Comparative analysis of autologous platelet-rich plasma and topical insulin injections on wound healing outcomes in patients with diabetic foot ulcers: a retrospective study

Sridhar Jaganathan; Dharaneesh Selvaraja Sangeethapriya; Baddam Nikhil Reddy

doi:10.18203/2349-2902.isj20251533

Authors

Sridhar Jaganathan Department of General Surgery, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India https://orcid.org/0000-0001-6113-0421
Dharaneesh Selvaraja Sangeethapriya Department of General Surgery, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India https://orcid.org/0009-0000-8710-6593
Baddam Nikhil Reddy Department of General Surgery, Vinayaka Mission’s Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-2902.isj20251533

Keywords:

Diabetic foot ulcer, Wound healing, Autologous platelet-rich plasma, Topical insulin, Granulation tissue, Re-intervention rate

Abstract

Background: Diabetes mellitus is a chronic condition leading to high blood sugar due to pancreatic dysfunction, insulin resistance, or decreased insulin production. Among diabetics, 4–10% develop diabetic foot ulcers (DFUs), with elderly patients at higher risk. A cost-effective and efficient treatment approach is needed for prolonged ulcers. Insulin promotes wound healing through molecular mechanisms involving AKT and ERK pathways. Platelet-rich plasma (PRP) contains high concentrations of platelets and growth factors that accelerate healing.

Methods: A randomized clinical study of 100 patients with post-debridement DFUs (<10×10 cm²) divided into two groups: Group A received PRP injections, and Group B received topical insulin. Wound healing was assessed on days 3, 7, 14, and 21 based on ulcer size reduction, granulation tissue formation, and need for further intervention. Data were analyzed using Statistical Software, with p<0.05 considered significant.

Results: The PRP group had a mean age of 57.18 years, and the Topical Insulin group, 56.28 years (p=0.36). PRP showed superior granulation tissue formation (59.88±1.30 vs. 44.48±1.71 at day 21), shorter hospital stays (21.34 vs. 30.94 days, p=0.0001), and fewer re-interventions (36% vs. 62%, p=0.009).

Conclusion: The findings consistently show that PRP outperforms Topical Insulin in key areas such as reducing ulcer size, promoting granulation tissue growth, shortening hospital stays, reduced need for re-interventions.

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References

Smith S, Taylor CR, Kanevsky E, Povoski SP, Hawley JR. Long-term safety and efficacy of breast biopsy markers in clinical practice. Expert Rev Med Dev. 2021;18(1):121-8. DOI: https://doi.org/10.1080/17434440.2020.1852928

Abbott CA, Carrington AL, Ashe H, Bath S, Every LC, Griffiths J, et al. The North‐West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community‐based patient cohort. Diabetic Med. 2002;19(5):377-84. DOI: https://doi.org/10.1046/j.1464-5491.2002.00698.x

Paulose-Ram R, Gu Q, Eberhardt M, Gregg E, Geiss L, Engelgau M. Lower extremity disease among persons aged> _40 years with and without diabetes--United States, 1999-2002. MMWR: Morbidity Mortality Weekly Report. 2005;54(45):56.

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28. DOI: https://doi.org/10.1001/jama.293.2.217

Liu Y, Petreaca M, Yao M, Martins-Green M. Cell and molecular mechanisms of keratinocyte function stimulated by insulin during wound healing. BMC Cell Biol. 2009;10:1-5. DOI: https://doi.org/10.1186/1471-2121-10-1

Ching YH, Sutton TL, Pierpont YN, Robson MC, Payne WG. The use of growth factors and other humoral agents to accelerate and enhance burn wound healing. Eplasty. 2011;11:41.

Lima MH, Caricilli AM, de Abreu LL, Araújo EP, Pelegrinelli FF, Thirone AC, et al. Topical insulin accelerates wound healing in diabetes by enhancing the AKT and ERK pathways: a double-blind placebo-controlled clinical trial. PloS one. 2012;7(5):36974. DOI: https://doi.org/10.1371/journal.pone.0036974

Alamdari NM, Shafiee A, Mirmohseni A, Besharat S. Evaluation of the efficacy of platelet-rich plasma on healing of clean diabetic foot ulcers: A randomized clinical trial in Tehran, Iran. Diab Metabolic Syndrome: Clin Res Rev. 2021;15(2):621-6. DOI: https://doi.org/10.1016/j.dsx.2021.03.005

Alavi A, Sibbald RG, Mayer D, Goodman L, Botros M, Armstrong DG, et al. Diabetic foot ulcers: Part I. Pathophysiology and prevention. J Am Acad Dermatol. 2014;70(1):156. DOI: https://doi.org/10.1016/j.jaad.2013.07.048

He M, Chen T, Lv Y, Song P, Deng B, Guo X, et al. The role of allogeneic platelet-rich plasma in patients with diabetic foot ulcer: Current perspectives and future challenges. Front Bioeng Biotechnol. 2022;10:993436. DOI: https://doi.org/10.3389/fbioe.2022.993436

Bhittani MK, Rehman M, Altaf HN, Altaf OS. Effectiveness of topical insulin dressings in management of diabetic foot ulcers. World J Surg. 2020;44:2028-33. DOI: https://doi.org/10.1007/s00268-019-05321-3

Li L, Chen D, Wang C, Yuan N, Wang Y, He L, et al. Autologous platelet‐rich gel for treatment of diabetic chronic refractory cutaneous ulcers: a prospective, randomized clinical trial. Wound Repair Regen. 2015;23(4):495-505. DOI: https://doi.org/10.1111/wrr.12294

Li S, Xing F, Yan T, Zhang S, Chen F. The efficiency and safety of platelet-rich plasma dressing in the treatment of chronic wounds: a systematic review and meta-analysis of randomized controlled trials. J Personal Med. 2023;13(3):430. DOI: https://doi.org/10.3390/jpm13030430

Ali MF, Palaniappan NK, Chellappa PM. Effectiveness of autologous platelet-rich plasma dressing in healing chronic diabetic foot ulcers in comparison with saline dressing. A randomized control study. J Curr Res Sci Med. 2023;9(1):61-6. DOI: https://doi.org/10.4103/jcrsm.jcrsm_69_22