Diabetic foot ulcer (DFU)—which is usually of vascular or neuropathic origin following trauma, pressure, or burn—is costly to treat and can cause personal pain and suffering for affected patients. In addition, the ulcers are notoriously difficult to cure, and compared to the general patient population, diabetics usually experience delayed wound healing — so much so that amputation is inevitable for about 2 percent of diabetes patients.
While researchers are aware that each patient’s nutritional status and underlying diabetic complications and comorbidities can delay healing, they have been unable to locate interventions that can improve a patient’s prognosis.
Researchers from the Department of Surgery at the University of Nevada studied the issue extensively by developing an overview of how DFUs are currently treated. As their findings confirmed the current unsatisfactory state of affairs, the investigators then studied the effectiveness of using nutritional supplement mixtures
consisting of arginine, glutamine, and beta-hydroxy-beta-methylbutyrate (HMB) to speed up wound healing in DFUs.
The proposed basis for including those three substances in the supplement was as follows:
Argine, a vasodilator, reduces bacterial load and potentiates the immunologic process, contributing to infection/inflammation reversal and expediting tissue repair.
Glutamine stimulates protein synthesis, supports immune function, and promotes intestinal mucosal integrity.
HMB, a normal anabolic muscle component, controls intracellular synthesis.
The researchers administered their investigational mixture in a small study sample of 22 diabetics with recurrent DFU. All of the subjects had been treated with three or more antibiotics, and they all continued to have refractory lesions. Patients served as their own controls, with healing of the current lesion being compared to past healing. The researchers measured healing time and the need for antibiotics, and they assessed results using a cost-benefit ratio that included direct costs, such as medication, surgery, and nursing time, and indirect costs, such as hospitalization and lost days of work.
When treated with the arginine/glutamine/HMB supplement, patients had significantly reduced antibiotic use. They required approximately two-thirds less antibiotics during their current DFU episode, and when they did need an antibiotic, oral forms were often sufficient. In the control episodes of DFU, patients used a total of 83 cycles of antibiotics, whereas during the treatment episode, only 36 cycles were needed. Additionally, overall cost in the treatment group was about 50 percent lower than in previous episodes.
The tested treatment reduced medication and care costs, and it suggested lower infection aggressiveness and better host immune response. The economic advantage extended to patients who had fewer out-of-pocket expenses and could return to normal activities faster. Though further study is needed, the present study offered hope that nutritional supplements may help accelerate DFU wound healing.