Association of Hemoglobin A1c and Wound Healing in Diabetic Foot Ulcers

Fesseha, Betiel; Abularrage, Christopher J.; Hines, Kathryn; Sherman, Ronald L.; Frost, Priscilla; Langan, Susan; Canner, Joseph K.; Likes, Kendall; Hosseini, Sayed Mohammad; Jack, Gwendolyne Anyanate; Hicks, Caitlin W.; Yalamanchi, Swaytha; Mathioudakis, Nestoras

doi:10.2337/dc17-1683

Cited by 47 publications

(55 citation statements)

References 45 publications

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“…No significant increase or decrease of the mortality was indicated among different HbA1c control levels. Consistent with previous literature, for patients with baseline HbA1c < 7.0%, elevated HbA1c during treatment was associated with accelerated wound healing [ 8 ], indicating that a slightly higher glycemic level was better for wound healing in DFU patients.…”

Section: Discussionsupporting

confidence: 89%

“…Although previous studies have suggested that lower baseline HbA1c level correlates with advanced wound healing [ 19 ], most studies noted that baseline HbA1c level was not associated with lower extremity wound healing in patients with diabetes. When baseline HbA1c was divided into < 6.5%, 6.5–8.0%, > 8.0%, as described by Fesseha et al [ 8 ], initial blood glucose level displayed no relationship with wound healing, based on the analysis using different adjusted models. A similar outcome was obtained in our investigation.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies focused on the benefit of blood glucose control to wound healing during the DFU treatment. Research by Fesseha et al [ 8 ] showed that increase of HbA1c during the treatment compared to admission was associated with a hazard ratio (HR) of nearly 2 for wound healing in DFU patients with baseline HbA1c < 7.5%, while no associated benefit was observed for DFU patients with baseline HbA1c over 7.5%. For the purpose of wound healing, this demands that blood glucose be controlled at higher levels if the initial HbA1c value is less than 7.5%.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies have focused on the control of blood glucose and the healing of DFU. Previous clinical studies showed no significant association between baseline HbA1c and wound healing [ 7 , 8 ]. However, recent research detected that, for those patients with baseline HbA1c < 7.5%, a rise in HbA1c during treatment was associated with an increased chance of wound healing [ 8 ].…”

Section: Introductionmentioning

confidence: 96%

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

Xiang

Wang

et al. 2018

Diabetes Ther

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IntroductionThe 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.MethodsHospitalized 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.ResultsBy 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.ConclusionA 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.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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

Xiang

Wang

et al. 2018

Diabetes Ther

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“…The list of independent clinical predictors of complete ulcer healing includes time since the beginning of the ulceration and the magnitude of its area. Of note, the HbA1c level did not influence this outcome, in line with a recently published observation [ 22 ]. Furthermore, it is well-known that end-stage renal failure and dialysis are associated with poor wound healing and limb amputation.…”

Section: Discussionsupporting

confidence: 90%

Negative-pressure wound therapy for management of chronic neuropathic noninfected diabetic foot ulcerations – short-term efficacy and long-term outcomes

et al. 2018

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PurposeNegative pressure wound therapy (NPWT) is an adjunct method used in the treatment of diabetic foot ulceration (DFU). Real world data on its effectiveness and safety is scarce. In this prospective observational study, we assessed the short-term efficacy, safety, and long-term outcomes of NPWT in patients with type 2 diabetes (T2DM) and neuropathic, noninfected DFUs.MethodsBased on wound characteristics, mainly area (>1 vs. ≤1 cm2), 75 patients with DFUs treated in an outpatient clinic were assigned to NPWT (n = 53) or standard therapy (n = 22). Wound area reduction was evaluated after 8 ± 1 days. Long-term outcomes assessed included complete ulceration closure and recurrence rate.ResultsPatients assigned to NPWT were characterized by greater wound area (15.7 vs. 2.9 cm2). Reduction in wound area was found in both the NPWT (−1.1 cm2, −10.2%, p = 0.0001) and comparator group (−0.3 cm2, −18.0%, p = 0.0038). No serious adverse events related to NPWT were noted. Within 1 year, 55.1% (27/49) of DFUs were closed in the NPWT group and 73.7% (14/19) in the comparator group (p = 0.15). In the logistic regression, wound duration and smaller initial area, but not treatment mode, were associated with closure. One-year follow-up after DFU resolution revealed an ~30.0% recurrence rate in both groups (p = 0.88).ConclusionsNPWT is a safe treatment for neuropathic, nonischemic, and noninfected DFU in patients with T2DM, although this observational study did not prove its effectiveness over standard therapy. Additionally, we report a high rate of both closure and recurrence of ulcers, the latter irrespective of initial ulcer area.

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Post-Revascularization Management

Yates,

Madassery

2023

Limb Preservation for the Vascular Specialist

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Association of Hemoglobin A1c and Wound Healing in Diabetic Foot Ulcers

Cited by 47 publications

References 45 publications

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

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

Negative-pressure wound therapy for management of chronic neuropathic noninfected diabetic foot ulcerations – short-term efficacy and long-term outcomes

Post-Revascularization Management

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