A research team supported by the National Institutes of Health (NIH) has identified a potential diagnostic aid to predict the recurrence of diabetic foot ulcers that appear fully healed. By measuring trans-epidermal water loss (TEWL), scientists could determine which wounds were more likely to reopen. TEWL is a significant factor in burn care, where skin layers are damaged. The study suggests incorporating full restoration of skin barrier function into existing wound treatment standards to ensure complete closure and better identify patients at risk of recurrence.
"This study is an important initial step to give clinicians treating diabetic foot ulcers a reliable diagnostic aid for the first time to assess an individual’s risk of ulcer recurrence," said Teresa Jones, M.D., program director for the Division of Diabetes, Endocrinology, & Metabolic Diseases at NIH’s National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK). "Foot ulcers are such a confounding issue with diabetes and being able to determine which wounds are at highest risk for recurrence could save many lives and limbs."
The NIDDK Diabetic Foot Consortium evaluated over 400 participants with visually closed or healed diabetic foot ulcers. They measured TEWL at the ulcer site and found that 35% with high TEWL reported wound recurrence within 16 weeks, compared to 17% with low TEWL. Participants with higher TEWL were 2.7 times more likely to experience recurrence than those with lower TEWL.
Diabetic foot ulcers are a major complication where unnoticed breaks in the skin due to neuropathy lead to non-traumatic lower-limb amputations. Untreated or unhealed ulcers increase death risk significantly as wounds appearing healed may not be closed below the surface, affecting the skin's barrier function.
Study results will publish in Diabetes Care by members of NIH’s Diabetic Foot Consortium, funded by various NIH/NIDDK grants.
About NIH: The National Institutes of Health is part of the U.S. Department of Health and Human Services and includes 27 Institutes and Centers conducting medical research on common and rare diseases. For more information about NIH programs, visit www.nih.gov.
