The Comparison of Nutritional Supplementation on Wound Healing in Type 2 Diabetes Patients with Foot Ulcers: A Systematic Review
##plugins.themes.bootstrap3.article.main##
Abstract
Diabetic foot ulcers are a common occurrence impacting nutritional status and morbidity. Nutritional support improves wound healing for diabetic patients with foot ulcers/lesions. This review aims to evaluate nutritional interventions such as arginine, glutamine, and omega-3 fatty acids on the wound healing outcomes of foot ulcers/lesions in patients with diabetes. The literature search utilized PubMed and CINCHL for peer-reviewed randomized controlled trials, cohort studies, retrospective trials, and case-control studies between 2005-2023. We assessed eligible criteria for the relationship between nutritional interventions arginine, glutamine, and omega-3 fatty acids and wound healing in diabetic participants. Eighteen studies met the inclusion criteria and were included in the review. Overall, there is a relationship between arginine, glutamine, and omega-3 fatty acids nutritional supplementation and a significant increase in wound healing. However, further research with larger sample sizes, longer durations, and more data is needed to conclude the supplementation dosage.
How to Cite
Martin*, D., & Kevin Haubrick. (2023). The Comparison of Nutritional Supplementation on Wound Healing in Type 2 Diabetes Patients with Foot Ulcers: A Systematic Review. Research Review, 4(02), 858–873. https://doi.org/10.52845/RR/2023/4.2.2
##plugins.themes.bootstrap3.article.details##
##article.keywords##
diabetic foot ulcer, arginine, glutamine, omega-3 fatty acids, wound healing, diabetes
##article.references##
1. Type 2 diabetes [Internet]. Centers for Disease Control and Prevention; 2022 [cited 2023 Jun 6]. Available from: https://www.cdc.gov/diabetes/basics/type2.html
2. Oliver, TI. Diabetic Foot Ulcer [Internet]. Stat Pearls Publishing; 2022 [cited 2023 Aug 6]. Available from: https://www.ncbi.nlm.nih.nih.gov/books/NBK430783/
3. National Report on Biochemical Indicators of Diet and nutrition in the U.S. population 2012 [Internet]. Centers for Disease Control and Prevention; 2021 [cited 2023 Jun 6]. Available from: https://www.cdc.gov/nutriti
onreport/index.html
4. Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, et al. Incidence and risk factors of diabetic foot ulcer: A population-based diabetic foot cohort (ADFC study)-two-year follow-up study. International Journal of Endocrinology.2018; 2018:1-9. doi:10.1155/2018/7631659
5. Kane K, Prelack K. Advanced Medical Nutrition therapy. Burlington: Jones & Bartlett Learning; 2019.
6. Moore ZE, Corcoran MA, Patton D. Nutritional interventions for treating foot ulcers in people with diabetes. Cochrane Database of Systematic Reviews.2020;2020(7). doi: 10.1002/14651858.cd011378. pub2
7. Bechara N, Gunton JE, Flood V, Hng T-M, McGloin C. Associations between nutrients and foot ulceration in diabetes: A systematic review. Nutrients. 2021;13(8):2576. doi:10.3390/nu13082576
8. Armstrong DG, Hanft JR, Driver VR, Smith AP, Lazaro‐Martinez JL, Reyzelman AM, et al. Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: A prospective randomized controlled trial. Diabetic Medicine. 2014;31(9):1069–77. doi:10.1111/dme.12509
9. Maykish A, Sikalidis AK. Utilization of hydroxyl-methyl butyrate, leucine, glutamine and arginine supplementation in nutritional management of sarcopenia—implications and clinical considerations for type 2 diabetes mellitus risk modulation. Journal of Personalized Medicine. 2020;10(1):19. doi:10.3390/jpm10010019
10. Arana V, Paz Y, González A, Méndez V, Méndez JD. Healing of diabetic foot ulcers in L-arginine-treated patients. Biomedicine & Pharmacotherapy. 2004;58(10):588-97. doi: 10.1016/j. biopha.2004.09.009
11. Soleimani Z, Hashemdokht F, Bahmani F, Taghizadeh M, Memarzadeh MR, Asemi Z. Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Journal of Diabetes and its Complications. 2017;31(9):1394–400. doi: 10.1016/j.jdiacomp.2017.06.010
12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The Prisma 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021; doi:10.1136/bmj. n71
13. Ryan, R. Cochrane Consumers and Communication Group: Data extraction template for included studies [Internet]. 2016 [cited 2023 Aug 6]. Available from: http://cccrg.cochrane.org/sites/cccrg.cochrane
org/files/public/uploads/meta-analysis_revised_december_1st_1_2016.pdf
14. Evidence Analysis Manuel: Steps in the Academy Evidence Analysis Process. [Internet]. Academy of Nutrition and Dietetics; 2016 [cited 2023 Aug 6]. Available from: https://www.andeal.org/vault/2440/web/files/2016_April_EA_
Manual.pdf
15. Banks MD, Ross LJ, Webster J, Mudge A, Stankiewicz M, Dwyer K, et al. Pressure ulcer healing with an intensive nutrition intervention in an acute setting: A pilot randomised controlled trial. Journal of Wound Care. 2016;25(7):384–92. doi:10.12968/jowc.2016.25.7.384
16. Basiri R, Spicer MT, Ledermann T, Arjmandi BH. Effects of nutrition intervention on blood glucose, body composition, and phase angle in obese and overweight patients with diabetic foot ulcers. Nutrients. 2022;14(17):3564. doi:10.3390/nu14173564
17. Basiri R, Spicer M, Levenson C, Ledermann T, Akhavan N, Arjmandi B. Improving dietary intake of essential nutrients can ameliorate inflammation in patients with diabetic foot ulcers. Nutrients. 2022;14(12):2393. doi:10.3390/nu14122393
18. Basiri R, Spicer MT, Levenson CW, Ormsbee MJ, Ledermann T, Arjmandi BH. Nutritional supplementation concurrent with nutrition education accelerates the wound healing process in patients with diabetic foot ulcers. Biomedicines. 2020;8(8):263. doi:10.3390/biomedicines8080263
19. Bauer JD, Isenring E, Waterhouse M. The effectiveness of a specialised oral nutrition supplement on outcomes in patients with chronic wounds: A pragmatic randomised study. Journal of Human Nutrition and Dietetics. 2013;26(5):452–8. doi:10.1111/jhn.12084
20. Cereda E, Klersy C, Serioli M, Crespi A, D’Andrea F. A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers. Annals of Internal Medicine. 2015;162(3):167–74. doi:10.7326/m14-0696
21. Jude EB, Dang C, Boulton AJ. Effect of L-arginine on the microcirculation in the neuropathic diabetic foot in type 2 diabetes mellitus: A double-blind, placebo-controlled study. Diabetic Medicine. 2009;27(1):113–6. doi:10.1111/j.1464-5491.2009. 02876.x
22. Leigh B, Desneves K, Rafferty J, Pearce L, King S, Woodward MC, et al. The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers. Journal of Wound Care. 2012;21(3):150–6. doi:10.12968/jowc.2012.21.3.150
23. Leigh B, Desneves K, Rafferty J, Pearce L, King S, Woodward MC, et al. The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers. Journal of Wound Care. 2012;21(3):150–6. doi:10.12968/jowc.2012.21.3.150
24. Wong A, Chew A, Wang CM, Ong L, Zhang SH, Young S. The use of a specialised amino acid mixture for pressure ulcers: A placebo-controlled trial. Journal of Wound Care. 2014;23(5):259–69. doi:10.12968/jowc.2014.23.5.259
25. Clark RK, Stampas A, Kerr KW, Nelson JL, Sulo S, Leon‐Novelo L, et al. Evaluating the impact of using a wound‐specific oral nutritional supplement to support wound healing in a rehabilitation setting. International Wound Journal. 2022;20(1):145–54. doi:10.1111/iwj.13849
26. Sipahi S, Gungor O, Gunduz M, Cilci M, Demirci MC, Tamer A. The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: A retrospective analysis of diabetic haemodialysis patients. BMC Nephrology. 2013;14(1). doi:10.1186/1471-2369-14-8
27. Hung S-Y, Tsai J-S, Yeh J-T, Chen K-H, Lin C-N, Yang H-M, et al. Amino acids and wound healing in people with limb-threatening diabetic foot ulcers. Journal of Diabetes and its Complications. 2019;33(10):107403. doi: 10.1016/j.jdiacomp.2019.06.008
28. Tehan PE, Burrows T, Hawes MB, Linton C, Norbury K, Peterson B, et al. Factors influencing diabetes‐related foot ulcer healing in Australian adults: A prospective cohort study. Diabetic Medicine. 2022;40(1). doi:10.1111/dme.14951
29. Basyreva LYu, Vakhrusheva TV, Letkeman ZV, Maximov DI, Fedorova EA, Panasenko ОM, et al. Effect of vitamin D3 in combination with omega-3 polyunsaturated fatty acids on NETosis in type 2 diabetes mellitus patients. Oxidative Medicine and Cellular Longevity. 2021; 2021:1–10. doi:10.1155/2021/8089696
30. Jones MS, Rivera M, Puccinelli CL, Wang MY, Williams SJ, Barber AE. Targeted amino acid supplementation in diabetic foot wounds: Pilot data and a review of the literature. Surgical Infections. 2014;15(6):708–12. doi:10.1089/sur.2013.158
31. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Annals of the New York Academy of Sciences. 2018;1411(1):153–65. doi:10.1111/nyas.13569
2. Oliver, TI. Diabetic Foot Ulcer [Internet]. Stat Pearls Publishing; 2022 [cited 2023 Aug 6]. Available from: https://www.ncbi.nlm.nih.nih.gov/books/NBK430783/
3. National Report on Biochemical Indicators of Diet and nutrition in the U.S. population 2012 [Internet]. Centers for Disease Control and Prevention; 2021 [cited 2023 Jun 6]. Available from: https://www.cdc.gov/nutriti
onreport/index.html
4. Yazdanpanah L, Shahbazian H, Nazari I, Arti HR, Ahmadi F, Mohammadianinejad SE, et al. Incidence and risk factors of diabetic foot ulcer: A population-based diabetic foot cohort (ADFC study)-two-year follow-up study. International Journal of Endocrinology.2018; 2018:1-9. doi:10.1155/2018/7631659
5. Kane K, Prelack K. Advanced Medical Nutrition therapy. Burlington: Jones & Bartlett Learning; 2019.
6. Moore ZE, Corcoran MA, Patton D. Nutritional interventions for treating foot ulcers in people with diabetes. Cochrane Database of Systematic Reviews.2020;2020(7). doi: 10.1002/14651858.cd011378. pub2
7. Bechara N, Gunton JE, Flood V, Hng T-M, McGloin C. Associations between nutrients and foot ulceration in diabetes: A systematic review. Nutrients. 2021;13(8):2576. doi:10.3390/nu13082576
8. Armstrong DG, Hanft JR, Driver VR, Smith AP, Lazaro‐Martinez JL, Reyzelman AM, et al. Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: A prospective randomized controlled trial. Diabetic Medicine. 2014;31(9):1069–77. doi:10.1111/dme.12509
9. Maykish A, Sikalidis AK. Utilization of hydroxyl-methyl butyrate, leucine, glutamine and arginine supplementation in nutritional management of sarcopenia—implications and clinical considerations for type 2 diabetes mellitus risk modulation. Journal of Personalized Medicine. 2020;10(1):19. doi:10.3390/jpm10010019
10. Arana V, Paz Y, González A, Méndez V, Méndez JD. Healing of diabetic foot ulcers in L-arginine-treated patients. Biomedicine & Pharmacotherapy. 2004;58(10):588-97. doi: 10.1016/j. biopha.2004.09.009
11. Soleimani Z, Hashemdokht F, Bahmani F, Taghizadeh M, Memarzadeh MR, Asemi Z. Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Journal of Diabetes and its Complications. 2017;31(9):1394–400. doi: 10.1016/j.jdiacomp.2017.06.010
12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The Prisma 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 2021; doi:10.1136/bmj. n71
13. Ryan, R. Cochrane Consumers and Communication Group: Data extraction template for included studies [Internet]. 2016 [cited 2023 Aug 6]. Available from: http://cccrg.cochrane.org/sites/cccrg.cochrane
org/files/public/uploads/meta-analysis_revised_december_1st_1_2016.pdf
14. Evidence Analysis Manuel: Steps in the Academy Evidence Analysis Process. [Internet]. Academy of Nutrition and Dietetics; 2016 [cited 2023 Aug 6]. Available from: https://www.andeal.org/vault/2440/web/files/2016_April_EA_
Manual.pdf
15. Banks MD, Ross LJ, Webster J, Mudge A, Stankiewicz M, Dwyer K, et al. Pressure ulcer healing with an intensive nutrition intervention in an acute setting: A pilot randomised controlled trial. Journal of Wound Care. 2016;25(7):384–92. doi:10.12968/jowc.2016.25.7.384
16. Basiri R, Spicer MT, Ledermann T, Arjmandi BH. Effects of nutrition intervention on blood glucose, body composition, and phase angle in obese and overweight patients with diabetic foot ulcers. Nutrients. 2022;14(17):3564. doi:10.3390/nu14173564
17. Basiri R, Spicer M, Levenson C, Ledermann T, Akhavan N, Arjmandi B. Improving dietary intake of essential nutrients can ameliorate inflammation in patients with diabetic foot ulcers. Nutrients. 2022;14(12):2393. doi:10.3390/nu14122393
18. Basiri R, Spicer MT, Levenson CW, Ormsbee MJ, Ledermann T, Arjmandi BH. Nutritional supplementation concurrent with nutrition education accelerates the wound healing process in patients with diabetic foot ulcers. Biomedicines. 2020;8(8):263. doi:10.3390/biomedicines8080263
19. Bauer JD, Isenring E, Waterhouse M. The effectiveness of a specialised oral nutrition supplement on outcomes in patients with chronic wounds: A pragmatic randomised study. Journal of Human Nutrition and Dietetics. 2013;26(5):452–8. doi:10.1111/jhn.12084
20. Cereda E, Klersy C, Serioli M, Crespi A, D’Andrea F. A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers. Annals of Internal Medicine. 2015;162(3):167–74. doi:10.7326/m14-0696
21. Jude EB, Dang C, Boulton AJ. Effect of L-arginine on the microcirculation in the neuropathic diabetic foot in type 2 diabetes mellitus: A double-blind, placebo-controlled study. Diabetic Medicine. 2009;27(1):113–6. doi:10.1111/j.1464-5491.2009. 02876.x
22. Leigh B, Desneves K, Rafferty J, Pearce L, King S, Woodward MC, et al. The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers. Journal of Wound Care. 2012;21(3):150–6. doi:10.12968/jowc.2012.21.3.150
23. Leigh B, Desneves K, Rafferty J, Pearce L, King S, Woodward MC, et al. The effect of different doses of an arginine-containing supplement on the healing of pressure ulcers. Journal of Wound Care. 2012;21(3):150–6. doi:10.12968/jowc.2012.21.3.150
24. Wong A, Chew A, Wang CM, Ong L, Zhang SH, Young S. The use of a specialised amino acid mixture for pressure ulcers: A placebo-controlled trial. Journal of Wound Care. 2014;23(5):259–69. doi:10.12968/jowc.2014.23.5.259
25. Clark RK, Stampas A, Kerr KW, Nelson JL, Sulo S, Leon‐Novelo L, et al. Evaluating the impact of using a wound‐specific oral nutritional supplement to support wound healing in a rehabilitation setting. International Wound Journal. 2022;20(1):145–54. doi:10.1111/iwj.13849
26. Sipahi S, Gungor O, Gunduz M, Cilci M, Demirci MC, Tamer A. The effect of oral supplementation with a combination of beta-hydroxy-beta-methylbutyrate, arginine and glutamine on wound healing: A retrospective analysis of diabetic haemodialysis patients. BMC Nephrology. 2013;14(1). doi:10.1186/1471-2369-14-8
27. Hung S-Y, Tsai J-S, Yeh J-T, Chen K-H, Lin C-N, Yang H-M, et al. Amino acids and wound healing in people with limb-threatening diabetic foot ulcers. Journal of Diabetes and its Complications. 2019;33(10):107403. doi: 10.1016/j.jdiacomp.2019.06.008
28. Tehan PE, Burrows T, Hawes MB, Linton C, Norbury K, Peterson B, et al. Factors influencing diabetes‐related foot ulcer healing in Australian adults: A prospective cohort study. Diabetic Medicine. 2022;40(1). doi:10.1111/dme.14951
29. Basyreva LYu, Vakhrusheva TV, Letkeman ZV, Maximov DI, Fedorova EA, Panasenko ОM, et al. Effect of vitamin D3 in combination with omega-3 polyunsaturated fatty acids on NETosis in type 2 diabetes mellitus patients. Oxidative Medicine and Cellular Longevity. 2021; 2021:1–10. doi:10.1155/2021/8089696
30. Jones MS, Rivera M, Puccinelli CL, Wang MY, Williams SJ, Barber AE. Targeted amino acid supplementation in diabetic foot wounds: Pilot data and a review of the literature. Surgical Infections. 2014;15(6):708–12. doi:10.1089/sur.2013.158
31. Everett E, Mathioudakis N. Update on management of diabetic foot ulcers. Annals of the New York Academy of Sciences. 2018;1411(1):153–65. doi:10.1111/nyas.13569
Issue
Section
Social Sciences and Humanities
