Complementary Therapy Interventions in Diabetic Foot Ulcer: A Systematic Review of Randomized Controlled Trials
Abstract
Diabetic foot ulcers (DFUs) are complications of diabetes mellitus that may impair wound healing and reduce quality of life. Complementary therapies have been investigated as adjuncts to conventional wound care, but evidence of their effectiveness remains heterogeneous. This systematic review aimed to evaluate the effects of complementary therapies with conventional care on wound-healing outcomes in patients with active diabetic foot ulcers. The review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement. Searches were conducted in Scopus, PubMed, ScienceDirect, and SAGE Journals for studies published from 2021 to 2026; the final search was conducted on 15 August 2026. Eligible studies were randomized controlled trials involving patients with active diabetic foot ulcers and complementary therapies as adjuncts to conventional care. Study quality and risk of bias were assessed using the Joanna Briggs Institute critical appraisal checklist for randomized controlled trials. The review protocol was not registered. Following reassessment, five randomized controlled trials met inclusion criteria. The studies reported improvements in wound-healing outcomes, including reduced ulcer size and improved wound-healing indicators. However, heterogeneity in interventions, treatment duration, participant characteristics, and outcome measures precluded quantitative synthesis and pooled effect estimation. The certainty of evidence was limited by small sample sizes, short follow-up periods, and variability in intervention protocols. Complementary therapies may provide additional benefits for wound healing when used alongside conventional care for active diabetic foot ulcers. However, evidence remains limited and heterogeneous. Larger RCTs using standardized interventions and standardized wound-healing outcomes.
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