Association of Glycosylated Haemoglobin and Wound Healing in Diabetic Foot Ulcer: A Prospective Cohort Study

Abstract

Introduction: Diabetes Mellitus (DM) is a disease that, over time, can affect practically all organ systems in the body, including the skin and circulatory systems. An estimated 15% of all diabetic patients develop a foot ulcer in their lifetime. Although it is clear from the literature review that strict glycaemic control prevents complications, the relationship between Glycosylated Haemoglobin (HbA1c) value and wound healing in diabetic foot patients is less well-defined. Aim: To determine the association between Glycosylated Haemoglobin (HbA1c) and wound healing rate in Diabetic Foot Ulcers (DFUs). Materials and Methods: This prospective cohort study was conducted in the Department of General Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India, between August 2018 and July 2020. All patients between 18 and 70 years old, diagnosed with diabetic foot according to the World Health Organisation definition, and presenting with a lower limb ulcer were included as study participants. A detailed clinical history, examination of the patient, limb, and ulcer, and baseline HbA1c assessment were performed. The ulcer wound was graded and staged according to the University of Texas Wound classification system. All selected patients were divided into two groups. Group-A (n=15) comprised patients with HbA1c ≤7%, and Group-B (n=15) consisted of patients with HbA1c >7%. The primary outcome was the wound healing rate per day in relation to HbA1c levels at baseline and subsequent followup. The secondary outcomes were the demographic profile and predisposing factors affecting the healing of DFUs. Student’s t-test (two-tailed, independent) and Chi-square/Fisher’s-exact tests were performed for statistical analysis. Results: The mean age of the subjects was 57.33±7.43 years in Group-A and 56.20±7.51 years in Group-B. There was a male preponderance in both Group-A (9) and Group-B (11). A total of 11 (36.7%) patients had a history of smoking, all of them being male. The mean healing rate per day was 0.09±0.02 cm2 /day in Group-A patients, which is higher compared to Group-B with 0.02±0.01 cm2 /day. Conclusion: Strict glycaemic control is a mainstay in preventing the progression of foot ulcers to gangrene and, therefore, amputation. A lower baseline HbA1c at the presentation of DFU is indicative of a favourable outcome in terms of wound healing, with comprehensive treatment and follow-up efforts.