A randomized control trial comparing the effects of manuka honey and tualang honey on wound granulation of post debridement diabetic foot wounds

The concern of a surgeon dealing with the management of diabetic ulcers is to get the wound debrided and dressed until it granulates. After this stage a proper tissue cover with skin graft is among the options available to encourage the wounds to heal. A resurgence of interest and an increasing number of case reports on the use of honey on diabetic foot ulcers, reflect a growing awareness and a need for cost-effective therapies. Given honey's great potential as an alternative in wound dressing, this double-blinded randomized controlled study was designed to investigate the wound healing property and the granulation tissue promoting effect of honey, comparing the local Malaysian tualang honey with the well-established manuka honey in the management of patients with diabetic foot wounds. Thirty-four patients with Wagner stage II or III diabetic foot ulcers were enrolled in the study, randomized into 2 groups of seventeen patients, treated with either manuka honey or tualang honey dressing on a daily basis post surgical debridement. Wound healing was assessed by measuring the granulation surface area utilizing a tracing technique. The primary outcome measure which was area of coverage with new granulation tissue was checked in each group after seven days. Other variables which might affect wound healing that were considered as confounders were recorded and analysed as well as the primary outcome. There was no significant difference (p=0.687) between manuka honey and tualang honey group in terms of mean percentage of granulation tissue surface area after one week of dressing in diabetic foot ulcers (manuka group 60.7%, tualang group 57.0%). All variables in both groups which were age, wound size, HbA1c, haemoglobin level, serum albumin level, absolute lymphocyte count and ankle-brachial systolic pressure index (ABSI), were comparable and were found not to be statistically significant to influence the primary outcome. Tualang honey induced granulation and exhibited beneficial action in promoting wound healing which was comparable to the more established manuka honey. The result suggests that tualang honey could be used as an alternative therapeutic agent for diabetic foot wounds with similar beneficial effects as those expected for manuka honey.