Local wound insulin infiltration (injection) and topical timolol gel versus normal saline and povidone iodine in treatment of diabetic foot ulcer

Abstract

Background: Diabetic foot ulcers (DFUs) are a common complication of diabetes mellitus, contributing significantly to patient morbidity. Effective wound management remains a challenge, prompting investigations into novel treatment methods. This randomized controlled study compares the efficacy of local wound insulin infiltration with topical timolol gel versus standard treatment with normal saline and povidone iodine for DFUs. To evaluate and compare the ulcer healing outcomes of local insulin with topical timolol gel versus normal saline with povidone iodine in treating diabetic foot ulcers.

Methods: A total of 30 patients with chronic DFUs were randomly assigned into two groups. Group 1 received local insulin infiltration (25% of daily insulin dose) and topical timolol gel, while Group 2 received normal saline and povidone iodine. Both groups followed a basal-bolus insulin regimen. The study included patients with Grade 1 or Grade 2 DFUs (Wagner classification) and excluded those with infections, osteomyelitis, or ulcers >20 cm². Outcomes assessed included healing rate, wound area reduction, time to healing, and adverse events over eight weeks.

Results: Group 1 showed a significantly higher healing rate (80% vs. 40%, p=0.012) and faster healing time (28.2±10.5 days vs. 42.1±12.1 days, p=0.008). Wound area reduction was significantly greater in Group 1 (75.2% vs. 40.5%, p=0.001). Minimal adverse events, such as hypoglycemia, were observed.

Conclusion: Local insulin infiltration combined with topical timolol gel is a safe and superior approach to enhance diabetic foot ulcer healing compared to standard treatment. This approach has the potential to improve clinical outcomes for patients with DFUs.