Dr Kevin Chan

Diabetes mellitus is one of the most common chronic illnesses in the developed world today and has a worldwide prevalence estimated at 2.8 percent. A study by the World Health Organization in 2000 showed that at least 171 million people globally suffer from diabetes. Its incidence is increasing rapidly and it is estimated to reach 5.6 percent by 2030.

Diabetes mellitus, often referred to simply as diabetes, is a long-term illness characterized by a high sugar level in the blood. Someone with diabetes is either not producing enough insulin (type 1) or is unable to effectively utilize the insulin produced (type 2). The incidence of diabetes (especially type 2) is more common in developed countries, with the greatest increase in prevalence expected to occur in Asia and Africa. Diabetes is one of the top 10 chronic diseases worldwide and if not managed properly, it will deteriorate steadily causing complications such as blindness, nerve damage, kidney failure, heart disease and limb amputation.

Studies show that diabetic foot ulcers affect 15 percent of all people with diabetes and the most debilitating complication of diabetes would be amputation. Foot ulcers precede approximately 85 percent of all major amputations of the lower limb. And within a year of amputation, approximately 9 to 20 percent of all people with diabetes would have to undergo a second amputation. The effects of amputation, subsequent costly physical and mental rehabilitation and fast spiraling healthcare costs would further contribute to patients' distress.

For a long time, the mainstays of treatment for patients with lower limb ulcers have been surgical debridement and wound dressing. This leads to the ever-present danger of nonhealing wounds as most diabetic patients have very poor blood supply because of greater incidence of peripheral vascular disease extremities, even after debridement. Poor blood supply means no matter how many antibiotics are prescribed, the tissue concentration of these expensive antibiotic cocktails rarely reaches therapeutic levels. Mixed with decreased sensation to the feet, dry and fissured skin, and a generally depressed immune system, and you have a festering ulcer waiting to happen.

In preventing an escalating number of people with diabetes and the fact that amputations and chronic wound care push up the burden on our healthcare costs, it becomes clear that hyperbaric oxygen therapy (HBOT) is the one of the ways to combat the disease.

HBOT is hardly a new invention. It has been in use since 1943, when it was adopted by the United States Navy for the treatment of decompression sickness, or the "bends "as the illness is more commonly known. Over the past 50 years, hyperbaric medicine has come into its own, with increasingly sophisticated trials and more. Conditions that seem to benefit from HBOT have increased tenfold. The Undersea and Hyperbaric Medical Society, the governing body of hyperbaric medicine, has approved HBOT for the treatment of 13 selected conditions: air or gas embolism; decompression sickness; carbon monoxide poisoning; clostridial myositis and myonecrosis (gas gangrene); crush injury, compartment syndrome and other acute traumatic ischemia; enhancement of healing in selected wound problems; exceptional blood loss; intracranial abscess; necrotizing soft tissues infections; osteomyelistis (refractory); delayed radiation injury; skin grafts and flaps; and thermal burns.

So what exactly is HBOT?

Dr Kevin U. Chan, director/medical director of the Hyberbaric & Occupational Medicine Pte Ltd and Flinders Practice Pte Ltd explains: "Hyperbaric Oxygen Therapy is simply the administration of pure oxygen to the patient in a pressurized environment (greater than 1 atmosphere). Due to the gas dynamics of a pressurized environment, the amount of oxygen dissolving into the plasma has increased by almost 400 percent. In short, there is a quantum leap in the amount of oxygen reaching the tissues.

"The sum total of the increase in tissue oxygenation is to combat the chronic hypoxia (low oxygen levels) that is all too common in diabetic foot infections. Furthermore, bacteria, which thrive in an oxygen poor environment, are destroyed by the tidal wave of oxygen that seems to occur with HBOT. Increased oxygen levels in the local tissue also seem to promote the effects of administered antibiotics," he elaborates.

In short, HBOT seems to have a plethora of beneficial effects on local tissues and makes a definite impact on decreasing the risk of amputation and increasing the rates of wound healing. This has been proven by a number of international trials in the past eight years.

Currently, HBOT is in its infancy in Singapore. The Hyperbaric & Occupational Medicine Pte Ltd, which began operation in late 2007, houses the largest walk-in-tri-compartment Multiplace Chamber in Southeast Asia.

Dr Chan believes that HBOT plays an important role in both primary treatment and supportive treatment for the management of various conditions. As a primary treatment, HBOT is used to treat diving accidents such as decompression sickness and arterial gas embolism, and it also works best as a supportive treatment when used in combination with surgical debridement and wound care assisted by a dedicated health care team.

He adds, "Its advantages are that the effects of existing treatments provide beneficial effects to wound healing. It is noninvasive, and causes minimal discomfort to the patient. This makes it very suitable for a wide spectrum of patients including the young and the old."

Put simply, HBOT seems to provide a noninvasive, effective way to treat chronic foot and other nonhealing wounds. While the jury is out on the long-term verdict and larger scale HBOT trials are underway, there is clear evidence that HBOT does improve the healing of wounds and provides a welcome ray of hope to people with diabetes worldwide.

The Hyperbaric & Occupational Medicine Pte Ltd and Flinders Practice Pte Ltd are located in Singapore's CBD, which is easily accessible by public transport.

FlyFreeForHealth2009 Articles in this column, which appear every two weeks, are provided by a panel of health professionals from www.flyfreeforhealth.com, a leading multimedia medical tourism platform dedicated to providing travel and lifestyle incentives for those adopting a healthy lifestyle.

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