Glycosylated Hemoglobin Levels And Wound Healing In Diabetic Foot Ulcers, In Type 2 Diabetes – One Year Prospective Study

Abstract

Introduction: Diabetes mellitus is a metabolic disorder that is characterized by hyperglycemia. It is associated with many chronic complications that lead to significant disability, morbidity and even mortality. Diabetic foot ulcers (DFUs) are now the most common cause of non-traumatic lower limb amputation. The main pathophysiological factors associated with DFUs are – neuropathy, vasculopathy, wound infection and poor wound healing. Diabetes is known to alter all stages of the normal wound healing process. Studies have proven that hyperglycemic state alters cellular and molecular processes which occur in wound healing. Thus, control of hyperglycemia or strict glycemic control may help to promote faster wound healing. The long-term glycemic control is best represented by glycosylated hemoglobin or HbA1c which is the level of average plasma glucose over 2 to 3 months. HbA1c is now an indispensable laboratory test that is used to screen and diagnose diabetes mellitus. It is also used to guide the treatment regimens to attain adequate glucose control. Elevated HbA1c levels have been implicated as predictors of microvascular complications of diabetes such as neuropathy, retinopathy and nephropathy. The aim of this study is to find an association between HbA1c and wound healing and also to establish HbA1c as a predictor of wound healing in DFUs. Methodology: This prospective study was conducted in KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi, from January 2017 to December 2017. It included 90 type 2 diabetic patients who were admitted to the hospital with diabetic foot ulcers. The HbA1c levels of all patients was measured at admission for all the 90 patients. The 90 patients were then divided into 3 groups based on their HbA1c levels into group 1 (<7%), group 2 (7% to 8%) and group 3 (>8%). The healing of diabetic foot ulcers with conventional saline dressing was recorded as area reduction over 15 days. The wound healing was calculated as area reduction per day or rate of wound healing (rate of wound healing = area reduction/15). The association between HbA1c levels and rate of wound healing was then analyzed. Results: Of the 90 patients, 67 (74.4%) were males and most of them (35 of 90 or 38.9%) aged more than 61 years. The mean duration of diabetes was around 9 years and majority of them (44.4%) had diabetic foot ulcer for 1 to 4 weeks. All of these parameters and other parameters such as location of ulcer and grade of ulcer showed no significant difference in distribution among the 3 groups. Presence of neuropathy, PVD or wound infection which are implicated as risk factors for DFU did not show statistically significant association with the rate of wound healing. Only HbA1c level was found to have statistically significant association with rate of wound healing. (P value < 0.001) Conclusion: This study concluded that HbA1c was the only independent factor to be significantly associated with wound healing and wound outcome. Few studies done previously have found a positive association between HbA1c levels and wound healing. Thus, HbA1c may be considered as a good predictor of wound healing in DFUs. More similar studies and RCTs are required to establish this.