JMIR Publications

ABSTRACT

Background:

Diabetic foot ulcer (DFU) is a severe complication of diabetes mellitus, often resulting in amputation and increased mortality. Conventional treatments may be insufficient, leading to interest in complementary therapies such as herbal medicine, acupuncture, maggot debridement therapy (MDT), and biological therapies. These approaches are widely used in Asia, yet their effectiveness and integration into clinical practice remain underexplored

Objective:

This scoping review aims to identify and evaluate the effectiveness, challenges, and opportunities of complementary therapies used for DFU wound healing in Asia.

Methods:

A scoping review was conducted using the PRISMA-ScR framework and Arksey & O'Malley's methodology. Articles were sourced from PubMed, Scopus, and ProQuest databases, covering studies published from 2014 to 2024. The PCC (Population, Concept, Context) model guided the selection of studies focusing on DFU patients, complementary therapies, and the Asian region. Ten studies met the inclusion criteria.

Results:

The most commonly applied therapies included herbal treatments (e.g., traditional Chinese medicinal foot soaks and Teucrium polium), biological therapies (MDT and Platelet-Rich Fibrin (PRF) with Hyaluronic Acid (HA)), physical therapies (acupuncture), and psychological therapies (music therapy). Key findings include: Maggot debridement therapy significantly increased miR-126 expression, enhancing angiogenesis and tissue regeneration (P < 0.05), Topical Teucrium polium application reduced wound size more effectively than placebo (P < 0.0001), PRF combined with HA reduced inflammation and increased VEGF levels by day 7 (P < 0.001), Music therapy reduced diabetes-related distress, significantly lowering distress scores (P < 0.001). However, challenges remain, including a lack of large-scale randomized controlled trials (RCTs), regulatory barriers, and cultural perceptions affecting therapy acceptance. Further research is necessary to validate these findings and develop standardized guidelines.

Conclusions:

Complementary therapies offer promising adjuncts for DFU management in Asia, where traditional medical practices are prevalent. Multidisciplinary collaboration among healthcare providers, policymakers, and traditional practitioners is essential for safe and effective integration. Further well-designed RCTs are required to confirm efficacy and inform evidence-based policies.