title: Diabetes medications: Impact on inflammation and wound healing.
abstract: Chronic wounds are a common complication in patients with diabetes that often lead to amputation. These non-healing wounds are described as being stuck in a persistent inflammatory state characterized by accumulation of pro-inflammatory macrophages, cytokines and proteases. Some medications approved for management of type 2 diabetes have demonstrated anti-inflammatory properties independent of their marketed insulinotropic effects and thus have underappreciated potential to promote wound healing. In this review, the potential for insulin, metformin, specific sulfonylureas, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors to promote healing is evaluated by reviewing human and animal studies on inflammation and wound healing. The available evidence indicates that diabetic medications have potential to prevent wounds from becoming arrested in the inflammatory stage of healing and to promote wound healing by downregulating pro-inflammatory cytokines, upregulating growth factors, lowering matrix metalloproteinases, stimulating angiogenesis, and increasing epithelization. However, no clinical recommendations currently exist on the potential for specific diabetic medications to impact healing of chronic wounds. Thus, we encourage further research that may guide physicians on providing personalized diabetes treatments that achieve glycemic goals while promoting healing in patients with chronic wounds.
authors.affiliation: Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Salazar
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA; Center for Tissue Repair and Regeneration, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Ennis
authors.affiliation: Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Center for Tissue Repair and Regeneration, University of Illinois at Chicago, Chicago, IL, USA. Electronic address: tjkoh@uic.edu.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Koh
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000378:metabolism; D003925:Diabetic Angiopathies / Q000150:complications / Q000276:immunology / Q000378:metabolism / Q000517:prevention & control*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000378:metabolism / Q000627:therapeutic use; D007333:Insulin Resistance; D000078790:Insulin Secretion; D008954:Models, Biological; D014657:Vasculitis / Q000150:complications / Q000276:immunology / Q000378:metabolism / Q000517:prevention & control*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054873:Dipeptidyl-Peptidase IV Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: DPP-4 inhibitor; Insulin; Metformin; Sulfonylurea; Thiazolidinedione; Wound healing