Comparative efficacy of stingless bee (kelulut) honey and medical-grade manuka honey following maggot debridement therapy in diabetic foot ulcer treatment

Abstract

Diabetes-based foot complications have become a healthcare burden to many developing countries where 25% of diabetics with poorly controlled diabetes tend to develop diabetic foot ulcer (DFU) in their lifetime. DFU is resistant to conventional methods and takes a longer time to heal. Medical-grade manuka honey has been proven to show positive wound healing outcomes and is used alternatively in healthcare settings. However, research on stingless bee (kelulut) honey has not been forthcoming. Thus, this study was conducted to evaluate the efficacy of kelulut honey in the healing of DFU as compared to medical-grade manuka honey based on the ulcer size reduction from baseline to days 7 and 14. Maggot debridement therapy (MDT) using sterile maggots of local species Lucilia cuprina was utilised as the debridement modality in this study. Quasi-experimental study design was applied to perform the study in University Malaya Medical Centre (UMMC) involving 60 participants with DFU who were divided into two groups receiving kelulut honey (Group 1) and medical-grade manuka honey (Group 2). Wound measurements were done at baseline, day 7, and day 14 using a mobile wound monitoring application system, NDKareTM. Statistical analysis with Mann-Whitney U test yielded a statistically significant percentage of ulcer size reduction (p<0.001) on day 14 between the kelulut honey group and medical-grade manuka honey group (47.10% vs 7.5%). The findings indicated that kelulut honey is more effective than medical-grade manuka honey and advocated kelulut honey as a potential wound dressing to improve the healing of DFU.