Better survival with hyperbaric oxygen therapy at 6 years
Hyperbaric oxygen therapy improves long-term survival in patients with chronic diabetic foot ulcers, according to 6-year follow-up data from the HODFU* study.
At 6 years, 63.2 percent of patients who received 37 of 40 hyperbaric oxygen treatments survived compared with 40.5 percent of those treated with placebo (p<0.05). [2015 European Association for the Study of Diabetes Annual Meeting, abstract 63]
“There was a statistically significant difference between patients treated with hyperbaric oxygen versus those treated with placebo,” said study author Dr. Magnus Löndahl from Lund University in Lund, Sweden. “In patients given hyperbaric oxygen, mortality was around 40 percent, and in those receiving placebo, mortality was around 60 percent.”
Chronic diabetic foot ulcer increases the risk for mortality, neuropathy and microvascular and macrovascular disease. A beneficial outcome of this study is that hyperbaric oxygen treatment appears to increase oxygen concentration in the tissue and hence, improves microvascular function.
To evaluate the long-term effects of hyperbaric oxygen therapy in chronic diabetic foot ulcer, patients were randomized to hyperbaric air or hyperbaric oxygen. Comorbidities were no different between groups at baseline as were prescriptions for diabetes and cardiovascular disease medications. Active treatment consisted of 40 sessions of 100 percent oxygen in hyperbaric chamber (90 minutes/day, 5 days/week for 8 weeks) or placebo carried out in air, both under 2.5 absolute atmospheres (ATA).
One-third of patients in both groups experienced sudden death, 20 percent died from infection, 20 percent from cancer, and 15 percent from acute myocardial infarction (MI).
Researchers said the findings need to be interpreted with caution, adding that more information are warranted before hyperbaric oxygen therapy can be offered in the clinic for patients with diabetic foot ulcer.
Dr. Giel Nijpels, session moderator from the Free University of Amsterdam, the Netherlands, said the downside is that hyperbaric oxygen therapy is offered only in large academic centers and is expensive. As the therapy is difficult to administer, it could also place a significant burden on clinicians.