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Probiotic supplementation aids wound healing in diabetic foot ulcer

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December 5, 2017

Patients with a diabetic foot ulcer who received probiotic supplementation for 12 weeks experienced faster wound healing coupled with an improved glycemic and lipid profile compared with patients assigned placebo, according to findings from a randomized controlled trial.

Sima Mohseni, of the infectious diseases and tropical medicine research center at Babol University of Medical Sciences in Iran, and colleagues analyzed data from 60 adults aged 40 years to 85 years with grade 3 diabetic foot ulcer, who randomly received either probiotic supplementation (n = 30) or placebo (n = 30) daily for 12 weeks between March and June 2016. Probiotic capsules contained lactobacillus acidophilus, lactobacillus casei, lactobacillus fermentum and Bifidobacterium bifidum. All participants also underwent standard treatment for wound care. Participants provided blood samples at baseline and 12 weeks and 3-day dietary records at baseline. Wound healing and glucose parameters served as the primary outcome; secondary outcomes included lipid profile and inflammation biomarkers.

At 12 weeks, patients assigned to probiotic supplementation saw reductions in ulcer length (mean, –1.3 vs. –0.8; P = .01), width (–1.1 vs. –0.7; P = .02) and depth (mean, –0.5 vs. –0.3; P = .02) when compared with patients assigned placebo. Patients assigned to probiotic therapy also saw reductions in fasting plasma glucose (mean, –29.6 mg/dL vs. –5.8 mg/dL; P = .01), serum insulin (mean, –4.3 µIU/mL vs. 0.4 µIU/mL; P = .03) and HbA1c (mean, –0.6% vs. –0.2%; P = .003), as well as a rise in the quantitative insulin sensitivity check index (mean, 0.01 vs. –0.01; P = .003) when compared with those assigned placebo.

Probiotic supplementation also had an effect on lipid profile and inflammatory markers when compared with placebo. Patients in the probiotic group had decreases in serum total cholesterol (mean, –4.8 vs. 7 mg/dL; P = .04), high sensitivity C-reactive protein (mean, –9 vs. –1.7 mg/L; P = .02) and plasma malondialdehyde ( mean, –0.8 vs. –0.2 mol/L; P = .001), as well as increases in plasma nitric oxide (mean, 6.2 vs. 0.8 mol/L; P = .01) and total antioxidant capacity concentrations (mean, 179.3 vs. –85.1 mmol/L; P < .001).

Researchers did not observe between-group changes in homeostatic model assessment of beta-cell function, or other lipid or inflammatory markers.

The researchers noted that information was not collected on fecal bacteria loads before and after probiotic administration, or on the characterization of the microbiome at baseline, during and after therapy. Bacterial cultures were not taken.

“Probiotics may help to improve inflammatory factors through producing [short chain fatty acids] in the gut and reducing production of hydrogen peroxide radicals,” the researchers wrote. “Furthermore, the beneficial effects of probiotics on oxidative stress might be related to the production of butyrate in the colon, and its impact on decreased lipid peroxidation, such as oxidized LDL, 8-isoprostanes and glutathione redox ratio.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.