MPPT – Frontiers in Medicine
New MPPT clinical study:
100% closure rate of pressure ulcers

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Impaired wound healing and diabetic foot ulcers - one of the major complications of diabetes

Diabetes mellitus is a chronic disease in which the body’s ability to produce or respond to the hormone, insulin, is impaired. Insulin is a hormone naturally produced by the pancreas. Even though the two states produce a slightly different clinical picture, they both result in elevated levels of glucose / sugar in the blood. Too high blood glucose levels cause damage to many of the body’s systems, in particular the blood vessels and the nerves. The impact is particularly strong in the eyes, kidneys and feet, where it, among others, can lead to, respectively, retinopathy and blindness; and nephropathy and kidney failure.

Diabetes also impair wound healing with the result that wounds tend to be chronic and can result in the development of osteomyelitis. The typical complications are foot ulcerations, which frequently result in amputation.

Using MPPT to heal a burn on foot in person with diabetes

Treatment goal

The most common complication of diabetes in relation to wound healing are diabetic foot ulcers. They are categorised depending whether they are neuropathic which means they are caused mainly by neural damage, ischaemic meaning they are mainly due to vascular damage or whether it seems to be a mixture of both, in which case they are categorised neuro-ischemic. The main cause of the ulcer is evaluated as this helps guide the best treatment options, for example offloading. The ulcers are also classified based on the severity, such as depth, level of infection, spread to other structures, such as bone (osteomyelitis) or skin (cellulitis), etc. Whereas these tasks provide important information, the most important undertaking from a patient’s perspective is to act with a sense of urgency and with a view to prevent or delay a potential amputation.  “The primary goal in the treatment of diabetic foot ulcers is to obtain wound closure.” “Prompt and aggressive treatment of diabetic foot ulcers can often prevent exacerbation of the problem and eliminate the potential for amputation. The aim of therapy should be early intervention to allow prompt healing of the lesion and prevent recurrence once it is healed.”

How Amicapsil can help

Amicapsil has shown strong treatment effects and is able to remove an infection in a diabetic foot ulcer 60% quicker and allowed patients to be discharged from hospital 31% quicker, when compared to an antibiotic or an antiseptic. This study was in patients in need of hospitalisation due to their diabetic foot ulcer.

Amicapsil removes microbial toxins and enzymes that are weakening the immune cells and preventing them from doing their job properly. This support of the immune system enables the body to repair the damage of the tissue and heal the wound. If the diabetic disease process in the tissue is very advanced, so that the vessels are nearly obstructed and the nerves are close to dying off, even the immune system is no longer able to prevent this from happening and there is no alternative left to amputation. However, it is usually possible to close a diabetic foot ulcer if it is taken seriously immediately when it appears. The optimal approach is, to apply Amicapsil immediately upon recognition of the ulcer. Is this not done, however, and the ulcer worsens with the treatment it is receiving, it is still highly recommended to apply Amicapsil in order to turn around the process.

The number of applications a diabetic foot ulcer / DFU will need in order to heal, depends fully on the progression of the diabetic disease process and on the age of the ulcer.

♦  If the deep tissue around the ulcer is not very affected and the ulcer is new and relatively small, 1 application will often be enough.

♦  If the ulcer has progressed into the category “difficult-to-heal”, daily application for 3 or 4 consecutive or semi-consecutive days can be necessary, and they may, in difficult cases, need to be followed up with weekly or fortnightly application until full closure of the ulcer is achieved. “Difficult to heal”, in the context, of diabetes means that the ulcer has failed to show good progress towards healing, i.e. 40-50% reduction in size, within 4 weeks.

♦  If the ulcer is older than 6-8 weeks, it is chronic. This means that the number of applications needed may increase. Sometimes, 3 weeks are needed to keep the healing progressing. A positive change will be noticeable from the beginning.

In summary, the actual healing process will be individual to each patient depending on the state of the disease, his/her carefulness with the ulcer for the duration of the healing period and the caution and professionalism of the care provided by all the healthcare professionals participating in the treatment of that particular ulcer.

There are two principal forms of diabetes mellitus:

  • Type 1 diabetes (formerly known as insulin-dependent) in which the pancreas fails to produce the insulin which is essential for survival. This form develops most frequently in children and adolescents, but is being increasingly noted later in life.
  • Type 2 diabetes (formerly named non-insulin-dependent) which results from the body’s inability to respond properly to the action of insulin produced by the pancreas. Type 2 diabetes is much more common and accounts for around 90% of all diabetes cases worldwide. It occurs most frequently in adults, but is being noted increasingly in adolescents as well.

Recently, a further possible division of diabetes into 5 subgroups has been proposed.

10% of the world’s population has diabetes mellitus. This means that 770 million people around the world suffer from diabetes. Of these, 10% have type 1 and 90% have type 2.

0.6% of the world’s population at any one time has a diabetic foot ulcer. That means that 46.2 million people in the world has a diabetic foot ulcer right now. In North America, this percentage is twice as high.

Every 30 seconds, one lower limb amputation in a diabetes patient occurs around the globe.

DFUs, Infection and Amicapsil

See case story of 5-year-old diabetic foot ulcer on plantar heel.

In the UK, for first presented diabetic foot ulcers, the outlook for the patient after the first 12 months is 35% healed, 48% unhealed and 17% amputated.

In a clinical study, Amicapsil removed the infection from diabetic foot ulcers in less than half the time compared to an antibiotic and an antiseptic. It also cut the number of days the patient needed to remain in hospital by one third.

34% of diabetic foot ulcers managed in the NHS (National Health Service, UK) are treated with systemic antibiotics. Only 16% of these healed. This indicates that antibiotics have a very limited effect on infected diabetic foot ulcers. This use of antibiotics is therefore sub-optimal and it is contributing disproportionately to the development of antibiotic resistance. Amicapsil can prevent an infection from developing and can treat a wound infection and it does not contribute to antimicrobial resistance / AMR.

Bone infection / osteomyelitis and skin infection / cellulitis are common complications of diabetic foot ulcers. Both osteomyelitis and cellulitis strongly increase the risk of developing sepsis.


Typical complications associated with diabetes mellitus:

Foot damage / Diabetic foot disease – changes is blood vessels and nerves lead to ulceration and potentially to amputation.

Eye damage / retinopathy – potentially leads to blindness.

Kidney damage / nephropathy – can lead to kidney failure, requiring dialysis or kidney transplant.

Heart disease / cardiovascular disease – including coronary artery disease, heart attack, stroke, atherosclerosis (narrowing of arteries).

Nerve damage / neuropathy – can lead to sensory loss and damage especially in the legs but also hands.