Ozone therapy as a treatment for diabetic foot ulcers: a systematic review and meta-analysis

Objective: Studies have suggested that ozone therapy stimulates antioxidant enzyme expression and activity, regulates growth factor production, increases local blood flow and provides antibacterial protection. We sought to analyse the evidence related to the use of ozone therapy in the treatment of diabetic foot ulcers (DFUs). Method: A systematic review and meta-analysis was conducted using published clinical trials indexed in the PubMed, Embase and Web of Science databases up to December 2020. Outcomes analysed included: number of ulcers cured; ulcer area reduction; length of hospital stay; changes in blood glucose levels; antioxidant activity; and number of amputations. Results: Initially, 61 studies were identified; however, only six met all of the eligibility criteria for inclusion in the final sample. It was found that patients receiving ozone therapy displayed higher rates of healing (i.e., healed ulcers), shorter hospital stays, increased catalase activity and reduced blood glucose levels. There was an observed increase in the number of ulcers healed; however, there was a considerable risk of bias in the studies evaluated. Conclusion: Although many studies have suggested ozone therapy as a promising candidate in the treatment of DFUs, further research is required, with a better scientific outline, to validate the results.