Diabetic wounds: Pathophysiology, complications and advances from conventional to modern therapies

Diabetic wounds, particularly foot ulcers, represent one of the most severe complications of diabetes mellitus, contributing to high morbidity, prolonged hospitalization and an increased risk of lower-limb amputation. Their management places a substantial economic burden on healthcare systems worldwide while severely impairing patients’ quality of life. Conventional therapies such as glycemic control, debridement, infection management and surgical interventions remain the cornerstone of care but are often inadequate due to persistent oxidative stress, impaired angiogenesis, neuropathy and immune dysfunction. These pathological factors delay granulation tissue formation, collagen deposition and epithelialization, resulting in chronic, non-healing wounds with a high recurrence rate. In recent years, nutraceuticals have emerged as promising adjuncts to conventional therapy. Bioactive compounds such as vitamins C and E, zinc, copper, magnesium, curcumin, resveratrol, omega-3 fatty acids, probiotics and herbal extracts demonstrate diverse therapeutic properties, including antioxidant activity, modulation of inflammatory pathways, promotion of angiogenesis and enhancement of tissue remodeling. Advances in delivery systems, particularly nanoparticles and hydrogels, have further improved their bioavailability and clinical potential. Although preclinical findings are encouraging, clinical validation through well-designed randomized controlled trials remains limited. This review provides a comprehensive overview of the pathophysiology, risk factors and complications of diabetic wounds, outlines conventional therapeutic approaches and emphasizes the emerging role of nutraceuticals. By integrating nutraceuticals with standard care, future strategies may enable more effective, safe and cost-efficient management of diabetic wounds.