ReviewToxics2026
The Impact of Heavy Metals Exposure on Diabetic Foot Complications: A Systematic Review of Development, Progression, and Wound Healing.
Review in Toxics, 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
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Diabetic foot ulcers (DFUs) constitute a significant global health burden; however, the influence of environmental heavy metals toxicity on their pathogenesis remains insufficiently investigated, particularly within low- and middle-income countries. This systematic review, conducted in strict accordance with PRISMA 2020 guidelines, assesses the impact of heavy metals exposure on the development, progression, and wound-healing kinetics of DFUs. A comprehensive search across PubMed/MEDLINE, Embase, Scopus, and Web of Science identified 32 eligible original studies. Quality appraisal was performed using the Newcastle-Ottawa Scale and SYRCLE's Risk of Bias tool. Synthesized epidemiological and toxicological data consistently indicate that chronic exposure to non-essential heavy metals, specifically cadmium and lead, significantly augments DFU prevalence and clinical severity, demonstrating a 64% increase in DFU prevalence for each 1 µg/L increase in blood cadmium concentration. Mechanistically, these xenobiotics induce a 'chronic inflammatory lock' characterized by severe oxidative stress, sustained NLRP3 inflammasome activation, and the suppression of protective Metallothionein 2A (MT2A) pathways, thereby impeding microvascular angiogenesis. Conversely, deficiencies in essential trace elements, such as zinc and selenium, actively impair extracellular matrix maintenance. Advanced therapeutic interventions, including metal-ion-releasing hydrogels, cell-free exosome therapies, and systemic EDTA chelation, demonstrate significant potential to counteract heavy-metal-induced cellular suppression and facilitate tissue repair. This review underscores the imperative of integrating environmental toxicant screening and targeted detoxification strategies into standard multidisciplinary diabetic foot management.
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.