Diyabetik Ayak Ülserinde Güncel Tedavi Yaklaşımları ve İlaç Uygulamaları
Özet
Diyabetik ayak ülserleri, diyabet hastalarında sık görülen ve tedavi edilmediğinde ciddi komplikasyonlara yol açabilen önemli bir sağlık sorunudur. Geleneksel tedavi yöntemleri genellikle yetersiz kalmakta ve iyileşme sürecini uzatabilmektedir. Nanoteknolojik ve biyoteknolojik gelişmeler, ilaçların hedef bölgeye etkin şekilde ulaşmasını sağlayarak iyileşme sürecini hızlandırmaktadır. Geliştirilen biyomalzemeler, yara iyileşmesini destekleyen ve enfeksiyon riskini azaltan özellikleri ile dikkat çekmektedir. Giyilebilir sensörler ve akıllı yara pansumanları, yaranın iyileşme sürecini izleme ve gerektiğinde otomatik müdahale etme imkanı sunmaktadır. Sonuç olarak, diyabetik ayak ülseri tedavisinde kullanılan yeni teknolojik gelişmeler hastaların yaşam kalitesini artırma ve iyileşme sürecini artırmaktadır. Ancak bu yeni geliştirilen yöntem ve ilaçların, klinik uygulamalardaki etkinliği ve maliyet-etkinliği hakkında daha fazla araştırmaya ihtiyaç duyulmaktadır. Bu çalışmada, diyabetik ayak ülseri hakkında detaylı bilginin yanı sıra tedavisinde kullanılan ve uygulanan yeni teknolojik ve biyoteknolojik gelişmelerden, biyomalzemelerden, giyilebilir sensörlerden, akıllı yara pansumanlarından ve gen tedavilerinden bahsedilmektedir.
Diabetic foot ulcers are a significant health problem that is common in diabetic patients and can lead to severe complications if left untreated. Traditional treatment methods are often inadequate and can prolong the healing process. Nanotechnological and biotechnological developments accelerate the healing process by ensuring that drugs reach the target area effectively. Developed biomaterials stand out with their properties that support wound healing and reduce the risk of infection. Wearable sensors and smart wound dressings offer the opportunity to monitor the wound's healing process and intervene automatically when necessary. As a result, new technological developments used in the treatment of diabetic foot ulcers increase the quality of life of patients and increase the healing process. However, more research is needed on the effectiveness and cost-effectiveness of these newly developed methods and drugs in clinical applications. In this study, in addition to detailed information about diabetic foot ulcers, new technological and biotechnological developments, biomaterials, wearable sensors, smart wound dressings and gene therapies used and applied in its treatment are mentioned.
Referanslar
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes care, 33(Supplement_1), S62-S69.
Karri, VVSR., Kuppusamy, G., Talluri, SV., et al. Current and emerging therapies in the management of diabetic foot ulcers. Current Medical Research and Opinion. 2016; 32(3):519-542.
Lemp, JM., Bommer, C., Xie, et al. Quasi-experimental evaluation of a nationwide diabetes prevention programme. Nature. 2023; 624(7990):138-144.
Lim, JZM., Ng Natasha, SL; Thomas, C. Prevention and treatment of diabetic foot ulcers. Journal of the Royal Society of Medicine. 2017; 110(3):104-109.
Everett, E., Mathioudakis, N. Update on management of diabetic foot ulcers. Annals of the New York Academy of Sciences. 2018; 1411(1):153-165.
Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., et al. Type 1 diabetes mellitus. Nature reviews Disease primers. 2017; 3(1):1-17.
DeFronzo, RA., Ferrannini, E., Groop, L., et al. Type 2 diabetes mellitus. Nature reviews Disease primers. 2015; 1(1):1-22.
Sweeting, A., Wong, J., Murphy, HR., et al. A clinical update on gestational diabetes mellitus. Endocrine reviews. 2022; 43(5):763-793.
Harding, JL., Pavkov, ME., Magliano, DJ., et al. Global trends in diabetes complications: a review of current evidence. Diabetologia. 2019; 62:3-16.
Choudhury, H., Pandey, M., Lim, YQ., et al. Silver nanoparticles: Advanced and promising technology in diabetic wound therapy. Materials Science and Engineering: C. 2020; 112:110925.
Syafril, S. (2018, March). Pathophysiology diabetic foot ulcer. In IOP Conference series: earth and environmental science (Vol. 125, No. 1, p. 012161). IOP Publishing.
Armstrong, DG., Boulton, AJ., Bus, SA. Diabetic foot ulcers and their recurrence. New England Journal of Medicine. 2017; 376(24):2367-2375.
Perez-Favila, A., Martinez-Fierro, ML., Rodriguez-Lazalde, J., et al. Current therapeutic strategies in diabetic foot ulcers. Medicina. 2019; 55(11):714.
Yazdanpanah, L., Nasırı, M., Adarvishi, S. Literature review on the management of diabetic foot ulcer. World Journal of Diabetes. 2015; 6(1):37.
Da Silva, J., Leal, EC., Carvalho, E., et al. Innovative functional biomaterials as therapeutic wound dressings for chronic diabetic foot ulcers. International Journal of Molecular Sciences. 2023; 24(12):9900.
Sorber, R., Abularrage, CJ. (2021, March). Diabetic foot ulcers: Epidemiology and the role of multidisciplinary care teams. In Seminars in vascular surgery (Vol. 34, No. 1, pp. 47-53). WB Saunders.
Venmathi Maran, B. A., Jeyachandran, S., & Kimura, M. A Review on the Electrospinning of Polymer Nanofibers and Its Biomedical Applications. Journal of Composites Science. 2024; 8(1):32.
Liu, M., Wei, X., Zheng, Z., et al. Recent advances in nano-drug delivery systems for the treatment of diabetic wound healing. International Journal of Nanomedicine. 2023; 1537-1560.
Bhandari, R., Sharma, A., & Kuhad, A. Novel nanotechnological approaches for targeting dorsal root ganglion (DRG) in mitigating diabetic neuropathic pain (DNP). Frontiers in Endocrinology. 2022; 12:790747.
Yaqoob, SB., Adnan, R., Rameez K., et al. Gold, silver, and palladium nanoparticles: A chemical tool for biomedical applications. Frontiers in Chemistry. 2020; 8:376.
Vijayakumar, V., Samal, SK., Mohanty, S., et al. Recent advancements in biopolymer and metal nanoparticle-based materials in diabetic wound healing management. International Journal of Biological Macromolecules. 2019; 122:137-148.
Lau, P., Bidin, N., Islam, S., et al. Influence of gold nanoparticles on wound healing treatment in rat model: photobiomodulation therapy. Lasers in Surgery and Medicine. 2017; 49(4):380-386.
Loera-Valencia, R., Neira, RE., Urbina, BP., et al. Evaluation of the therapeutic efficacy of dressings with ZnO nanoparticles in the treatment of diabetic foot ulcers. Biomedicine & Pharmacotherapy. 2022;155:113708.
Sivaraj, D., Noishiki, C., Kosaric, N., et al. Nitric oxide-releasing gel accelerates healing in a diabetic murine splinted excisional wound model. Frontiers in Medicine. 2023; 10:1060758.
Fan, X., Gao, Y., Yang, F., et al. A copper single‐atom cascade bionanocatalyst for treating multidrug‐resistant bacterial diabetic ulcer. Advanced Functional Materials. 2023; 33(33):2301986.
Geng, X., Liu, K., Wang, J., et al. Preparation of ultra-small copper nanoparticles-loaded self-healing hydrogels with antibacterial, inflammation-suppressing and angiogenesis-enhancing properties for promoting diabetic wound healing. International Journal of Nanomedicine. 2023; 3339-3358.
Yusuf AA., Adeleke, OA. Nanofibrous scaffolds for diabetic wound healing. Pharmaceutics. 2023; 15(3):986.
Karabulut, B., Kerimoğlu, O., Uğurlu, T. Dendrimers-drug delivery systems. Clinical and Experimental Health Sciences. 2015; 5(1): 31-40.
Kwon, MJ., An, S., Choi, S., et al. Effective healing of diabetic skin wounds by using nonviral gene therapy based on minicircle vascular endothelial growth factor DNA and a cationic dendrimer. The journal of Gene Medicine. 2012; 14(4):272-278.
Xu, Y., Hu, Q., Wei, Z., et al. Advanced polymer hydrogels that promote diabetic ulcer healing: mechanisms, classifications, and medical applications. Biomaterials Research. 2023; 27(1):36.
Garland, NT., Song, JW., Ma, T., et al. A miniaturized, battery‐free, wireless wound monitor that predicts wound closure rate early. Advanced Healthcare Materials. 2023; 12(28):2301280.
Bhushan, P. (2021). Correlating the Effect of Dynamic Variability in the Sensor Environment on Sensor Design.
Baykan, H., Kara, M. Demonstration of the effectiveness of epidermal growth factor in diabetic foot ulcers. Journal of Contemporary Medicine. 2022; 12(6):827-831.
Tang, N., Zheng, Y., Jiang, X., et al. Wearable sensors and systems for wound healing-related pH and temperature detection. Micromachines. 2021; 12(4):430.
Vijean, V., Mohammed, SA., Ahmad, R., et al. (2022, December). Early Detection of Diabetic Foot Ulcers through Wearable Shoe Design. In 2022 4th International Conference on Artificial Intelligence and Speech Technology (AIST) (pp. 1-5). IEEE.
Bembnowicz, P., Yang, GZ., Anastasova, S., et al. (2013, May). Wearable electronic sensor for potentiometric and amperometric measurements. In 2013 IEEE International Conference on Body Sensor Networks (pp. 1-5). IEEE.
Zhang, M., Zhao, X. Alginate hydrogel dressings for advanced wound management. International Journal of Biological Macromolecules. 2020; 162:1414-1428.
Erdem, R. Nanolif bazlı yara örtüsü yüzeyi geliştirilmesi. 2013. PhD Tezi. Marmara Universitesi (Turkiye).
Wong, WF., Ang, KP., Sethi, G., et al. Recent advancement of medical patch for transdermal drug delivery. Medicina. 2023; 59(4):778.
Obaidat, R., Shameh, AA., Aljarrah, M., et al. Preparation and evaluation of polyvinylpyrrolidone electrospun nanofiber patches of pioglitazone for the treatment of atopic dermatitis. AAPS PharmSciTech. 2022; 23(1):51.
Karataş, A., Sonakın, Ö. Mi̇krofabri̇kasyon teknoloji̇si̇ ve i̇laç taşıyıcı si̇stemler üzeri̇nde uygulamaları. Ankara Üniversitesi Eczacılık Fakültesi Dergisi. 2007; 36(1): 47-74.
Zhang, J., Liu, H., Yu, Q., et al. Hair derived microneedle patches for both diabetic foot ulcer prevention and healing. ACS Biomaterials Science & Engineering. 2022; 9(1):363-374.
Saboia-Dantas, CJ., Dechichi, P., Fech, RL., et al. Progressive platelet rich fibrin tissue regeneration matrix: Description of a novel, low cost and effective method for the treatment of chronic diabetic ulcers—Pilot study. Plos One. 2023;18(5):e0284701.
Mastrogiacomo, M., Nardini, M., Collina, MC., et al. Innovative cell and platelet rich plasma therapies for diabetic foot ulcer treatment: The allogeneic approach. Frontiers in Bioengineering and Biotechnology. 2022; 10:869408.
Cazzell, S., Moyer, PM., Samsell, B., et al. A prospective, multicenter, single-arm clinical trial for treatment of complex diabetic foot ulcers with deep exposure using acellular dermal matrix. Advances In Skin & Wound Care. 2019; 32(9):409-415.
Tettelbach, WH., Cazzell, SM., Hubbs, B., et al. The influence of adequate debridement and placental-derived allografts on diabetic foot ulcers. Journal of Wound Care. 2022; 31(9):16-26.
Oropallo, A., Goodwin, A., Morrissey, M., et al. Human amnion chorion membrane allografts in the treatment of chronic diabetic foot ulcers: A literature review. Advances in Skin & Wound Care. 2021; 34(4):1-7.
Referanslar
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes care, 33(Supplement_1), S62-S69.
Karri, VVSR., Kuppusamy, G., Talluri, SV., et al. Current and emerging therapies in the management of diabetic foot ulcers. Current Medical Research and Opinion. 2016; 32(3):519-542.
Lemp, JM., Bommer, C., Xie, et al. Quasi-experimental evaluation of a nationwide diabetes prevention programme. Nature. 2023; 624(7990):138-144.
Lim, JZM., Ng Natasha, SL; Thomas, C. Prevention and treatment of diabetic foot ulcers. Journal of the Royal Society of Medicine. 2017; 110(3):104-109.
Everett, E., Mathioudakis, N. Update on management of diabetic foot ulcers. Annals of the New York Academy of Sciences. 2018; 1411(1):153-165.
Katsarou, A., Gudbjörnsdottir, S., Rawshani, A., et al. Type 1 diabetes mellitus. Nature reviews Disease primers. 2017; 3(1):1-17.
DeFronzo, RA., Ferrannini, E., Groop, L., et al. Type 2 diabetes mellitus. Nature reviews Disease primers. 2015; 1(1):1-22.
Sweeting, A., Wong, J., Murphy, HR., et al. A clinical update on gestational diabetes mellitus. Endocrine reviews. 2022; 43(5):763-793.
Harding, JL., Pavkov, ME., Magliano, DJ., et al. Global trends in diabetes complications: a review of current evidence. Diabetologia. 2019; 62:3-16.
Choudhury, H., Pandey, M., Lim, YQ., et al. Silver nanoparticles: Advanced and promising technology in diabetic wound therapy. Materials Science and Engineering: C. 2020; 112:110925.
Syafril, S. (2018, March). Pathophysiology diabetic foot ulcer. In IOP Conference series: earth and environmental science (Vol. 125, No. 1, p. 012161). IOP Publishing.
Armstrong, DG., Boulton, AJ., Bus, SA. Diabetic foot ulcers and their recurrence. New England Journal of Medicine. 2017; 376(24):2367-2375.
Perez-Favila, A., Martinez-Fierro, ML., Rodriguez-Lazalde, J., et al. Current therapeutic strategies in diabetic foot ulcers. Medicina. 2019; 55(11):714.
Yazdanpanah, L., Nasırı, M., Adarvishi, S. Literature review on the management of diabetic foot ulcer. World Journal of Diabetes. 2015; 6(1):37.
Da Silva, J., Leal, EC., Carvalho, E., et al. Innovative functional biomaterials as therapeutic wound dressings for chronic diabetic foot ulcers. International Journal of Molecular Sciences. 2023; 24(12):9900.
Sorber, R., Abularrage, CJ. (2021, March). Diabetic foot ulcers: Epidemiology and the role of multidisciplinary care teams. In Seminars in vascular surgery (Vol. 34, No. 1, pp. 47-53). WB Saunders.
Venmathi Maran, B. A., Jeyachandran, S., & Kimura, M. A Review on the Electrospinning of Polymer Nanofibers and Its Biomedical Applications. Journal of Composites Science. 2024; 8(1):32.
Liu, M., Wei, X., Zheng, Z., et al. Recent advances in nano-drug delivery systems for the treatment of diabetic wound healing. International Journal of Nanomedicine. 2023; 1537-1560.
Bhandari, R., Sharma, A., & Kuhad, A. Novel nanotechnological approaches for targeting dorsal root ganglion (DRG) in mitigating diabetic neuropathic pain (DNP). Frontiers in Endocrinology. 2022; 12:790747.
Yaqoob, SB., Adnan, R., Rameez K., et al. Gold, silver, and palladium nanoparticles: A chemical tool for biomedical applications. Frontiers in Chemistry. 2020; 8:376.
Vijayakumar, V., Samal, SK., Mohanty, S., et al. Recent advancements in biopolymer and metal nanoparticle-based materials in diabetic wound healing management. International Journal of Biological Macromolecules. 2019; 122:137-148.
Lau, P., Bidin, N., Islam, S., et al. Influence of gold nanoparticles on wound healing treatment in rat model: photobiomodulation therapy. Lasers in Surgery and Medicine. 2017; 49(4):380-386.
Loera-Valencia, R., Neira, RE., Urbina, BP., et al. Evaluation of the therapeutic efficacy of dressings with ZnO nanoparticles in the treatment of diabetic foot ulcers. Biomedicine & Pharmacotherapy. 2022;155:113708.
Sivaraj, D., Noishiki, C., Kosaric, N., et al. Nitric oxide-releasing gel accelerates healing in a diabetic murine splinted excisional wound model. Frontiers in Medicine. 2023; 10:1060758.
Fan, X., Gao, Y., Yang, F., et al. A copper single‐atom cascade bionanocatalyst for treating multidrug‐resistant bacterial diabetic ulcer. Advanced Functional Materials. 2023; 33(33):2301986.
Geng, X., Liu, K., Wang, J., et al. Preparation of ultra-small copper nanoparticles-loaded self-healing hydrogels with antibacterial, inflammation-suppressing and angiogenesis-enhancing properties for promoting diabetic wound healing. International Journal of Nanomedicine. 2023; 3339-3358.
Yusuf AA., Adeleke, OA. Nanofibrous scaffolds for diabetic wound healing. Pharmaceutics. 2023; 15(3):986.
Karabulut, B., Kerimoğlu, O., Uğurlu, T. Dendrimers-drug delivery systems. Clinical and Experimental Health Sciences. 2015; 5(1): 31-40.
Kwon, MJ., An, S., Choi, S., et al. Effective healing of diabetic skin wounds by using nonviral gene therapy based on minicircle vascular endothelial growth factor DNA and a cationic dendrimer. The journal of Gene Medicine. 2012; 14(4):272-278.
Xu, Y., Hu, Q., Wei, Z., et al. Advanced polymer hydrogels that promote diabetic ulcer healing: mechanisms, classifications, and medical applications. Biomaterials Research. 2023; 27(1):36.
Garland, NT., Song, JW., Ma, T., et al. A miniaturized, battery‐free, wireless wound monitor that predicts wound closure rate early. Advanced Healthcare Materials. 2023; 12(28):2301280.
Bhushan, P. (2021). Correlating the Effect of Dynamic Variability in the Sensor Environment on Sensor Design.
Baykan, H., Kara, M. Demonstration of the effectiveness of epidermal growth factor in diabetic foot ulcers. Journal of Contemporary Medicine. 2022; 12(6):827-831.
Tang, N., Zheng, Y., Jiang, X., et al. Wearable sensors and systems for wound healing-related pH and temperature detection. Micromachines. 2021; 12(4):430.
Vijean, V., Mohammed, SA., Ahmad, R., et al. (2022, December). Early Detection of Diabetic Foot Ulcers through Wearable Shoe Design. In 2022 4th International Conference on Artificial Intelligence and Speech Technology (AIST) (pp. 1-5). IEEE.
Bembnowicz, P., Yang, GZ., Anastasova, S., et al. (2013, May). Wearable electronic sensor for potentiometric and amperometric measurements. In 2013 IEEE International Conference on Body Sensor Networks (pp. 1-5). IEEE.
Zhang, M., Zhao, X. Alginate hydrogel dressings for advanced wound management. International Journal of Biological Macromolecules. 2020; 162:1414-1428.
Erdem, R. Nanolif bazlı yara örtüsü yüzeyi geliştirilmesi. 2013. PhD Tezi. Marmara Universitesi (Turkiye).
Wong, WF., Ang, KP., Sethi, G., et al. Recent advancement of medical patch for transdermal drug delivery. Medicina. 2023; 59(4):778.
Obaidat, R., Shameh, AA., Aljarrah, M., et al. Preparation and evaluation of polyvinylpyrrolidone electrospun nanofiber patches of pioglitazone for the treatment of atopic dermatitis. AAPS PharmSciTech. 2022; 23(1):51.
Karataş, A., Sonakın, Ö. Mi̇krofabri̇kasyon teknoloji̇si̇ ve i̇laç taşıyıcı si̇stemler üzeri̇nde uygulamaları. Ankara Üniversitesi Eczacılık Fakültesi Dergisi. 2007; 36(1): 47-74.
Zhang, J., Liu, H., Yu, Q., et al. Hair derived microneedle patches for both diabetic foot ulcer prevention and healing. ACS Biomaterials Science & Engineering. 2022; 9(1):363-374.
Saboia-Dantas, CJ., Dechichi, P., Fech, RL., et al. Progressive platelet rich fibrin tissue regeneration matrix: Description of a novel, low cost and effective method for the treatment of chronic diabetic ulcers—Pilot study. Plos One. 2023;18(5):e0284701.
Mastrogiacomo, M., Nardini, M., Collina, MC., et al. Innovative cell and platelet rich plasma therapies for diabetic foot ulcer treatment: The allogeneic approach. Frontiers in Bioengineering and Biotechnology. 2022; 10:869408.
Cazzell, S., Moyer, PM., Samsell, B., et al. A prospective, multicenter, single-arm clinical trial for treatment of complex diabetic foot ulcers with deep exposure using acellular dermal matrix. Advances In Skin & Wound Care. 2019; 32(9):409-415.
Tettelbach, WH., Cazzell, SM., Hubbs, B., et al. The influence of adequate debridement and placental-derived allografts on diabetic foot ulcers. Journal of Wound Care. 2022; 31(9):16-26.
Oropallo, A., Goodwin, A., Morrissey, M., et al. Human amnion chorion membrane allografts in the treatment of chronic diabetic foot ulcers: A literature review. Advances in Skin & Wound Care. 2021; 34(4):1-7.
