Quality of life dynamics in patients with diabetic foot syndrome with combined treatment by physiotherapy and autologous plasma

Abstract

Introduction. Diabetic neuro- and angiopathy are major factors causing diabetic foot ulcers. Ischemia reduces oxygen and nutrients supply to wounds. In oxygen and nutrients deprived conditions, epithelial cells in wounds fail to sufficiently release important wound healing factors such as vascular endothelial growth factor (VEGF) and platelet-derived growth factor (PDGF). In recent studies a pool of growth factors from autologous plasma rich growth factors were analyzed. The aim of the study is to evaluate the efficacy of combined photodynamic (PDT) and autologous plasma rich growth factor therapy (PRGFT) on quality of life improvements in patients with diabetic foot syndrome. Materials and methods. 61 outpatients with type 2 diabetes mellitus and Wagner grade II diabetic foot syndrome were included in this study. Patients of the 1st group (n = 30) received standard therapy (ST), in the 2nd group (n = 31) ST was supplemented by PDT and PRGFT. Results. Using PDT in combined therapeutic management of chronic ulcer in patients with DM resulted in complete purification of the wound surfaces during shorter time durations vis-a-vis standard therapy, thus influencing all quality of life indicators according to EuroQol scale, including the category of «mobility» (improvement by 2.72 %), «self-care» (by 7.85 %), «usual activities» (by 7.06 %), «pain/discomfort» (by 5.25 %) and «anxiety/depression» categories (by 19.74 %). PRGFT was included in the combined treatment scheme post PDT-course to stimulate epithelialization of wound defects in patients of the 2nd group. Efficacy of this combined algorithm was confirmed by overall EuroQol scale category improvements: «mobility» — by 18 %, «self-care» — by 9 %, «usual activities» — by 9 %, «pain/discomfort» 15 % and «anxiety/depression» categories by 20 %. Conclusions. Combined photodynamic and autologous plasma rich growth factor therapy is preferable to standard therapy in the therapeutic management and improvement of quality of life in outpatients with diabetic foot syndrome.