Researchers have identified a potential biomarker that could predict the recurrence of diabetic foot ulcers after they have healed. In a study published in Diabetes Care, the team found that transepidermal water loss (TEWL) measured two weeks after a foot ulcer had closed was significantly higher in adults who experienced a recurrence of the wound at 16 weeks compared to those who did not.
Chandan K. Sen, PhD, a researcher at the University of Pittsburgh, explained that measuring TEWL could help redefine wound closure criteria and provide a more accurate prediction of ulcer recurrence. Currently, wound closure is defined by the absence of discharge for two consecutive weeks, but Sen proposed that skin barrier function, indicated by TEWL, should also be considered in this definition.
The study, conducted between June 2020 and December 2022, involved adults from the National Institute of Diabetes and Digestive and Kidney Diseases Diabetic Foot Consortium. These participants had recently healed diabetic foot ulcers. TEWL was measured two weeks after wound closure, and participants were then monitored weekly for 16 weeks to track any recurrence of the wound.
Data from 368 participants revealed that 21.5% experienced wound recurrence. The study found that TEWL at baseline was significantly higher in those who had a recurrence (27.71 g/m² per hour) compared to those who did not (22.72 g/m² per hour). A cutoff value of 30.05 g/m² per hour was used to divide participants into high and low TEWL groups. The recurrence rate was 35% for those with high TEWL, compared to 17% for those with low TEWL. The odds of recurrence were 2.66 times higher for individuals with high TEWL, and this risk remained significant in further statistical models.
Additionally, participants with high TEWL had wound recurrences on average 13.4 days earlier than those with lower TEWL (91.4 days versus 104.8 days). The study also found a 2% increase in the odds of recurrence for every unit increase in TEWL.
Self-reported wound recurrence was highly correlated with clinician assessments. Of the 75 participants who reported a recurrence, 93% had it confirmed by a clinician. Conversely, 96% of those who did not report a recurrence had no confirmation of one.
Sen emphasized the clinical utility of TEWL in managing diabetic foot ulcers, suggesting it could improve early intervention. However, he noted that further research is necessary to confirm TEWL as a reliable biomarker and to establish new clinical standards for wound closure that incorporate skin barrier function.
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