Adolopment of guidelines for diabetic foot ulcers: an umbrella review with de novo meta-analysis of randomized controlled trials evaluating effectiveness and safety of hyperbaric oxygen therapy for chronic diabetic foot ulcers
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| Year of publication | 2021 |
| Type | Appeared in Conference without Proceedings |
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| Description | Background One of the approved guidelines by the Czech Health Research Council in the project Clinical Practice Guidelines is the guideline focused on the issue of Diabetic foot ulcers (DFU). There were identified several existing high-quality guidelines which were adapted, however the question of the effectiveness of hyperbaric oxygen therapy was not sufficiently developed in none of the identified guidelines. Objective The objective of this work is to evaluate the effectiveness and safety of hyperbaric oxygen therapy (HBOT) of chronic diabetic foot ulcers (CDFU) for the need of DFU guideline adolopment. Methods The existing evidence in identified guidelines regarding the effectiveness of HBOT of CDFU was not sufficiently developed, so we first searched an Epistemonikos and identified 25 eligible systematic reviews (SR) with mutually conflicting results. No of the umbrella review existed or were registered, so we registered the protocol of our umbrella review first. As the results of SR were conflicting, despite the fact we followed JBI methodology for umbrella reviews we developed de novo meta-analysis, with detailed sensitivity and subgroup analyses for risk of bias, number of HBOT sessions, peripheral arterial disease patients, and Wagner grade. We carried out a GRADE assessment of the certainty of evidence and recommendation development. Results Findings We found 25 eligible systematic reviews and extracted data from 18 RCTs with 1222 patients. Discussion HBOT likely increases healing rates, may decrease the number of amputations, and is not associated with severe adverse events or increased mortality in chronic diabetic foot ulcers. |
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