The global burden of diabetic wounds

In a recent issue of the Annals of Medicine, Zhang et al. published a meta‐analysis on diabetic ulcer prevalence based on 67 papers.1 In total, an impressive number of more than 800 000 subjects from 33 countries were included in this meta‐analysis, making it one of the largest analyses of this kind. Beyond doubt, diabetes mellitus type 2 (DM2) is one of the epidemics of the dawning millennium. Some predictions say that one out of 10 people will be diagnosed with DM2 by mid‐century. One of the major complications of DM is the development of chronic distal ulcers. As wound healing is an orchestrated process, a plethora of factors must be considered for chronic wounds in DM: impaired angiogenesis, reduced growth factor expression, altered signalling via RAGES (receptors of advanced glycation end products), increased inflammation at ulcer margins as well as reduced cell proliferation and centripetal cell migration. Obviously, most of this is also true for chronic wounds with different pathophysiological backgrounds.2,3,4,5 Despite multiple molecular targets, the key clinical point when treating diabetic ulcers is pressure reduction. This can be done with total (nonremovable) contact casts, cast walkers and (removable) foot pads.6 7