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Those with diabetic foot ulcers (DFUs) finally have some hope in nanotechnology that helps in targetted drug delivery and fastens the wound. What this essentially means is sending nanoparticles in a tissue-friendly matrix that increases the production of collagen in the diabetic wound. This has actually been found to work on mice as part of a UK study in 2020.
Dr Farah Ingale, senior consultant, diabetologist and director of internal medicine, Fortis Hospital, Mumbai, says nanotechnology has the potential to speed up the healing of diabetic foot compared to conventional treatments. “This basically involves some mechanisms. The first is targetted drug delivery where nanoparticles can deliver therapeutic agents directly to the site of the diabetic foot ulcer or infection. By encapsulating drugs within nanoparticles, they can be protected, controlled and released sustainably, which can help maximize their effectiveness. The second mechanism is aimed at improving bioavailability. Many drugs have poor solubility or limited ability to penetrate the tissues effectively; nanoparticles can ensure better uptake and distribution within the wound area. The third process involves designing nanomaterials with specific properties to enhance wound healing. These materials can also regulate moisture levels, oxygen supply and pH balance at the wound site, creating optimal conditions for healing. The fourth method involves functionalizing nanoparticles with bioactive molecules to promote tissue regeneration, which can help speed up the healing process and encourage the development of healthy tissues,” she explains.
But the benefits of technology can be availed only with early detection and monitoring. “Nanotechnology-based sensors and diagnostic devices can play a crucial role in early detection and continuous monitoring of the healing progress. By providing real-time information about the wound status, healthcare providers can intervene promptly to adjust treatment strategies and ensure faster healing outcomes,” says Dr Ingale.
Diabetes can impair blood vessels, which impact blood circulation causing Peripheral Arterial Disease (PAD). When this occurs, it can slow the healing process as blood flow to extremities is impacted. High blood sugar levels can weaken the body’s immune system. In the long run, even a minor foot injury can result in serious infections, wounds and limb amputations. The wounds lead to excessive inflammation that damages healthy tissue and prevents an effective immune response and healing process.
“Diabetic foot can impact the overall lifestyle of the affected person and can cause a series of problems, including limited mobility, chronic pain, emotional and psychological problems like frustration, anxiety, stress and depression,” says Dr Ingale.
As of now diabetic foot is treated with wound care, infection management and controlling blood sugar levels but it is a lifelong process. Comparatively nanotechnology can provide many benefits, including improved treatment outcomes, reduced need for systemic medication, cost-effective wound dressing and personalised treatment and monitoring.
The prevalence of DFUs is between 1.3 and 12 per cent in various countries. Indians rarely take up issues pertaining to DFU seriously because of socio-cultural beliefs, delayed health-seeking behaviour and out-of-pocket expenditure. Around one in five patients with diabetes is likely to develop foot ulcers. Foot complications, including DFUs, substantially contribute to diabetes-related mortality because of infections and stubborn wounds that require amputation. A study by the Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, spanning several centres across the country, found that a person with DFU was three times more likely to die earlier (mainly because of cardiac issues) than a routine diabetic person without ulcer. Also, mortality due to foot ulcers was higher than certain cancers.
Even with the best of therapy, only 30 per cent of wounds associated with diabetes heal despite several advanced treatment modalities. These include advanced moist wound therapy, bioengineered tissue or skin substitutes, peptides, growth factors, electric stimulation and negative pressure wound therapy. Also, the ulcer recurrence rate is 40 to 70 per cent.
Dr Ingale believes that nanotechnology has the potential to play a significant role in the overall treatment of diabetes beyond wound healing. “These can include areas like glucose monitoring and insulin delivery. In the field of glucose monitoring, nanotechnology-based sensors and devices can play a vital role. These sensors can provide real-time data on glucose levels to patients so that they can make all the required changes to their diet, lifestyle and even medication. Further, nanotechnology also offers vast opportunities in the field of improving insulin delivery methods with precision,” she adds.
