A Cochrane review included 6 studies; 4 assessed hydrogels, with an additional study evaluating larval therapy against hydrogel, and one evaluated surgical debridement. Pooling the 3 studies which compared hydrogel with gauze or standard care suggested that hydrogels are significantly more effective in healing diabetic foot ulcers (RR 1.84, 95% CI 1.3 to 2.61; NNT 5, 95% CI 2 to 10). Surgical debridement showed no significant benefit over standard treatment. One small trial, available in abstract form only, suggested that larvae resulted in a greater reduction in wound area compared with hydrogel, but this evidence has not been confirmed by publication of full trial results. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in RCTs of people with diabetes.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and blinding).