Topical Insulin Appears Viable in Treatment of Pressure Ulcers

AUGUST 18, 2016
Jeannette Y. Wick, RPh, MBA, FASCP
Nursing home residents sometimes develop pressure ulcers, especially if they have low serum albumin levels, are incontinent, have fragile skin, or are bedbound. Pressure ulcers are notoriously difficult to treat, and have systemic repercussions if they do not heal. Normal wound healing progresses from hemostasis, to inflammation, granulation, and maturation. Frail skin cannot complete these steps. Current treatment approaches for pressure ulcers include hydrocolloid, transparent film, hydrogel, alginate, normal saline, foam, polymeric membrane, silver-impregnated gauze, honey-impregnated insulin, cadexomer iodine, gauze, silicone dressings, collagen matrix, and composite dressings.
Research indicates that insulin has wound-healing properties, and this is the subject of a study that appears in the journal Ostomy Wound Management. Based on findings that insulin increases wound collagen, granulation tissue, wound tensile strength, and local production of insulin-like growth factors by fibroblasts, these researchers looked at its potential in pressure ulcers.
The research team recruited patients admitted to an acute care facility who had a Grade 2 or Grade 3 pressure ulcer. They randomized subjects to treatment with either normal saline-impregnated gauze (control group, n=25) or insulin dressing (1 unit/cm of wound surface, n=25). Staff applied dressings twice daily for 7 days. The insulin was sprayed over the wound surface with an insulin syringe, allowed to dry for 15 minutes, and then covered with sterile gauze.
Whenever insulin is used, clinicians worry about systemic effects and especially hypoglycemia. The researchers monitored for these potential effects. At baseline, the 2 groups' variables and wound characteristics were similar.
Within a week, patients in the control group experienced a decrease in mean wound area of about 4%. Patients treated with insulin saw decreases of 35%. Decreases in Pressure Ulcer Scale scores were significantly better in the treatment arm, and patients treated with topical insulin experienced no significant decreases in blood glucose.
The researchers report that insulin treatment improved pressure ulcers better than saline gauze. They acknowledge that studies with larger sample sizes, longer follow-up times, and different types of chronic wounds and control treatments are needed to confirm insulin's role as a wound-healing accelerant.

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