What's the buzz : bee products and their potential value in diabetic wound healing

Foot ulceration, secondary to diabetes, is the most common reason for lower limb amputation, accounting for 50-70% of non-traumatic lower limb amputations. Rather than progressing through the usual wound healing phases, diabetic wounds become 'stuck', predominantly in the inflammatory phase. Normal feedback mechanisms that conclude the inflammatory stage are short-circuited, and the inflammatory response is upregulated and persistent. Chronic diabetic wounds always have a bacterial load, and the increased tissue bacterial burden may impede healing. Since ancient times, bee-derived products have been used as medicines and as potential wound healing therapies. Their anti-inflammatory and anti-bacterial properties have been widely reported. Honey, propolis, royal jelly, and bee venom have pre-clinical wound healing properties. This review seeks to examine factors that prevent diabetic wound healing and the potential of four bee products to promote diabetic human healing in these wounds. The indication for key clinical trials in this exciting area of bee-derived products is also emphasized.