practices for DFU. However, they are not effective due to poor healing and high recurrence rates.

Extracorporeal Shockwave therapy (ESWT) is a non-invasive method to re-initiate chronic wounds by activating the body’s healing pathways to promote healing in a variety of wound healing applications. It works on the principle of simultaneously reducing the wound bed inflammation and surrounding tissue inflammation by increasing angiogenesis and enhancing the production of growth factors. Hence, researchers conducted a meta-analysis to evaluate the efficacy and safety of ESWT for the treatment of DFU patients. A systematic search was conducted using databases like PubMed, EMBASE, Cochrane Controlled Register of Trials (CENTAL), and Web of Science for retrieving randomized controlled trials (RCTs) evaluating the efficacy and safety of ESWT.

The search strategy consisted of combining various medical subject heading terms by two authors. Eligible studies included adult patients who received ESWT alone or in combination with the standard of care. Completely healed ulcers are defined as the complete closure of the ulcer at the time of ulcer healing assessment and were considered the primary outcome of the measurement. STATA 14.0 software was used for conducting a meta-analysis to evaluate the efficacy and safety of ESWT

Findings:

• About ten RCTs with moderate methodological quality were included for data analysis.
• A significant association was seen between ESWT and completely healed ulcers (risk ratio [RR]: 1.57) and a lower rate of unchanged ulcers (RR: 0.25) compared to controls.
• Subgroup analysis further revealed that ESWT had a better prognosis than both hyperbaric oxygen therapy (HOT) and the standard of care (SOC).
• The average transcutaneous partial oxygen pressure (TcPO2) was significantly improved with ESWT.
• However, no significant difference was found in the rate of ≥ 50 % improved ulcers and treatment-emergent adverse events (TEAEs) between the ESWT and controls .

Thus, the study concluded that ESWT is safe and, efficacious with statistically significant improvements in the DFU. Further studies have to be done on a large scale to confirm the best approach for DFU. 

Further reading: Wu F, Qi Z, Pan B, Tao R. Extracorporeal shock wave therapy (ESWT) favors healing of diabetic foot ulcers: A systematic review and meta-analysis. Diabetes Res Clin Pract. Published online September 3, 2024. doi:10.1016/j.diabres.2024.111843