A comparative study to assess the effectiveness of Topical Insulin Dressing vs Normal Saline Dressing on wound healing of Diabetic Foot Ulcer

Diabetic foot ulcer (diabetic foot ulcer) is an injury entering through the profound vascular and collagenous (dermis) layers of the skin in diabetic patients. Helpless information by walking care and helpless foot care rehearses were distinguish as signi icant danger factors for foot issues in diabetes. The principle target of the investigationwas to survey the effectiveness of topical insulin dressing versus saline dressing and analyze the degree of diabetic injury healing. Quasi-experimental with comparative research design was embraced for the investigation. Convenience sampling technique was utilized to choose 60 examples. Structured interview was used to collect background variable and Wagner diabetic wound assessment scale for assessing diabetic wound. The diabetic wound was dressed with topical insulin dressing and normal saline dressing for 6 days. The calculated paired ’t’ test value of t = 15.703was found to be statistically highly signi icant at p<0.001 level whereas the calculated paired ’t’ test value of t = 3.247 was found to be statistically highly signi icant at p<0.01 level. There was signi icant that the topical insulin dressing is the more effective and improving the level of wound healing than normal saline dressing.


INTRODUCTION
Diabetic Mellitus is portrayed by expanded blood glucose level because of de icient or wasteful insulin. Diabetes is a chunk of ice infection as per 2016 assessment the pervasiveness of diabetes mellitus in grown-up was around fourth worldwide and this implies that more than 150 million people currently in luenced. As per the American Diabetes Association and International Diabetes Federation, at regular intervals one leg is severed because of diabetes on the planet (Shahbazian et al., 2013). Diabetes mellitus is one of the most well-known metabolic issues in luencing a huge piece of our populace. Aside from its impact on all organ frameworks, these metabolic confusions in luence different cycles in the body also. Diabetic injuries are hard to treat with traditional medicines. Postponed wound mending has led to expanded horribleness and mortality in the population (Thamupriyadharshini, 2020). Diabetes mellitus (DM) is a metabolic disorder marked by chronic hyperglycemia along with defective metabolism of carbohydrates, lipids and proteins. Individuals with controlled blood sugar level are less likely to develop diabetic complications. Diabetic keto acidosis, hypoglycemia Hyperosmolar Hyperglycemia Non ketotic Syndrome (HHNS) are acute complication. Chronic complication leads to microangiopathy and macroangiopathy causing diabetic neuropathy considered of admission. Despite proper topical insulin treatment and a strict diabetic diet 15% of diabetic populations develop nonhealing ulcers which lead to amputations of the lower limb signi icantly (Shen et al., 2020). The major complications of diabetic wound are poor circulation, skin changes, infections, gangrene, sepsis and amputation. The untreated wound becomes infected that may spread to muscle and bone, it's known as Osteomyelitis (Sarinnapakorn et al., 2016). Poor knowledge by walking care and helpless foot care rehearses were recognized as signi icant danger factors for foot issues in diabetes. Proof recommends that predictable patient's instruction with prophylactic foot care for those decided to be at most noteworthy danger may diminish foot ulceration amputation (Bhittani et al., 2020).
Despite skin insulin treatment and a carefully controlled eating routine, roughly 15% of all patients with diabetes will, eventually, have nonrecuperating wounds and this is the main sources of lower limit amputation (Ramarao and Ramu, 2017). The essential strides in the treatment of diabetes foot ulcer is wound conclusion height of the in luenced foot and help of weight are fundamental segment of treatment and ought to be started from the outset introduction sick itting footwear ought to be supplanted with a post employable shoe or another sort of weight remembering footwear Foot issues in diabetic patients represent more medical clinic con irmations than some other long haul confusions of diabetes and furthermore bring about expanding dismalness and mortality. The diabetic foot disorder envelops various pathologies, including diabetic neuropathy, fringe vascular illness, Charcot neuroarthropathy, foot ulceration, osteomyelitis, and the possibly preventable end point amputation (Praveen and Kumar, 2017).
In the present day, there are various types of dressing available and these form a pivotal part in the healing of foot ulcers. Wound healing in complex process involving cell adhesion, migration, proliferation, differentiation and apoptosis at both cellular and molecular levels (Ghatage et al., 2017). In choosing a dressing for a contaminated diabetic foot ulcer, a few elements must be considered. Tainted injuries will in general have weighty exudate that should be controlled to forestall maceration of encompassing tissue. There might be extensive scent related with disease that might be undesirable and troubling for the patient and family (Athavale et al., 2014). A dressing must be agreeable and satisfactory for the patient and should help mitigate or at any rate, not decline torment, partic-ularly at dressing changes. Preferably the dressing ought to likewise help in the administration of the disease itself (Martínez-Jiménez et al., 2018). Topical dressing comprises as one of the modalities of care for diabetic foot ulcers. Different types of moist dressing and topical agents are used in the modern day for wound healing (Prasad et al., 2018). Saline is isotonic and as it dissipates from the dressing, it gets hypertonic and liquid from the injury tissues is brought into the dressing, advancing parching of the injury (Sanjay et al., 2018). Topical insulin has proved to be ef icacious in promoting wound healing by activating serin-threonine kinase and extra cellular signal regulated protein kinase pathway (Lima et al., 2012). The purpose of this study (1) to assess the level of wound healing among patients with diabetic foot ulcer in the Topical insulin dressing and Normal Saline dressing group.
(2) to assess the effectiveness of topical insulin dressing VS normal saline dressing on diabetic wound healing among patients with diabetic foot ulcer. (3) to compare the effectiveness of topical insulin dressing VS normal saline dressing on diabetic wound healing among patients with diabetic foot ulcer. (4) to associate the selected demographic variables with topical insulin dressing VS normal saline dressing on diabetic wound healing among patients with diabetic foot ulcer.

MATERIALS AND METHODS
Quasi-experimental with comparative research design was adopted for the study to assess the effectiveness of topical insulin dressing versus normal saline dressing on wound healing of Diabetic Foot Ulcer at Gajapathi Health Center, Tiruvallur. The 60 samples who met the inclusion criteria were selected by convenience sampling technique and written informed consent was obtained. Structured interview was used to collect background variable and Wagner diabetic wound assessment scale for assessing diabetic wound. The diabetic wound was dressed with topical insulin dressing and normal saline dressing for 6 days. The results of the study were compared with the pre and post test and effectiveness of insulin and normal saline dressing among patients with diabetic foot ulcer were analyzed.

Description of the demographic variables
The present study shows that in the topical insulin dressing group, most of them 15(50%) were in the age group of 50-60 years, 17(56.7%) were male, 29  Assessment of level of wound healing among patients with diabetic foot ulcer.
The current investigation shows that the pretest mean score of twisted mending among patients with diabetic foot ulcer in the effective insulin dressing bunch was 2.67±0.66 and the post-test mean score was 1.43±0.57. The determined combined 't' test estimation of t = 15.703 was discovered to be factually profoundly huge at p<0.001 level. It additionally depicts that the pretest mean score of twisted recuperating among patients with diabetic foot ulcer in the ordinary saline dressing bunch was 2.70±0.65 and the post-test mean score was 2.43±0.73. The determined combined 't' test estimation of t = 3.247 was discovered to be measurably profoundly huge at p<0.01 level. The above inding plainly induces that effective insulin dressing and typical saline dressing controlled to patients with diabetic foot ulcer had critical impact which brought about the improvement in the degree of twisted recuperating among patients with diabetic foot ulcer in both the gatherings Table 1. (Kanase et al., 2020) Conducted an investigation to a near investigation of effective insulin and ordinary saline dressing in twisted mending in diabetic foot ulcer. The investigation demonstrated that effective insulin is pro icient in patients with diabetic foot ulcer when contrasted with ordinary saline. There was the quickest recuperation and decrease in size of ulcer with insulin.
Comparison of the effectiveness of topical insulin dressing vs normal saline dressing on diabetic wound healing among patients with diabetic foot ulcer.
The present study shows that the pretest mean score of wound healing among patients with diabetic foot ulcer in the topical insulin dressing group was 2.67±0.66 and the mean score in the normal saline dressing group was 2.70±0.65. The calculated student independent 't' test value of t = 0.197 was not found to be statistically signi icant. It also portrays that the post-test mean score of wound healing among patients with diabetic foot ulcer in the topical insulin dressing group was 1.43±0.57 and the post-test mean score in the normal saline group was 2.43±0.73. The calculated student independent't' test value of t = 5.931 was found to be statistically signi icant at p<0.001 level. The above inding shows that there was signi icant difference in the post level of wound healing between the topical insulin dressing group and normal saline dressing group which clearly infers that topical insulin dressing was found to be effective in improving the level of wound healing considerably than the normal saline dressing in the post-test.
Associate the selected demographic variables with topical insulin dressing vs normal saline dressing on diabetic wound healing among patients with diabetic The current examination shows that the segment factors sex and occupation had demonstrated factually critical relationship with post-test level of twisted mending among patients with diabetic foot ulcer at p<0.05 level and the other segment factors had not indicated measurably huge relationship with post-test level of twisted recuperating among patients with diabetic foot ulcer in the effective insulin dressing gathering. Furthermore shows that none of the segment factors had indicated factually huge relationship with post-test level of twisted recuperating among patients with diabetic foot ulcer in the typical saline dressing gathering. (Kamat and Sunil, 2019) directed A near report between effective insulin versus ordinary saline dressings in twisted mending in diabetic foot ulcers. There was measurably huge decrease in the zone of ulcer at end of day 15 (p esteem <0.001).

CONCLUSIONS
The investigator analyzed the data has come to a conclusion that, the present study showed the effectiveness of topical insulin dressing vs normal saline dressing. There was signi icant that the topical insulin dressing is the more effective and improving the level of wound healing than normal saline dressing.