Efficacy of Hyperbaric Oxygen Therapy in Diabetic Foot Ulcers

Clinician treating a diabetic foot ulcer.
Clinician treating a diabetic foot ulcer.
The efficacy and safety profile of hyperbaric oxygen therapy remains controversial because of conflicting data and small sample sizes in clinical trials.

The use of hyperbaric oxygen therapy (HBOT) in the treatment of diabetic foot ulcers may not result in a difference in outcomes when compared with standard therapy (ST), according to a study published by Clinical Therapeutics.

Researchers performed a meta-analysis of 9 randomized controlled trials including 526 patients to determine the efficacy and safety profile of using HBOT as a treatment modality in patients with diabetic foot ulcers, with a focus on the “incidence of healed ulcers, major amputations, minor amputations and reduction in the ulcer wound area.”

There were no differences identified between patients treated with HBOT compared with ST with regard to the incidence of healed ulcers (risk ratio [RR] = 2.22, 95% CI, 0.87-5.62; P =.32; I2 = 81%), minor amputations (RR = .95; 95% CI, 0.39-2.29; P =.91; I2 = 74%), major amputations (RR = .47; 95% CI, 0.17-1.28; P =.14; I2 = 61%), and adverse events (RR = 1.00; 95% CI, 0.64-1.56; P =.99; I2 = 26%). However, it was found that HBOT resulted in a statistically significant greater reduction in ulcer wound area when compared with ST (standard mean difference = 1.12; 95% CI, 0.20-2.04; P =.04; I2 = 70%).

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The investigators concluded that overall, the use of HBOT does not result in a significant difference in the incidence of healing, minor or major amputations, or adverse events.  However, it was associated with a greater reduction in wound area, and therefore clinicians should consider using HBOT as it may serve as valuable adjuvant therapy in patients with diabetic foot ulcers.


Zhao D, Luo S, Xu W, Hu J, Lin S, Wang N.  Efficacy and safety of hyperbaric oxygen therapy used in patients with diabetic foot:  a meta-analysis of randomized clinical trials [published online September 18, 2017].  Clin Ther.  doi:10.1016/j.clinthera.2017.08.014