A research team funded by the National Institutes of Health (NIH) has identified a diagnostic aid that has the potential to accurately predict the recurrence of diabetic foot ulcers that appear to be fully healed. By measuring the skin's barrier function through a process known as trans-epidermal water loss, or TEWL, scientists were able to determine which wounds were more likely to reopen. TEWL measurements are a major factor in burn care, where deep layers of the skin are often damaged. The findings suggest that full restoration of skin barrier function should be incorporated into existing wound treatment standards to ensure complete wound closure and to better identify patients at risk of wound recurrence.
"This study is an important initial step to give clinicians treating diabetic foot ulcers a reliable diagnostic aid for the first time to assess an individual's risk of ulcer recurrence," said Teresa Jones, M.D. program director for the Division of Diabetes, Endocrinology, & Metabolic Diseases at NIH's National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK). "Foot ulcers are such a confounding issue with diabetes and being able to determine which wounds are at highest risk for recurrence could save many lives and limbs."
Scientists, working together through the NIDDK Diabetic Foot Consortium, evaluated over 400 study participants who had a diabetic foot ulcer that visually appeared to be closed or healed. They measured TEWL at the site of the foot ulcer and found that 35% of participants with high TEWL (more water loss) reported a wound recurrence by 16 weeks, compared to just 17% for those with low TEWL (less water loss). Participants with higher TEWL were 2.7 times more likely to experience a wound recurrence than participants with low TEWL.
Diabetic foot ulcers are a major complication of diabetes where a break in the skin of the foot is often unnoticed by a patient due to nerve damage, known as neuropathy. They are the leading cause of non-traumatic lower-limb amputations, and untreated or unhealed ulcers significantly increase the risk of death. Wounds that appear to be healed on the surface may not be fully closed below the superficial surface of the skin, hampering the effectiveness of the skin's barrier function to keep in water and keep out pathogens, such as bacteria.
Study results will publish in Diabetes Care, a journal of the American Diabetes Association. The study was funded by NIH/NIDDK grants (U01DK119099, U24DK122927, U01DK119100, U01DK119083, U01DK119094, U01DK119085 and U01DK119102) and carried out by members of NIH's Diabetic Foot Consortium .
Reference: High Trans-Epidermal Water Loss at the Site of Wound Closure is Associated with Increased Recurrence of Diabetic Foot Ulcers: The NIDDK Diabetic Foot Consortium TEWL Study. Diabetes Care. 2025. DOI: 10.2337/dc25-0300
