A Brief Review about the Effect of Honey on Diabetic Foot Ulcer; from In Vitro Studies to Clinical Trials

Document Type : Review


1 Student Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran. Student Research Committee, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran.

2 Department of Traditional Pharmacy, School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran.


Diabetes mellitus has many complications; one of the most important ones is diabetic foot ulcer (DFU). Due to the increasing prevalence of diabetes in the world and evidences of the role of honey in treatment of DFU, we decided to review the effect of honey on DFU. We searched the keywords of “honey”, “diabetic foot ulcer”, “treatment”, “diabetes mellitus”, “wound dressing” and “wound healing” in indexing systems of PubMed, Scopus and ISI Web of Science between 2007 to 1 Jun 2017, in English and Persian languages. Out of 120 articles published, 20 articles met the inclusion criteria, including one in vivo study, four in vitro studies and 15 human studies. The results showed the efficacy of honey as a wound healing agent in some types of wounds. Mechanisms of healing methods included hyper osmosis, stimulating cytokine production, producing transforming growth factor-β1 and etc. In some articles, honey was used in combination with other medications like Commiphora molmol, Nigella sativa and povidone iodine. Honey showed minor side effects, in some studies, like mild burning or minor sensation. Despite these complications, the treatment was not stopped and in some cases the disorder was resolved by changing the combination ingredients. Although, the reviewed studies showed healing effect for honey in DFU, more studies are needed to confirm the efficacy.


Main Subjects

[1] Kumhar M,  Saini T, Dara N. Foot wear and foot care knowledge -an independent risk factor for diabetic foot in Indian diabetics. Ind Med Gaz. 2014; 4(1): 25-28.
[2] Mariam TGAlemayehu ATesfaye EMequannt WTemesgen KYetwale F, Limenih MA. Prevalence of diabetic foot ulcer and associated factors among adult diabetic patients who attend the diabetic follow-up clinic at the university of gondar referral hospital, north-west Ethiopia. J Diabetes Res.  2017; Article ID: 2879249.
[3] Esteghamati AGouya MMAbbasi MDelavari AAlikhani SAlaedini F, Safaie A, Forouzanfar M, Gregg EW. Prevalence of diabetes mellitus and impaired fasting glucose in the adult population of Iran: The national survey of risk factors for non-communicable diseases of Iran. Diabetes Care. 2008; 31(1): 96-98.
[4] Amini MParvaresh E. Prevalence of macro- and microvascular complications among patients with type 2 diabetes in Iran: a systematic review. Diabetes Res Clin Pract. 2009; 83(1): 18-25.
[5] Al-Maskari FEl-Sadig M. Prevalence of risk factors for diabetic foot complications. BMC Fam Pract. 2007; Article ID 59.
[6] Nyamu PNOtieno CFAmayo EOMcLigeyo SO. Risk factors and prevalence of diabetic foot ulcer at Kenyatta national hospital. East Afr Med J. 2003; 80(1): 36-43.
[7] Mason JO'Keeffe CHutchinson AMcIntosh AYoung RBooth A. A systematic review of foot ulcer in patients with type 2 diabetes mellitus. II: treatment. Diabet Med. 1999; 16(11): 889-909.
[8] Cavanagh PRLipsky BABradbury AWBotek G. Treatment for diabetic foot ulcers. Lancet. 2005; 366(9498): 1725-1735.
[9] Naves CC. The diabetic foot: a historical overview and gaps in current treatment. Adv Wound Care (New Rochelle). 2016; 5(5): 191-197.
[10] WHO traditional medicine strategy 2014- 2023. [Accessed 2017]. Available from: http://apps.who.int/iris/bitstream/handle/10665/92455/9789241506090_eng.pdf;jsessionid=C974502B4AE880F7A5CC95F627A6605D?sequence=1. 
[11] Denisow BDenisow-Pietrzyk M. Biological and therapeutic properties of bee pollen: a review. J Sci Food Agric. 2016; 96(13): 4303-4309.
[12] Zubair RAziz N. As smooth as honey the historical use of honey as topical medication. JAMA Dermatol. 2015; 151(10): 1102.
[13] Bogdanov SJurendic TSieber RGallmann P. Honey for nutrition and health: a review. J Am Coll Nutr. 2008; 27(6): 677-689.
[14] Jull ABCullum NDumville JCWestby MJDeshpande SWalker N. Honey as a topical treatment for wounds (review). Cochrane Database Syst Rev. 2015; Article ID  CD005083.
[15] Tovey FI. Honey and healing. J R Soc Med. 1991; 84(7): 447.
[16] Erejuwa OO. Effect of honey in diabetes mellitus: matters arising. J Diabetes Metab Disord. 2014; 13(1): 1-4.
[17] Emami MSadeghpour OZarshenas MM. Geriatric management in medieval Persian medicine. J Midlife Health. 2013; 4(4): 210-215.
[18] Al-Waili NSalom KAl-Ghamdi AAnsari MJAl-Waili AAl-Waili T. Honey and cardiovascular risk factors, in normal individuals and in patients with diabetes mellitus or dyslipidemia. J Med Food. 2013; 16(12): 1063-1078.
[19] Mullai VMenon T. Bactericidal activity of different types of honey against clinical and environmental isolates of Pseudomonas aeruginosa. J Altern Complement Med. 2007; 13(4): 439-441.
[20] Maedaa Y, Loughrey A, Earle JAP, Millar BC, Rao JR, Kearns A, McConville O, Goldsmith CE, Rooney PJ, Dooley JS, Lowery CJ, Snelling WJ, McMahon A, McDowell D, Moore JE. Antibacterial activity of honey against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Complement Ther Clin Pract. 2008; 14(2): 77-82.
[21] Alzahrani HA, Bakhotmah BA, Boukraâ L. In vitro susceptibility of diabetic wound bacteria to mixtures of honey, Commiphora molmol and Nigella sativa. Open Nutraceuticals J. 2011; 4(1): 172-175.
[22] Momin MKurhade SKhanekar PMhatre S. Novel biodegradable hydrogel sponge containing curcumin and honey for wound healing. J Wound Care. 2016; 25(6): 364-372. 
[23] Nho YC, Park JS, Lim YM. Preparation of hydrogel by radiation for the healing of diabetic ulcer. Radiat Phys Chem. 2014; 94(1): 176-180.
[24] Lotfy MBadra GBurham WAlenzi FQ. Combined use of honey, bee propolis and myrrh in healing a deep, infected wound in a patient with diabetes mellitus. Br J Biomed Sci. 2006; 63(4): 171-173.
[25] Siavash M, Shokri S, Haghighi S, Mohammadi M, Shahtalebi MA, Farajzadehgan Z. The efficacy of topical royal jelly on diabetic foot ulcers healing: a case series. J Res Med Sci. 2011; 16(7): 904-909.
[26] Mohamed HEl Lenjawi BAbu Salma MAbdi S. Honey based therapy for the management of a recalcitrant diabetic foot ulcer. J Tissue Viability. 2014; 23(1): 29-33.
[27] Abdelatif MYakoot MEtmaan M. Safety and efficacy of a new honey ointment on diabetic foot ulcers: a prospective pilot study. J Wound Care. 2008; 17(3): 108-110.
[28] Shukrimi ASulaiman ARHalim AYAzril A. A Comparative study between honey and povidone iodine as dressing solution for Wagner type II diabetic foot ulcers. Med J Malaysia. 2008; 63(1): 44-46.
[29] Makhdoom AKhan MSLagahari MARahopoto MQTahir SMSiddiqui KA. Management of diabetic foot by natural honey. J Ayub Med Coll Abbottabad. 2009; 21(1): 103-105.
[30] Moghazy AMShams MEAdly OAAbbas AHEl-Badawy MAElsakka DM,  Hassan SA, Abdelmohsen WS, Ali OS, Mohamed BA. The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers. Diabetes Res Clin Pract. 2010; 89(3): 276-281.
[31] Siavash MShokri SHaghighi SShahtalebi MAFarajzadehgan Z. The efficacy of topical royal jelly on healing of diabetic foot ulcers: a double-blind placebo-controlled clinical trial. Int Wound J. 2015; 12(2): 137-142.
[32] Kegels F. Clinical evaluation of honey-based products for lower extremity wounds in a home care setting. Wounds. 2011; 7(2): 46-53.
[33] Jan WA, Shah H, Khan M, Fayaz M, Ullah N. Comparison of conventional Pyodine dressing with honey dressing for the treatment of diabetic foot ulcers. J Postgrad Med Inst. 2012; 26(4): 402-407.
[34] Kamaratos AVTzirogiannis KNIraklianou SAPanoutsopoulos GIKanellos IEMelidonis AI.  Manuka honey-impregnated dressings in the treatment of neuropathic diabetic foot ulcers. Int Wound J. 2014; 11(3): 259-263.
[35] Surahio ARKhan AAFarooq MFatima I. Role of honey in wound dressing foot ulcer. J Ayub Med Coll Abbottabad. 2014; 26(3): 304-306.
[36] Bahar A, Saeedi M, Kshi Z, Akha O, Rabee KDavoodi M. The effect of Aleo vera and honey gel in healing diabetic foot ulcers. J Mazandaran Univ Med Sci. 2015; 25(128): 110-114.
[37] Imran MHussain MBBaig M. A randomized, controlled clinical trial of honey-impregnated dressing for treating diabetic foot ulcer. J Coll Physicians Surg Pak. 2015; 25(10): 721-725.
[38] Tsang KKKwong EWTo TSChung JWWong TK. A pilot randomized, controlled study of nanocrystalline silver, manuka honey, and conventional dressing in healing diabetic foot ulcer. Evid Based Complement Alternat Med. 2017; Article ID 5294890.
[39] Chaithirayanon S. Comparative study between talcum and zinc oxide cream for the prevention of irritant contact diaper dermatitis in infants. J Med Assoc Thai. 2016; 99(S8): 1-6.
[40] Ernst E. Adverse effects of herbal drugs in dermatology. Br J Dermatol. 2000; 143(5): 923-929.
[41] Ball DW. The chemical composition of honey. J Chem Educ. 2007; 84(10): 1643.