Evaluating Remote Ischemic Conditioning (RIC) and Standard of Care vs. Sham Therapy and Standard Care

A double blind, randomized controlled clinical trial comparing wound closure rates of diabetic foot ulcers (DFUs) in subjects receiving active RIC treatment plus standard of care compared to those receiving sham treatment plus standard of care.

The general objective of this double-blind study is to test the effectiveness of RIC in a population of patients with diabetic foot ulcers: Active treatment 3x per week (RIC) plus SOC compared to Sham Comparator 3x per week and SOC

Determine median time to initial wound closure in both active and sham group.

Eligibility Criteria:
Inclusion Criteria:

1. Subjects of any gender between the ages of 18 and under 90 at the time of consent. The goal will be to enroll 50% of the subjects who are Medicare beneficiaries.
2. Target ulcer has a minimum area of 0.7 cm2 and a maximum area of 20.0 cm2, measured at randomization after sharp debridement, as assessed by photographic planimetry.
3. Target ulcer open for a minimum of 4 weeks and a maximum of 52 weeks duration prior to the screening visit.
4. Target ulcer is located on any aspect of the foot, including the toe, lateral dorsal, medial or plantar aspect of the foot. At least 50% of the ulcer must be below the malleolus.
5. Target ulcer is Wagner Grade I or Grade II without exposed bone.
6. Subjects' wound score on IDSA tool is Grade 1 or 2.
7. Adequate perfusion without critical limb ischemia, confirmed by vascular assessment of the affected foot through any of the following methods within 3 months of the first screening visit:

   Toe pressure ≥ 50 mm Hg; Ankle pressure ≥70 mm Hg; ABI between 0.7 and ≤ 1.3; TCOM ≥ 40 mmHg; Doppler ultrasound scan of peripheral blood flow with wave patterns that are triphasic or biphasic; Skin Perfusion Pressure (SPP) ≥30 mmHg.
8. Diagnosis of type 1 or 2 Diabetes mellitus,
9. Subject has a known glycated hemoglobin A1c (HbA1c) level of less than 12% within the last three months.
10. If subject has two or more ulcers, they must be separated by at least 2 cm and the largest one will be included as the study DFU though all will be similarly treated.
11. The target ulcer has been offloaded for at least 14 days prior to randomization.
12. Subject is willing to use prescribed off-loading method for the duration of the study.
13. Subject is available for the entire study period and all follow up visits. In addition, the subject is able and willing to adhere to the protocol requirements.
14. Subject able and willing to give written informed consent.

Exclusion Criteria:

1. Target ulcer is due to a non-diabetic etiology.
2. Presence in target ulcer of cellulitis, osteomyelitis or other clinical evidence of infection.
3. If the Target ulcer has reduced in area by 20% or more after 2 weeks of standard of care from the first screening visit (S1) to the TV-0/randomization visit.
4. An ulcer that has healed by more than 20% in the 2 weeks prior to screening: "historical" run-in period.
5. Presence of any foot ulcer (whether or not on the target foot) for which local or systemic antibiotic treatment is required.
6. A history of more than 8 weeks' treatment with immunosuppressants (including systemic corticosteroids at doses greater than 5mg of Prednisone or equivalent), cytotoxic chemotherapy, or application of topical steroids to the ulcer surface within one month prior to initial screening, or treatments with such medications during the screening period, or anticipated requirement of such medications during the study.
7. Subjects with an amputation on the affected foot, only if it impedes proper offloading of the target DFU.
8. Subjects with active Charcot foot, or inactive Charcot foot, if it impedes proper offloading of the target DFU.
9. Women who are pregnant or considering becoming pregnant within the next 6 months.
10. Presence of subject having recent or current alcohol or drug abuse.
11. Subjects with severe kidney disease who are currently untreated or undergoing dialysis treatment.
12. Participation in another study involving treatment with an investigational product within the previous 30 days.
13. Any other medical or psychological conditions that, in the opinion of the Investigator, may make subject's participation unreliable or may interfere with study assessments.
14. There is a history of radiation to the target ulcer.
15. Subject has received HBO less than 30 days prior to screening.
16. Subject has received a cellular tissue product (CTP) less than 30 days prior to screening.