Exploring the molecular mechanism to safety of hyperbaric oxygen therapy in diabetic foot ulcer – A narrative review

Abstract

Diabetic foot ulcers (DFU) are a challenge that requires special management due to the high rate of amputation and death. Hyperbaric oxygen therapy is growing in popularity in diabetic feet with ulceration (DFU). In this review, the authors compile the available evidence regarding the mechanisms and safety of hyperbaric oxygen therapy in DFU patients. We reviewed current knowledge regarding the pathophysiology of DFU and molecular mechanisms, practice guidelines, and safety of hyperbaric oxygen therapy in diabetes with foot ulcers. The pathophysiology of diabetes mellitus wounds reveals persistent inflammation and reduced angiogenesis in hyperglycaemic circumstances, disrupting the diabetic wound healing cascade. Accelerating angiogenesis has been associated with improved wound healing. At the molecular level, hyperbaric oxygen therapy-induced oxidative stress reduces pro-inflammation while increasing growth factors and other pro-angiogenic cytokines. Clinical trials with DFU patients reveal that hyperbaric oxygen therapy outperforms standard therapy in terms of efficacy outcomes, particularly wound and amputation healing rates. Barotrauma and short-term vision impairment are two potential side effects of hyperbaric therapy. Current knowledge advances our understanding of hyperbaric oxygen therapy and its use in diabetic patients with foot wounds. This may inform the development of new DFU therapy.