Evidence-Based Practice: Honey for Diabetic Wound Healing

This report critically appraises the use of honey in accelerating wound healing for diabetic patients, employing the PICO(T) framework. It synthesizes findings from five research articles, including observational studies, randomized controlled trials, and systematic reviews, to evaluate honey's efficacy compared to standard wound care. The analysis highlights key themes such as honey's effectiveness in reducing wound healing time, bacterial clearance, and the potential of Manuka honey-impregnated dressings. The report also incorporates patient and clinician perspectives, discussing the benefits and implications of implementing honey-assisted wound healing in clinical practice, and provides recommendations for its integration into healthcare settings, including staff training and public awareness initiatives. The report is a contribution to Desklib, a platform for AI-based study tools.

EVIDENCE BASED PRACTICE
USING PICO(T)
NAME OF THE STUDENT:
NAME OF THE UNIVERSITY:
AUTHOR NOTE:

INTRODUCTION TO THE NURSING TOPIC
The wound healing in diabetic patients is a challenging aspect, the unstable blood
glucose levels interferes with the immune system functionality and provokes the
inflammation process (Dangwal et al. 2015)
The enhanced blood sugar also prevents the oxygen and the nutrients from
energizing cells, along with that the peripheral neuropathy also slows the
process of healing as well.

INTRODUCTION CONTINUED….
Hence, the context of wound healing is a
challenge for the health care
professionals and many ne initiatives are
being incorporated (Dangwal et al.
2015).
The use of honey to accelerating wound
for diabetic patients will be researched in
this paper using PICO(t) format.

PICOT TABLE & RESEARCH QUESTION
P: Population Diabetic patients with wounds
I: Intervention Use of honey
C: Comparison No use of honey or usual care
O: Outcome Accelerated wound healing
T: Time
The research question for the study is:
Does use of honey accelerate wound healing in the
patients with diabetes as compared to the use of
usual care for wound healing?

SEARCH STRATEGY AND FORMATION OF
THE QUESTION
A variety of databases had been used for identifying the research evidence
The used databases include PubMed, MEDLINE,
Cochrane library, and Google scholar
The search terms or phrases used for the research
included “honey”, “ accelerated wound healing”,
“Diabetes”, “foot ulcers”, and “Usual care”
The search terms or phrases were joined using
Boolean operators such as “AND”, “OR”, and
“NOT” (Eriksen and Frandsen 2018)

SELECTION CRITERIA
Inclusion criteria:
• Articles published in the last 5 years
• Articles published in English
• Articles using human subjects with diabetes
• Articles that researched on adult consented participants
Exclusion criteria:
• Articles that were published before 2014
• Articles published in any other language other than English
• Articles with research done on animal models
• Articles involving participants that are not adults

LEVEL OF EVIDENCE
• The articles were extracted easily using the search strategy outlined and most of
the articles were extracted from either MEDLINE or Cochrane library. The quality
of the evidence was analysed using the standard critical appraisal method
Research
number
Research type Source of database
1. Prospective observational
study
Cochrane library
2. Randomized controlled trial Medline
3. Systematic review and meta
analysis
Cochrane library
4. Randomized controlled trial Google scholar
5. Randomized controlled
clinical trial
Medline

ARTICLE 1: Surahio et al. (2015)
• Prospective observational study
• Database: Cochrane library
• Study design: observational study
• No bias present
• The study concluded that for the foot ulcer wound healing, the use of honey
on the surgical wound helped heal the wound within 7-35 days and the use of
honey for the wound healing reduced the risk for amputation drastically which
is a very important concern for the3 patients with diabetes.

CRITICAL APPRAISAL OF ARTICLE 1
• The findings had been that among the 172 patients admitted to the facility, only three patients
had to undergo big tow amputation which attributes to only 1.17%, 2 patients had to undergo
below knee amputations which attributes to 1.16%, and twenty patients under went split skin
grafting which contributes to 11.6% of the total number of patients. Hence, it indicates that more
than 80% had their wound healed efficiently with the use of honey
• Hence, it can be considered that the results were very helpful
• The research design has been appropriate and the data collected had been interpreted and
discussed adequately. However, the limitations of the study had not been discussed in the article.

ARTICLE 2: Tsang et al. (2017)
• An open-label prospective pilot randomized controlled trial
• Database: Medline
• Study design: randomized controlled trial
• Possible randomized selection bias
• The data findings indicate that ulcer healing proportions had been that
Nanocrystalline silver and Manuka honey both had very high ulcer reduction
rate, with nAg group having 97.45% reduction rate and Manuka Honey group
having 86.21% reduction rate. Hence, this study discusses the immense benefit
honey dressing can have on wound healing for diabetics.

CRITICAL APPRAISAL OF ARTICLE 2
• The research design had been appropriate considering the novel
comparasion of two very new yet very effective technique for wound healing.
• The data findings indicate at 97.45% reduction rate for the nanocrystalline
silver group and Manuka Honey group having 86.21% reduction rate
• The insight provided indicates at honey associated care intervention
technique to be effective and efficient in wound healing for the diabetics.
• The limitations were discussed as the small sample size, minimal censor
points for examining ulcer size, and possibility of random selection bias

ARTICLE 3: Wang et al. (2018)
• Systematic review with Meta-analysis
• Database: Cochrane Library
• Study design: systematic review
• No bias reported
• The data findings indicated the fact that the use of honey in the wound
healing process for the diabetic patients helped reducing the wound
debridement time, wound healing time, and bacterial clearance time