Optimizing wound healing in diabetic foot ulcers: impact of ulcer location and treatment approaches

Background: Diabetic foot ulcers (DFUs) are a common and severe complication of diabetes mellitus, often leading to prolonged healing times and increased risk of amputation. Aim: This study evaluates the healing period among diabetic cases with ulcers affecting different anatomical areas and assesses the impact of honey and hydrogel treatments on wound closure time. Methodology: A prospective, single-blinded, randomized controlled trial was conducted at the Diabetic Foot Center, King Fahad Specialist Hospital, Saudi Arabia, from February 2019 to February 2023. The study included 120 participants with type 2 diabetes and second-degree foot ulcers. Participants were divided into four treatment groups: honey alone, hydrogel alone, honey and hydrogel combination, and a control group receiving Fucidin ointment. Healing times were analyzed based on ulcer location and treatment type. Results: The mean healing time across all groups was 12.76±4.08 days. Healing times varied significantly based on the ulcer location (p=0.002), with hindfoot wounds taking the longest to heal. Among treatment groups, the combination of honey and hydrogel demonstrated the shortest healing time (10.83 ± 3.5 days), which was significantly faster than the control group (p=0.004). This combination was particularly effective in ulcers on the forefoot. Additionally, greater wound size correlated with longer healing times (p<0.001). Conclusion: Wound location significantly affects healing duration in diabetic ulcers. The combination of honey and hydrogel enhances wound closure rates, especially in ulcers affecting the forefoot. These findings support the incorporation of honey-hydrogel therapy in clinical management of DFUs.