Thursday, June 27, 2013

Letter: Topical Honey for Diabetic Foot Ulcers

Dtsch Arztebl Int 2013; 110(21): 373
Local Treatment of Chronic Wounds in Patients With Peripheral Vascular Disease, Chronic Venous Insufficiency and Diabetes by Dr. med. Mike Rüttermann, Dr. med. Andreas Maier-Hasselmann, Brigitte Nink-Grebe, Marion Burckhardt in volume 3/2013
The data regarding different treatments for wounds are still disappointingly scant. No grade B recommendations are available for wound care products, and grade A seems completely out of the question! A grade B recommendation exists only in favor of hydrogel, hyperbaric oxygenation in ulcers that are beyond treatment in diabetic foot syndrome, and integrated care. In view of the many patients and the vast market in wound care products, this is sobering. I was therefore all the more surprised at the recommendation not to use honey for chronic wounds (the context was really generally that of chronic wounds) because honey resulted in more pain in a single study of venous ulcers. Why was a special scenario (venous ulcers) generalized to include all chronic wounds?
Years of experience with manuka honey in patients with diabetic foot syndrome have shown that pain usually does not constitute a problem in these wounds owing to the comorbid polyneuropathy. I would have welcomed a fact-based recommendation, differentiated by evidence level (which exists for a negative recommendation only for venous ulcers). Numerous small, qualitatively moderate to poor studies of honey treatment in diabetic foot syndrome have shown mostly promising results, which are entirely consistent with my own observations. Obviously, high-quality randomized controlled studies of honey treatment in diabetic foot syndrome are absolutely necessary and desirable. But until these have been conducted and reported, the treatment of the diabetic foot syndrome with honey provides an efficient, cost-effective variant with a poor evidence base. This, however, is also the case for all other wound treatments. 

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