Reynald C Allam1, Freya Van Driessche2, Yiliang Zhu3. 1. Morton Plant Hospital Wound Healing Center , Clearwater, Florida. 2. Department of Dermatology, University of Miami , Miami, Florida. 3. Department of Epidemiology, University of South Florida , Tampa, Florida.
Abstract
Objective: Diabetic foot ulcers (DFUs) that fail to heal with standard care should be treated with advanced wound care products. Efficacy of advanced therapies is dependent on many factors. A secondary analysis of pivotal trial data for a bilayered cellular construct used in the treatment of DFU was undertaken to determine if glycemic control and other factors had an effect on time to healing. Approach: We analyzed the effect of age, gender, diabetes type, insulin usage, body mass index, smoking, initial and ending glycohemoglobin (HgbA1c), Charcot deformity, and wound area, duration, and location on likelihood of healing for wounds treated with bilayered cellular construct (BLCC). Results: In those treated with BLCC, initial wound area (cm2), age, and history of Charcot deformity were found to significantly affect healing. Neither initial HgbA1c nor change in HgbA1c was associated with healing. The bilayered product was found to be equally effective regardless of initial or change in HgbA1c levels (p-values 0.94 and 0.44, respectively). In the control group, initial HgbA1c, insulin usage, female gender, and wound location at the toes significantly influenced healing. Innovation: BLCC subgroup analysis to elucidate selection criteria allowing for targeted use of advanced products on those more likely to respond as well as direct further research into prognostic indicators for BLCC-treated patients. Conclusion: The bilayered cellular construct product remains equally effective regardless of initial or change in HgbA1c levels. Further specific research into the effect of glucose control and other factors on the effectiveness of different advanced DFU treatment products is recommended.
Objective: Diabetic foot ulcers (DFUs) that fail to heal with standard care should be treated with advanced wound care products. Efficacy of advanced therapies is dependent on many factors. A secondary analysis of pivotal trial data for a bilayered cellular construct used in the treatment of DFU was undertaken to determine if glycemic control and other factors had an effect on time to healing. Approach: We analyzed the effect of age, gender, diabetes type, insulin usage, body mass index, smoking, initial and ending glycohemoglobin (HgbA1c), Charcot deformity, and wound area, duration, and location on likelihood of healing for wounds treated with bilayered cellular construct (BLCC). Results: In those treated with BLCC, initial wound area (cm2), age, and history of Charcot deformity were found to significantly affect healing. Neither initial HgbA1c nor change in HgbA1c was associated with healing. The bilayered product was found to be equally effective regardless of initial or change in HgbA1c levels (p-values 0.94 and 0.44, respectively). In the control group, initial HgbA1c, insulin usage, female gender, and wound location at the toes significantly influenced healing. Innovation: BLCC subgroup analysis to elucidate selection criteria allowing for targeted use of advanced products on those more likely to respond as well as direct further research into prognostic indicators for BLCC-treated patients. Conclusion: The bilayered cellular construct product remains equally effective regardless of initial or change in HgbA1c levels. Further specific research into the effect of glucose control and other factors on the effectiveness of different advanced DFU treatment products is recommended.
Authors: Andrea L Christman; Elizabeth Selvin; David J Margolis; Gerald S Lazarus; Luis A Garza Journal: J Invest Dermatol Date: 2011-06-23 Impact factor: 8.551