Oxygen Therapy for Diabetic Wounds: Hope or Hype??>

Oxygen Therapy for Diabetic Wounds: Hope or Hype?

by UCB Health & Wellness Publications

Faster healing, better circulation, cellular regeneration—the benefits touted by proponents of hyperbaric oxygen therapy (HBOT) sound like the next frontier of medicine, improving the body’s ability to heal itself. But are they too good to be true?

Since 2002, the number of hospitals offering HBOT has tripled to nearly 1,300, according to a 2017 Kaiser Health News investigative report. Standalone wound care centers also offer the treatment, which was originally designed as a niche therapy for deep-sea divers suffering from decompression sickness (aka the bends), a potentially fatal condition in which gases dissolved in the blood become bubbles as pressure decreases, damaging the body’s organs. Theoretically, HBOT can help heal wounds, too: Injured tissue may need more oxygen to heal, and HBOT increases the amount of blood oxygen.

During treatment, patients lie in a cylindrical chamber and breathe 100 percent oxygen with the atmospheric pressure raised up to three times higher than normal. This increases oxygen concentration in the blood and, advocates say, boosts the body’s natural healing processes and promotes blood vessel growth. Treatments take up to two hours; daily treatments for a month or more may be needed to see results, if any.

While HBOT can be employed to treat conditions such as radiation-related skin damage or nonhealing skin grafts, most of the demand in the United States is driven by the ever-increasing number of people with diabetes, who tend to experience slow-healing wounds because of poor circulation. About 1 in 20 people with diabetes will develop a foot ulcer, for example, and more than 10 percent of those wounds will lead to amputation.

Skeptics say it’s the frequency of HBOT sessions—and the subsequent Medicare reimbursements—that lead hospitals to recommend the treatment, rather than proven results. Medicare typically pays about $450 for a two-hour session in a hyperbaric chamber for foot ulcers in people with diabetes that haven’t shown signs of healing in 30 days with standard treatment—an approval that some say led to the abundance of HBOT treatment facilities available today and the treatment’s overuse.

The Kaiser report stated that the treatment is so profitable that hyperbaric management companies often provide hospitals with the equipment and staff, splitting profits with them.

The science behind hyperbaric oxygen therapy (HBOT)

The question most people have is: Does it work? The FDA has approved HBOT for certain conditions, including wounds related to poor blood flow, gangrene, and soft-tissue infections.

But scientific evidence supporting HBOT usage is questionable. Most studies have been observational and, thus, unable to establish a direct cause and effect. The few published clinical trials (which actively compare one treatment against another) have been small or lacking in quality. It’s difficult for doctors to determine whether a wound has healed on its own over time or as a result of HBOT intervention. Some evidence suggests that HBOT may benefit certain types of wounds, but it’s not clear whether the therapy would exceed the results of standard wound treatment.

What to Do If You Develop a Diabetic Foot Ulcer

In addition to adhering to your doctor's instructions, follow these self-help tips to speed healing and prevent infection.

In a study of people with diabetes, published in Diabetes Care in January 2018, Dutch researchers found that the addition of HBOT to conventional treatment did not improve healing of lower-extremity wounds, although the authors acknowledged previous studies that noted some benefit under certain circumstances. The American Diabetes Association (ADA) found the evidence on HBOT inconclusive, pointing out that many studies suffered from design flaws, making it difficult to assess the treatment’s true impact, while other research showed no benefit.

Despite the limited approval by the FDA and lack of support from the ADA, HBOT is marketed for a variety of other conditions, including asthma, depression, heart disease, and cancer. The FDA issued guidance in 2013 warning that the safety and effectiveness of HBOT for such conditions had not been established.

Should you ever consider HBOT?

Only if you’ve exhausted standard treatment options and your wound hasn’t healed is HBOT worth considering, especially if your amputation risk is high. The strongest HBOT research supports its use as an adjunct therapy for wounds with poor circulation in people with diabetes. In such cases, it might improve healing and decrease the amputation rate.

HBOT side effects are generally mild and include ear pain or pressure, temporary nearsightedness, and sinus pressure. More serious risks, such as a collapsed lung and seizures, are rare but possible. Because of a fire risk—a simple spark can set one off in the pure oxygen environment—patients can’t use battery-powered devices in the chamber or wear any petroleum-based cosmetics or hair or skin-care products.

This article first appeared in the 2019 UC Berkeley Diabetes White Paper.

Also see Keeping Your Feet Healthy with Diabetes.