Evidence mapPaperPMID 40821981Full record

SynthesisPeerJ2025

Comparison of the efficacy of 12 interventions in the treatment of diabetic foot ulcers: a network meta-analysis.

Xuyang Hu, Huixin Meng, Jiaru Liang, Hang An, Jiaqi Zhou, Yuling Gao, Chong You, Zhenni Zhang, Xiaoyang Gong, Yong Liu

Abstract readComparative StudyNetwork Meta-AnalysisSystematic Review
In one paragraph

Synthesis in PeerJ, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Review
  4. Electrical stimulation: a novel adjunct therapy for diabetic foot ulcers.Frontiers in clinical diabetes and healthcare · 2025
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Xuyang Hu *Department of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Huixin Meng *Institute (College) of Integrative Medicine, Dalian Medical University, Dalian, China.
Jiaru LiangInstitute (College) of Integrative Medicine, Dalian Medical University, Dalian, China.
Hang AnInstitute (College) of Integrative Medicine, Dalian Medical University, Dalian, China.
Jiaqi ZhouDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Yuling GaoDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Chong YouInstitute (College) of Integrative Medicine, Dalian Medical University, Dalian, China.
Zhenni ZhangDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Xiaoyang GongDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Yong LiuDepartment of Rehabilitation Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: This study aimed to comprehensively compare the efficacy of 12 interventions for diabetic foot ulcer (DFU) using a network meta-analysis (NMA). Methods: The NMA was conducted by PRISMA guidelines, and the protocol was registered in PROSPERO (CRD42023461811). PubMed, Web of Science, Cochrane Library, and Embase databases were systematically searched from inception to September 2023. Randomized controlled trials (RCTs) enrolling patients with DFU were included if they compared epidermal growth factor (EGF), platelet-derived growth factor (PDGF), platelet-rich plasma (PRP), stem cells (SC), low-frequency ultrasound (LFU), negative pressure wound therapy (NPWT), low-level laser therapy (LLLT), electric stimulation (ES), extracorporeal shockwave therapy (ESWT), amniotic membrane therapy (AMT), hyperbaric oxygen therapy (HBOT), and topical oxygen therapy (TOT) against standard of care (SOC) or placebo. The primary endpoint assessed was the wound healing rate. Secondary endpoints comprised wound healing time, percentage area reduction (PAR), and amputation rate. The surface under the cumulative ranking curve (SUCRA) was calculated to rank the efficacy of interventions. Results: A total of 99 RCTs involving 7,356 patients were included. Among the 12 interventions analyzed, only LFU (OR = 2.20; 95% CI [0.99-4.91]) and ES (OR = 1.88; 95% CI [0.87-4.05]) did not demonstrate statistically significant improvements in ulcer healing rate compared with SOC. Based on SUCRA rankings, SC (SUCRA = 89.7%; OR = 5.71; 95% CI [2.64-12.34]) and AMT (SUCRA = 89.2%; OR = 5.11; 95% CI [3.12-8.37]) ranked highest in promoting ulcer healing, while LFU (29.4%) and SOC (10.4%) ranked lowest. Regarding wound healing time, AMT (MD = -26.91 days; 95% CI [-44.27 to -9.55]), PRP (MD = -21.65 days; 95% CI [-33.61 to -9.69]), and NPWT (MD = -16.79 days; 95% CI [-31.12 to -2.26]) significantly reduced healing durations compared to SOC. SUCRA rankings indicated that AMT (84.7%) and PRP (74.6%) ranked highest, while LFU (29.4%) and SOC (10.4%) remained lowest. Concerning PAR, LLLT (MD = 34.27; 95% CI [17.35-51.20]) and ESWT (MD = 27.50; 95% CI [11.00-44.00]) showed significant improvements over SOC, with LLLT (SUCRA = 93.9%) and ESWT (SUCRA = 84.0%) ranking highest, while SOC (21.0%) and TOT (18.3%) ranked lowest. For amputation rate, SC (OR = 0.12; 95% CI [0.03-0.55]) and HBOT (OR = 0.35; 95% CI [0.16-0.78]) significantly lowered the risk compared to SOC, with SUCRA rankings placing SC (79.9%) and PRP (73.2%) as most effective, while NPWT (26.4%) and SOC (9.9%) were least effective. Conclusions: SC and AMT emerged as highly effective, demonstrating superior efficacy in improving healing rate compared to PDGF, ES, and HBOT. AMT also showed significant effects in shortening ulcer healing time. LLLT exhibited considerable effectiveness in reducing ulcer areas, and SC therapy was associated with reduced amputation rate.

Indexed as

Diabetic FootExtracorporeal Shockwave TherapyHumansHyperbaric OxygenationLow-Level Light TherapyNegative-Pressure Wound TherapyPlatelet-Rich PlasmaRandomized Controlled Trials as TopicTreatment OutcomeWound HealingAmputation rateDiabetic foot ulcersNetwork meta-analysisPercentage area reductionWound healing rateWound healing time

Identifiers

PMID40821981
PMCPMC12352421

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.