Natural honey and diabetic wound healing: A review of literature

Honey has been used widely for the treatment of various types of chronic burns, necrotic diabetic foot and post-operative split skin wounds. Despite the fact that wounds in diabetic patients are similar to wounds in normal patients, the healing process is different from that of other wounds. The most worrisome aspect of diabetic wounds is that the healing process is unduly prolonged. Poor oxygenation of tissues occurs in diabetic wounds and is caused by early inflammatory responses and a heavy load of Reactive Oxygen Species (ROS) induced by high blood sugar levels in diabetic patients. The formation of advanced glycation end-products (AGEs) under severe hyperglycemic conditions and interaction with their receptors (RAGE) are also known to impair wound healing among diabetic patients. The antioxidant, anti-inflammatory and antibacterial effects of natural honey significantly promote the healing process in diabetic wounds. This is due to the presence of hydrogen peroxide (H2O2) produced by the action of glucose oxidase on glucose in the honey, nitric oxide and the hyperosmolar nature of natural honey. Honey also stimulates angiogenesis in the wound environment thereby enhancing wound healing in diabetics. The potent antioxidants in natural honey include, phenolics, flavonoids, ascorbic acid and certain enzymes such as catalase. Glucose oxidase from the bee crop slowly breaks down glucose into gluconic acid, which lowers the pH of honey, and the presence of hydrogen peroxide helps to kill bacteria in diabetic wounds. In a wound site, the lower pH of honey (3.5–4) reduces protease activity, increases oxygen release from hemoglobin, and stimulates the activity of macrophages and fibroblasts, while the hydrogen peroxide content sterilizes the wound and stimulates vascular endothelial growth factor (VEGF) production.