Armstrong DG, Hanft JR, Driver VR, Smith AP, Lazaro-Martinez JL, Reyzelman AM, Furst GJ, Vayser DJ, Cervantes HL, Snyder RJ, Moore MF, May PE, Nelson JL, Baggs GE, Voss AC, Diabetic Foot Nutrition Study Group., et al.
Diabetic medicine : a journal of the British Diabetic Association. Date of publication 2014 Sep 1;volume 31(9):1069-77.
1. Diabet Med. 2014 Sep;31(9):1069-77. doi: 10.1111/dme.12509. Epub 2014 Jun 19.
Effect of oral nutritional supplementation on wound healing in diabetic foot
ulcers: a prospective randomized controlled trial.
Armstrong DG(1), Hanft JR, Driver VR, Smith AP, Lazaro-Martinez JL, Reyzelman AM,
Furst GJ, Vayser DJ, Cervantes HL, Snyder RJ, Moore MF, May PE, Nelson JL, Baggs
GE, Voss AC; Diabetic Foot Nutrition Study Group.
Collaborators: Caporusso J, Dove C, Sigal F, Brill L, Penny H, Theriot M, Abdoo
D, Alvarez-Hernandez J, Dutra T, Pollak R, Zgonis T, Gottlieb I, Jaakola E, Moss
S, Wrobel J, Wunderlich R, Hwang JS, Kemp S, Landsman A, Mozen N, Rogers L,
Serena T, Shimozaki K, Bianchini J, Kezelian H, Serracino-Inglott K.
Author information:
(1)Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery,
University of Arizona College of Medicine, Tucson, AZ.
AIMS: Among people with diabetes, 10-25% will experience a foot ulcer. Research
has shown that supplementation with arginine, glutamine and
β-hydroxy-β-methylbutyrate may improve wound repair. This study tested whether
such supplementation would improve healing of foot ulcers in persons with
diabetes.
METHODS: Along with standard of care, 270 subjects received, in a double-blinded
fashion, (twice per day) either arginine, glutamine and
β-hydroxy-β-methylbutyrate or a control drink for 16 weeks. The proportion of
subjects with total wound closure and time to complete healing was assessed. In a
post-hoc analysis, the interaction of serum albumin or limb perfusion, as
measured by ankle-brachial index, and supplementation on healing was
investigated.
RESULTS: Overall, there were no group differences in wound closure or time to
wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l
and/or an ankle-brachial index of < 1.0, a significantly greater proportion of
subjects in the arginine, glutamine and β-hydroxy-β-methylbutyrate group healed
at week 16 compared with control subjects (P = 0.03 and 0.008, respectively).
Those with low albumin or decreased limb perfusion in the supplementation group
were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to
heal.
CONCLUSIONS: While no differences in healing were identified with supplementation
in non-ischaemic patients or those with normal albumin, addition of arginine,
glutamine and β-hydroxy-β-methylbutyrate as an adjunct to standard of care may
improve healing of diabetic foot ulcers in patients with risk of poor limb
perfusion and/or low albumin levels. Further investigation involving arginine,
glutamine and β-hydroxy-β-methylbutyrate in these high-risk subgroups might prove
clinically valuable.
© 2014 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on
behalf of Diabetes UK.
DOI: 10.1111/dme.12509
PMCID: PMC4232867
PMID: 24867069 [Indexed for MEDLINE]
