With the advent of several innovative wound care management tools, the choice of products and treatment modalities available to clinicians continues to expand. High costs associated with wound care, especially diabetic foot wounds, make it important for clinician scientists to research alternative therapies and optimally incorporate them into wound care protocols appropriately. This article reviews using sugar as a treatment option in diabetic foot care and provides a guide to its appropriate use in healing foot ulcers. In addition to a clinical case study, the physiological significance and advantages of sugar are discussed.
VevesAFalangaVArmstrongDGSabolinskiML, Apligraf Diabetic Foot Ulcer Study. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: A prospective randomized multicenter clinical trial. Diabetes Care.2001;24 (2): 290–5.
9.
BreastedJH. The Edwin Smith surgical papyrus. Chicago: University of Chicago Press; 1930.
10.
ForrestRD. Early history of wound treatment. J R Soc Med.1982;75 (3): 198–205.
11.
GordonHMiddletonKRSealDSullenK. Sugar and wound healing. Lancet.1985;2 (8456): 663–4.
12.
PieperBCaliriMH. Nontraditional wound care: A review of the evidence for the use of sugar, papaya/papain, and fatty acids. J Wound Ostomy Continence Nurs.2003;30 (4): 175–83.
13.
DawsonJS. Preiskel Elective Prize. The role of sugar in wound healing. A comparative trial of the healing of infected wounds using traditional gauze/antiseptic packing, and granulated sugar, undertaken during an elective period at Kagando Hospital, Uganda. Ann R Coll Surg Engl.1996;78 (2 Suppl): 82–5.
14.
ChirifeJHerszageL. Sugar for infected wounds. Lancet.1982;2 (8290): 157.
15.
ChirifeJHerszageLJosephAKohnES. In vitro study of bacterial growth inhibition in concentrated sugar solutions: Microbiological basis for the use of sugar in treating infected wounds. Antimicrob Agents Chemother.1983;23 (5): 766–73.
16.
ChirifeJScarmatoGHerszageL. Scientific basis for use of granulated sugar in treatment of infected wounds. Lancet.1982;1 (8271): 560–1.
17.
HaddadMCVannuchiMTChensoMZHaulyMC. [The use of sugar in infected wounds]. Rev Bras Enferm.1983;36 (2): 152–4.
18.
RostenbergAJrWassermannEMedanskyRS. Sugar paste in the treatment of leg ulcers. AMA Arch Derm.1958;78 (1): 94.
19.
ViauFMangenotDBovalCPerronJ. [Treatment of eschars with commercial granulated sugar]. Presse Med.1985;14 (14): 792.
20.
DuffetAMViauF. [Treatment of wounds and ulcers with crystallized sugar. Technical aspects and results]. Rev Infirm.1986;36 (20): 37–8.
21.
DrouetN. The use of sugar and honey for the treatment of infected wounds. Presse Med.1983;12 (38): 2355–56.
22.
ShiCMNakaoHYamazakiMTsuboiROgawaH. Mixture of sugar and povidone-iodine stimulates healing of MRSA-infected skin ulcers on db/db mice. Arch Dermatol Res.2007;299 (9): 449–56.
23.
BajajGKarnNKShresthaBPKumarPSinghMP. A randomised controlled trial comparing eusol and sugar as dressing agents in the treatment of traumatic wounds. Trop Doct.2009;39 (1): 1–3.
24.
ChiwengaSDowlenHMannionS. Audit of the use of sugar dressings for the control of wound odour at Lilongwe Central Hospital, Malawi. Trop Doct.2009;39 (1): 20–2.
25.
AutryEBarrosS, USDA Foreign Agricultural Service. Brazil sugar annual report 2009. GAIN Report BR9004. 2009.
26.
BarnesWB. Sugar sweetens the lot of patients with bedsores. JAMA.1973;223: 122.
27.
KnutsonRAMerbitzLACreekmoreMASnipesHG. Use of sugar and povidone-iodine to enhance wound healing: Five year's experience. South Med J.1981;74 (11): 1329–35.
28.
DavidsonNJSowdenJMFletcherJ. Defective phagocytosis in insulin controlled diabetics: Evidence for a reaction between glucose and opsonising proteins. J Clin Pathol.1984;37 (7): 783–6.
29.
BagdadeJDStewartMWaltersE. Impaired granulocyte adherence. A reversible defect in host defense in patients with poorly controlled diabetes. Diabetes.1978;27 (6): 677–81.
30.
TrousdaleRKJacobsSSimhaeeDAWuJKLustbaderJW. Wound closure and metabolic parameter variability in a db/db mouse model for diabetic ulcers. J Surg Res.2009;151 (1): 100–7.
31.
VelanderPTheopoldCHirschTBleizifferOZuhailiBFossumMHoellerDGheerardynRChenMVisovattiSSvenssonHYaoFErikssonE. Impaired wound healing in an acute diabetic pig model and the effects of local hyperglycemia. Wound Repair Regen.2008;16 (2): 288–93.
32.
ArcherHGBarnettSIrvingSMiddletonKRSealDV. A controlled model of moist wound healing: Comparison between semi-permeable film, antiseptics and sugar paste. J Exp Pathol (Oxford).1990;71 (2): 155–70.
33.
KilicA. Healing of diabetic ulcers with granulated sugar. Plast Reconstr Surg.2001;108 (2): 585.
34.
TobaKSudohNNaganoKEtoMMizunoYNakagawaHKawabataYYamamiNHaraMFukushimaYOuchiY. [Randomized prospective trial of gentian violet with dibutyryl cAMP and povidone-iodine with sugar as treatment for pressure sores infected with methicillin-resistant Staphylococcus aureus in elderly patients.]Nippon Ronen Igakkai Zasshi.1997;34 (7): 577–82.
35.
ScheiePORehbergR. Response of Escherichia coli B-r to high concentrations of sucrose in a nutrient medium. J Bacteriol.1972;109 (1): 229–35.
36.
SilvettiAN. An effective method of treating long-enduring wounds and ulcers by topical applications of solutions of nutrients. J Dermatol Surg Oncol.1981;7 (6): 501–8.
37.
De FeoMGregorioRRenzulliAIsmenoGRomanoGPCotrufoM. Treatment of recurrent postoperative mediastinitis with granulated sugar. J Cardiovasc Surg (Torino).2000;41 (5): 715–9.
38.
DebureAGachotBLacourBKreisH. Acute renal failure after use of granulated sugar in deep infected wound. Lancet.1987;1 (8540): 1034–5.
39.
HerszageLMontenegroJRJosephAL. Tratamiento de las heridas supuradas con acúcar granulado comercial. Bol Trab Soc Argent Cir.1980;41 (21–22): 315–30.
40.
ScottWJ. Water relations of Staphylococcus aureus at 30 degrees C. Aust J Biol Sci.1953;6 (4): 549–64.
41.
GenigeorgisCA. Present state of knowledge on staphylococcal intoxication. Int J Food Microbiol.1989;9 (4): 327–60.
42.
ToveyFI. Honey and healing. J R Soc Med.1991;84 (7): 447.
43.
MolanPC. The role of honey in the management of wounds. J Wound Care.1999;8 (8): 415–8.
44.
NakaoHYamazakiMTsuboiROgawaH. Mixture of sugar and povidone–iodine stimulates wound healing by activating keratinocytes and fibroblast functions. Arch Dermatol Res.2006;298 (4): 175–82.
SzerafinTVaszilyMPéterffyA. Granulated sugar treatment of severe mediastinitis after open-heart surgery. Scand J Thorac Cardiovasc Surg.1991;25 (1): 77–80.
47.
EngelsenSBPérezS. Internal motions and hydration of sucrose in a diluted water solution. J Mol Graph Model.1997. 15 (2): 122–31.
48.
TophamJ. What's new in wound treatment?Not a lot! J Tissue Viability.1994;4 (3): 86–9.
49.
Topical antimicrobial drug products for over-the-counter human use. Tentative final monograph for healthcare antiseptic products. 21 CFR Parts 333 and 369. Federal Register.1994;59 (116): 31402–52.
50.
ViauF. Treatment of wounds, eschars, and leg ulcers with crystallized sugar. Sem Hop Paris.1986;62 (30): 2431–5.
51.
AnaniaWCRosenRCWallaceJAWeinblattMAGerlandJSCastilloJ. Treatment of diabetic skin ulcerations with povidone-iodine and sugar. Two case reports. J Am Podiatr Med Assoc.1985;75 (9): 472–4.
52.
LisleJ. Use of sugar in the treatment of infected leg ulcers. Br J Community Nurs.2002;7 (6 Suppl): 40, 42, 44, 46.
53.
BoultonAJArmstrongDGAlbertSFFrykbergRGHellmanRKirkmanMSLaveryLALemasterJWMillsJLSrMuellerMJSheehanPWukichDK, American Diabetes Association; American Association of Clinical Endocrinologists. Comprehensive foot examination and risk assessment: A report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care.2008;31 (8): 1679–85.
54.
CanavanRJUnwinNCKellyWFConnollyVM. Diabetes- and nondiabetes-related lower extremity amputation incidence before and after the introduction of better organized diabetes foot care: Continuous longitudinal monitoring using a standard method. Diabetes Care.2008;31 (3): 459–63.
