Zhong Jiaxin, Lan Yi, Cai Zixin
National Clinical Research Center for Metabolic Diseases, Key Laboratory of Cardiometabolic Medicine of Hunan Province, Metabolic Syndrome Research Center, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
Department of Ultrasound, The Second Xiangya Hospital, Central South University, Changsha, 410011, China.
Adv Ther. 2025 Sep 27. doi: 10.1007/s12325-025-03380-8.
Diabetic ulcers (DUs) are a common complication of diabetes, significantly impairing quality of life and placing a burden on healthcare systems. Electrical stimulation (ES) therapy is a non-invasive technique that promotes wound healing using various current types, including direct current (DC), pulsed current (PC), and alternating current (AC). However, the comparative efficacy and safety of these ES modalities for DUs remain unclear.
This study presents a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the efficacy and safety of various ES therapies for DU treatment. A comprehensive literature search was conducted to identify studies evaluating ulcer healing rates, the number of healed ulcers, and adverse events. The treatments analyzed included symmetry biphasic square-wave pulse, asymmetric biphasic square-wave pulse, very low levels of stimulation current, twin-peak monophasic pulse, cathodal direct current (CDC), high-voltage pulsed current (HVPC), and low-intensity biphasic pulse current. The SUCRA (surface under the cumulative ranking curve) and mean rank values were used to assess the relative effectiveness of each modality.
The analysis included data from 11 RCTs. Treatment effects were compared using SUCRA and mean ranking values. HVPC, CDC, and asymmetric biphasic square-wave pulse were ranked highest for ulcer healing rates and the number of healed ulcers, with asymmetric biphasic square-wave pulse demonstrating the most consistent efficacy across these outcomes.
This network meta-analysis suggests that HVPC, CDC, and asymmetric biphasic square-wave pulse are the most effective ES therapies for promoting DU healing.
糖尿病溃疡（DUs）是糖尿病常见的并发症，严重影响生活质量并给医疗系统带来负担。电刺激（ES）疗法是一种非侵入性技术，可使用多种电流类型促进伤口愈合，包括直流电（DC）、脉冲电流（PC）和交流电（AC）。然而，这些ES模式对糖尿病溃疡的相对疗效和安全性仍不明确。
本研究对比较各种ES疗法治疗糖尿病溃疡疗效和安全性的随机对照试验（RCT）进行网络荟萃分析（NMA）。进行了全面的文献检索，以确定评估溃疡愈合率、愈合溃疡数量和不良事件的研究。分析的治疗方法包括对称双相方波脉冲、不对称双相方波脉冲、极低水平刺激电流、双峰单相脉冲、阴极直流电（CDC）、高压脉冲电流（HVPC）和低强度双相脉冲电流。使用累积排序曲线下面积（SUCRA）和平均排名值来评估每种模式的相对有效性。
分析纳入了11项RCT的数据。使用SUCRA和平均排名值比较治疗效果。HVPC、CDC和不对称双相方波脉冲在溃疡愈合率和愈合溃疡数量方面排名最高，其中不对称双相方波脉冲在这些结果中显示出最一致的疗效。
该网络荟萃分析表明，HVPC、CDC和不对称双相方波脉冲是促进糖尿病溃疡愈合最有效的ES疗法。
