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Medicina
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New Insights into Diabetes Complications—Diabetic Foot
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New Insights into Diabetes Complications—Diabetic Foot

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Endocrinology".

Deadline for manuscript submissions: 30 July 2026 | Viewed by 3359

Special Issue Editors

Dr. Álvaro Astasio Picado

E-Mail Website
Guest Editor
Nursing and Physiotherapy Department, Faculty of Health Sciences, University of Castilla-La Mancha, 45600 Talavera de la Reina, Toledo, Spain
Interests: diabetes; diabetic foot; physiotherapy
Special Issues, Collections and Topics in MDPI journals
Dr. Enrico Brocco

E-Mail
Guest Editor
Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, 35031 Abano Terme, PD, Italy
Interests: diabetes; diabetic foot; foot and ankle

Special Issue Information

Dear Colleagues,

Diabetic foot remains one of the most severe and challenging complications of diabetes mellitus, representing a leading cause of hospitalization, disability, and non-traumatic lower limb amputation worldwide. Since the early recognition of diabetic neuropathy and ischemia as key pathogenic factors, decades of research have deepened our understanding of the molecular, vascular, and biomechanical mechanisms contributing to foot ulceration and impaired wound healing. Despite advances in glycemic control and multidisciplinary care, the global burden of diabetic foot disease continues to rise, underscoring the urgent need for innovative diagnostic, preventive, and therapeutic strategies.

The aim of this Special Issue, New Insights into Diabetes Complications—Diabetic Foot, is to provide a comprehensive platform for state-of-the-art research addressing the complex interplay of factors that underlie diabetic foot development and progression. We seek to highlight novel mechanisms, emerging technologies, and clinical practices that can transform patient outcomes and reduce the socioeconomic impact of this devastating condition.

We particularly welcome cutting-edge studies that explore molecular pathways of tissue damage, biomarkers for early detection, advanced imaging techniques, regenerative therapies, bioengineered dressings, and artificial intelligence-driven tools for risk stratification and wound management. Multidisciplinary and translational research, as well as systematic reviews and meta-analyses that synthesize current evidence, are also encouraged.

We invite original research articles, comprehensive reviews, and clinical studies that contribute to a deeper understanding of diabetic foot pathology and its prevention. Through this Special Issue, we aim to foster collaboration among researchers, clinicians, and technologists to pave the way toward more personalized and effective care for individuals with diabetes.

Dr. Álvaro Astasio Picado
Dr. Enrico Brocco
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • diabetic foot
  • diabetes complications
  • neuropathy
  • peripheral arterial disease
  • wound healing
  • ulceration
  • infection
  • biomarkers
  • regenerative medicine
  • tissue engineering
  • inflammation
  • microcirculation
  • artificial intelligence
  • predictive modeling
  • precision medicine
  • preventive care
  • multidisciplinary management
  • amputation prevention
  • translational research
  • emerging therapies

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Published Papers (3 papers)

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17 pages, 838 KB  
Article
The Combined Use of Ozone and Negative Pressure Wound Therapy in the Management of Diabetes-Related Foot Disease: A Retrospective Exploratory Cohort Study
by Izabella Kuźmiuk-Glembin, Agnieszka Białomyzy, Michał Sadowski, Bogdan Biedunkiewicz, Leszek Tylicki and Tomasz Niewęgłowski
Medicina 2026, 62(5), 827; https://doi.org/10.3390/medicina62050827 - 27 Apr 2026
Viewed by 390
Abstract
Background and Objectives: Diabetes mellitus (DM) is a major global health concern, with diabetes-related foot disease (DFD) representing one of its most severe complications, often resulting in chronic infection, osteomyelitis, and limb amputation. Conventional therapies frequently fail in refractory cases, necessitating novel [...] Read more.
Background and Objectives: Diabetes mellitus (DM) is a major global health concern, with diabetes-related foot disease (DFD) representing one of its most severe complications, often resulting in chronic infection, osteomyelitis, and limb amputation. Conventional therapies frequently fail in refractory cases, necessitating novel adjunctive strategies. Ozone therapy (OT) possesses antimicrobial, immunomodulatory, and oxygen-enhancing properties, while negative pressure wound therapy (NPWT) facilitates granulation, exudate removal, and tissue perfusion. This study explored the combined efficacy of OT and NPWT in advanced DFD. Materials and Methods: An exploratory, retrospective, observational cohort study was conducted at a specialized wound care center in Gdańsk, Poland, between 2019 and 2022. The study included 30 patients (n = 30) with refractory DFD involving both soft tissue and bone infection who had not responded to previous conventional treatment. The analyzed treatment approach consisted of surgical debridement, application of topical ozonated preparations, and (NPWT) with instillation of ozonated saline administered over a six-week period. Clinical outcomes included wound healing assessed using the Wagner classification and wound volume reduction, pain intensity measured using the Numeric Rating Scale (NRS), inflammatory biomarkers (C-reactive protein [CRP] and procalcitonin [PCT]), and microbiological characteristics of wound cultures. Statistical analyses were performed using the Wilcoxon signed-rank test and the chi-square test, and regression modeling was applied to identify potential predictors of therapeutic response. Statistical significance was defined as p < 0.05. Results: By week six, 100% of ulcers improved to Wagner stage ≤1, with 26.7% achieving stage 0. Median wound volume decreased from 5.5 cm3 to 0 cm3 (p < 0.001). Pain scores declined from 7.2 ± 0.96 points to 0.2 ± 0.5 points (p < 0.001). CRP and PCT levels decreased significantly (p < 0.001), and microbiological clearance was observed in all cases. Higher body mass index (BMI) was associated with poorer pain reduction. Conclusions: The combination of standard wound care with OT and NPWT was associated with clinically relevant improvements in wound healing, infection control, systemic inflammation, and pain reduction in patients with refractory DFD. Although limited by a non-controlled design and small cohort size, these findings support further randomized controlled trials to define the role of this combined approach in integrated diabetic foot care. Full article
(This article belongs to the Special Issue New Insights into Diabetes Complications—Diabetic Foot)
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14 pages, 991 KB  
Article
Predictors of Peripheral Neuropathy in Metabolic Disease: A Multivariable Analysis Incorporating the Toronto Clinical Scoring System and Sudomotor Assessment
by Cristina Mocanu (Chitan), Radu-Cristian Cimpeanu, Teodor Salmen, Marius-Costin Chitu, Raluca-Elena Alexa, Claudiu Cobuz, Vasilica Cristescu, Anca Pantea Stoian and Cristian Serafinceanu
Medicina 2026, 62(3), 586; https://doi.org/10.3390/medicina62030586 - 20 Mar 2026
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Abstract
Background and Objectives: Peripheral neuropathy (PNP) is a frequent and debilitating complication among patients with diabetes mellitus (DM) and other metabolic conditions, substantially affecting morbidity, functional status, and quality of life. Identifying predictors of PNP is essential for optimizing early diagnostic strategies and [...] Read more.
Background and Objectives: Peripheral neuropathy (PNP) is a frequent and debilitating complication among patients with diabetes mellitus (DM) and other metabolic conditions, substantially affecting morbidity, functional status, and quality of life. Identifying predictors of PNP is essential for optimizing early diagnostic strategies and improving long-term management outcomes. The aim of this study was to determine the predictive factors of PNP in a cohort of patients with DM. Materials and Methods: A cross-sectional study including 117 patients diagnosed with DM assessed for PNP was conducted. All patients were evaluated clinically and biologically. PNP was clinically assessed using the Toronto Clinical Scoring System (TCSS) score and sudomotor function by Sudoscan. Results: The patients included were mostly males with type 2 DM and metabolic syndrome phenotypes. Moreover, the patients with PNP were much older than those without PNP (65 [57–69] vs. 59.50 [46–68] years, p = 0.008), with a longer duration of DM (10 [6–15.50] vs. 5.5 (2–14] years, p = 0.019), and associated autonomic diabetic neuropathy (χ2 = 24.382, p < 0.001). Furthermore, TCSS and Sudoscan were correlated with a history of PNP, especially Sudoscan, which showed a very good discriminative ability for diabetic neuropathy diagnosis (AUC = 0.816). In a multivariable logistic regression including age, DM duration, and HbA1c, age was independently associated with PNP, with each additional year increasing the odds of neuropathy by approximately 6% (OR = 1.06, 95% CI 0.02–1.09, p = 0.002). When age was excluded, DM duration showed a borderline association with PNP (OR = 1.055, CI95% 0.997–1.117), suggesting potential overlap between these variables. Adding sudomotor assessment to the initial model improved the model performance (AUC 0.70–0.72). Conclusions: Age emerged as the main independent predictor of diabetic neuropathy, highlighting the role of cumulative metabolic exposure in the development of neural damage. Moreover, sudomotor assessment may have a complementary role in PNP assessment. Full article
(This article belongs to the Special Issue New Insights into Diabetes Complications—Diabetic Foot)
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17 pages, 1053 KB  
Systematic Review
Comparative Evidence on Negative Pressure Therapy and Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers: A Systematic Review of Independent Effectiveness and Clinical Applicability
by Álvaro Astasio-Picado, Jesús Jurado-Palomo, Belén Pozo-Aranda and Paula Cobos-Moreno
Medicina 2026, 62(1), 109; https://doi.org/10.3390/medicina62010109 - 4 Jan 2026
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Abstract
Background and Objectives: To evaluate and synthesize evidence on the independent clinical effectiveness, safety, and applicability of Negative Pressure Wound Therapy (NPWT) and Hyperbaric Oxygen Therapy (HBOT) in diabetic foot ulcers (DFUs), and to determine whether current evidence allows for a direct [...] Read more.
Background and Objectives: To evaluate and synthesize evidence on the independent clinical effectiveness, safety, and applicability of Negative Pressure Wound Therapy (NPWT) and Hyperbaric Oxygen Therapy (HBOT) in diabetic foot ulcers (DFUs), and to determine whether current evidence allows for a direct comparison between both interventions: NPWT and HBOT are widely advanced therapies for DFUs. Although both show benefits, the relative superiority of one over the other remains unclear. Systematic review of the literature conducted in accordance with PRISMA guidelines. Materials and Methods: A comprehensive literature search was performed using two electronic databases. The review included randomized controlled trials, systematic reviews, meta-analyses, and non-randomized studies. Methodological quality and risk of bias were assessed using validated tools: RoB 2.0 for randomized trials, AMSTAR-2 for systematic reviews, and ROBINS-I for non-randomized studies. Results: A total of 22 studies were included. NPT was shown to be effective in accelerating wound healing, though results varied depending on the type of intervention and clinical context. HBOT demonstrated beneficial effects on angiogenesis and significantly reduced the rate of major amputations. Both therapies presented significant advantages in the management of diabetic foot ulcers. Conclusions: Negative pressure therapy and hyperbaric oxygen therapy are both effective treatments for diabetic foot ulcer healing. However, treatment selection should be individualized based on patient-specific clinical factors, ulcer severity, and available healthcare resources. Integrating these advanced therapies within a multidisciplinary care approach may optimize outcomes and reduce the risk of complications. Future research should include standardized, head-to-head RCTs. Full article
(This article belongs to the Special Issue New Insights into Diabetes Complications—Diabetic Foot)
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