People with chronic diabetic foot ulcers could soon have a new way to treat their wounds for faster healing and fewer hospital stays, according to researchers from Michigan State University and South Shore Hospital, who suggest that the combination of two common diabetes drugs – injectable insulin and orally-administered metformin – actually increases the amount of metformin at the wound site.
As metformin can accelerate wound healing, this could be welcome news for the 18.6m people worldwide who develop a diabetic foot ulcer, or DFU, in their lifetimes, reports News-Medical.net
“When we collected human exudates from diabetic foot ulcers and analysed their composition, one of the things that we noticed in the composition of the exudates, which has not been observed anywhere else, was the presence of metformin,” said Morteza Mahmoudi, Associate Professor, Department of Radiology and Precision Health Programme, MSU College of Human Medicine
“Until now, pharmacological studies had not found an interaction between insulin and metformin,” he added. “Our study shows that there could be at least an indirect role of consuming both insulin and metformin in a way that metformin can end up in a wound area where it enhances the body’s capacity to heal.”
Mahmoudi and co-researcher Lisa Gould, a plastic surgeon and wound care clinician at South Shore Hospital and a clinical associate professor of medicine at Brown University, recently published a paper in ACS Pharmacology and Translational Science that details the previously unheard of connection between insulin and metformin in DFU exudates.
“Our findings can affect how clinicians approach healing chronic wounds,” Mahmoudi said. “For example, if a patient gets a wound, the synergistic role of insulin and metformin could be helpful.
“Additionally, wound dressing developers need to consider the interactions of anything they put on top of wounds with exudates. Exudates can interact with the wound dressings and affect their safety and therapeutic efficacy. Additional research will be evaluating this.”
Study details
Analysis of biogenic amines and small molecule metabolites in human diabetic
wound ulcer exudate.
Published in ACS Pharmacology & Translational Science on 4 September 2024
Abstract
Diabetic foot ulcers (DFUs) pose a significant challenge in wound care due to their chronic nature and impaired healing processes. This study examines the biogenic amines and small molecule metabolites present in DFU wound exudates to identify their potential roles in wound healing. Under an IRB-approved protocol, wound fluid samples were collected from 25 diabetic patients and analyzed using ultrahigh-pressure liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry. The analysis identified 721 metabolites, with 402 confirmed through stringent criteria. Key metabolites significantly contributing to the wound exudates include betaine, lactic acid, carnitine, choline, creatine, and metformin (a widely used first-line treatment for type 2 diabetes). These molecules are known to influence wound healing processes, such as collagen synthesis, angiogenesis, inflammation modulation, and energy metabolism. Notably, the presence of drugs such as metformin and beclomethasone in the exudates suggests significant pharmacodynamic interactions that could influence wound healing. Specifically, we discovered that the combined use of insulin and metformin administered systemically significantly increased the concentration of metformin in the wound exudates (from 0.3% ± 0.0 to 3.1% ± 3.4; p = 0.00 49). This study highlights the complexity of DFU exudate composition and underscores the potential for targeted metabolic profiling to develop personalized wound care strategies.
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