Análise evolutiva do tratamento da úlcera neuropática em pé diabético
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Feb 14, 2025
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Resumo
Objetivo: Identificar os principais pontos evolutivos acerca do tratamento da úlcera neuropática em pé diabético nos últimos 5 anos. Métodos: Trata-se de uma revisão integrativa de caráter descritivo com artigos publicados entre 2019 a 2024, nos idiomas Inglês e Espanhol, com texto completo disponível. Utilizou-se como questão norteadora: Quais são as novas opções terapêuticas para o tratamento da úlcera neuropática em lesões nos pés dos portadores de diabetes? A coleta de artigos foi realizada por meio da base de dados PubMed e Scielo. Os descritores foram: “Neuropathic Ulcer”, “Diabetic Foot”, “Treatment”, “Medicine”, “Patient”, totalizando 40 artigos encontrados. Resultados: A pesquisa aponta fortes evidências para eficácia do tratamento com o Fator de Crescimento Epidérmico Recombinante (FCEhr), sendo necessária a efetiva demonstração dos resultados no estudo realizado no Brasil. Como medicamento já em uso, há destaque para o ácido alfa lipóico, devido às suas propriedades antioxidantes. Para o tratamento da dor neuropática, o uso de capsaicina é eficaz para a melhoria da qualidade de vida do paciente. Considerações finais: Considera-se que as novas apresentações terapêuticas descritas no estudo têm contribuído para a queda global no número de amputações, nos últimos anos.
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Como Citar
LemosL. G. H., Pinel NetoO., & NunesM. A. P. (2025). Análise evolutiva do tratamento da úlcera neuropática em pé diabético. Revista Eletrônica Acervo Saúde, 25, e19233. https://doi.org/10.25248/reas.e19233.2025
Seção
Revisão Bibliográfica
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Referências
1. AMARA F, et al. Review of Diabetic Polyneuropathy: Pathogenesis, Diagnosis and Management According to the Consensus of Egyptian Experts. Curr Diabetes Rev, 2019; 15(4): 340-345.
2. ATLAS, Diabetes et al. International diabetes federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2022; 33: 2.
3. BOBIRCA F, et al. The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions-A Single-Center Study. Life (Basel), 2022; 12(8): 1156.
4. CASTANEIRA J, et al. Recidiva de úlcera del pie en pacientes diabéticos tratados con Heberprot-P®. Rev Cubana Angiol Cir Vasc, 2020; 21(2).
5. CHANDLER LA, et al. Wound Conforming Matrix Containing Purified Homogenate of Dermal Collagen Promotes Healing of Diabetic Neuropathic Foot Ulcers: Comparative Analysis Versus Standard of Care. Adv Wound Care, 2020; 9(2): 61-67.
6. CONFORTO EC, et al. Roteiro para revisão bibliográfica sistemática: aplicação no desenvolvimento de produtos e gerenciamento de projetos. Gestão de Desenvolvimento de Produtos, 2011; 8: 1-12.
7. DADFAR R, et al. Therapeutic Utilization of Zinc Supplementation Concurrent with Ozone Therapy Ameliorates Diabetic Foot Ulcer and Attenuates Serum Level of C-reactive Protein- A Case Report Study. Adv Biomed Res, 2023; 12: 18.
8. D'AMICO M, et al. Data-driven CAD-CAM vs traditional total contact custom insoles: A novel quantitative-statistical framework for the evaluation of insoles offloading performance in diabetic foot. PLoS One, 2021; 16(3): 247915.
9. DE LIMA AEF, et al. Ozonioterapia como opção ao tratamento de lesões cutâneas em humanos: revisão integrativa da literatura. Arquivos de Ciências da Saúde da UNIPAR, 2022; 26(3): 233-242.
10. DLUDLA PV, et al. Capsaicin, its clinical significance in patients with painful diabetic neuropathy. Biomed Pharmacother, 2022; 153: 113439.
11. ESCALANTE P, et al. Factores pronósticos de amputación mayor en pacientes con pie diabético sometidos a cirugía. Rev Cubana Angiol Cir Vasc, 2020; 21(3).
12. GARCIA H e ARÍSTIDES L. Procedimientos quirúrgicos del pie diabético neuropático. Rev Cubana Angiol Cir Vasc, 2020; 21(2).
13. GUERRIERO FP, et al. Overcoming Barriers to Wound Healing in a Neuropathic and Neuro-Ischaemic Diabetic Foot Cohort Using a Novel Bilayer Biodegradable Synthetic Matrix. Biomedicines, 2023; 11(3): 721.
14. HAMMER GD e MCPHEE SJ. Fisiopatologia da doença. McGraw Hill Brasil, 2015; 784.
15. HASSANZADEH S, et al. Effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients in southwestern Iran: a randomized clinical trial. BMC Endocr Dis, 2023; 23(1): 224.
16. HASTINGS MK, et al. Qualitative study of musculoskeletal tissues and their radiographic correlates in diabetic neuropathic foot deformity. Foot (Edinb), 2021; 47: 101777.
17. HUSSAIN N, et al. The efficacy and safety profile of capsaicin 8% patch versus 5% Lidocaine patch in patients with diabetic peripheral neuropathic pain: a randomized, placebo-controlled study of south Asian male patients. J Diabetes Metab Disord, 2021; 20(1): 271-278.
18. JESUS BM. Eficácia da Terapia de Pressão Negativa no Pé Diabético. Dissertação de Mestrado. Universidade da Beira Interior (Portugal), 2021; 36.
19. KALAN LR, et al. Strain-and Species-Level Variation in the Microbiome of Diabetic Wounds Is Associated with Clinical Outcomes and Therapeutic Efficacy. Cell Host Microbe, 2019; 25(5): 641-6555.
20. LAZZARINI PA, et al. Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review. Diabetes Metab Res Rev, 2020; 36(1): 3275.
21. MARTINEZ GI e RODRIGUEZ RY. Úlcera del pie diabético tratado con Heberprot-p®. Rev Cubana Angiol Cir Vasc, 2020; 21(1).
22. MEIMETI E, et al. Marine Isopod Ceratothoa Oestroides Extract: a Novel Treatment for Diabetic Foot Ulcers? Case Report of an Immunosuppressed Patient. Med Arch, 2019; 73(2): 131-133.
23. MENS MA, et al. Biomechanical and musculoskeletal changes after flexor tenotomy to reduce the risk of diabetic neuropathic toe ulcer recurrence. Diabet Med, 2022; 39(4): 14761.
24. MEYROWITZ HN, et al. Venous, Arterial, and Neuropathic Leg Ulcers With Emphasis on the Geriatric Population. Cureus, 2023; 15(4): 38123.
25. MIN KR, et al. Association between baseline abundance of Peptoniphilus, a Gram-positive anaerobic coccus, and wound healing outcomes of DFUs. PLoS One, 2020; 15(1): 227006.
26. MONTEIRO RL, et al. Protocol for evaluating the effects of a foot-ankle therapeutic exercise program on daily activity, foot-ankle functionality, and biomechanics in people with diabetic polyneuropathy: a randomized controlled trial. BMC Musculoskelet Disord, 2018; 19(1): 400.
27. NAMGOONG S, et al. A Pilot Study Comparing a Micronized Adipose Tissue Niche versus Standard Wound Care for Treatment of Neuropathic Diabetic Foot Ulcers. J Clin Med, 2022; 11(19): 5887.
28. PORTH CM e MATFIN G. Fisiopatologia. In: Fisiopatologia, 2021; 911-911.
29. PUTZ Z, et al. Vitamin D in the Prevention and Treatment of Diabetic Neuropathy. Clin Ther, 2022; 44(5): 813-823.
30. REEVES ND,et al. Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy. Medicina, 2021; 57(5): 457.
31. RUIZ-TOLEDO J, et al. Evaluation of the Complementary Health Provision of the Podiatric Foot Care Program for Diabetic Patients in Catalonia (Spain). Int J Environ Res Public Healt, 2021; 18(10): 5093.
32. SOCIEDADE BRASILEIRA DE DIABETES. Diretrizes da Sociedade Brasileira de Diabetes 2019-2020, 2022; 8(2): 178-180.
33. SORIA B, et al. Cell Therapy of Vascular and Neuropathic Complications of Diabetes: Can We Avoid Limb Amputation? Int J Mol Sci, 2023; 24(24): 17512.
34. SYABARIYAH S, et al. The Effect of Vibration on the Acceleration of Wound Healing of Diabetic Neuropathic Foot Ulcer: A Prospective Experimental Study on Human Patients. Healthcare, 2023; 11(2): 191.
35. TANG F, et al. Fast-Access Multidisciplinary Approach to Management of Diabetic Foot Ulcers: The Diabetic Rapid Evaluation and Lower Limb Amputation Management (DREAM) Clinic. Clin Med Insights Endocrinol Diabetes, 2023; 16: 11795514231196464.
36. WALKER CA, et al. Hospitalists' Needs Assessment and Perceived Barriers in Wound Care Management: A Quality Improvement Project. J Wound Ostomy Continence Nurs, 2019; 46(2): 98-105.
37. YANG H, et al. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Front Endocrinol (Lausanne), 2020.
38. ZIEGLER D, et al. Current concepts in the management of diabetic polyneuropathy. J Diabetes Investig, 2021; 12(4): 464-475.
39. ZIEGLER D, et al. Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations. Diabetes Res Clin Pract, 2022; 186: 109063.
40. ZWAFERINK JBJ, et al. Optimizing footwear for the diabetic foot: Data-driven custom-made footwear concepts and their effect on pressure relief to prevent diabetic foot ulceration. PLoS One, 2020; 15(4): 224010.
2. ATLAS, Diabetes et al. International diabetes federation. IDF Diabetes Atlas, 7th edn. Brussels, Belgium: International Diabetes Federation, 2022; 33: 2.
3. BOBIRCA F, et al. The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions-A Single-Center Study. Life (Basel), 2022; 12(8): 1156.
4. CASTANEIRA J, et al. Recidiva de úlcera del pie en pacientes diabéticos tratados con Heberprot-P®. Rev Cubana Angiol Cir Vasc, 2020; 21(2).
5. CHANDLER LA, et al. Wound Conforming Matrix Containing Purified Homogenate of Dermal Collagen Promotes Healing of Diabetic Neuropathic Foot Ulcers: Comparative Analysis Versus Standard of Care. Adv Wound Care, 2020; 9(2): 61-67.
6. CONFORTO EC, et al. Roteiro para revisão bibliográfica sistemática: aplicação no desenvolvimento de produtos e gerenciamento de projetos. Gestão de Desenvolvimento de Produtos, 2011; 8: 1-12.
7. DADFAR R, et al. Therapeutic Utilization of Zinc Supplementation Concurrent with Ozone Therapy Ameliorates Diabetic Foot Ulcer and Attenuates Serum Level of C-reactive Protein- A Case Report Study. Adv Biomed Res, 2023; 12: 18.
8. D'AMICO M, et al. Data-driven CAD-CAM vs traditional total contact custom insoles: A novel quantitative-statistical framework for the evaluation of insoles offloading performance in diabetic foot. PLoS One, 2021; 16(3): 247915.
9. DE LIMA AEF, et al. Ozonioterapia como opção ao tratamento de lesões cutâneas em humanos: revisão integrativa da literatura. Arquivos de Ciências da Saúde da UNIPAR, 2022; 26(3): 233-242.
10. DLUDLA PV, et al. Capsaicin, its clinical significance in patients with painful diabetic neuropathy. Biomed Pharmacother, 2022; 153: 113439.
11. ESCALANTE P, et al. Factores pronósticos de amputación mayor en pacientes con pie diabético sometidos a cirugía. Rev Cubana Angiol Cir Vasc, 2020; 21(3).
12. GARCIA H e ARÍSTIDES L. Procedimientos quirúrgicos del pie diabético neuropático. Rev Cubana Angiol Cir Vasc, 2020; 21(2).
13. GUERRIERO FP, et al. Overcoming Barriers to Wound Healing in a Neuropathic and Neuro-Ischaemic Diabetic Foot Cohort Using a Novel Bilayer Biodegradable Synthetic Matrix. Biomedicines, 2023; 11(3): 721.
14. HAMMER GD e MCPHEE SJ. Fisiopatologia da doença. McGraw Hill Brasil, 2015; 784.
15. HASSANZADEH S, et al. Effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients in southwestern Iran: a randomized clinical trial. BMC Endocr Dis, 2023; 23(1): 224.
16. HASTINGS MK, et al. Qualitative study of musculoskeletal tissues and their radiographic correlates in diabetic neuropathic foot deformity. Foot (Edinb), 2021; 47: 101777.
17. HUSSAIN N, et al. The efficacy and safety profile of capsaicin 8% patch versus 5% Lidocaine patch in patients with diabetic peripheral neuropathic pain: a randomized, placebo-controlled study of south Asian male patients. J Diabetes Metab Disord, 2021; 20(1): 271-278.
18. JESUS BM. Eficácia da Terapia de Pressão Negativa no Pé Diabético. Dissertação de Mestrado. Universidade da Beira Interior (Portugal), 2021; 36.
19. KALAN LR, et al. Strain-and Species-Level Variation in the Microbiome of Diabetic Wounds Is Associated with Clinical Outcomes and Therapeutic Efficacy. Cell Host Microbe, 2019; 25(5): 641-6555.
20. LAZZARINI PA, et al. Effectiveness of offloading interventions to heal foot ulcers in persons with diabetes: a systematic review. Diabetes Metab Res Rev, 2020; 36(1): 3275.
21. MARTINEZ GI e RODRIGUEZ RY. Úlcera del pie diabético tratado con Heberprot-p®. Rev Cubana Angiol Cir Vasc, 2020; 21(1).
22. MEIMETI E, et al. Marine Isopod Ceratothoa Oestroides Extract: a Novel Treatment for Diabetic Foot Ulcers? Case Report of an Immunosuppressed Patient. Med Arch, 2019; 73(2): 131-133.
23. MENS MA, et al. Biomechanical and musculoskeletal changes after flexor tenotomy to reduce the risk of diabetic neuropathic toe ulcer recurrence. Diabet Med, 2022; 39(4): 14761.
24. MEYROWITZ HN, et al. Venous, Arterial, and Neuropathic Leg Ulcers With Emphasis on the Geriatric Population. Cureus, 2023; 15(4): 38123.
25. MIN KR, et al. Association between baseline abundance of Peptoniphilus, a Gram-positive anaerobic coccus, and wound healing outcomes of DFUs. PLoS One, 2020; 15(1): 227006.
26. MONTEIRO RL, et al. Protocol for evaluating the effects of a foot-ankle therapeutic exercise program on daily activity, foot-ankle functionality, and biomechanics in people with diabetic polyneuropathy: a randomized controlled trial. BMC Musculoskelet Disord, 2018; 19(1): 400.
27. NAMGOONG S, et al. A Pilot Study Comparing a Micronized Adipose Tissue Niche versus Standard Wound Care for Treatment of Neuropathic Diabetic Foot Ulcers. J Clin Med, 2022; 11(19): 5887.
28. PORTH CM e MATFIN G. Fisiopatologia. In: Fisiopatologia, 2021; 911-911.
29. PUTZ Z, et al. Vitamin D in the Prevention and Treatment of Diabetic Neuropathy. Clin Ther, 2022; 44(5): 813-823.
30. REEVES ND,et al. Sensory-Motor Mechanisms Increasing Falls Risk in Diabetic Peripheral Neuropathy. Medicina, 2021; 57(5): 457.
31. RUIZ-TOLEDO J, et al. Evaluation of the Complementary Health Provision of the Podiatric Foot Care Program for Diabetic Patients in Catalonia (Spain). Int J Environ Res Public Healt, 2021; 18(10): 5093.
32. SOCIEDADE BRASILEIRA DE DIABETES. Diretrizes da Sociedade Brasileira de Diabetes 2019-2020, 2022; 8(2): 178-180.
33. SORIA B, et al. Cell Therapy of Vascular and Neuropathic Complications of Diabetes: Can We Avoid Limb Amputation? Int J Mol Sci, 2023; 24(24): 17512.
34. SYABARIYAH S, et al. The Effect of Vibration on the Acceleration of Wound Healing of Diabetic Neuropathic Foot Ulcer: A Prospective Experimental Study on Human Patients. Healthcare, 2023; 11(2): 191.
35. TANG F, et al. Fast-Access Multidisciplinary Approach to Management of Diabetic Foot Ulcers: The Diabetic Rapid Evaluation and Lower Limb Amputation Management (DREAM) Clinic. Clin Med Insights Endocrinol Diabetes, 2023; 16: 11795514231196464.
36. WALKER CA, et al. Hospitalists' Needs Assessment and Perceived Barriers in Wound Care Management: A Quality Improvement Project. J Wound Ostomy Continence Nurs, 2019; 46(2): 98-105.
37. YANG H, et al. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Front Endocrinol (Lausanne), 2020.
38. ZIEGLER D, et al. Current concepts in the management of diabetic polyneuropathy. J Diabetes Investig, 2021; 12(4): 464-475.
39. ZIEGLER D, et al. Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations. Diabetes Res Clin Pract, 2022; 186: 109063.
40. ZWAFERINK JBJ, et al. Optimizing footwear for the diabetic foot: Data-driven custom-made footwear concepts and their effect on pressure relief to prevent diabetic foot ulceration. PLoS One, 2020; 15(4): 224010.