Comparison of Resin Salve and Octenidine in Patients With Neuropathic Diabetic Foot Ulcers

PRIMARY OBJECTIVES

Primary objectives are:

- to scrutinize complete healing of neuropathic diabetic foot ulceration over time.

- to analyze successful eradication rate of pathogenic bacteria from the ulcers within the study period as documented by negative swab culture.

- to analyze the rate of ulcers with 50% decrease in ulcer size and disappearing of clinical signs of infection over time.

SECONDARY OBJECTIVES

Secondary objectives are:

- to assess potential contributors to delayed ulcer healing.

- to study the safety and compliance related with the treatment methods.

- to estimate the overall costs of the ulcer treatment with the resin salve treatment or octenidine treatment.

INCLUSION AND EXCLUSION CRITERIA

Inclusion criteria are:

- an adult patient (18-80 years) with infected neuropathic foot ulceration due to type I or II diabetes.

- PEDIS-classification ≥ Grade II.

Exclusion criteria are:

- a patient whose life expectancy is less than 6 months.

- an ulceration of ischemic or neuroischemic origin.

- presence of systemic inflammatory response signs.

- heel ulceration.

- presence of osteomyelitis.

- pregnancy.

- known hypersensitivity to any of the ingredient including in the study or control treatment products. - a patient who is unable to give informed consent.

- a patient who has an advanced malignant disease.

METHODS Patient selection Altogether 40 adult patients (18 - 80 years) suffering from infected neuropathic fore- or mid-foot ulceration originated from type I or II diabetes (PEDIS-classification ≥ Grade II) are randomly allocated into two groups (n = 20 patients / group) to receive either topical resin salve treatment or topical octenidine treatment for an appropriate diabetic ulceration. The patients who are recruited to the current study, are selected by the physicians, who are specialized in the treatment of diabetes and its complications. Treatment is commenced and followed-up at the outpatient clinic of the Diabetic Foot Clinic Regional Diabetic Centre, Department of Hypertension and Diabetology, Gdansk, Poland. Informed consent will be obtained from all patients.

FOLLOW-UP Demographics, clinically relevant medical, and follow-up data is gathered on the Clinical Report Form (CRF) by the responsible physicians for every patient at the beginning of the study, and within the every visit at the Diabetic Foot Clinic of the Regional Diabetic Centre until the study ends at six months later, at last. Thus, all recruited patients visit at the Diabetic Foot Clinic: 1. in the beginning of the study, and at 1, 2, 3, and 4 week time-points thereafter. After that, consecutive visit for every 3 to 4 weeks are arranged until the ends after the 6 months from the initiation. If the patient's clinical situation requires more frequent visits at the Diabetic Foot Clinic, those are arranged on the basis of the decision of research physician.

If the ulcer healing takes less than 6 months, the last follow-up information on the CRF is filled when the ulcer is considered being fully healed (primary objective is achieved). If the ulcer is not fully healed in 6 months, the treatment is considered unsuccessful, and follow-up is discontinued (primary objective is not achieved). Photographs are taken within every control visit at the outpatient department. Any notable improvement, deterioration, or any factor that might contribute with the ulcer healing during the follow-up, e.g. mechanical / surgical ulcer revision, cleansing, or antibiotic treatment will be registered on the CRF: Thus, CRF includes the details of:

- size of the ulcer [width (mm) x length (mm) x depth (mm)].

- signs of infection.

- swab culture.

- plain x-ray.

- erythrocyte sedimentation rate (ESR).

- C-reactive protein (CRP).

- full blood count.

- photographs with an appropriate measure.

- use of antibiotics.

- rate of dressing changes.

- potential side-effects (i.e. signs of hypersensitivity or allergic reaction).

- the use of off-loading shoe, and any specific notes or observations during the treatment period.

SAFETY ISSUES Hypersensitivity or allergy for resin or control treatment is taken into account, and if any symptoms of allergic reactions i.e. contact dermatitis appear, the study is discontinued for this particular patient.