HBOT is beneficial for diabetic foot ulcers.A meta-analysis presented at ADA 2026 supports the benefits of hyperbaric oxygen therapy (HBOT) for ulcer healing and reducing the risk of major amputation in individuals with diabetic foot ulcers (DFUs).
Compared with standard care, HBOT significantly improved the primary outcome of ulcer healing in the pooled analysis of 19 studies, with moderate heterogeneity (risk ratio [RR], 1.97, 95 percent confidence interval [CI], 1.48–2.62; p<0.0001; I²=50.6 percent). [ADA 2026, abstract 1462-P]
HBOT was also associated with a significant reduction in the risk of a major amputation (ie, proximal to ankle) compared with standard care in the pooled analysis of seven studies (RR, 0.48, 95 percent CI, 0.24–0.97; p=0.0412; I²=36.5 percent).
Conversely, HBOT did not confer a significant benefit in the risk of a minor amputation (ie, distal to ankle; RR, 1.00, 95 percent CI, 0.54–1.88; I²=49 percent) or adverse events (AEs; RR, 1.27, 95 percent CI, 0.80–2.00; I²=0 percent).
A serious diabetes complication
“DFUs are a serious complication of diabetes and are associated with delayed healing, infection, hospitalization, and amputation. HBOT may improve tissue oxygenation and wound healing; however, its clinical benefit remains debated,” noted the investigators, led by Dr Syed Anas Hussain from the New York City Health + Hospitals/Metropolitan, New York, New York, US, at ADA 2026.
HBOT augments angiogenesis, improves collagen deposition and leukocyte activities, and reduces oedema. The body receives 100 percent oxygen at an atmospheric pressure that is higher than normal, thereby increasing the concentration of oxygen in human cells and wound tissue, reducing bacterial colonization, and eventually accelerating the wound-healing process. [Med Clin N Am 2013;97:957-980; J Dent Res 2010;89:219-229; J Diabet Complic 2002;16:153-158]
Recent evidence has shown the benefit of HBOT as an adjuvant to standard therapy, with improved healing of chronic DFUs and reduced amputations in patients with diabetes, but most of these studies have small sample sizes. [J Hum Growth Dev 2024;34:430-440; J Anaesthesiol Clin Pharmacol 2020;36:213-218; J Wound Ostomy Continence Nurs 2017;44:536-545; Diabetes Care 2010;33:998-1003]
To evaluate the efficacy and safety of HBOT as an adjunct to standard medical and surgical care for DFUs, Hussain and colleagues searched electronic databases, including PubMed, CENTRAL, Embase, Scopus, Google Scholar, and PakMediNet, for randomized controlled trials (RCTs) comparing standard care with or without HBOT in patients with DFUs.
The investigators conducted an updated systematic review and meta-analysis of 19 RCTs, with a pooled sample of 1,269 participants. Of these, 635 comprised the HBOT group, while 634 comprised the control group.
“[Taken together, the] findings demonstrate HBOT’s potential as an adjunct to standard care, with improved ulcer healing and reduced risk of major amputation in participants with DFUs. There were no significant differences in minor amputation or AEs,” said Hussain and colleagues.
However, the investigators noted that the moderate heterogeneity and potential publication bias warrant cautious interpretation. Large, well-designed trials are thus warranted to validate the impact of HBOT on amputation subtypes and safety outcomes.