BENGALURU: Around 6.2 crore Indians are affected by diabetes currently. When the blood sugar level is more than 200mg per decilitre consistently for five years, a peripheral neuropathy (weakness, numbness and pain from nerve damage, usually in the hands and feet) is a possibility. Diabetic foot ulcers are common in such patients.
While surgical debridement (cleaning dead tissue in a wound) is done commonly, lesser known maggot therapy is an option. Maggot therapy is a type of biotherapy that involves applying live, disinfected maggots on soft tissue wounds. The larvae eat necrotic/dead tissue in the wound and disinfect it. The thought of creepy crawlies in your limb may be unacceptable but it has shown successful results. Charaka Samhita, an ancient Sanskrit text that is one of the foundational texts for Ayurveda in India, mentions maggot therapy.
In the US, the Food and Drug Administration (FDA) has approved the use of maggots as medical device. Dr BR Srinivas, a diabetologist who runs City Healthcare Hospital in Kolar, has been treating diabetics for more than a decade now. “One cannot believe the kind of diabetic foot ulcers you get to see in rural areas. They are unaware of the necrotic/dead tissue. Since there is no sensation they step on foreign objects and are not aware of it. Once I found three stapler pins embedded in a patient’s foot,” he said.
Appalled by the number of patients coming with diabetic foot ulcers where the amount of dead tissue to be removed was a lot and non-healing, he turned to Charaka Samhita for a solution and treated five patients with favourable results. Now he has written to the director of AYUSH in Karnataka requesting him to use the therapy in AYUSH hospitals in the state.
AYUSH director Raj Kishore Singh said that a protocol had to be developed before using it. He has also written to the Drug Controller General of India to recognise maggots as a medical device.
Dr Sanjay Reddy, consultant diabetologist, Fortis hospital, Cunningham Road, said, “It is rare in Indian hospitals because we are not sure where ulcer grade maggots are available. I do not have first-hand experience of working with it but even a physician can administer it. In UK, there are medical-grade maggots that are approved and are used commercially. It’s been there for ages. It costs 20-30 pounds in the UK. It’s legal, it’s available all across the world.”
On the aspect of legality, Indian laws are silent on maggot therapy. “If one is using a new form of therapy, they should take the local ethics committee permission giving evidence for the procedure and then go ahead. But maggots therapy are not patented or anything, and neither is it a new drug or device or biological substance or biotechnology,” Reddy added.
Dr R Balaji, HOD, Plastic Surgery, Kempegowda Institute of Medical Sciences, has been treating diabetic foot for the past 25 years. “I’d rather use surgical debridement than maggots because the latter is time consuming. Also, culture maggots are available only in Mumbai,” he said.