Introduction and Objective: Diabetic foot ulcers (DFUs) remain a major complication of diabetes associated with impaired healing and amputation risk. Hyperbaric oxygen therapy (HBOT) has been proposed as an adjunctive treatment, but evidence continues to evolve. The objective of this updated systematic review and meta-analysis is to analyze the efficacy of hyperbaric oxygen for the treatment of diabetic foot ulcers.Methods: A systematic search was performed on electronic databases, including Pubmed, CENTRAL, Embase, Scopus, Google Scholar, and PakMediNet, for RCTs evaluating oxygen therapy for diabetic ulcers. The primary outcome was ulcer healing rate. Secondary outcomes included major amputations (proximal to ankle), minor amputations (distal to ankle), and adverse events. Binary outcomes were pooled using random-effects models and expressed as risk ratios (RR) with 95% confidence intervals (CI).Results: Nineteen RCTs, including 1,269 participants (635 HBOT, 634 control), were analyzed. HBOT significantly improved ulcer healing versus control (RR 1.97, 95% CI 1.48-2.62) with moderate heterogeneity (I²=51%). Funnel plot inspection and Egger’s test indicated potential publication bias (p<0.001). Seven RCTs (467 participants) demonstrated HBOT significantly reduced major amputation risk (RR 0.48, 95% CI 0.24-0.97; I²=36.5%) but showed no significant effect on minor amputations (seven RCTs, 374 participants; RR 1.00, 95% CI 0.54-1.88; I²=49%) or adverse events (four RCTs, 258 participants; RR 1.27, 95% CI 0.80-2.00; I²=0%).Conclusion: This updated meta-analysis supports HBOT’s beneficial effect on ulcer healing and major amputation reduction in diabetic foot ulcers. However, moderate heterogeneity and potential publication bias warrant cautious interpretation. Further large-scale, well-designed trials are needed to clarify HBOT’s impact on amputation subtypes and safety outcomes.
S. Hussain: None. R. Rehman: None. F. Amin: None. A. Abid: None. N. Saleem: None.
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