2025-05-30 アメリカ国立衛生研究所(NIH)
<関連情報>
- https://www.nih.gov/news-events/news-releases/scientists-identify-diagnostic-aid-determine-risk-diabetic-foot-ulcer-recurrence
- https://diabetesjournals.org/care/article/doi/10.2337/dc25-0300/160530/High-Transepidermal-Water-Loss-at-the-Site-of
創傷閉鎖部位の高い経表皮水分喪失は糖尿病性足潰瘍の再発増加と関連する: NIDDK糖尿病足コンソーシアムTEWL研究 High Transepidermal Water Loss at the Site of Wound Closure Is Associated With Increased Recurrence of Diabetic Foot Ulcers: The NIDDK Diabetic Foot Consortium TEWL Study
Chandan K. SenCorresponding Author;Gayle M. Gordillo;Sashwati Roy;Jordan Jahnke;Mithun Sinha;Lava Timsina;Shomita S. Mathew-Steiner;Michael S. Conte;Crystal Holmes;Teresa L.Z. Jones;Rodica Pop-Busui;Giselle Kolenic;Cathie Spino;Geoffrey C. Gurtner;NIDDK Diabetic Foot Consortium TEWL Study
Diabetes Care Published:May 30 2025
DOI:https://doi.org/10.2337/dc25-0300
Graphical Abstract
OBJECTIVE
The National Institute of Diabetes and Digestive and Kidney Diseases Diabetic Foot Consortium tested the hypothesis that compromised restoration of the skin barrier function of closed diabetic foot ulcers (DFUs), as measured by high transepidermal water loss (TEWL), is associated with an increased risk of DFU recurrence.
RESEARCH DESIGN AND METHODS
This was a multicenter noninterventional study measuring TEWL in 418 adult participants with diabetes and a recently healed DFU. TEWL was measured at the center of the closed wound and at an anatomically similar reference area on the contralateral foot within 2 weeks of wound closure (visit 1); measurements were repeated at a wound closure confirmation visit 2 weeks later (visit 2). Participants were observed for up to 16 weeks to assess for wound recurrence. Participant self-reported and clinician assessments of DFU wound recurrence were recorded.
RESULTS
DFU recurrence by week 16 occurred in 21.5% of participants. Mean TEWL at the center of the healed DFU at visit 1 was higher for those with recurrence compared with those without (P = 0.006). Among participants with high TEWL (>30.05 g · m-2 · h-1), 35% reported wound recurrence by 16 weeks versus 17% of those with low TEWL. The odds ratio for recurrence for participants with high TEWL was 2.66 (P < 0.001). Self-reported wound recurrence was highly concordant with clinician assessment of wound recurrence.
CONCLUSIONS
Compromised wound healing mechanisms culminating in wound closure associated with defective skin barrier function is associated with increased risk of DFU recurrence. Measurement of TEWL has value as a predictor of functional wound healing and could affect clinical practice, leading to better outcomes.
