Effect of topical insulin in diabetic foot ulcer healing among patients with diabetes in Asia: a systematic review

Objective: The aim of this systematic review is to provide a comprehensive understanding on the effectiveness of topical insulin in the healing of diabetic foot ulcers (DFUs) in patients with diabetes in Asian countries. Method: A systematic review of both observational and randomised controlled trials evaluating insulin efficacy on DFUs—but which was limited to studies in Asian countries between 2016 and 2024—was conducted. Guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Electronic databases including PubMed, Scopus, MEDLINE and Google Scholar were searched for studies comparing insulin interventions with standard of care or other interventions, based on specific inclusion criteria. Results: A total of 16 relevant studies (out of 1132 on initial search) reporting on 1056 patients were included. Of the studies, eight reported wound healing rates in terms of reduction in wound size. Data on days of hospitalisation, number of dressing changes and insulin applications, quality of life, cost-effectiveness, and the psychological parameters of anxiety and depression, were not considered by any of the included studies. Conclusion: The findings of this review provide supportive evidence that insulin was an efficient adjunct for healing DFUs. The findings identified existing evidence and gaps within it that may inform future studies in other Asian countries and beyond.