Comparative Efficacy and Safety of Electrical Stimulation Therapies for Diabetic Ulcers: A Network Meta-analysis of Randomized Controlled Trials.

INTRODUCTION

Diabetic ulcers (DUs) are a common complication of diabetes, significantly impairing quality of life and placing a burden on healthcare systems. Electrical stimulation (ES) therapy is a non-invasive technique that promotes wound healing using various current types, including direct current (DC), pulsed current (PC), and alternating current (AC). However, the comparative efficacy and safety of these ES modalities for DUs remain unclear.

METHODS

This study presents a network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the efficacy and safety of various ES therapies for DU treatment. A comprehensive literature search was conducted to identify studies evaluating ulcer healing rates, the number of healed ulcers, and adverse events. The treatments analyzed included symmetry biphasic square-wave pulse, asymmetric biphasic square-wave pulse, very low levels of stimulation current, twin-peak monophasic pulse, cathodal direct current (CDC), high-voltage pulsed current (HVPC), and low-intensity biphasic pulse current. The SUCRA (surface under the cumulative ranking curve) and mean rank values were used to assess the relative effectiveness of each modality.

RESULTS

The analysis included data from 11 RCTs. Treatment effects were compared using SUCRA and mean ranking values. HVPC, CDC, and asymmetric biphasic square-wave pulse were ranked highest for ulcer healing rates and the number of healed ulcers, with asymmetric biphasic square-wave pulse demonstrating the most consistent efficacy across these outcomes.

CONCLUSION

This network meta-analysis suggests that HVPC, CDC, and asymmetric biphasic square-wave pulse are the most effective ES therapies for promoting DU healing.