Hyperbaric Therapy for Diabetic Wounds

HBOT is FDA-cleared for diabetic lower-extremity wounds that have not responded to standard wound care.

Diabetic foot ulcers are a serious complication of diabetes. Studies estimate that 15% to 25% of people with diabetes will develop a foot ulcer at some point in their lives. These wounds are a leading cause of non-traumatic lower-limb amputations in the United States.

HBOT is an FDA-approved treatment option for these hard-to-heal wounds. If you want a broader overview of how HBOT works, start with our guide to hyperbaric oxygen therapy.

How HBOT Treats Diabetic Wounds

Diabetes damages both circulation and nerve function. Over time, small blood vessels narrow and blood flow to the feet drops. This creates a low-oxygen (hypoxic) environment in wound tissue. Wounds can’t heal without oxygen.

HBOT puts you in a pressurized chamber and delivers 100% pure oxygen. This floods the blood with dissolved oxygen and pushes it into tissue that normal circulation can’t reach.

Inside the wound, that oxygen does three important things. It stimulates new blood vessel growth through angiogenesis, rebuilding the supply network in damaged tissue. It restores the killing power of white blood cells, which need oxygen to destroy bacteria. And it drives collagen production, the structural protein required to form new tissue.

Together, these effects create conditions where a wound that wasn’t healing can finally start to close.

What the Research Shows

The evidence for HBOT in diabetic wounds is substantial. Two key studies support its use.

A 2015 Cochrane systematic review by Kranke et al. analyzed randomized controlled trials on HBOT for chronic wounds. The review found that HBOT reduced major amputations in patients with diabetic foot wounds. This is the most rigorous level of evidence available in medicine. (PMID: 25970028)

A 2011 study by Londahl et al. examined the relationship between ulcer healing after HBOT and blood flow measurements including transcutaneous oximetry and toe blood pressure. The study found that patients with adequate blood flow benefited most from treatment. It reinforced the importance of patient selection. (PMID: 21523396)

The Cochrane review found reduced rates of major amputation among patients who received HBOT compared to those who didn’t. For the right patient, that’s a meaningful clinical difference.

Who Qualifies for HBOT Treatment

Not every diabetic wound qualifies. Doctors use the Wagner grading scale to classify wound severity. Most insurance coverage and clinical guidelines require a Wagner Grade III or higher wound. That means a wound with deep ulceration, abscess, or bone involvement.

You’ll typically need to meet all of these criteria:

• A diabetic lower-extremity wound rated Wagner Grade III or above
• Failure to respond after 30 days of standard wound care (debridement, offloading, infection control, blood sugar management)
• Adequate arterial circulation, confirmed by vascular testing (transcutaneous oximetry or ankle-brachial index)

If circulation is severely compromised, HBOT won’t be effective. Your wound care team will run tests to confirm your wound can benefit before starting treatment.

Most protocols run 20 to 40 sessions at 2.0 to 2.4 atmospheres absolute (ATA), each lasting 90 to 120 minutes, five days per week over 4 to 8 weeks.

Insurance and Medicare Coverage

Medicare covers HBOT for diabetic lower-extremity wounds under specific conditions. Your wound must meet the Wagner Grade III or higher threshold, fail 30 days of standard care, and be documented by a treating physician.

Most major private insurers follow similar criteria. Coverage isn’t automatic, and prior authorization is often required.

For a detailed breakdown of how insurance handles HBOT costs, visit our guide to HBOT insurance coverage. You can also learn about out-of-pocket costs on our HBOT cost guide.

If you’re unsure whether you qualify, a wound care center or hyperbaric medicine physician can review your records and help you through the authorization process.

Frequently Asked Questions

Does Medicare cover HBOT for diabetic wounds?

Yes, under specific criteria. Your wound must be Wagner Grade III or higher, must have failed at least 30 days of standard wound care, and you must have adequate arterial blood flow confirmed by testing. Your doctor will document all of this when requesting prior authorization.

How many sessions does it take to heal a diabetic wound?

Most protocols involve 20 to 40 sessions. Your care team will evaluate your progress at the 20 to 30 session mark. If the wound is responding, treatment continues. If it isn’t, they’ll reassess the plan.

Can HBOT prevent amputation?

Research suggests it can reduce amputation rates in qualifying patients. The Kranke et al. 2015 Cochrane review found reduced major amputations among diabetic patients treated with HBOT compared to those who weren’t. It’s not a guarantee, but for the right patient, it’s a meaningful benefit.

Is HBOT a replacement for wound care?

No. HBOT works alongside standard care, not instead of it. You’ll still need debridement, proper offloading of the foot, infection management, and tight blood sugar control. HBOT is one part of a comprehensive wound care plan.

References

1. Kranke P, et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015. PMID: 25970028
2. Londahl M, et al. Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure, and ankle-brachial index in patients with diabetes and chronic foot ulcers. Diabetologia. 2011. PMID: 21523396

Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.