Effect of Insulin on Healing of Pressure Sore
Archives of Critical Care Medicine,
Vol. 1 No. 1 (2015),
23 October 2023
Abstract
Background: Pressure ulcers are skin lesions at bony prominences that develop due to direct pressure on soft tissue. They occur more frequently in paraplegic patients and elderly who are taken care at nursing homes. Nevertheless, patients who underwent major surgeries such as heart and lung operation with prolonged operation and postoperation period are also susceptible to develop soars. These ulcers lead to increased hospitalization rate and high healthcare costs. Because insulin exerts some of its effects through insulin-like growth factor, insulin would be effective on wound healing process.
Objectives: Our aim is to evaluate the effect of topical insulin on healing of pressure sores.
Patients and Methods: This double-blinded clinical trial was conducted on patients with pressure ulcer in Shahid Modarres Hospital,
Tehran, Patients were randomly allocated to two groups. One of these groups was treated with normal saline and the other group by insulin solution (1 U/mL) and after 14 days, wounds were evaluated for size reduction (mm2) and presence of granulation tissue.
Results: A total of 44 patients, with female to male ratio of 1:1 and mean age of 61.84 (12.63) years, participated in the study; 20 patients (45.5%) had hemoglobin level of < 12 mg/dL and 22 patient (50%) had diabetes (Fasting blood glucose > 6.99 mmol/L). Mean size of sore
before and after intervention was respectively 532.27 (390.3) mm2 and 397 (362.5) mm2 with significant reduction in size. However, the changes in sore size before and after intervention between two groups showed no significant difference. In addition, the difference was not significant between patients with and without diabetes. Anemia did not have any effect on wound healing.
Conclusions: Although reduction in wound size was slightly better with insulin dressing than with normal saline (10% vs. 8.5% of sore surface, respectively) this difference was not statistically significant. There was significant decrease in wound size and presence of granulation tissue after 14 days in all cases irrespective of used dressing.
- Pressure Ulcer
- Insulin Solution
- Granulation Tissue
- Wound Healing
How to Cite
References
Bryant R. An introduction to Acute And Chronic Wound Care:
Nursing Management. J ET Nurs. 1992;19(2):38–9.
Hill L. Wound care nursing. The question of pressure. Nurs Times.
;88(12):76–82.
Lyder CH. Pressure ulcer prevention and management. JAMA.
;289(2):223–6.
Bluestein D, Javaheri A. Pressure ulcers: prevention, evaluation,
and management. Am Fam Physician. 2008;78(10):1186–94.
Reddy M, Gill SS, Kalkar SR, Wu W, Anderson PJ, Rochon PA.
Treatment of pressure ulcers: a systematic review. JAMA.
;300(22):2647–62.
Thomas DR. Prevention and treatment of pressure ulcers: what
works? what doesn't? Cleve Clin J Med. 2001;68(8):704–22.
Frank C. Approach to skin ulcers in older patients. Can Fam Physician. 2004;50:1653–9.
Nelson E, O'meara S, Craig D, Iglesias C, Golder S, Dalton J, et al.
A series of systematic reviews to inform a decision analysis for
sampling and treating infected diabetic foot ulcers. Health Technol Assess. 2006;10(12):1–221.
Whitney J, Phillips L, Aslam R, Barbul A, Gottrup F, Gould L, et al.
Guidelines for the treatment of pressure ulcers. Wound Repair
Regen. 2006;14(6):663–79.
Sarabahi S. Recent advances in topical wound care. Indian J Plast
Surg. 2012;45(2):379–87.
Rund CR. Non-conventional topical therapies for wound care.
Ostomy Wound Manage. 1996;42(5):18–6.
Tarnow P, Agren M, Steenfos H, Jansson JQ. Topical zinc oxide
treatment increases endogenous gene expression of insulinlike growth factor-1 in granulation tissue from porcine wounds.
Scand J Plast Reconstr Surg Hand Surg. 1994;28(4):255–9.
Agren MS, Ostenfeld U, Kallehave F, Gong Y, Raffn K, Crawford
ME, et al. A randomized, double-blind, placebo-controlled
multicenter trial evaluating topical zinc oxide for acute open
wounds following pilonidal disease excision. Wound Repair Regen. 2006;14(5):526–35.
Stromberg HE, Agren MS. Topical zinc oxide treatment improves
arterial and venous leg ulcers. Br J Dermatol. 1984;111(4):461–8.
Cangul IT, Gul NY, Topal A, Yilmaz R. Evaluation of the effects
of topical tripeptide-copper complex and zinc oxide on openwound healing in rabbits. Vet Dermatol. 2006;17(6):417–23.
Grotendorst GR, Martin GR, Pencev D, Sodek J, Harvey AK.
Stimulation of granulation tissue formation by platelet-derived growth factor in normal and diabetic rats. J Clin Invest.
;76(6):2323–9.
Lynch SE, Colvin RB, Antoniades HN. Growth factors in wound
healing. Single and synergistic effects on partial thickness porcine skin wounds. J Clin Invest. 1989;84(2):640–6.
Bao P, Kodra A, Tomic-Canic M, Golinko MS, Ehrlich HP, Brem H.
The role of vascular endothelial growth factor in wound healing.
J Surg Res. 2009;153(2):347–58.
Eppley BL, Woodell JE, Higgins J. Platelet quantification and
growth factor analysis from platelet-rich plasma: implications
for wound healing. Plast Reconstr Surg. 2004;114(6):1502–8.
Paavonen K, Puolakkainen P, Jussila L, Jahkola T, Alitalo K. Vascular endothelial growth factor receptor-3 in lymphangiogenesis
in wound healing. Am J Pathol. 2000;156(5):1499–504.
Robson MC, Phillips LG, Lawrence WT, Bishop JB, Youngerman
JS, Hayward PG, et al. The safety and effect of topically applied
recombinant basic fibroblast growth factor on the healing of
chronic pressure sores. Ann Surg. 1992;216(4):401–6.
Liu Y, Petreaca M, Yao M, Martins-Green M. Cell and molecular
mechanisms of keratinocyte function stimulated by insulin during wound healing. BMC Cell Biol. 2009;10:1.
Lima MH, Caricilli AM, de Abreu LL, Araujo EP, Pelegrinelli FF, Thirone AC, et al. Topical insulin accelerates wound healing in diabetes by enhancing the AKT and ERK pathways: a double-blind
placebo-controlled clinical trial. PLoS One. 2012;7(5).
Falanga V. Wound healing and its impairment in the diabetic
foot. Lancet. 2005;366(9498):1736–43.
Zhang XJ, Wu X, Wolf SE, Hawkins HK, Chinkes DL, Wolfe RR. Local
insulin-zinc injection accelerates skin donor site wound healing.
J Surg Res. 2007;142(1):90–6.
Madibally SV, Solomon V, Mitchell RN, Van De Water L, Yarmush
ML, Toner M. Influence of insulin therapy on burn wound healing in rats. J Surg Res. 2003;109(2):92–100.
Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair
and regeneration. Nature. 2008;453(7193):314–21.
Brem H, Tomic-Canic M. Cellular and molecular basis of wound
healing in diabetes. J Clin Invest. 2007;117(5):1219–22.
Gallagher KA, Liu ZJ, Xiao M, Chen H, Goldstein LJ, Buerk DG, et
al. Diabetic impairments in NO-mediated endothelial progenitor cell mobilization and homing are reversed by hyperoxia and
SDF-1 alpha. J Clin Invest. 2007;117(5):1249–59.
Hanam SR, Singleton CE, Rudek W. The effect of topical insulin
on infected cutaneous ulcerations in diabetic and nondiabetic
mice. J Foot Surg. 1983;22(4):298–301.
Pierre EJ, Barrow RE, Hawkins HK, Nguyen TT, Sakurai Y, Desai M, et al. Effects of insulin on wound healing. J Trauma.
;44(2):342–5.
Greenway SE, Filler LE, Greenway FL. Topical insulin in wound
healing: a randomised, double-blind, placebo-controlled trial. J
Wound Care. 1999;8(10):526–8.
Pressure ulcers in America: prevalence, incidence, and implications for the future. An executive summary of the National
Pressure Ulcer Advisory Panel monograph. Adv Skin Wound Care.
;14(4):208–15.
Lyder CH, Yu C, Stevenson D, Mangat R, Empleo-Frazier O, Emerling J, et al. Validating the Braden Scale for the prediction of pressure ulcer risk in blacks and Latino/Hispanic elders: a pilot study.
Ostomy Wound Manage. 1998;44(3A Suppl):42S–9S.
Apikoglu-Rabus S, Izzettin FV, Turan P, Ercan F. Effect of topical insulin on cutaneous wound healing in rats with or without acute
diabetes. Clin Exp Dermatol. 2010;35(2):180–5.
Zhou DP, Lu LQ , Mao XL. [Insulin and hyperosmotic glucose solution external used for treating pressure sore]. Hunan Yi Ke Da Xue
Xue Bao. 2001;26(5):475–6
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