The Use of Traditional and Complementary Medicine Practices In Diabetic Outpatient Settings: Literature Review

Abstract

Diabetes is a chronic disease whose importance is increasing all over the world due to its prevalence and the health problems it causes. In diabetes, many complications including diabetic foot develop due to insufficient insulin production by the pancreas or inability of the body to use the produced insulin effectively. Medical treatment plays an important role in the healing of diabetic foot wounds. The treatment includes selecting the right antibiotic, surgical interventions, wound debridement, supplying revascularization, reconstruction, wound care, metabolic control, weight relief and negative pressure application. Complementary and alternative medicine applications used for diabetic foot wounds were examined in the present literature review.

Keywords

• Diabetes
• diabetic foot wound
• traditional and complementary

Diyabetik Ayakta Geleneksel ve Tamamlayıcı Tıp Uygulamalarının Kullanımı: Literatürün Gözden Geçirilmesi

Abstract

Diyabet görülme sıklığı ve yol açtığı sağlık sorunları nedeniyle tüm dünyada önemi giderek artan kronik bir hastalıktır. Diyabette, pankreasın yetersiz insülin üretmesi veya üretilen insülini vücudun etkin olarak kullanamamasına bağlı olarak diyabetik ayağı da içeren birçok komplikasyon gelişir. Diyabetik ayak yarasının iyileştirilmesinde tıbbi tedavinin yeri önemlidir. Tedavi; doğru antibiyotik seçimi, cerrahi girişimler, yara debridmanı, revaskülarizasyonun sağlanması, rekonstrüksiyon, yara bakımı, metabolik kontrol, ayağın yüklenmesini azaltma ve negatif basınç uygulamalarını içerir. Bu literatür derlemesinde diyabetik ayak yaraları için kullanılan tamamlayıcı ve alternatif tıp uygulamaları irdelendi.

Keywords

• Diyabet
• diyabetik ayak yarası
• geleneksel ve tamamlayıcı tedavi
• Diabetes
• diabetic foot wound
• traditional and complementary

References

1. International Diabetes Federation [Internet]. Idf Diabetes Atlas Eighth Edition, 2017. [Cited 2021 Dec 28]. Available from: https://diabetesatlas. org/upload/resources/previous/files/8/IDF_DA_8e-EN-final.pdf.
2. American Diabetes Association. 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes, Diabetes care, 43(Supplement 1), 2020; S14-31.
3. TEMD [Internet]. Diyabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu. Baskı (14). TEMD Yayınları, Ankara, 2020. [Cited 2021 Dec 29]. Available from: https://temd.org.tr/admin/uploads/tbl_ kilavuz/20200625154506-2020tbl_kilavuz86bf012d90.pdf.
4. Lee GBW, Charn TC, Chew ZH, Ng TP. Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs. Fam pract. 2004; 21(6): 654-60.
5. Ching SM, Zakaria ZA, Paimin F, Jalalian M. Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: a cross-sectional study in Malaysia. BMC Complement Med Ther. 2013; 13(1): 1-7.
6. IWGDF [Internet]. Uluslararası Diyabetik Ayak Çalışma Grubu, 2019 Rehberi. [Cited 2021 Dec 29]. Available from: https://iwgdfguidelines. org/wp-content/uploads/2020/10/Turkish-translation-IWGDF2019- guidelines.pdf.
7. Türkiye Diyabet Programı 2015-2020 [Internet]. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu: Ankara, 2014. [Cited 2021 Dec 27]. Available from: http://beslenme.gov.tr/content/files/ diyabet/ turkiyediyabetprogrami.pdf.
8. Saltoğlu N, Kılıçoğlu Ö, Baktıroğlu S, Oşar-Siva Z, Aktaş Ş, Altındaş M, Yılmaz T. Diyabetik Ayak Yarası ve İnfeksiyonunun Tanısı, Tedavisi ve Önlenmesi: Ulusal Uzlaşı Raporu. J Klimik 2015; 28(Özel Sayı 1): 2-34.

9. Talhaoğlu D. Diyabetik Ayak Nedeniyle Debridman Uygulanan Hastalarda Kullanılan Klorheksidin Solüsyonunun Mikroorganizma Üremesi Üzerine Etkisi [Yüksek lisans Tezi]. [Kayseri]: Erciyes Üniversitesi Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı; 2019.
10. International Diabetes Federation [Internet]. IDF Diabetes Atlas, 10th edn. Brussels, Global Picture. [Belgium]: International Diabetes Federation, 2021. [Cited 2022 Jan 20]. Available from: https:// diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_ Edition_2021.pdf.
11. Wu L, Fang J, Chen L, Zhao Z, Luo Y, Lin C, et al. Low serum adropin is associated with coronary atherosclerosis in type 2 diabetic and non-diabetic patients. Clin Chem Lab Med (CCLM). 2014; 52(5): 751-8.
12. Yayman YE. Diyabetik Ayak Hastalarında Serum Adropin Düzeyleri. [Uzmanık Tezi]. [İstanbul]: T.C. Sağlık Bilimleri Üniversitesi Fatih Sultan Mehmet Eğitim ve Araştırma Hastanesi. İç Hastalıkları Kliniği; 2020.
13. Lim JZM, Ng NSL, Thomas C. Prevention and treatment of diabetic foot ulcers. J R Soc Med. 2017; 110(3): 104–9. DOI:10.1177/0141076816688346
14. Armstrong DG, Boulton AJM, Bus SA. Diabetic Foot Ulcers and Their Recurrence. N Engl J Med. 2017; 376(24): 2367–75. DOI:10.1056/ nejmra1615439
15. Öper M. Diyabet Hastalarında Ayak Bakımı Eğitiminin Etkisi ve Ayak Ülseri Gelişme Riskinin Belirlenmesi. [Uzmanlık Tezi]. [Denizli]: T.C. Pamukkale Üniversitesi Tıp Fakültesi Aile Hekimliği Anabilim Dalı; 2019.
16. World Health Organızatıon [Internet]. General guidelines for methodologies on research and evaluation of traditional medicine. 2000. [Cited 2021 Dec 20]. Available from: https://www.who.int/ whr/2000/en/whr00_en.pdf.
17. Tokaç M. Geleneksel tıbba akademik yaklaşım: GETTAM. SD Sağlık Düşüncesi ve Tıp Kültürü Dergisi. 2013; 28: 82-5.
18. Fuhrmann T, Smith N, Tausk F. Use Of Complementary And Alternative Medicine Among Adults With Skin Disease: Updated Results From A National Survey. J Am Acad Dermato. 2010; 63(6): 1000-5.
19. National Center For Complementary And Alternative Medicine [Internet]. [Cited 2021 Dec 20]. Available from: http://nccam.nih.gov/ health/whatiscam/
20. Kökten G. Bir Üniversite Hastanesinde Polikliniğe Başvuran Cildiye Hastalarında Tamamlayıcı ve Alternatif Tıp Yöntemlerinin Kullanımı. [Yüksek Lisans Tezi]. [Şanlıurfa]: Harran Üniversitesi Sağlık Bilimleri Enstitüsü Hemşirelik Anabilim Dalı; 2017.
21. National Center for Complementary and Integrative Health [Internet]. Acupunture. [Cited 2022 Jan 19]. Available from: https:// www.nccih.nih.gov/health/acupuncture-in-depth.
22. Tekeoğlu İ, Tekeoğlu HN. Akupunktur; Rehabilitasyon Kliniğinde Uygulamaları. Biotech&Strategic Health Res. 2019; 3: 131-7.
23. Yönetiminde Tamamlayıcı Sağlık Uygulamaları. Diyabet, Obezite ve Hipertansiyonda Hemşirelik Forumu Dergisi. 2020; Cilt (12): 29-36.
24. Korhan EA, Uyar M, Eyigör C, Yönt GH, Çelik S, Khorshıd L. The effects of music therapy on pain in patients with neuropathic pain. Pain Manag Nurs. 2014; 15(1): 306-14.
25. National Center for Complementary and Integrative Health [Internet]. Yoga. [Cited 2022 Jan 19]. Available from: Yoga: What You Need To Know | NCCIH (nih.gov).
26. Raveendran AV, Deshpandae A, Joshi SR. Therapeutic Role of Yoga in Type 2 Diabetes. Endocrinol Metab. 2018; 33(3): 307. DOI:10.3803/ enm.2018.33.3.307
27. Maniei M, Aghababaeian H, Karimi H, Firozzadeh K, Amirgholami N, Moghaddam AS, et al. The Use of Aloe Vera after Infrared Therapy in the Treatment of a Diabetic Foot Ulcer: A Case Report. Biotechnol Bioeng. 2019; 10(2): 43-9.
28. Coelho FH, Salvadori G, Rados PV, Magnusson A, Danilevicz CK, Meurer L, et al. Topical Aloe vera (Aloe barbadensis Miller) extract does not accelerate the oral wound healing in rats. Phytother Res. 2015; 29(7): 1102-5.
29. National Center for Complementary and Integrative Health [Internet]. Aloe vera. [Cited 2022 Jan 19]. Available from: Aloe Vera | NCCIH (nih.gov).
30. National Center for Complementary and Integrative Health [Internet]. St. John’s Wort. [Cited 2022 Jan 19]. Available from: St. John’s Wort | NCCIH (nih.gov).
31. Lyles JT, Kim A, Nelson K, Bullard-Roberts AL, Hajdari A, Mustafa B, et al. The chemical and antibacterial evaluation of St. John' s Wort oil macerates used in Kosovar traditional medicine. Front Cell Infect Microbiol. 2017; 8: 1639.
32. Wang C, Guo M, Zhang N, Wang G. Effectiveness of honey dressing in the treatment of diabetic foot ulcers: A systematic review and meta-analysis. Complement Ther Clin Pract. 2018; p32. DOI: 10.1016/j. ctcp.2018.09.004
33. Molan P, Rhodes T. Honey: A Biologic Wound Dressing. Wounds. 2015; 27: 141-51.
34. National Center for Complementary and Integrative Health [Internet]. Tea tree oil. [Cited 2022 Jan 19]. Available from: Tea Tree Oil | NCCIH (nih.gov).
35. Pazyar N, Yaghoobi R, Bagherani N, Kazerouni AA. Review Of Applications of Tea tree oil in dermatology. Int J Dermatol. 2013; 52(7): 784-90.
36. Sürme Y, Çürük GN. Yara Bakımında Fitoterapi: Çay Ağacı Yağı. Erü Sağlık Bilimleri Fakültesi Dergisi. 2020; 7(2): 35-41.
37. Eskin SG. Diyabetik Ayaklı Hastada Beslenmenin Önemi. Diyabetik Ayak Problemleri, Enfeksiyonlar ve Charcot Nöroosteoartropatisi: 1. Baskı. Türkiye Klinikleri. Ankara; 2020. 14-8 p.
38. Takiishi T, Gysemans C, Bouillon R, Mathieu C. Vitamin D and diabetes. Endocrinol Metab Clin North Am. 2010; 39: 419-46.
39. Corcoran MA, Moore ZE. Systemic nutritional interventions for treating foot ulcers in people with diabetes. Cochrane Database Syst Rev. 2014; (11).
40. Seçkiner S. Diyabetik Ayağın İyileşmesinde Beslenme Tedavisinin Rolü Var mı?. Beslenme ve Diyet Dergisi. 2019; 47: 82-91.
41. Armstrong DG, Hanft JR, Driver VR, Smith APS, Lazaro‐Martinez JL, Reyzelman AM. Diabetic Foot Nutrition Study Group. Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial. Diabet Med. 2014; 31(9): 1069- 77.
42. National Center for Complementary and Integrative Health [Internet]. Reflexology. [Cited 2022 Jan 18]. Available from: Reflexology | NCCIH (nih.gov).
43. Song HJ, Son H, Seo HJ, Lee H, Choi SM, Lee S. Effect of self-administered foot reflexology for symptom management in healthy persons: a systematic review and meta-analysis. Complement Ther Med. 2015; 23(1): 79-89.
44. Nehir U, Kuş FS, Fırat T. Diabetik Ayak Ülserli Hastada Maggot Debridman Tedavisine Ağrısız Yaklaşım: Olgu Sunumu. IAAOJ Health Sci. 2018; 4(1): 1-7.
45. Çağlayan HZB, Ataoğlu EE, Kibaroğlu S. Nörolojide Geleneksel ve Tamamlayıcı Tıp Uygulamalarının Etkinliğinin Değerlendirilmesi. Turk J Neurol. 2018; 24(2).
46. Yüce UÖ, Derya ATİK, Karatepe H, Erdoğan Z, Çoşar AA. Reiki ve Diyabet. Acta Medica Alanya. 2017; 1(2): 103-7.
47. National Center for Complementary and Integrative Health [Internet]. Reiki. [Cited 2022 Jan 18]. Available from: Reiki | NCCIH (nih.gov).
48. Khorshid L, Yapucu Ü. Tamamlayıcı Tedavilerde Hemşirenin Rolü. Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 2005; 8(2): 124-30.
49. Avrupa Hipertansiyon Derneği. Avrupa Hipertansiyon Derneği hipertansiyon kılavuzu ile neler değişti. Türk Kardiyol Der Arş. 2014; 42: 1-6.
50. Fenton MV, Morris DL. The İntegration Of Holistic Nursing Practices And Complementary And Alternative Modalities İnto Curricula Of Schools Of Nursing. Altern Ther Health Med. 2003; 9(4): 62.
51. Richardson SF. Complementary Health and Healing in Nursing Education. J Holist Nurs. 2003; 21(1): 20–35. DOI:10.1177/0898010102250273
52. Bondi A, Morgan T, Fowler SB. Effects of Reiki on Pain and Anxiety in Women Hospitalized for Obstetrical- and Gynecological- Related Conditions. J Holist Nurs. 2021 Mar;39(1):58-65. DOI:10.1177/0898010120936437
53. World Health Organization [Internet]. State of the world's nursing 2020: investing in education, jobs and leadership. 2020. [Cited 2021 Dec 20]. Available from: https://apps.who.int/iris/handle/10665/331677.
54. Güven ŞD, Muz G, Efe Ertürk N, Özcan A. Use Of Complementary and Alternative Treatment In The Patients With Hypertension. Balıkesir J Health Sci. 2013;2(3): 160-6.
55. Çevik K. Hemşirelikte Tamamlayıcı ve Alternatif Tedavi: Refleksoloji. EGEHFD. 2013; 29(2): 71-82.
56. Sağlık Bakanlığı [Internet]. Hemşirelikte Temel Yetkinlikler Kılavuzu. Şubat 2021. [Cited 2022 Jan 24]. Available from: https://nursing.ku.edu. tr/wpcontent/uploads/2021/02/Hemsirelikte-Temel-Yetkinlikler- Kilavuzu-Subat-2021.pdf.
57. Garrow AP, Xing M, Vere J, Verrall B, Wang L, Jude EB. Role of acupuncture in the management of diabetic painful neuropathy (DPN): a pilot RCT. Acupunct Med. 2014; 32(3): 242-9.
58. Jeon E, Kwon H, Shin I, Kang S, Shon H. Effect of acupuncture on diabetic peripheral neuropathy: an uncontrolled preliminary study from Korea. Acupunct Med. 2014; 32(4): 350-2.
59. Dimitrova A, Murchison C, Oken B. Effects of acupuncture on neuropathic pain: a systematic review and meta-analysis. Neurol. 2015; 84(3):306-13.
60. Bailey A, Wingard D, Allison M, Summers P, Calac D. Acupuncture treatment of diabetic peripheral neuropathy in an American Indian community. J Acupunct Meridian Stud. 2017; 10(2): 90-5.
61. Shin KM, Lee S, Lee EY, Kim CH, Kang JW, Lee CK, et al. Electroacupuncture for painful diabetic peripheral neuropathy: a multicenter, randomized, assessor-blinded, controlled trial. Diabetes Care. 2018; 41(10): e141-e142.
62. Yu Z, Zhang W, Li B, Bao P, Wang F, Sun J, et al. Efficacy and safety of acupuncture combined with Chinese Herbal Medicine for diabetic nephropathy: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2021; 100(35).
63. Korhan EA, Uyar M, Eyigör C, Yönt GH, Çelik S, Khorshıd L. The effects of music therapy on pain in patients with neuropathic pain. Pain Manag Nurs. 2014; 15(1): 306-14.
64. Ji L, Bai JJ, Sun J, Ming Y, Chen LR. Effect of combining music media therapy with lower extremity exercise on elderly patients with diabetes mellitus. Int J Nurs Sci. 2015; 2(3): 243-7.
65. Chittoria RK, Shijina K, Chavan V. Effect of music therapy as an adjunct in management of diabetic foot ulcer. Diabetes Res Open J. 2019; 5(1): 23-5.
66. Cui J, Yan JH, Yan LM, Pan L, Le JJ, Guo YZ. Effects of yoga in adults with type 2 diabetes mellitus: A meta-analysis. J Diabetes Investig. 2016; 8(2): 201–9. DOI:10.1111/jdi.12548
67. Bock BC, Thind H, Fava JL, Dunsiger S, Guthrie KM, Stroud L, et al. Feasibility of yoga as a complementary therapy for patients with type 2 diabetes: the Healthy Active and in Control (HA1C) study. Complement Ther Med. 2019 February; 42: 125–31.
68. Atiba A, Ueno H, Uzuka Y. The effect of aloe vera oral administration on cutaneous wound healing in type 2 diabetic rats. J Vet Med Sci. 2011; 73(5): 583–9.
69. Sari Y, Purnawan I, Kurniawan DW, Sutrisna E. A Comparative Study of the Effects of Nigella sativa Oil Gel and Aloe Vera Gel on Wound Healing in Diabetic Rats. J Evid Based Integr Med. 2018; 23: 1-6.
70. Najafian Y, Khorasani ZM, Najafi MN, Hamedi SS, Mahjour M, Feyzabadi Z. Efficacy of aloe vera/plantago major gel in diabetic foot ulcer: a randomized double-blind clinical trial. Curr Drug Discov Technol. 2019; 16(2): 223-31.
71. Baghdadi M, Rafiei H, Rashvand F, Oveisi S. Effect of Aloe vera Gel, Calendula officinalis Ointment and Simple Prophylactic Sacral Dressings for Pressure Injury Development. Chronic Wound Care Management and Research, 2020; 7: 19-26.
72. Altıparmak M, Eskitaşçıoğlu T. Comparison of systemic and topical Hypericum perforatum on diabetic surgical wounds. J Invest Surg. 2018; 31(1): 29-37.
73. Gökçe S. Diyabetik ayak için deneysel bir çalışma: diyabetik sıçanlarda hypericum perforatum-klinoptilolit-hidrokolloid örtünün yara iyileşmesine etkisi. [Doktora Tezi]. [İzmir]: Ege Üniversitesi Sağlık Bilimleri Enstitüsü İç Hastalıkları Ana Bilim Dalı; 2015.
74. Moghazy AM, Shams ME, Adly OA, Abbas AH, El-Badawy MA, Elsakka DM, et al. The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract. 2010; 89(3): 276–81.
75. Tsang KK, Kwong EWY, To TSS, Chung JWY, Wong TKS. A pilot randomized, controlled study of nanocrystalline silver, manuka honey, and conventional dressing in healing diabetic foot ulcer. J Evid Based Integr Med. 2017; 15p.
76. Karimi Z, Behnammoghadam M, Rafiei H, Abdi N, Zoladl M, Talebianpoor MS, et al. Impact of olive oil and honey on healing of diabetic foot: a randomized controlled trial. Clin Cosmet Investing Dermatol. 2019; 12: 347.
77. Cooney DR, Cooney NL. Gas gangrene and osteomyelitis of the foot in a diabetic patient treated with tea tree oil. Int Emerg Nurs. 2011; 4(1): 1-4.
78. Sürme Y, Çürük GN. Diyabetik ratlarda çay ağacı yağının yara iyileşmesine etkisi. [Doktora Tezi]. [Kayseri]: Erciyes Üniversitesi, Sağlık Bilimleri Enstitüsü; 2019.
79. Aryani R, Nurulhuda U, Dinarti Arisanty IP, Zaki M. Comparison of honey and natural ointment based on honey-tea tree oil on the healing of diabetic foot ulcer. Enferm Clín. 2020; 30: 14–7. DOI: 10.1016/j. enfcli.2019.12.016
80. Soleimani Z, Hashemdokht F, Bahmani F, Taghizadeh M, Memarzadeh MR, Asemi Z. Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications. 2017; 31(9): 1394–400.
81. Maier HM, Ernst JI, Arjmandi B, Kim JS, Spicer MT. Deficiencies in nutritional intake in patients with diabetic foot ulcers. Journal of Nutritional Therapeutic. 2017; 5(4): 85-92.
82. Suzukı A, Kotake M, Ono Y, Kato T, Oda N, Hayakawa N, et al. (2006). Hypovitaminosis D İn Type 2 Diabetes Mellitus: Association with Microvascular Complications and Type of Treatment. Endocr J. 2006; 53(4): 503–10. DOI:10.1507/endocrj.k06-001
83. Tiwari S, Pratyush DD, Gupta SK, Singh SK. Vitamin D deficiency is associated with inflammatory cytokine concentrations in patients with diabetic foot infection. Br J Nutr. 2014; 112(12): 1938–43. DOI:10.1017/ s0007114514003018
84. Razzaghi R, Pourbagheri H, Momen-Heravi M, Bahmani F, Shadi J, Soleimani Z, et al. The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. J Diabetes Complications. 2017; 31(4): 766–72.
85. Yarahmadi A, Saeed Modaghegh MH, Mostafavi-Pour Z, Azarpira N, Mousavian A, Bonakdaran S, et al. The effect of platelet-rich plasma-fibrin glue dressing in combination with oral vitamin E and C for treatment of non-healing diabetic foot ulcers: a randomized, double-blind, parallel-group, clinical trial. Expert Opin Biol Ther. 2021; 21(5): 687–96.
86. Afzali H, Jafari Kashi A, Momen-Heravi M, Razzaghi R, Amirani E, Bahmani F, et al. The effects of magnesium and vitamin E co-supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: a randomized, double-blind, placebo-controlled trial. Wound Repair and Regen. 2019 May; 27(3):277-84. DOI:10.1111/wrr.12701
87. Song Y, He K, Levitan EB, Manson JE, Liu S. Effects of oral magnesium supplementation on glycaemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006; 23(10): 1050–6. DOI:10.1111/j.1464-5491.2006.01852.x
88. Keskek SO, Kırım S, Karaca A, Saler T. Low serum magnesium levels and diabetic foot ulcers. Pak J Med Sci. 2013; 29(6). DOI:10.12669/ pjms.296.3978
89. Razzaghi R, Pidar F, Momen-Heravi M, Bahmani F, Akbari H, Asemi Z. Magnesium Supplementation and the Effects on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: a Randomized, Double-Blind, Placebo-Controlled Trial. Biol Trace Elem Res. 2017; 181(2): 207–15. DOI:10.1007/s12011-017-1056-5
90. Dalal K, Maran VB, Pandey RM, Tripathi M. Determination of efficacy of reflexology in managing patients with diabetic neuropathy: A randomized controlled clinical trial. J Evid Based Integr Med. 2014; 1-11.
91. Ibrahim MM, Rizk SMA. The efficacy of foot reflexology on the reduction of peripheral diabetic neuropathic pain. IOSR Journal of Nursing and Health Science. 2018; 7(5): 44-55.
92. Silva NCMD, Chaves ÉDCL, Carvalho ECD, Carvalho LC, Iunes DH. Foot reflexology in feet impairment of people with type 2 diabetes mellitus: randomized trial. Rev Lat Am Enfermagem. 2015; 23(4): 603-10.
93. Cicek SC, Demir S, Yilmaz D, Yildiz S. Effect of reflexology on ankle brachial index, diabetic peripheral neuropathy, and glycemic control in older adults with diabetes: A randomized controlled trial. Complement Ther Clin Pract. 2021; 44: 101437.
94. Hajimohammad K, Esmaili R, Rahimi Z. Maggot debridement therapy for diabetic foot ulcer: a case report. J Crit Care Nurs. 2017; 10(3): e9836.
95. Siddique N, Casserly S, Donohoe E, Smith D, Diabetes SC. Healing made possible in complicated diabetic foot ulcers—a case report of maggot therapy. The Diabetic Foot Journal. 2018; 21(1): 29-33.
96. Siavash M, Najjarnezhad A, Mohseni N, Abtahi SM, Karimy A, Sabzevari MH. Efficacy of Maggot Debridement Therapy on Refractory Atypical Diabetic Foot Ulcers: An Open-Label Study. Int J Low Extrem Wounds. 2021 Dec;20(4):315-20.
97. Wainstein J, Feldbrin Z, Boaz M, Harman-Boehm I. Efficacy of Ozone– Oxygen Therapy for the Treatment of Diabetic Foot Ulcers. Diabetes Technol Ther. 2011; 13(12): 1255–60.
98. Izadi M, Kheirjou R, Mohammadpour R, Aliyoldashi MH, Moghadam SJ, Khorvash F, et al. Efficacy of comprehensive ozone therapy in diabetic foot ulcer healing. Diabetes Metab Syndr. Jan-Feb 2019;13(1):822-5.
99. Kadir K, Syam Y, Yusuf S, Zainuddin M. Ozone Therapy on Reduction of Bacterial Colonies and Acceleration of Diabetic Foot Ulcer Healing. Home Healthcare Now. 2020; 38(4): 215–20. DOI:10.1097/ nhh.0000000000000889
100. Amarprakash PD. Case Study Of Leech Applıcatıon In Dıabetıc Foot Ulcer. International Journal of Research in Ayurveda & Pharmacy, 2012; 3(5).
101. Zaidi SA. Unani treatment and leech therapy saved the diabetic foot of a patient from amputation. Int Wound J. 2014; 13(2): 263–4. DOI:10.1111/iwj.12285
102. Laila S, Fatemeh E, Lida B. Treatment of diabetic foot ulcer with medicinal leech therapy and honey curcumin dressing: a case report. TMR. 2019; 4(6): 338.
103. Ávila-Sansores GM, del Socorro Gómez-Aguilar PI, Tuz-Poot FR. Efecto del Reiki como cuidado de enfermería en el control metabólico de diabéticos tipo 2. Rev Enferm Inst Mex Seguro Soc. 2010; 18(2): 75.