Context: Diabetes mellitus is associated with morbid complications such as diabetic foot ulcers (DFUs) that may lead to amputations or mortality if not managed adequately.
Objective: New adjunctive interventions to treat diabetic wounds include topical biologics and growth factors. This study aims to evaluate their efficacy in improving wound healing outcomes and safety.
Data sources: Comprehensive database searches of MEDLINE via PubMed, EMBASE and Cochrane performed from inception to December 2022.
Study selection: Three independent researchers selected the studies. Randomised-controlled trials that compared the use of a topical biologic growth factor-containing regimen to other biologics or standard of care (SOC) were included.
Data extraction and synthesis: This review followed PRISMA guidelines. Risk of bias analysis was performed using the Jadad scale. Network meta-analysis was performed. Treatments were grouped into common nodes based on the type of biologic agent.
Main outcomes and measures: Primary outcomes of interest were healing rate and time to wound closure. Secondary outcomes included wound infection, serious adverse events, and amputation rate.
Results: Human umbilical cord (HUC) was associated with the highest cure, followed by recombinant human epidermal growth factor (hEGF). A significantly greater reduction in the time to cure DFUs was seen in HUC, hEGF and fibroblast growth factor (FGF). There was a significantly lower risk of adverse events (AEs) when platelet-rich plasma (PRP) was administered.
Conclusion: HUC, hEGF and FGF are promising topical biologics with statistically significant primary outcomes compared to SOC, while PRP is effective in reducing ulcer-related AEs. HUC has been found to be the most effective in terms of cure rate and a reduction in time to cure.
Keywords: Diabetes Complications; Diabetes mellitus; Diabetic foot; Diabetic neuropathies; Diabetic ulcers; Wound healing.
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