10 October 2010

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Can Advanced Therapies Speed Healing Of DFUs?

By Brian McCurdy, Senior Editor

Given that diabetic foot ulcers can result in complications as devastating as amputation, timely healing of such ulcers is critical. A new study in the Archives of Dermatology cites the benefits of advanced biological therapies.

   The study focused on 2,517 patients with diabetic neuropathic foot ulcers who received advanced biological therapy via Apligraf (Organogenesis), becaplermin (Regranex, Systagenix Wound Management) or Procuren (Cytomedix).

   On average, physicians used advanced therapy within 28 days from the patients’ first wound clinic visit, according to the study. The study authors note that wounds treated with engineered skin as the first advanced biological therapy were 31.2 percent more likely to heal than wounds initially treated with topical recombinant growth
factor and 40 percent more likely to heal than those first treated with platelet releasate.

   Paul Kim, DPM, says one can ensure timely healing by optimizing the wound macro-environment (via offloading bony prominences) and micro-environment (via low bacterial counts and optimization of tissue inhibitor of metalloproteinases/matrix metalloproteinases (TIMP/MMP) ratios and adequate microvascular perfusion). He does not believe that every diabetic foot ulcer requires advanced therapies such as bioengineered alternative tissues (BATs) like Apligraf, Dermagraft (Advanced Biohealing), Integra (Integra LifeSciences) or GraftJacket (Wright Medical Technology).

   Dr. Kim does note that a dormant wound that does not demonstrate quantifiable changes in its dimensions over four weeks requires advanced wound healing technologies. Jason Hanft, DPM, concurs, citing Sheehan’s 2003 Diabetes Care study, which found that diabetic foot ulcers that do not decrease by 50 percent after four weeks of treatment have a low probability of healing and a higher chance of complications.

   Such wounds require active treatment products like living skin equivalents and growth factors, according to Dr. Hanft. He also notes that other Diabetes Care studies by Lavery and colleagues in 2006 and Ndip and colleagues in 2010 have emphasized the use of biologically active therapies early in wounds with a higher risk of infection. Dr. Hanft says these wounds include: wounds greater than four weeks old; recurrent diabetic foot ulcers; wounds in patients with renal failure; traumatic wounds; wounds with significant depth; and ischemic wounds.

Are Advanced Therapies Cost Effective?

Although the advanced therapies can be expensive, Dr. Kim says such therapies are “considerably less expensive” than the alternative of amputation. He notes the “staggering costs” associated with amputations caused by untreated or undertreated diabetic foot ulcers. “(Amputations cause) a substantial burden to the healthcare system,” maintains Dr. Kim.
Other costs associated with amputations include lost wages and employability, as well as a decrease in a patient’s overall quality of life, notes Dr. Kim, an Associate Professor at the Midwestern University College of Health Sciences in Glendale, Ariz.

    “I have a friend who is a lower extremity amputee and he always reminds me that ‘We are born with two feet and one is not a spare,’” says Dr. Kim, who emphasizes the need to make every effort to salvage limbs.

   Dr. Hanft agrees that advanced therapies are cost effective.

    “We can significantly reduce costs and save the healthcare system money by rapid use of active therapies and fast wound closure with lower complication rates,” notes Dr. Hanft, the Director of Podiatric Medical Education at Baptist Health in South Miami, Fla.

Study Cites Potential Benefits Of Bariatric Surgery For Patients With Diabetes

By Brian McCurdy, Senior Editor

A new study in the Journal of the American Medical Association finds that bariatric surgery is associated with less usage of diabetes medication and decreased overall healthcare costs.

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