Whether it is a wound or ulcer, healing is a complex and multi-factorial process. Hyperglycemia and other metabolic derangements, together delay or prevent wound healing for people with diabetes.
The different phases of wound healing are: Homeostasis, Inflammation, Proliferation and Remodelling. There is some evidence that specific nutrients are required in each of these phases, with nutrient requirements varying depending on the phase of wound healing and the duration of each of these phases.
To examine the literature relating to nutrient requirements for each phase of the wound/ulcer healing process and relate it to people with diabetes.
The databases, PubMed, EBSCO, Cochrane and CINAHL were searched for articles using the terms "Nutrition", "nutrition management", "nutrition support", "wound", "wound care", "wound management", "phases of wound healing", "stages of wound healing". Only studies in English, published between January 1995 and April 2016, were included; animal studies were excluded. An overview of the literature, focusing on specific nutrition requirements for the different phases of wound healing was compiled from the literature published during this period.
Current wound/ulcer related nutrition interventions focus on optimal nutrition by prevention of malnutrition, ensuring adequate protein intake, addition of specific macro and micro nutrients and optimising blood glucose control. Some articles suggest, certain phytonutrients have a role in wound healing and can improve outcomes in people with diabetes. There was also some evidence suggesting that nutritional requirements differ with the phase of wound/ulcer healing and thus maybe treatment should be adapted accordingly.
Current nutritional management of diabetic wounds/ulcers may no longer be optimal. A paradigm shift may be required to adapt nutritional therapy to the requirements of the wound/ulcer at each healing phase: treatment may have moved beyond a one size fits all scenario.