There is no “clinical” difference when comparing dressings for treating chronic diabetic foot ulcers, according to new research published by the National Institute for Health Research Health Technology Assessment (NIHR, HTA) programme.
Statistically, however, the costs associated with the provision of dressings could result in savings to the NHS of around £2 million per year. Up to 15% of all people with diabetes will suffer with an ulcer of the foot at some stage of their lives. Healing of these ulcers is slow and uncertain with only a third healing within three months, and only half in six months. There are a large number of dressing products available, ranging from the relatively simple and inexpensive ones to those which are more sophisticated, and expensive. The clinical trial, led by Professor William Jeffcoate of Nottingham University Hospitals Trust, compared the effectiveness of three different types of dressings; a simple dry dressing, a dressing which is impregnated with iodine, and a modern hydrofibre dressing. Three hundred and seventeen patients with uninfected ulcers, which had been present for at least six weeks, were recruited from one of nine expert centres around the UK and randomised to receive one of these treatments. Each ulcer was managed with one of the three dressings for six months (or until they healed). The researchers then compared the number of ulcers which healed in the time period to measure their effectiveness. The results showed that a greater proportion of smaller ulcers healed within the specified time. There was, however, no difference between the three dressings in terms of the number of ulcers which healed in the time frame, the time to healing, any adverse events and health-related quality of life. “We have found no evidence to suggest any difference in the effectiveness, safety or health-related quality of life between these dressings,” said Prof. Jeffcoate. “Until further trial evidence is available, we therefore believe that clinicians should select the cheapest and most convenient product available for treatment.” Other research looking into dressings for treating ulcers assessed the cost-effectiveness of using antimicrobial silver-donating dressings beneath compression therapy to treat venous leg ulcers. This study suggested that there were no significant differences when it came to healing rates and quality of life. However, the economic analysis showed a significantly higher cost for those treated with antimicrobial dressings with there being no difference in clinical outcomes
