SynthesisFrontiers in endocrinology2026
Adjunctive therapies added to standard of care for diabetic foot ulcers: a systematic review and network meta-analysis with pairwise comparisons.
Synthesis in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Diabetic foot ulcers (DFUs) remain one of the most disabling and costly complications of diabetes. Although standard of care (SOC) is the foundation of DFU management, many ulcers fail to heal adequately, prompting increasing use of adjunctive therapies. However, the comparative effectiveness of different adjunctive strategies remains uncertain. Objective: To evaluate and compare the efficacy and safety of adjunctive therapies added to SOC for patients with DFUs using systematic review, pairwise meta-analysis, and network meta-analysis. Methods: PubMed, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, WHO ICTRP, and ChiCTR were searched from inception to February 18, 2026. Randomized controlled trials evaluating adjunctive therapies plus SOC for DFUs were included. Interventions were classified into eight clinically interpretable categories: oxygen-based therapies, device-based and physical wound therapies, growth factor and blood-derived therapies, placental and perinatal tissue-derived products, acellular matrix/skin substitute/scaffold products, cell-based and adipose-derived therapies, topical pharmacologic and bioactive agents, and nanotechnology-based, natural product, and bioactive dressing therapies. Outcomes included ulcer area reduction, complete healing, time to healing, adverse events, and amputation. Results: Eighty-four randomized controlled trials involving 7,232 participants were included. Compared with SOC alone, several adjunctive therapies improved healing-related outcomes. Device-based therapies, placental products, growth factor/blood-derived therapies, matrix/skin substitute products, and oxygen-based therapies were associated with greater ulcer area reduction. Oxygen-based therapies, matrix/skin substitute products, device-based therapies, placental products, topical pharmacologic/bioactive agents, and growth factor/blood-derived therapies increased the likelihood of complete healing. Cell-based/adipose-derived therapies, growth factor/blood-derived therapies, and matrix/skin substitute products shortened time to healing. Most adjunctive therapies did not increase adverse events, while placental products were associated with a lower risk of adverse events. Oxygen-based and growth factor/blood-derived therapies showed potential reductions in amputation risk, although the evidence was limited. Conclusions: Adjunctive therapies added to SOC may improve healing outcomes in patients with DFUs, but their benefits vary across clinical endpoints. Oxygen-based therapies, device-based therapies, placental products, growth factor/blood-derived therapies, and matrix/skin substitute products showed the most consistent potential benefits. Nevertheless, heterogeneity, sparse networks, variable certainty of evidence, and limited direct comparisons preclude a definitive treatment hierarchy. High-quality randomized trials with standardized outcome definitions and adequate follow-up are needed to clarify the optimal use of adjunctive therapies in DFU management. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261385489.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.