The Association of HbA1c Variability with 12Week and 12Month Outcomes on Diabetes Related Foot Ulcer Healing.

Abstract

This study aimed to determine the relationship between HbA1c variability and foot ulcer healing at 12weeks and 12months. Using National Diabetic Foot Care Audit (NDFA) and hospital records, demographics, baseline ulcer characteristics and healing outcomes for subjects presenting with a foot ulcer between 2017-2022 were collected at 12weeks and 12months. Subjects had diabetes duration > 3years and ≥ 3 HbA1c recordings in the 5years prior to presentation. At 12weeks, factors associated with an active ulcer were presence on hind foot (adjusted odds ratios) (2.1 [95% CI 1.3-3.7]), ischaemia (2.1 [95% CI:1.4-3.2]), area > 1 cm2 (2.7 [95% CI:1.7-4.2]) and diabetes duration > 24years vs 3-10 (AOR 2.0 [95% CI 1.2-3.5]). After adjustment, HbA1c variability 6-10mmol/mol and > 14.5mmol/mol had AOR of 1.76 (95% CI 1.1-2.8; p = 0.0192) and 1.5 (95% CI 0.9-2.6; p = 0.1148) of an active ulcer at 12weeks vs variability < 6mmol/mol. At 12months, ischaemia (AOR 2.4 [95% CI 1.5-3.8]) and diabetes duration > 24years vs 3-10years (AOR 3.3 [95% CI 1.7-6.4] were significant factors. HbA1c variability was not significant at 12months. In keeping with the national NDFA data, in our cohort ulcer characteristics, but not HbA1c variability, were the key factors associated with ulcer healing at 12weeks and 12months.