Diabetes & Metabolic Syndrome: Clinical Research & Reviews 16 (2022) 102678

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Diabetes & Metabolic Syndrome: Clinical Research & Reviews

journal homepage: www.elsevier.com/locate/dsx

The effect of topical olive oil dressing on the healing of grade 1 and 2
diabetic foot ulcers: An assessor-blind randomized controlled trial in
type 2 diabetes patients
Aminreza Abdoli a, Roghayeh Shahbazi b, Ghazal Zoghi c, Parivash Davoodian d,
Somayeh Kheirandish c, Mohsen Azad a, Masoumeh Kheirandish c, *
a
Student Research Committee, Faculty of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
b
Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
c
Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
d
Infectious and Tropical Diseases Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

a r t i c l e i n f o a b s t r a c t

Article history: Background and aims: We aimed to compare the effect of topical olive oil dressing plus standard care
Received 7 February 2022 with standard care alone on the treatment of grade 1 and 2 diabetic foot ulcers (DFUs) in type 2 diabetes
Received in revised form mellitus (T2DM) patients.
5 November 2022
Methods: This assessor-blind randomized controlled trial included 60 T2DM patients with DFU referred
Accepted 17 November 2022
to the Diabetes Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from February 21 to August 22,
2017. Patients were randomly assigned to intervention (n ¼ 30) and control (n ¼ 30) groups. The
Keywords:
intervention group received standard care, including wound irrigation with normal saline and oral an-
Diabetes
Diabetic foot
tibiotics plus daily topical olive oil dressing for four weeks, and the control group only received standard
Healing care. The wound healing assessment scale (wound degree, color, drainage, and surrounding tissue
Olive oil healing) was recorded weekly and the total wound status was determined at the end of the study.
Results: Treatment with olive oil led to significantly higher scores of ulcer degree, color, drainage, and
surrounding tissue healing at weeks one, two, three and four in the olive oil group than in the control
group (P < 0.001). Also, the total wound status score was higher in the olive oil group compared to the
control group (P < 0.001). The proportions of completely healed, partially healed, and unhealed wounds
were 76.6%, 23.3% and 0% in the intervention group, and 0%, 93.3% and 6.7% in the control group,
respectively.
Conclusions: Topical olive oil dressing promoted the healing of DFU and it can be recommended as a safe
and effective treatment in this regard.
Trial registration: Iranian Registry of Clinical Trials (IRCT), IRCT20150607022585N4. Registered 05/12/
2018. Retrospectively registered, https://www.irct.ir/trial/19460.
© 2022 Published by Elsevier Ltd on behalf of Research Trust of DiabetesIndia (DiabetesIndia) and
National Diabetes Obesity and Cholesterol Foundation (N-DOC).

1. Introduction
Type 2 diabetes mellitus (T2DM) is among the most prevalent
chronic diseases worldwide. It is estimated that by 2045, over 629
million people will be affected by diabetes worldwide [1,2]. Dia-
betic foot is a significant complication of diabetes that results from
* Corresponding author. Endocrinology and Metabolism Research Center, Hor-
mozgan University of Medical Sciences, P.O. Box: 7919915519, Bandar Abbas, Iran.
E-mail address: kheirandishm@yahoo.com (M. Kheirandish).
neuropathy, ischemia, and infection and can lead to lower limb
amputation and prolonged hospital stay in several cases [3]. With
an annual incidence rate of 25e80%, diabetic foot affects more than
15% of people with diabetes [4,5]. Also, the treatment of diabetic
foot is very costly both for the afflicted individual and the society
[6].
In addition to conventional antidiabetic treatment, that is con-
trol of blood sugar, diabetic foot ulcer (DFU) is usually managed by
broad-spectrum antibiotics to control the infection, and daily
wound care including debridement, antiseptic bath, and

https://doi.org/10.1016/j.dsx.2022.102678
1871-4021/© 2022 Published by Elsevier Ltd on behalf of Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC).
A. Abdoli, R. Shahbazi, G. Zoghi et al.
amputation of toes if they become gangrenous [7]. However, poor
wound healing has been reported in patients with diabetes, with a
large number of patients suffering from DFU despite standard
treatment. Unhealed DFU may lead to ulcer infection, gangrene,
amputation, and death [8e11]. Nonetheless, early and effective
management of DFU can prevent the aforementioned
complications.
The heavy cost of hospitalization for unhealed DFU and treat-
ment of its complications has led to a search for new therapeutic
methods. Some studies have revealed that herbal and alternative
medicine products such as honey, Propolis, Aloe vera, Tangzu
Yuyang, Astragali Radix, Rehmanniae Radix, and Semelil are
beneficial to ulcer healing [12e18]. Olive oil has also been investi-
gated for the management of DFU in quite a few studies, mostly in
comparison with other agents [12,15,18e20]. The potential positive
effect of olive oil on tissue blood flow and its possible anti-
inflammatory properties can be the underlying mechanisms
through which olive oil contributes to diabetic foot wound healing
[21]. It has been stated by the above-mentioned studies regarding
the effect of olive oil on DFU, that further studies are required to
confirm their results. Thus, we aimed to compare the effects of
topical olive oil dressing plus standard care with standard care
alone on DFU.
2. Methods
2.1. Study design
The current study was an assessor-blind randomized controlled
trial performed on T2DM patients with DFU who were referred to
the Diabetes Clinic of Shahid Mohammadi Hospital, Bandar Abbas,
Iran, from February 21 to August 22, 2017. According to the sug-
gested formula for calculating the sample size in randomized
clinical trials, with type I error of 1% (a ¼ 0.01), type II error of 10%
(b ¼ 0.1, power ¼ 90%), and based on the mean and standard de-
viation of wound healing scores in the intervention and control
groups reported in a previous study [21], a sample size of at least 24
was calculated for each group. We allocated 30 participants to each
group. Subjects were patients with T2DM who had presented with
an ulcer in their lower extremities. Inclusion criteria were: T2DM,
age of 30e65 years, 18 body mass index (BMI) 35 kg/m2, grade 1
or 2 ulcer on toes, soles, heels or dorsum of the feet based on
Wagner's classification [22] for more than 4 weeks, and written
informed consent to participate in the study. Exclusion criteria
were any history of smoking, addiction, or alcohol consumption,
comorbidities such as cancer, chronic kidney disease, liver failure,
congestive heart failure, and vasculitis, as well as having received
medications that delay ulcer healing including glucocorticoids,
immunosuppressive agents, and cytotoxic drugs. Patients with foot
gangrene who were candidates for amputation, patients with active
infection who required intravenous antibiotic therapy, patients
with venous, ischemic, or traumatic ulcers, and those who failed to
attend the clinic for more than two consecutive follow-up visits
were also excluded. Diabetes was the only underlying disease
affecting wound healing. Other comorbidities were hypertension
and dyslipidaemia.
Among 83 participants with DFU who had been referred to the
clinic, 60 were eligible and were invited to take part in the study.
Patient enrolment and eligibility assessments were done by the
principal investigator. Details of patient enrolment, allocation,
follow-up, and analysis are demonstrated in Fig. 1. Participants
were randomly assigned to intervention (n ¼ 30) and control
groups (n ¼ 30) for 4 weeks. Simple randomization was done
through randomly-generated numbers using the Random
2
Diabetes & Metabolic Syndrome: Clinical Research & Reviews 16 (2022) 102678
Allocation software by the study methodologist. Accordingly, a total
of 60 sealed envelopes numbered from 1 to 60 were prepared by
the principal investigator, each including a group (intervention/
control). An envelope was given to each patient in order of their
attendance at the Diabetes Clinic. The study protocol was approved
by the Ethics Committee of Hormozgan University of Medical Sci-
ences, Bandar Abbas, Iran under the ethics code: HUMS.-
REC.1396.24. The research has also been retrospectively registered
at the Iranian Registry of Clinical Trials (IRCT) with certificate No.:
IRCT20150607022585N4, and is accessible at the following web-
site: www.irct.ir.
2.2. Variables assessment
A general information questionnaire was used to collect data on
demographic, clinical and anthropometric characteristics of par-
ticipants. Data on DFU were recorded by a general physician, who
was blinded to the grouping of patients, using an ulcer healing
assessment checklist [21]. The checklist included data on grade,
size, site, duration, vascular and neuropathy status of the wound
(recorded at the initial visit), wound healing assessment scale
(recorded on a weekly basis), total wound healing status, and
adverse complications such as sensitivity, bleeding, infection, and
pain (recorded at the end of intervention). Wound grade was
determined using Wagner's classification. Wound size was deter-
mined through measuring surface area and depth of ulcer. At
baseline, the largest area and the deepest part of the wound (using
a sterile probe) were measured in millimeter. Lower-extremity
vascular insufficiency was diagnosed based on the lack of both
dorsalis pedis and posterior tibialis pulses in the involved foot.
Neuropathy was assessed based on vibration sensation using a
standard 256 Hz tuning fork (Surgicon, Germany) and pressure
sensation using a 10-g monofilament (Gima, Italy). Wound healing
assessment was performed based on four characteristics of the
wound, including grade, color, surrounding tissues and drainage,
and total ulcer status was determined at the end of each week. Each
parameter had 100 scores, and based on the total score obtained
(ranged from 50 to 400 with higher scores indicating better wound
healing), status of ulcer healing was determined as complete (a
score of 400), partial (at least 30 scores increase compared to the
first week) and lack of healing (no increase in wound healing
scores) at the end of intervention [21]. Furthermore, at the end of
each week, photographs were taken of the ulcer area for all patients
to monitor the wound healing process using a digital camera.
To improve the quality of DFU diagnosis and primary outcome
(total ulcer status score) and secondary outcomes (individual
wound parameters, including wound color, degree, drainage, and
surrounding tissue healing) measurements, we used standard
questionnaire and classification [21,22], and all variables and out-
comes were assessed by the same trained physician who was
blinded to the grouping of patients. Furthermore, all variables and
outcomes regarding DFU diagnosis, classification, status, and
improvement were also evaluated by an expert endocrinologist
who was also unaware of the received treatment by each patient.
Anthropometric indices, including height without shoes and
with the precision of 0.5 cm, weight with light clothes and with the
precision of 100 g using Seca scale, and body mass index (BMI) by
dividing weight (kg) by height squared (m2) were measured at
baseline. Fasting blood samples were collected once (at baseline) to
evaluate fasting plasma glucose (FPG) and glycosylated hemoglobin
(HbA1c) of patients. FPG was measured by the gluco-oxidase
method using a commercial kit (Human, Germany) and HbA1c
was measured by column chromatography using a commercial kit
(Biosource, Spain).
A. Abdoli, R. Shahbazi, G. Zoghi et al.
Fig. 1. Patients' enrollment and follow-up flow chart. Patients in the intervention group received standard care and daily dressing with topical olive oil for 4 weeks; those in the
control group received standard care and daily routine dressing at the same time.
2.3. Intervention
At first visit, the goals, methods of intervention and duration of
the project, as well as comprehensive education about DFU
morbidity, were fully explained to the patients. Furthermore, the
general and clinical characteristics of attendees were collected. DFU
was assessed by the same general physician for all recruited pa-
tients. During the first session, all patients were also trained about
the proper dressing technique. Both groups received standard
therapies and care for diabetes and foot ulcer management. Stan-
dard care in the control group included irrigating and cleaning the
center and periphery of ulcers with 1000 ml of sterile normal saline
solution then leaving it to dry and subsequently dressing the
wound with sterile gauze. In the intervention group, before dres-
sing with sterile gauze, the surface of the patient's ulcer was fully
covered by olive oil using a sterile syringe and then dressing was
done by sterile gauze. The olive oil used was virgin olive oil made
cold-pressed and without the use of any heat or chemicals,
extracted purely mechanically, by grinding olives into a paste fol-
lowed by pressing. Daily dressing was done by the patients of both
groups at home. Oral antibiotics were prescribed for both groups
based on ulcers' status and clinical diagnosis for mild to moderate
infected wounds with at least two signs or symptoms of inflam-
mation (erythema, warmth, tenderness, pain, and induration) or
3
Diabetes & Metabolic Syndrome: Clinical Research & Reviews 16 (2022) 102678
purulent secretion [23], without wound culture. Patients with
moderate to severe wound infection were excluded from the study.
Given the polymicrobial nature of diabetic ulcer infections [24], all
patients received cloxacillin for 2 weeks. We used virgin olive oil
(Louyeh Food Industry, Roodbar-Ganzha, Gilan), with no contami-
nation in three microbial tests. Daily follow-up phone calls were
made for all subjects. Weekly assessment of wound healing was
done by the same general physician (who was not aware of the
grouping of the participants) for all patients in both groups, at the
recruitment center.
2.4. Statistical analysis
The statistical analysis of data was performed using the SPSS
software version 25.0 (IBM Corp. Armonk, NY, USA). The indepen-
dent t-test was used to compare the mean of continuous variables
between the two groups. The Chi-squared test was used to compare
categorical variables between groups. P-value<0.05 was considered
statistically significant.
3. Results
From the 60 patients included in the current study 60% (n ¼ 36)
were female and 40% (n ¼ 24) were male. The proportions of ulcers
A. Abdoli, R. Shahbazi, G. Zoghi et al. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 16 (2022) 102678

on toes, soles, heels, and dorsum were 14 (46.66%), 9 (30%), 5 3.2. Secondary outcomes
(16.66%), 2 (6.66), respectively in the intervention group, and 12
(40%), 8 (26.66%), 7 (23.33%), 3 (10%), respectively in the control At baseline (week 0), there were no significant differences be-
group (P > 0.05). The general characteristics of patients in the tween the intervention and control groups regarding wound de-
intervention and control groups are demonstrated in Table 1. Pa- gree, color, drainage, and healing of surrounding tissue (P > 0.05).
tients in both groups were comparable regarding age, sex, occu- However, treatment with topical virgin olive oil increased the mean
pation, marital status, and education, as well as all other general scores of ulcer degree, color, drainage and surrounding tissue
characteristics (see Table 1). healing in the olive oil group compared to the control group at
weeks one, two, three and four of the study (P < 0.001) (Table 2).
None of the participants complained about adverse effects through
3.1. Primary outcome
treatment with olive oil dressing.
Pre-intervention mean of total wound status score was not
4. Discussion
statistically different between the two groups (P ¼ 0.092). At the
end of the study, although the score of total ulcer status increased
In the current study, we evaluated the effect of topical olive oil
in both the intervention and control groups compared to baseline
dressing on the healing of DFU. Findings of our study demonstrated
values, this increase was significantly higher in the olive oil group
that olive oil can be beneficial to the healing of grade 1 and 2 of
(393.33 ± 12.75) compared to the control group (240.00 ± 22.40)
DFUs. Based on our results, a significant difference was observed in
(P < 0.001). Based on the total ulcer score, complete wound healing
the total status of wound healing between olive oil group and
was observed in 76.6% subjects of the intervention group, while
control group at the end of weeks one, two, three and four, which
none of the subjects in the control group experienced complete
indicates the beneficial role of topical olive oil as an adjunct therapy
wound healing (P < 0.001). Lack of wound healing was 0% and 6.7%
for DFU.
in the intervention and control groups, respectively (P < 0.001)
Some possible mechanisms have been suggested for the thera-
(results not included in the table). The majority of subjects in the
peutic effects of olive oil. Evidence shows that olive oil might be
control group had partial wound healing (Figs. 2 and 3).
effective in wound treatment by increasing the blood flow and
reducing inflammation in damaged tissue [21]. Furthermore,
Table 1 topical olive oil promotes pressure ulcer healing by reducing
General characteristics of the intervention and control groups. oxidative damage and stimulating dermal reconstruction [21,25].
Variables Groups Essential fatty acid content of olive oil is believed to induce cell
healing [26]. Also, anti-microbial, anti-inflammatory, and antioxi-
Intervention (n ¼ 30) Control (n ¼ 30)
dant properties of olive oil have been reported in animal models
Age (years), mean ± SD 51.60 ± 9.04 52.93 ± 9.32 [26].
Sex, N (%)
The results of our study were partly similar to the results of the
Male 14 (46.7) 10 (33.3)
Female 16 (53.3) 20 (66.7) study of Nasiri et al. [21]. and Elshenawie et al. [12], who investi-
Height (cm), mean ± SD 164.42 ± 9.46 162.93 ± 10.33 gated the effects of topical olive oil dressing on the grade 1 and 2
Weight (kg), mean ± SD 72.50 ± 14.26 68.63 ± 10.68 DFUs, and the effect of ozonated olive oil ointment dressing on the
BMI (kg/m2), mean ± SD 26.80 ± 4.72 25.98 ± 4.07 healing of all grades of superficial and deep DFUs, respectively. In
Occupation, N (%)
Unemployed 18 (60.0) 21 (70.0)
Nasiri et al.’s study, the total status of wound improved at the end of
Employed 6 (20.0) 9 (30.0) weeks one, two and four of intervention, while unlike our study,
Retired 6 (20.0) 0 (0.0) they did not find a significant difference between the two groups at
Marital status, N (%) the end of week 3 [21]. On the other hand, in Elshenawie et al.’s
Married 28 (93.3) 30 (100.0)
study, a significant difference was reported between patients
Divorced 2 (6.7) 0 (0.0)
Single 0 (0.0) 0 (0.0) managed by ozonated olive oil dressing and patients managed by
Education, N (%) conventional dressing regarding ulcer healing after two, three, four,
Illiterate 3 (10.0) 2 (6.7) and five weeks [12]. Although in our study daily dressing was done
Less than high school diploma 13 (43.3) 11 (36.7) by the patients and weekly examination was performed by a gen-
High school diploma 14 (46.7) 17 (56.7)
Higher education 0 (0.0) 0 (0.0)
eral physician, wound improvement was significant like other
Duration of diabetes, N (%) studies in which daily dressing was performed by a physician
>10 years 14 (46.7) 12 (40.0) [12,21]. It appears that increasing patients' awareness and
5e10 years 8 (26.7) 6 (20.0) involving them in their DFU care has a significant impact on wound
<5 years 8 (26.7) 12 (40.0)
healing.
Comorbidities, N (%)
Hypertension 12 (36.0) 10 (30.0) In another study by Aziza et al., improvement in the wound
Dyslipidemia 23 (69.0) 20 (60.0) healing process was observed in patients receiving olive oil oint-
FBS (mg/dl), mean ± SD 193.90 ± 93.10 169.87 ± 61.58 ment at the end of week two of intervention, while in contrast with
HbA1c (%), mean ± SD 9.31 ± 2.42 8.86 ± 1.67 our results, no significant differences were reported between
Medications, N (%)
Hypoglycemic agents 20 (66.7) 17 (56.7)
treatment and control groups at weeks one, two and four [20]. The
Insulin 10 (33.3) 13 (43.3) discrepancy between the two studies can be explained by the fact
Antibiotics, N (%) that Aziza et al. included patients with both type 1 and type 2
Cloxacillin 9 (27.0) 11 (33.0) diabetes and the majority of T2DM patients were non-insulin
Ulcer gradea, N (%)
dependent. Moreover, they used ozonated olive oil. Also, the con-
Grade 1 18 (60.0) 16 (53.3)
Grade 2 12 (40.0) 14 (46.7) ventional hospital dressing was slightly different in their study as
Ulcer duration (months), mean ± SD 6.60 ± 4.56 6.73 ± 4.12 well as the assessment methods.
Abbreviations: N, number; SD, standard deviation; BMI, body mass index; FBS,
In the present study, the proportion of patients with completely
fasting blood sugar; HbA1c, glycated hemoglobin. healed, partially healed and unhealed wounds were 76.7%, 23.3%,
a
Based on Wagner Diabetic Foot Ulcer Grade Classification System. and 0%, respectively in the intervention group. Our results were to
4
A. Abdoli, R. Shahbazi, G. Zoghi et al. Diabetes & Metabolic Syndrome: Clinical Research & Reviews 16 (2022) 102678

Fig. 2. Wound healing in the topical olive oil group. Figure A: Pre-intervention, Figure B: At the end of week 3, Figure C: At the end of week 4.

Fig. 3. Wound healing in the topical olive oil group. Figure A: Pre-intervention; Figure B: At the end of week 4.

Table 2
Scores of ulcer parameters and total ulcer status at baseline and at the end of the study in olive oil and control groups.

Variables Groups P-valuea

Intervention (n ¼ 30) (Mean ± SD) Control (n ¼ 30) (Mean ± SD)

Ulcer degree score week 0 29.17 ± 11.23 28.17 ± 10.46 0.723

week 1 49.17 ± 14.45 33.17 ± 9.96 <0.001
week 2 66.17 ± 11.19 39 ± 11.02 <0.001
week 3 78.50 ± 8.72 46.33 ± 11.74 <0.001
week 4 92.83 ± 6.39 53 ± 11.11 <0.001
Ulcer color score week 0 65.67 ± 5.04 65.33 ± 5.07 0.795
week 1 75.67 ± 5.04 68.67 ± 6.81 <0.001
week 2 81.67 ± 6.48 72.67 ± 6.91 <0.001
week 3 86.67 ± 4.79 75.67 ± 6.79 <0.001
week 4 97.33 ± 4.5 78 ± 7.14 <0.001
Ulcer drainage score week 0 39.67 ± 10.33 37 ± 7.94 0.266
week 1 52.67 ± 9.44 40.67 ± 6.91 <0.001
week 2 67 ± 12.36 44.67 ± 8.19 <0.001
week 3 80.33 ± 9.28 47.67 ± 8.58 <0.001
week 4 95.67 ± 6.26 51.67 ± 9.5 <0.001
Surrounding tissues healing score week 0 34.83 ± 9.24 30 ± 11.67 0.081
week 1 54.17 ± 13.52 36.67 ± 12.55 <0.001
week 2 75 ± 13.77 42 ± 10.47 <0.001
week 3 90.83 ± 9.48 49 ± 12.06 <0.001
week 4 99 ± 2.03 57.33 ± 12.51 <0.001
Total ulcer status score week 0 167.63 ± 18.13 160.50 ± 13.79 0.092
week 1 230.33 ± 17.95 178.83 ± 19.33 <0.001
week 2 290 ± 20.38 198.33 ± 17.09 <0.001
week 3 336.83 ± 16.05 220.33 ± 21.97 <0.001
week 4 393.33 ± 12.75 240 ± 22.4 <0.001
a
Analyzed by the independent t-test.

5
A. Abdoli, R. Shahbazi, G. Zoghi et al.
some extent similar to the study of Nasiri et al. [21]. in which
proportions of complete healing, partial healing and lack of healing
were 73.3%, 26.7 and 0%, respectively in those treated with olive oil.
Almost identical protocol and ethnicity in our study and Nasiri
et al.'s study can justify similar findings. Elshenawie et al. [12], and
Aziza et al. [20] reported different results. Compared to our study,
in the study of Elshenawie et al., a lower percentage of patients
(60%) experienced complete healing at the end of follow-up, while
Aziza et al. indicated that majority of patients had complete wound
healing in the intervention group (88%).
The contradiction between our outcomes and findings of
Elshenawie et al. [12] and Aziza et al. [20] can be explained by
differences in the type and degrees of ulcers, study protocol, type of
olive oil, as well as dressing techniques.
In a recent study, Karimi et al. compared the impact of olive oil
with honey on DFU healing and their results were consistent with
our findings [15]. Olive oil has also been reported to be as useful as
fish oil for the prevention of heel pressure injury in intensive care
unit patients in another study by Karimi et al. [27]. They attributed
the preventive effect of olive oil to its capacity to maintain skin
moisture and freshness along with skin protective properties owing
to the presence of vitamins A and E [27], which may also be
beneficial for DFUs. Similarly, Poursadra et al. showed that olive oil,
although inferior to henna oil, can be effective for the healing of
pressure ulcers [28].
Dermatitis, allergic reactions, phototoxic reactions, and irrita-
tion are some of the possible side effects of topical herbal remedies
[29]. We observed neither allergic reactions nor other side effects
such as wound bleeding, infection, sensitivity and pain over the 4-
week follow up which confirms the safety of olive oil similar to
other studies [21].
The major strength of the current study was that patients in
both groups were comparable regarding demographic and
anthropometric features, as well as factors associated with T2DM
such as disease duration, HbA1c, and FBS. Moreover, most previous
studies used ozonated olive oil which may not be commercially
available, especially in countries with limited resources, while we
used ordinary olive oil. Besides, in our study the dressing was
changed by the patients themselves and still favorable results were
achieved, which obviates the need for attending the clinics and
reduces the costs of patient care.
Our study had a number of limitations. Nutritional status [30]
and type of occupation can increase the risk of feet injury and affect
ulcer healing [12], but we did not evaluate nutritional status or
occupation of patients in either groups.
5. Conclusions
In conclusion, our study revealed that application of topical olive
oil effectively improved DFU healing process while it did not have
any adverse effects. Topical olive oil might be an effective, safe,
accessible, and inexpensive adjunctive therapy along with standard
therapies for the management of superficial DFU. However, further
studies with longer durations and considering all types and grades
of foot ulcers are required to determine the effectiveness of topical
olive oil on wound treatment.
Declaration of competing interest
The authors declare that they have no conflict of interest.
Acknowledgement
We would like to express our sincerest gratitude towards the
patients who participated in the study and the personnel at Shahid
6
Diabetes & Metabolic Syndrome: Clinical Research & Reviews 16 (2022) 102678
Mohammadi Hospital, Bandar Abbas, Iran. We also thank the
Technology and Research Vice-Chancellery for funding the current
study under the grant ID: HUMS.REC.1396.24.
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