In the study, when sucrose compared to octasulfate to placebo dressing in 240 patients with neuroischemic diabetic foot ulcers, wound healing was knowingly improved among patients given the active dressing. Currently there are no proven treatments for neuroischemic ulcers, defined as those arising in the presence of both peripheral neuropathy and peripheral arterial disease, with the latter condition significantly worsening prognosis. This study was published in Lancet Diabetes & Endocrinology.
The potassium salt of sucrose octasulfate acts at the tissue level to inhibit excess matrix metalloproteinases, which impede wound healing by the degradation of growth factors and destruction of the extracellular matrix. The ingredient also acts to restore growth factor function and tissue formation. Authors said, "A sucrose octasulfate dressing is effective and safe, and its use is easy to implement by all healthcare professionals. This dressing could form an important part of modern multidisciplinary management of neuroischemic diabetic foot ulcers."
"Sucrose octasulfate dressings seem to be a promising addition to our current treatment strategies for diabetic foot ulcers positioned away from the heel, which have not shown a significant reduction in area despite good offloading and other best practice treatments, and where patients also have peripheral arterial disease that is not being considered for vascular intervention." However, she also questioned the generalizability of the findings, given some of the study's exclusion criteria based on ulcer location and size, and the presence of infection.
Dressings were applied by nursing staff or the patient's relatives, with frequency of dressing changes individually determined based on wound condition. Median treatment duration was 115 days for the sucrose octasulfate dressing and 135 days for controls. The primary outcome, wound closure at week 20, was achieved in 48% of the sucrose octasulfate treatment group vs 30% of controls, giving an adjusted odds ratio (OR) of 2.6 (P=.002).
The only other significant variable that predicted the primary outcome was duration of wound prior to treatment. Those whose wounds had been present for more than 6 months prior had a much lower rate of wound closure at week 20 compared with those whose wounds had been present for less than 6 months (OR, 0.27; P<.001). The estimated time to wound closure was also significantly shorter with the active treatment vs placebo, at 120 vs 180 days (P=.029).
The confirmation of the study's generalizability is needed. Results were certainly more encouraging than findings for most intrusions, which have been reported. Also, results of a full health economic analysis were expected, it is obvious that the sucrose octasulfate dressing is easy to apply, and therefore, apart from the dressing itself, there should be no additional costs in a treated patient's clinical pathway.