Diabetic foot ulcers (DFUs) remain a major cause of morbidity and lower-limb amputation, and optimal treatment strategies continue to evolve. A cross-sectional analysis of published meta-analyses evaluated the consistency and quality of evidence comparing stem cell therapies with conventional treatments for DFUs.
The analysis systematically reviewed nine meta-analyses and assessed methodological quality using Oxford Levels of Evidence criteria and the AMSTAR instrument. The Jadad decision algorithm was applied to identify the most methodologically robust evidence among overlapping reviews. Nine meta-analyses evaluating stem cell therapy for DFUs were included in the analysis.
Findings
- Five meta-analyses were classified as Level II evidence, while four were categorized as Level III evidence.
- AMSTAR quality scores ranged from 7 to 10, with a median score of 9.
- The highest-quality meta-analysis identified by the Jadad algorithm demonstrated significantly improved ulcer healing rates with stem cell therapy compared with conventional treatment (P <0.0001).
- Stem cell therapy was also associated with greater pain-free walking distance (P <0.00001) and lower amputation rates (P <0.0001).
- Adverse event rates were lower in the stem cell therapy groups than in the conventional treatment groups (P <0.001).
The analysis suggests that stem cell therapy may improve clinical outcomes in patients with DFUs, including ulcer healing and amputation risk. However, the findings should be interpreted cautiously because of heterogeneity among studies, overlap of primary data across meta-analyses, and the secondary nature of the analysis.
