Evolving spectrum of diabetic wound: Mechanistic insights and therapeutic targets

Diabetes mellitus is a chronic metabolic disorder resulting in an increased blood glucose level and prolonged hyperglycemia, causes long term health conse-quences. Chronic wound is frequently occurring in diabetes patients due to compromised wound healing capability. Management of wounds in diabetic patients remains a clinical challenge despite many advancements in the field of science and technology. Increasing evidence indicates that alteration of the biochemical milieu resulting from alteration in inflammatory cytokines and matrix metalloproteinase, decrease in fibroblast and keratinocyte functioning, neuropathy, altered leukocyte functioning, infection, etc., plays a significant role in impaired wound healing in diabetic people. Apart from the current pharmacotherapy, different other approaches like the use of conventional drugs, antidiabetic medication, antibiotics, debridement, offloading, platelet-rich plasma, growth factor, oxygen therapy, negative pressure wound therapy, low-level laser, extracorporeal shock wave bioengineered substitute can be considered in the management of diabetic wounds. Drugs/therapeutic strategy that induce angiogenesis and collagen synthesis, inhibition of MMPs, reduction of oxidative stress, controlling hyperglycemia, increase growth factors, regulate inflammatory cytokines, cause NO induction, induce fibroblast and keratinocyte proliferation, control microbial infections are considered important in controlling diabetic wound. Further, medicinal plants and/or phytoconstituents also offer a viable alternative in the treatment of diabetic wound. The focus of the present review is to highlight the molecular and cellular mechanisms, and discuss the drug targets and treatment strategies involved in the diabetic wound.

Automated summary

Diabetes mellitus results in increased blood glucose level and prolonged hyperglycemia, leading to chronic wounds in diabetic patients. The impaired wound healing in diabetes is caused by various factors such as inflammatory cytokines, matrix metalloproteinase, decreased fibroblast and keratinocyte functioning, neuropathy, altered leukocyte functioning, and infection. In addition to pharmacotherapy, various approaches including conventional drugs, antidiabetic medication, antibiotics, and different therapies can be considered in the management of diabetic wounds. The focus is on inducing angiogenesis, collagen synthesis, inhibiting MMPs, reducing oxidative stress, controlling hyperglycemia, increasing growth factors, regulating inflammatory cytokines, and controlling microbial infections.