Effect of electrical stimulation on patients with diabetes-related ulcers: a systematic review and meta-analysis

Abstract Background This study aimed to systematically review the literature to better understand the efficacy of electrical stimulation (ES) for the treatment of patients with diabetes-related ulcers. Methods We searched the Embase, Medline, and Cochrane Library databases through July 31, 2021. Original trials for ES treatment of patients with diabetes-related ulcers with placebo or standard care as the control group were included. The primary outcomes were ulcer area reduction and healing rates. Meta-analyses were performed to compare the standardized mean difference (SMD) in the percentage of ulcer reduction and risk ratio of non-healing rates between ES treatment and placebo or standard care. We used the Revised Cochrane risk-of-bias tool for randomized trials to assess the risk of bias for each included article. Funnel plots and Egger’s test were used to assess publication bias. Results Compared to placebo or standard care, ES had a significant benefit for the treatment of patients with diabetes-related ulcers in terms of percentage of ulcer reduction (SMD = 2.56, 95% CI: 1.43–3.69; P < 0.001 (Q-test), I 2 = 93.9%) and ulcer healing rates [risk ratio of non-healing rates for the ES group was 0.72 (95% CI: 0.54–0.96; P = 0.38 (Q-test), I 2 = 2.3%)]. Two, four, and three of the included studies were categorized into low risk of bias, some concerns, and high risk of bias, respectively. No publication bias was found. Conclusions Based on the findings of this meta-analysis, ES could be used to treat patients with diabetes-related ulcers. ES treatment was effective for ulcer area reduction and ulcer healing, although it had a high heterogeneity level among the included studies. Pulsed current ES has the potential benefit of increasing ulcer healing compared to direct current ES. Further large-scale clinical trials are needed to define the adverse events and potentiators of ES in the treatment of patients with diabetes-related ulcers.