Comparison of the Effectiveness and Safety of Different Non-surgical Offloading Interventions for Diabetic Foot Ulcers: A Network Meta-analysis of Randomized Controlled Trials

Abstract

Objective

The aim of this study is to conduct a network meta-analysis of the effectiveness and safety of different non-surgical offloading interventions for patients with diabetic foot ulcers.

Methods

We searched PubMed, EMBASE, OVID, Web of Science, and Cochrane Library for randomized controlled trials (RCTS) on the efficacy of non-surgical interventions for DFU offloading. Outcome measures included the rate of ulcer healing, reduction in ulcer area, and incidence of adverse events. The Cochrane Risk of Bias Tool version was used to assess the risk of bias of the included trials.

Results

A total of 22 RCTs involving 1226 patients were included. Network meta-analysis showed that compared to removable knee high offloading device (OR = 3.66, 95% CI (1.78, 8.46)], removable ankle high offloading device (OR = 3.17, 95% CI (1.32, 7.85)], therapeutic shoe (OR = 3.72, 95% CI (1.53, 9.78)], standard treatment (OR = 4.15, 95% CI (1.05, 13.89)], TCC significantly increased the ulcer healing rate (P < .05). The analyses did not reveal any statistically significant differences between the results of the various types of non-surgical offloading measures in terms of ulcer reduction area and incidence of adverse events. The ranking probability graph showed that TCC (SUCRA = 0.59) was most likely to improve ulcer healing rates, therapeutic shoes (SUCRA = 0.25) performed best in terms of ulcer reduction area, and non-removable walkers (SUCRA = 0.63) were most likely to reduce the incidence of adverse events.

Conclusions

Non-removable offloading devices (TCC and non-removable walkers) have the best effectiveness and safety in the non-surgical offloading interventions of patients with diabetic foot ulcers, which is of great significance in promoting ulcer healing and improving prognosis.