Mariana Bezerra Miranda

This umbrella review synthesized evidence on associations between nutritional status and DFU outcomes and on the effects of nutritional interventions on wound healing and related clinical parameters. We conducted an umbrella review of systematic reviews evaluating (1) the associations between nutritional status and DFU outcomes and (2) the effects of nutritional interventions on DFU healing and related outcomes. PubMed, Scopus, Web of Science, and Embase were searched from inception to October 2026. Ten systematic reviews were included. Poor nutritional status and micronutrient deficiencies were consistently associated with impaired healing, greater ulcer severity, and increased risks of amputation and mortality. Exploratory cross-intervention pooling showed favorable effects on ulcer healing (eOR = 1.46; 95% CI: 1.17-1.81), C-reactive protein (eG = −0.76; 95% CI: −1.15 to −0.37), glycated hemoglobin (eG = −1.59; 95% CI: −2.93 to −0.24), and ulcer area (eG = −0.99; 95% CI: −1.94 to −0.05), but not erythrocyte sedimentation rate. Poor nutritional status and micronutrient deficiencies are consistently associated with adverse DFU outcomes. Although nutritional interventions showed favorable pooled effects on selected outcomes, limited evidence certainty and heterogeneity preclude identifying a specific supplement, dose, or formulation that reliably improves DFU healing.

Diabetic wounds are characterized by persistent inflammation, prolonged healing time, and an increased risk of amputation. The use of natural compounds combined with established therapies can increase the effectiveness of treatments for these lesions. In this context, natural products have stood out as therapeutic adjuvants due to their anti-inflammatory, antioxidant, antimicrobial, and regenerative properties. Terminalia fagifolia Mart., a medicinal species native to the Brazilian Cerrado, has a rich phytochemical composition; however, its clinical potential in wound healing has not yet been investigated. This is the first clinical trial to investigate the potential synergistic effects of Terminalia fagifolia Mart. extract, alone or in combination with photobiomodulation, on the healing of non-infected diabetic foot ulcers. A total of 102 participants with type 2 diabetes and lower limb ulcers will be randomly allocated into three groups: G1 (Terminalia fagifolia Mart. + wound occlusion), G2 (GaAs 904, 10 J/cm² + Terminalia fagifolia Mart. + wound occlusion), and a control group using Endophoton KLD (GaAs 904) at a dose of 10 J/cm² + conventional dressing. One hundred and two volunteers will be recruited and treated on two non-consecutive days per week for 10 weeks, totaling 20 sessions. The primary outcome variable will be the rate of ulcer size reduction over the 10-week period. This study is expected to provide preliminary evidence regarding the safety, feasibility, and potential efficacy of the synergistic use of T. fagifolia Mart. extract combined with photobiomodulation in the treatment of diabetic foot ulcers. Clinical trial registration This study was registered at Brazilian Clinical Trials Registry (ReBEC) on December 27, 2023 (RBR-25ng5pt || https://ensaiosclinicos.gov.br/rg/RBR-25ng5pt ).

Chronic lower-limb wounds represent a major clinical and socioeconomic burden due to delayed healing and high recurrence rates. Light-emitting diode (LED) photobiomodulation has been proposed as a noninvasive and low-cost adjunctive therapy; however, clinical evidence remains inconsistent. This systematic review aimed to synthesize evidence from randomized clinical trials investigating the efficacy of LED photobiomodulation for chronic lower-limb wound healing and to identify irradiation parameters associated with improved outcomes. A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Embase up to May 2026. Six randomized clinical trials met the inclusion criteria. Wavelengths ranged from 620 to 950 nm, and energy densities varied between 2.4 and 126 J/cm². The findings suggest that LED photobiomodulation may promote wound area reduction, improve wound bed quality, and increase microcirculation, particularly in diabetic foot ulcers. However, one study using a high energy density (126 J/cm²) did not demonstrate beneficial effects, suggesting a possible dose-dependent response. The overall certainty of the evidence, assessed using the GRADE approach, was classified as very low due to inconsistency and indirectness among the included studies. Although LED photobiomodulation appears to be safe and demonstrates therapeutic potential, substantial heterogeneity in irradiation parameters, small sample sizes, and methodological limitations preclude definitive conclusions regarding its clinical efficacy. Well-designed randomized controlled trials with standardized protocols and dose–response investigations are needed to establish optimal therapeutic parameters and confirm clinical efficacy.

This systematic review presents qualitative comparisons between LED and LASER photobiomodulation in cutaneous wound healing, limited by the substantial heterogeneity of experimental parameters. Chronic wounds represent a major clinical challenge due to prolonged healing times, high risk of infection, and increased healthcare costs. Photobiomodulation (PBM) using low‐level laser therapy (LLLT) and light‐emitting diode (LED) devices has emerged as a promising therapeutic strategy for tissue repair. However, the equivalence of the biological and therapeutic effects of these light sources remains debated. The aim of this review is to clarify these effects by systematically comparing LLLT and LED sources on cutaneous wound healing. Comprehensive searches were conducted in PubMed, Web of Science, Scopus, and Embase using terms related to wound healing, LLLT, and LED. We included exclusively controlled in vivo or in vitro studies that directly compared the effects of LLLT and LED on cutaneous wound healing or related biological processes. Of 2020 identified studies, 16 met the inclusion criteria. Both LED and laser promote relevant cellular effects, contributing to the tissue repair process. Findings indicate that both devices promote similar photobiomodulatory effects by activating key cellular and molecular mechanisms essential for wound repair. This review presents predominantly qualitative comparisons between LED and LASER in wound healing, limited by the substantial heterogeneity of experimental parameters. Nevertheless, the available evidence indicates that, although LLLT shows quantitatively superior effects on parameters such as blood vessel density and caliber and type I collagen deposition, both modalities demonstrate similar preclinical effects. (International Prospective Register of Systematic Reviews registration number: CRD420251086145).

Diabetic foot ulcers (DFU) negatively impact the quality of life and increase the risk of morbidity and mortality. Although photobiomodulation (PBM) produces better results in DFU healing than standard treatment or in the absence of irradiation, the ideal parameters are not standardized. This study aimed to evaluate the effect of PBM at a wavelength of 660 nm on reducing the DFU area. We compared the PBM treatment of non-infected DFUs. The sessions were held twice a week on non-consecutive days for 10 weeks (20 interventions) using HeNe 660 nm, 20 mW, in continuous mode, with three energy densities (4 J/cm², 8 J/cm², or 12 J/cm²). All patients underwent photobiomodulation therapy and conventional therapy (stereo gauze and Helianthus annuus vegetable oil), administered sequentially during the same treatment session. The control group was treated with GaAs at 904 nm, 70 mW, and an energy density of 10 J/cm² in continuous mode. The sessions were held twice a week on non-consecutive days for 10 weeks (20 sessions). The primary variable was the ulcer size reduction rate. There was no statistically significant difference in the ulcer reduction rate between the groups after 5 (p = 0.2582) and 10 weeks (p = 0.1164). Within each group, a significant reduction in ulcer size was observed over time (p < 0.0001). Regardless of the wavelength, all patients experienced a 50% reduction in the wound area when applying an energy density of 8–12 J/cm². However, the red group, which was treated at a lower energy density (4 J/cm²), had a lower proportion of responders. The application of PBM at a red wavelength of 660 nm at doses of 4, 8, and 12 J/cm², as well as the application of infrared light at 904 nm (10 J/cm²) significantly improved DFU healing after 10 weeks of treatment. Clinical Trial Registration: This study was registered at ClinicalTrials.gov, approved on July 9, 2022 (NCT05530486 || https://www.clinicaltrials.gov/).

Diabetic foot ulcers (DFUs) cause limitations in physical functioning and performance of activities of daily living (ADLs), accompanied by high emotional burden, anxiety, and depression. Furthermore, persistent and recurrent ulcers, severe amputations, and limitations in ambulation are associated with a significant impact on the quality of life (QOL) and economic burden. Photobiomodulation (PBM) has emerged as a painless, noninvasive, and low-cost option. The biostimulatory and bioinhibitory effects of PBM depend on the parameters used. This double-blind, randomized clinical trial will be conducted at the Integrated Center of Medical Specialties. One Hundred and thirty-six volunteers will be randomized into four groups. GaAlAs 830 nm, 30 mW, in continuous mode (IBRAMED^®) with three energy densities (4 J/cm², 8 J/cm², or 12 J/cm²) will be used. The control group will use 904 nm GaAs, 70 mW, and an energy density of 10 J/cm² (ENDOPHOTON KLD) in pulsed mode, for two non-consecutive days per week for 10 weeks, totaling 20 sessions. The primary outcomes will be ulcer reduction and healing rates. Secondary outcomes will be the University of Texas classification, blood glucose levels, quality of life, healing time, time to recurrence, and viability. Ulcers will be assessed at day 1, 5 weeks, 10 weeks of treatment, and at a 12-week follow-up after treatment completion. The results of the proposed study may provide relevant evidence on the effective parameterization and feasibility of photobiomodulation as an accessible and applicable therapeutic resource in the clinical practice of DFUs.

This study aimed to systematically verify the available systematic reviews and meta-analyses of Low-level laser therapy (LLLT) in diabetic foot ulcer (DFUs) to identify the effects and optimal parameters of LLLT in the management of DFUs. This umbrella review was written according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) report items and registered in the International Prospective Register of Systematic Review (PROSPERO). The search for articles was performed in the Pubmed, Scopus, Web of Science and Embase databases. The following terms were used: Diabetic Foot, Diabetic Neuropathies, Peripheral Vascular Diseases, Peripheral Neuropathy, Diabetic Foot Ulcer, LASER Therapy, Low-Level Light Therapy, LLLT, LASER Biostimulation, Low Intensity LASER Irradiation, Low Power LASER Irradiation, Low Intensity LASER Therapy, Low Power LASER Therapy. A search was performed in the references section of the included studies. The systematic review (SR) included studies that compared LLLT with non-therapeutic doses (parameters considered low to modify healing), sham irradiation, and conventional DFU treatment. The interventions were performed using red and infrared wavelengths. Although two studies included in the SR used wavelengths below 600 nm, these were combined with diodes with infrared wavelengths within the same device. Another study performed a comparative analysis of LLLT at different wavelengths (632 nm and 904 nm), with area reduction rates of 63.7% and 56.8%, respectively, with no statistically significant difference. This is study indicated that, compared with standard treatment and non-irradiation treatments, the use of photobiomodulation (PBM) with different parameters was effective in promoting UPD healing. Further studies are warranted to determine the ideal parameters for improving patient outcomes. (International Prospective Register of Systematic Review Registration number: CRD42022362447).

Diabetic foot ulcers (DFUs) result in tissue damage or impairment of deeper structures that affect quality of life. The impacts are numerous, and even after a long treatment period, 65% of patients experience recurrence. Among the interventions used to accelerate the healing process of DFUs, photobiomodulation therapy (PBMT) is a painless, noninvasive, and low-cost treatment. To achieve effective therapeutic results optimal PBMT parameters are necessary. The positive effect of PBMT on diabetic cells may be dependent on fluence (J/cm²) and wavelength (nm). This double-blind, randomized clinical trial will be conducted at the University Clinic of Physical Therapy. One hundred patients will be randomly placed in 4 groups. A Laserpulse Ibramed (Helium-Neon, HeNe, 660 nm) with 20 W power will be used (continuous mode), with doses stipulated for each treatment group (GL1, 4 J/cm²; GL2, 8 J/cm²; GL3, 12 J/cm²) and Endophoton KLD GaAs 904 nm (ST, 10 J/cm²) for 2 nonconsecutive days per week for 10 weeks, for a total of 20 sessions. The primary outcomes will be ulcer healing rate and University of Texas classification scores. Patients’ DFUs will be assessed on the 1st day, 5 weeks, and 10 weeks of treatment then 1 month after the end of treatment. This study may aid effective clinical decision-making for the management of DFUs.

Purpose: This study aimed to examine the impact of a 904 nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. Methods: The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904 nm 30w) with three different energy densities (4 J/cm²; 8 J/cm²; 10 J/cm²) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. Results: GaAs 904 nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10 J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10 J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). Conclusion: GaAs 904 nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10 J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. Clinical Trial Registration number: NCT04246814.