The pooled analysis of seven randomized controlled trials (RCTs) demonstrated that HA-based dressings improved complete ulcer healing rates and shortened recovery time compared with standard wound care, highlighting the compound as a promising addition to diabetic foot management.
The research team, led by Ling Yao from the Department of Orthopedic Surgery at The Affiliated Hospital (GROUP) of Putian University, Fujian, China, examined data from 444 patients with a total of 456 ulcers.
To conduct the review, the investigators searched multiple electronic databases, including PubMed, BIOSIS, EMBASE, the Cochrane Central Register of Controlled Trials, and Google Scholar, with the final search completed on August 31, 2024.
Eligible studies compared HA or its derivatives with other dressing materials and assessed outcomes, such as complete healing rate, time to closure, and any treatment-related complications. Statistical analyses were performed using the Cochrane Collaboration’s RevMan 5.0 software, and potential biases were evaluated with the Cochrane “Risk of bias” tool.
Key Findings:
- Patients treated with hyaluronic acid (HA) had nearly four times higher odds of complete ulcer closure (odds ratio [OR] 3.92) compared to those receiving conventional dressings.
- HA therapy led to faster healing, with a standardized mean difference (SMD) of –0.83.
- The risk of adverse events remained low (OR 0.79), indicating that HA is both effective and safe for managing chronic diabetic wounds.
The authors noted key limitations, including the small number of trials and participants, incomplete reporting of patient details and ulcer stages, and moderate study heterogeneity (I² = 62%). Differences in ulcer size, location, patient profiles, and HA application methods may have contributed to these variations.
The review highlights the clinical potential of HA-based therapies for diabetic foot ulcer care, a condition that remains a leading cause of infection, hospitalization, and lower-limb amputation worldwide. By enhancing tissue repair and reducing healing time without elevating complication risks, HA could become an important adjunct to current treatment protocols.
However, the authors emphasized the need for larger, high-quality trials to validate their conclusions and to identify the most effective HA formulations and application methods. Until then, HA and its derivatives stand out as a safe, promising option to improve outcomes for patients struggling with the chronic wounds of diabetes.
Reference:
Yao, L., Xie, Q., Dai, J., & Huang, G. (2025). Effectiveness of hyaluronic acid and its derivatives on diabetic foot ulcer: A systematic review and meta-analysis. Frontiers in Endocrinology, 16, 1627558. https://doi.org/10.3389/fendo.2025.1627558
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