Effectiveness of dietary interventions in individuals with diabetes for preventing and healing chronic wounds; a systematic review with meta-analysis.

Abstract

Background: Optimising the nutritional status of individuals with diabetes is essential to optimise glycaemic control, as well as to prevent and promote wound healing. A variety of nutrition interventions are available. This systematic review and meta-analysis aimed to describe and synthesise the effectiveness of nutrition interventions for the prevention and management of chronic wounds in people with diabetes.

Methods: Five databases and four clinical trial registries were searched for nutrition intervention studies. Included studies involved a nutrition intervention, such as personalised medical nutrition therapy, education and/or nutrient supplementation for those with diabetes and a chronic wound. Meta-analysis was completed utilising mean wound size at follow-up and non-adjusted data where available. Quality was appraised using RoB 2 and ROBINS, and certainty of evidence was assessed using GRADE.

Results: Twenty-three studies were included; all included studies were in diabetes-related foot ulcer populations. Meta-analyses demonstrated nutrient supplements, including single and multi-nutrient supplements, significantly reduced wound depth (MWD -0.200 [95% CI -0.364, -0.035], p = 0.0172), width (WMD -0.466 [95% CI -0.724, -0.208], p = 0.0004) and length (-0.443 [95% CI -0.841, -0.045], p = 0.0292), the quality of included studies was low and the certainty of evidence was very low. While substantial heterogeneity was detected (I² = 56%-68%), a random-effects meta-analysis was conducted to account for between-study variability, providing an overall estimate while acknowledging differences in study characteristics. Two studies evaluating the effect of nutrition education demonstrated significant wound size reduction (n = 1) and proportion of people healed (n = 1).

Conclusion: There is low-quality evidence that nutrient supplementation improves wound healing. Nutrition education may have a role in enhancing wound size reduction. Further studies are needed using robust methodologies to comprehensively determine the effectiveness of nutrition interventions for wound healing.