Reasonable Glycemic Control Would Help Wound Healing During the Treatment of Diabetic Foot Ulcers

Abstract

Introduction: The effect of glycemic control on wound healing in patients with diabetic foot ulcers (DFUs) is inconsistent among different studies. This study was performed to investigate the association between level of hemoglobin A1c (HbA1c) at baseline as well as during treatment and wound healing and mortality in patients with DFU.

Methods: Hospitalized DFU patients were recruited consecutively with their basic clinical data collected and treated according to clinical practice guidelines. These patients were followed-up for 1 year to observe the outcomes, including ulcer healing and death. The associations between baseline HbA1c level or mean HbA1c level during treatment and wound healing as well as mortality were evaluated in univariate and multivariate logistic regression models.

Results: By the end of the follow-up, 40 (13.4%) patients had died. A total of 168 (65.1%) patients achieved ulcer healing in the remaining 258 living participants. Baseline HbA1c was not associated with ulcer healing in unadjusted or adjusted models (P > 0.05). The wound healing rate was higher (OR 2.01, 95% CI 1.02-3.96, P < 0.05) after adjustment when HbA1c was controlled between 7.0% and 8.0% during treatment compared to HbA1c controlled at less than 7.0%. This probability of ulcer healing increased to 3 (OR = 3.01, 95% CI 1.32-6.86, P = 0.01) after adjustment in the subgroup with baseline HbA1c no more than 8.0%. Neither baseline HbA1c nor mean HbA1c during treatment presented any correlation with 1-year death rate.

Conclusion: A reasonable HbA1c target, a range between 7.0% and 8.0% during treatment, could facilitate ulcer healing without increase of mortality in patients with DFU, especially for those with better glycemic control at admission.

Keywords: Diabetic foot ulcers; HbA1c; Mortality; Wound healing.

Fig. 1

Kaplan–Meier curves of ulcer healing among different a baseline HbA1c groups or b groups stratified by mean HbA1c during treatment. Kaplan–Meier curves of death among different c baseline HbA1c groups or d groups stratified by mean HbA1c during treatment. HbA1c measurements were categorized as quartiles (≤ 7.0%, 7.1–8.0%, 8.1–9.0%, > 9.0%). Thick solid line, HbA1c ≤ 7.0%. Dashed line, HbA1c 7.1–8.0%. Thin solid line, HbA1c 8.1–9.0%. Dotted line, HbA1c > 9.0%. Log-rank test was used to make comparisons of ulcer healing and death among different groups stratified by baseline HbA1c or mean HbA1c during treatment

Fig. 2

1-year accumulated death rate of patients with DFU at different glycemic level. Dark gray, groups stratified by baseline HbA1c. Light gray, groups stratified by mean HbA1c during treatment