title: Local use of insulin in wounds of diabetic patients: higher temperature, fibrosis, and angiogenesis.
abstract: BACKGROUND
  Clinical trials have shown the effectiveness of systemic and local insulin therapy in improving wound healing. Diabetic wounds remain a challenge for healthcare providers. Impaired angiogenesis and reduced granulation tissue formation contribute to inadequate wound healing. The aim of this study was to investigate the effect of local insulin administration in acute and chronic diabetic wounds.
  
  
  METHODS
  Eight diabetic patients presenting with full-thickness wounds, of different causes, were included in this study. Five wounds were due to necrobiosis, one to trauma, and two to postneoplasm resection. All wounds were treated with regular bedside treatment. In addition, half of the wound surface was treated with insulin and the other half did not receive insulin. Thermographic and biopsy specimens of the two sides were obtained on days 0 and 14. The presence of fibrosis, change in temperature, and amount of blood were evaluated.
  
  
  RESULTS
  Significant differences in the number of vessels were observed on the insulin-treated side (96 ± 47) when compared with the no-insulin side (32.88 ± 45) (p < 0.026). The percentage of fibrosis (insulin: 44.42 ± 30.42 percent versus no insulin: 12.38 ± 36.17 percent; p < 0.047) and the mean temperature (insulin: 1.27 ± 1.12°C versus no-insulin: 0.13 ± 1.22°C; p < 0.001) were also significantly different between sides. No adverse events related to the study occurred.
  
  
  CONCLUSIONS
  The use of local insulin improves the formation of new blood vessels, increases fibrosis, and correlates with increased temperature.
  
  
  METHODS
  Therapeutic, II.
authors.affiliation: San Luis Potosí, Mexico; and Galveston, Texas From the Departments of Surgery and Dermatology, Hospital Central "Dr. Ignacio Morones Prieto"; Department of Surgery, University of Texas Medical Branch; Shriners Hospitals for Children; Department of Pathology, Hospital General de Soledad; Coordinación para la Innovación y Aplicación de la Ciencia y la Tecnología, and Department of Epidemiology and Public Health, Facultad de Medicina, Universidad Autónoma de San Luis Potosí.
authors.forename: Mario Aurelio
authors.initials: MA
authors.lastname: Martínez-Jiménez
authors.forename: Jorge
authors.initials: J
authors.lastname: Aguilar-García
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Valdés-Rodríguez
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Metlich-Medlich
authors.forename: Laura Judith Porro
authors.initials: LJP
authors.lastname: Dietsch
authors.forename: Francisco Israel
authors.initials: FI
authors.lastname: Gaitán-Gaona
authors.forename: Eleazar Samuel
authors.initials: ES
authors.lastname: Kolosovas-Machuca
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: González
authors.forename: Jesús Martín
authors.initials: JM
authors.lastname: Sánchez-Aguilar
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003925:Diabetic Angiopathies / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000473:pathology; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D015552:Injections, Intralesional; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D018919:Neovascularization, Physiologic / Q000187:drug effects; D011446:Prospective Studies; D012881:Skin Temperature; D012883:Skin Ulcer / Q000188:drug therapy* / Q000209:etiology; D013817:Thermography; D014945:Wound Healing / Q000187:drug effects; D014947:Wounds and Injuries / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin