Diabetic Ulcers Research Articles

Assessment of Antimicrobial Activity of Chitosan, ZnO, and Urtica dioica-ZnO NPs Against Staphylococcus aureus Isolated from Diabetic Ulcers.

Staphylococcus aureus (S. aureus) is considered as one of the challenging ulcer infections in diabetic patients especially those who have acquired antibiotic-resistant infections. Nanotechnology products have enormous potential to treat diseases including infectious diseases. As chitosan and zinc oxide (ZnO) nanoparticles (NPs) have harbored a high antimicrobial effect, this survey was aimed to synthesize chitosan, ZnO, and ZnO-Urtica. diocia (ZnO-U. diocia) NPs, and to assess their antimicrobial effects and their influence on virulencegenes expression in S. aureus isolates from diabetic ulcers. The antibacterial effect of NPs was detected by microdilution method. The most frequently components in U. diocia aqueous extract were linalool,4-thujanol, camphor, carvacrol, propanedioic acid, and di(butyl) phthalate. More than 95% of clinical S. aureus isolates were resistant to several antibiotics including erythromycin, cefoxitin, clindamycin, and ciprofloxacin. The most resistant isolates were S. aureus ATDS 52, ATDS 53, F5232, and F91. The lowest MIC and MBC by the NPs on the isolates was detected as 0.128 g/mL and 0.178g/mL, respectively. A significant decrease of 90% in the expression rates of lukED and RNAIII genes was reported for S. aureus isolates treated with the NPs. The synthetized ZnO-U. diocia and chitosan NPs can be proposed as a reliable and effective antimicrobial agent targeting diabetic ulcers infections caused by S. aureus because of its high effects on the bacterial growth and virulence genes expression.

Anthocyanidin-Loaded Superabsorbent Self-Pumping Dressings for Macrophage Immunomodulation and Diabetic Wound Healing.

Management of diabetic chronic wound exudate is a serious challenge in healthcare worldwide since it is related to the speed of diabetic wound healing. However, current foam dressings not only absorb fluid to generate swelling and compress the wound to hinder wound healing but also are very thick and less comfortable to use. Herein, a superabsorbent self-pumping ultrathin dressing is reported to accelerate diabetic wound healing by achieving superior exudate absorption and management in an ultrathin state. The self-pumping dressing is composed of a drainage layer loaded with anthocyanidin and a thermoplastic polyurethane absorbent layer embedded with superabsorbent particles. The dressing realizes the self-pumping process of unidirectional exudate draining to the absorption layer through the drainage layer without significant dressing swelling to compress the diabetic wound. The dressing is experimentally proven to unidirectionally drain excessive exudate with inflammatory factors and modulate the conversion of macrophages from M1 to M2 in diabetic wounds, thereby promoting the healing of diabetic skin ulcers faster than commercial foam dressings. Therefore, the dressing provides a new idea and novel method for accelerating diabetic skin ulcer healing.

Management of Diabetic Foot Ulcers with Two Forefoot Offloading Techniques: Case Series.

Offloading is a key principle to healing diabetic foot ulcers. Nonremovable knee-high offloading devices are considered the criterion standard for offloading plantar forefoot ulcers. However, patients exhibit a limited tolerance for these devices, which contributes to a lack of use. In this case series describing two patients, the authors share two alternative offloading modalities for the treatment of diabetic plantar forefoot ulcers. One patient was managed using a football offloading dressing, and the other was managed with a modified felted football dressing. The football and modified felted football offloading dressings provide a cost-effective, less time-consuming application and often are a better-tolerated alternative to nonremovable knee-high offloading devices. Clinical findings support further investigation into dressing options tolerated by patients with improved adherence and optimal healing outcomes.

Relationship Between Complications and Readmissions in Type 2 Diabetes Mellitus Patients in Aceh, Indonesia

Introduction: Complications in diabetes mellitus patients are among the causes of hospital readmissions. Readmissions negatively impact patients’ quality of life and increase health and care costs. This study aims to explore the relationship between complications and readmissions in type 2 diabetes mellitus patients. Methods: A correlational study was utilized with a cross-sectional design. A total of 184 readmission patients with type 2 diabetes mellitus were selected as the sample using the accidental sampling technique. Data were collected through a questionnaire consisting of the Diabetes Early Readmission Risk Indicators (DERRI™) and the Readmission Questionnaire providing 4 answer choices, i.e. ≤ 30 days; > 30–60 days; > 60–90 days; and > 90 days. The Chi-square test was employed for data analysis. Results: Of all respondents, the majority are in late adulthood (50-61 years), totaling 70 individuals (38.0%) with a mean age of 57.3 years; 111 individuals (60.3%) are male; 99 (53.8%) have completed elementary education; 102 (55.4%) work as farmers/laborers/fishermen; and 67 (36.4%) use Humalog as their insulin. Moreover, 69 respondents (37.5%) have experienced the third readmission, which is the highest number of readmissions. The bivariate analysis reveal that there is a significant relationship between complications of type 2 diabetes mellitus and patient readmission (p=0.000). Conclusion: The findings demonstrate complications as a factor associated with readmissions of type 2 diabetes mellitus patients. The complications leading to the readmissions include hypoglycemia, hypertension, heart problems, kidney problems, diabetic ulcers, and strokes. Also, age contributes as a factor increasing the readmission risk of patients with type 2 diabetes mellitus. The results emphasize the need to re-evaluate health service strategies and nursing interventions by providing effective discharge planning to prevent complications or reduce readmissions in type 2 diabetes mellitus patients.

In-vitro and in-vivo evaluation of angiogenic potential of a novel lithium chloride loaded silk fibroin / alginate 3D porous scaffold with antibacterial activity, for promoting diabetic wound healing

Healing diabetic ulcers with chronic inflammation is a major challenge for researchers and professionals, necessitating new strategies. To rapidly treat diabetic wounds in rat models, we have fabricated a composite scaffold composed of alginate (Alg) and silk fibroin (SF) as a wound dressing that is laden with molecules of lithium chloride (LC). The physicochemical, bioactivity, and biocompatibility properties of Alg-SF-LC scaffolds were investigated in contrast to those of Alg, SF, and Alg-SF ones. Afterward, full-thickness wounds were ulcerated in diabetic rats in order to evaluate the capacity of LC-laden scaffolds to regenerate skin. The characterization findings demonstrated that the composite scaffolds possessed favorable antibacterial properties, cell compatibility, high swelling, controlled degradability, and good uniformity in the interconnected pore microstructure. Additionally, in terms of wound contraction, re-epithelialization, and angiogenesis improvement, LC-laden scaffolds revealed better performance in diabetic wound healing than the other groups. This research indicates that utilizing lithium chloride molecules loaded in biological materials supports the best diabetic ulcer regeneration in vivo, and produces a skin replacement with a cellular structure comparable to native skin.

Pengaruh Zinc Chitosan Cream terhadap Proses Penyembuhan Ulkus Diabetikum pada Pasien Diabetes Mellitus Tipe II

The aim of this study was to analyze the healing process of diabetic ulcers in Type II Diabetes Mellitus patients on day 1, day 7 and day 14 at the Asri Wound Care Center Medan clinic. The research method used is Quasi Experimental research using a one group pretest-posttest design. The intervention used is Zinc Chitosan Cream. The tests used are the Kruskal Wallis Test and the Wilcoxon Test. The research results show that the Sig. (2-tailed) day 1 to day 7 for an Asymp Sig value of 0.000 < 0.05 there is a significant difference, day 7 to day 14 for an Asymp Sig value of 0.157 < 0.05 there is no significant difference, day 1 to day for the 14th Asymp Sig value of 0.000 < 0.05, there is a significant difference, it can be concluded that the effect of Zinc Chitosan Cream on healing diabetic ulcers in Type II Diabetes Mellitus patients only affects days 1 - 7 and day 1 - 14, whereas for days 7 – day 14 in healing diabetic ulcers in patients with Type II Diabetes Mellitus does not affect the wound healing process. In conclusion, Zinc Chitosan Cream in healing diabetic ulcers in Type II Diabetes Mellitus patients only has an effect on days 1 - 7 and days 1 - 14. Keywords: Type II Diabetes Mellitus, Diabetic Ulcers, Zinc Chitosan Cream.

Penurunan Kompresi Balutan Pada Perawatan Ulkus Diabetikum Disertai Dengan Gangguan Pada Pembuluh Darah Arteri dan Vena

Diabetic ulcers are one of the complications of diabetes mellitus. Diabetic ulcers can be aggravated by the presence of vascular disorders, such as arteries and veins because they will give a painful sensation to the ulcer area. Therefore, proper wound care is needed to minimize the effects of these vascular disorders, namely by reducing the compression of the wound dressing. This study aims to look at the development of diabetic ulcers accompanied by arterial and venous vascular disorders by providing decreased dressing compression during wound care. The research design used is a single case study on a patient with grade IV diabetic ulcer accompanied by arterial and venous vascular disorders. The intervention was to decrease dressing compression for 10 days of wound care.. From the wound care, improvement was obtained with reduced slough, the firm boundaries of the wound began to appear, the wound area was reduced from 10 x 7 cm to 9.3 x 7 cm. Decreasing dressing compression during wound care is considered a positive development for diabetic ulcers with arterial and venous compromise.

Natural Polymer-Based Hydrogel Dressings for Wound Healing.

Significance: Acute wounds such as severe burns and chronic wounds like diabetic ulcers present a significant threat to human health. Wound dressings made from natural polymers offer inherent properties that effectively enhance wound healing outcomes and reduce healing time. Recent Advances: Numerous innovative hydrogels are being developed and translated to the clinic to successfully treat various wound types. This underscores the substantial potential of hydrogels in the future wound care market. Economically, annual sales of wound care products are projected to reach $15-22 billion by 2024. Critical Issues: While chitosan-, cellulose-, and collagen-based hydrogel dressings are currently commercially available, scaling-up and manufacturing hydrogels for commercial products remain a challenging process. In addition, ensuring the sterility and stability of the chemical or biological components comprising the hydrogel is a critical consideration. Future Directions: In light of the persistent increase in wound fatalities and the resulting economic and social impacts, as well as the importance of educating the public about dietary health and disease, there should be increased investment in new wound care dressings, particularly hydrogels derived from natural products. With numerous researchers dedicated to advancing preclinical hydrogels, the future holds promise for more innovative and more personalized hydrogel wound dressings.

Effects of Piper crocatum leaf extract-based ointments on bacteria associated with diabetic ulcers: an in vitro study

Effects of Piper crocatum leaf extract-based ointments on bacteria associated with diabetic ulcers: an in vitro study

Advanced Fe-COF-based photothermal cascade nano-generator for sterilization and promoting wound healing

Pharmacological treatments of diabetic ulcers remain a huge challenge due to the impaired angiogenesis and uncontrolled bacterial infection. Here, iminopyrazine-based Fe-covalent organic frameworks (Fe-COF) were synthesized via a subcomponent assembly strategy, and functionalized through covalent modification of L-arginine and encapsulated with photosensitizer IR780 and hyaluronic acid for enhancing diabetic wound healing. The functionalized Fe-COF (Fe-COF NRs) showed peroxidase-like activity and near-infrared (NIR)-controlled NO generation property, which can be used for synergistic photothermal/photodynamic antibacterial therapy and NO-based gas therapy. Treatment with Fe-COF NRs + NIR caused pathogenic elimination and enhanced angiogenesis, subsequently leading to accelerated wound healing in a rat model of infected diabetic wound. Mechanistically, the results from RNA sequencing analysis indicated that Fe-COF NRs treatment significantly induced the expression of genes involved in angiogenesis, but obviously inhibited the expression of proinflammatory cytokines. Gene Ontology enrichment and Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed that collagen-containing extracellular matrix, hair follicle development, PI3K-Akt signaling pathway, wound healing and skin development were significantly enriched after Fe-COF NRs treatment. Taken together, Fe-COF NRs provide a novel therapeutic strategy for the treatment of infected diabetic wound.

Protocolized Foot Exercises Help in Improvement of Diabetic Foot Ulcers and Quality of Life When Added to Standard Therapy-A Randomized Clinical Trial.

Diabetic foot disease is the major cause of nontraumatic limb amputations worldwide causing a high socioeconomic and psychological toll and a huge burden to the healthcare system. Currently, standard treatment of diabetic foot ulcer is through multidisciplinary therapy. Foot exercises have been shown to improve healing in diabetic ulcers although evidence is limited and applicability is non-uniform. Our study aimed to generate more evidence regarding the benefit of addition of protocolized foot exercises so that it can be instituted as a standard of care. It was an open label Randomized controlled trial with seventy-two patients and study duration of one and half years Patients with diabetic foot ulcers were randomized into two groups. Both groups received standard therapy for diabetic foot ulcer. The intervention group in addition received three months of protocolized foot exercises. At the end of three months ulcer healing and quality of life were m compared among both the groups. Regular exercises for three months caused significant reduction in ulcer area compared to the non-intervention group [100% versus 45.22%, 95% CI =36.30(16.04-56.56), P-value = 0.001]. Quality of life analyzed by SF-36 score showed significant improvement in components like physical function [69.4 ± 8.9 versus 63.7 ± 11.0, 95% CI = 5.73 (0.97-10.48), P-value = 0.01], emotional well-being [65.2 ± 7.6 versus 60.8 ± 7.9, 95% CI = 4.44 (0.79-8.10), P-value = 0.01], and pain components [55.4 ± 18.5 versus 47.5 ± 14.5, 95% CI = 7.99 (0.16-15.81), P-value = 0.04) at 3 months although change in social functioning, physical health limitation, health change, energy and general health improvement were not significant. Addition of protocolized foot exercises are beneficial for patients of diabetic foot ulcers in terms of ulcer healing as well as improvement of quality of life provided compliance to exercises can be ensured.

Effect of Using Photobiomodulation (660 Nanometers) for the Treatment of Diabetic Ulcers: Protocol for a Randomized Controlled Trial.

Diabetic foot ulcers (DFUs) result in tissue damage or impairment of deeper structures that affect quality of life. The impacts are numerous, and even after a long treatment period, 65% of patients experience recurrence. Among the interventions used to accelerate the healing process of DFUs, photobiomodulation therapy (PBMT) is a painless, noninvasive, and low-cost treatment. To achieve effective therapeutic results optimal PBMT parameters are necessary. The positive effect of PBMT on diabetic cells may be dependent on fluence (J/cm2) and wavelength (nm). This double-blind, randomized clinical trial will be conducted at the University Clinic of Physical Therapy. One hundred patients will be randomly placed in 4 groups. A Laserpulse Ibramed (Helium-Neon, HeNe, 660 nm) with 20 W power will be used (continuous mode), with doses stipulated for each treatment group (GL1, 4 J/cm2; GL2, 8 J/cm2; GL3, 12 J/cm2) and Endophoton KLD GaAs 904 nm (ST, 10 J/cm2) for 2 nonconsecutive days per week for 10 weeks, for a total of 20 sessions. The primary outcomes will be ulcer healing rate and University of Texas classification scores. Patients' DFUs will be assessed on the 1st day, 5 weeks, and 10 weeks of treatment then 1 month after the end of treatment. This study may aid effective clinical decision-making for the management of DFUs.

Inhibition of Enzyme and Bacteria Activities in Diabetic Ulcer-like Scenarios via WAAPV-Loaded Electrospun Fibers.

In diabetic ulcers, an increased secretion of human neutrophil elastase (HNE) and bacterial infections play crucial roles in hindering healing. Considering that, the present study proposed the development of multi-action polycaprolactone (PCL)/polyethylene glycol (PEG) electrospun fibers incorporating elastase-targeting peptides, AAPV and WAAPV, via blending. Characterization confirmed WAAPV's efficacy in regulating proteolytic enzymes by inhibiting HNE. The engineered fibers, particularly those containing PEG, exhibited optimal wettability but an accelerated degradation that was mitigated with the peptide's inclusion, thus promoting a sustained peptide release over 24 h. Peptide loading was verified indirectly through thermal stability and hydration capacity studies (hydrophobic bonding between PCL and WAAPV and hydrophilic affinities between PCL/PEG and AAPV) and determined at ≈51.1 µg/cm2 and ≈46.0 µg/cm2 for AAPV and ≈48.5 µg/cm2 and ≈51.3 µg/cm2 for WAAPV, respectively, for PCL and PCL/PEG. Both AAPV and WAAPV effectively inhibited HNE, with PEG potentially enhancing this effect by interacting with the peptides and generating detectable peptide-PEG complexes (≈10% inhibition with PCL + peptide fibers after 6 h of incubation, and ≈20% with PCL/PEG + peptide fibers after 4 h incubation). Peptide-loaded fibers demonstrated antibacterial efficacy against Staphylococcus aureus (up to ≈78% inhibition) and Escherichia coli (up to ≈66% inhibition), with peak effectiveness observed after 4 and 2 h of incubation, respectively. This study provides initial insights into the WAAPV's potential for inhibiting HNE and bacteria activities, showing promise for applications in diabetic ulcer management.

Effect of Topical Application of Black Seed Oil (Nigella Sativa) on Wound Healing in Diabetic Rat Ulcer Model

Objective : This study aims to evaluate the use of topical black seed oil on wound healing in a diabetic rat model. Method:10 experimental rats were induced with streptozotocin at a dose of 55 mg/kg BW. Diabetic rats were anesthetized and then the wound was made with a biopsy push with a diameter of 10 mm. The rats were divided into 2 groups, namely the untreated group and the topical treatment group with 1 ml of 100% Black Seed Oil every day for 14 days. Wound healing evaluation was carried out on days 7 and 14. Gene expression analysis was performed using molecular technique RT PCR an histopathologically using He staining. Data analysis used T test. Result: On day 7 there was a decrease in TNF expression with p <0.05, while on day 14 it also showed a decrease in TNF alpha expression with p <0.01. Histopathological showed positive development by showing better wound healing with complete epithelialization, granulation with lower inflammatory cells, higher fibroblasts and collagen compared to the control group. Conclusion :Black seed oil can increase the speed of wound healing in diabetic rat models by inhibiting TNF alpha expression.

Surgical Offloading versus Medical Conservative Methods in Management of Diabetic Foot Plantar Ulcers (Interventional study)

Abstract Background As a result, peripheral neuropathy is frequently caused by diabetes (DM). Diabetic plantar foot pressure ulcers develop from the lack of protective pain sensibility as a result of recurrent shear and tear pressures. Relieving pressure on the foot's sole is necessary for the ulcers to heal. The purpose of the study is to compare the effectiveness of surgical and nonsurgical unloading procedures in the healing of plantar ulcers. Subjects and Methods 50 diabetic foot ulcer patients who visited Ain Shams University, the national institute of DM, and the endocrinology outpatient clinic participated in this interventional trial (NIDE). We employed mechanical and surgical unloading methods in this trial, and patients were monitored for 6 months to see how long it took for their injuries to recover. Results At the conclusion of the follow-up period, 88% of the surgical group's pressure ulcers were fully healed, compared to 86.7% of the non-surgical patients (6 months). Infection, recurrence, and non-healing were complications we encountered throughout the follow-up period. Regarding the treatment of plantar diabetic foot ulcers, offloading is crucial (DFUs). Compared to using only non-surgical methods, surgical offloading may hasten the recovery time. A well- trained team is necessary to prevent the issues with improperly fitting footwear and to teach the patient how to use them on a regular basis with the non-surgical offloading technique.

Less Invasive Off-loading Surgery of Chronic Plantar Diabetic Forefoot Ulcers: A Narrative Review

Less Invasive Off-loading Surgery of Chronic Plantar Diabetic Forefoot Ulcers: A Narrative Review

The efficacy of topical oxygen therapy for wound healing: A meta-analysis of randomized controlled trials and observational studies.

In preclinical studies, topical oxygen treatment (TOT) was shown to enhance wound healing by applying supplemental oxygen topically to the surface of a moist wound at normobaric conditions. The objective of this systematic review and meta-analysis is to provide a thorough evaluation of published RCTs and observational studies that compare supplemental TOT with standard wound care. A total of 1077 studies were obtained from a variety of databases, including PubMed, ScienceDirect, Web of Science, ProQuest, Scopus, ClinicalTrials.gov, EU Clinical Trial Registers, and Preprints.org. The Jadad scale was employed to assess the reliability of RCT studies, while the Newcastle-Ottawa Scale (NOS) was employed to assess the quality of observational studies. Seven RCT studies (n = 692) and two controlled observational studies (n = 111) were analysed. The rate of healed wounds was 25.8% in the control group and 43.25% in the adjuvant TOT group, which shows the use of TOT significantly increased the number of healed wounds (RR = 1.77; 95% CI 1.18-2.64; p = 0.005). A significant decrease in the percentage of wound area was found in the TOT group in RCT studies (mean difference = 15.64; 95% CI 5.22-26.06; p = 0.003). In observational studies, the rate of healed wounds was 37.5% in the standard care group and 80.95% in the adjuvant TOT group, which shows a significant increase in the number of healed wounds in the adjuvant TOT group (RR = 2.15; 95% CI 1.46-3.15; p < 0.00001). Topical oxygen therapy is considered a great adjuvant therapy for chronic wound healing, particularly wounds with vascular compromise such as diabetic ulcers and pressure ulcers. Further studies on this topic are still needed as there are a lot of potential uses for this technology in various types of wounds.

Periplaneta americana extract promotes infectious diabetic ulcers wound healing by downregulation of LINC01133/SLAMF9

Wound healing in diabetic ulcers remains a significant clinical challenge, primarily due to bacterial infection and impaired angiogenesis. Periplaneta americana extract (PAE) has been widely used to treat diabetic wounds, yet its underlying mechanisms are not fully understood. This study aimed to elucidate these mechanisms by analyzing long non-coding RNA (lncRNA) expressions in the wound tissues from diabetic anal fistula patients treated with or without PAE, using high-throughput sequencing. Peripheral blood monocytes from patients were differentiated into M0 macrophages with human macrophage colony-stimulating factor (hM-CSF) and subsequently polarized into M1 macrophages with lipopolysaccharide. The results indicated that LINC01133 and SLAMF9 were downregulated in wound tissues of patients treated with PAE. Furthermore, PAE suppressed M1 macrophage polarization and enhanced human umbilical vein endothelial cell (HUVEC) proliferation, migration, and angiogenesis. These effects were diminished when LINC01133 or SLAMF9 were overexpressed. Mechanistically, LINC01133 was shown to upregulate SLAMF9 through interaction with ELAVL1. Overexpression of SLAMF9 reversed the effects of LINC01133 silencing on macrophage polarization and HUVEC functions. In conclusion, PAE facilitates the healing of infected diabetic ulcers by downregulating the LINC01133/SLAMF9 pathway.

Assessing the Physical and Clinical Characteristics of a New Adjustable Compression Wrap: Insights from a Single-center Pilot Study in India

Introduction: Adjustable wraps are a revolutionary avenue in compression therapy because of their ease of application and removal, as well as their ability to be manipulated and readjusted, particularly in older adult patients with leg ulcers. Methods: We analyzed the physical and clinical features of a new adjustable wrap marketed by Vein Care, India. Hirai leg was used to demonstrate the stiffness of the wrap, followed by validation on five healthy male participants. Next, we conducted a pilot clinical study to assess the effect of wearing the wrap for 4 h on volume reduction in seven patients with open leg venous ulcers. Results: The Vein Care Calf Compression Wrap® functioned similarly to a short stretch bandage, which we demonstrated through the tests performed on Hirai’s leg and on healthy participants. In the pilot clinical study, following 4 h of application, a statistically significant decrease in total leg volume (median 34.5 cc; P = 0.018) was observed. Moreover, a significant decrease in volume at the calf level compared to the lower leg (P = 0.038) was noticed. However, no significant correlations were found in volumetric reduction with age or body mass index. The wrap posed challenges in applying pressure exceeding 40 mmHg due to its unique composition, stretch, and stiffness properties. This characteristic is especially significant for patients with diabetic or mixed arteriovenous ulcers (ankle–brachial index &gt;0.5 and &lt;0.8). Conclusions: The wrap’s clinical utility and effectiveness necessitate additional clinical trials and studies with a greater number of patients from diverse demographics.

Comparison of Severity in Diabetic Ulcer Patients with and Without Sepsis

Diabetes mellitus patients in Central Java grow yearly. According to data provided by the Central Java Health Department in 2019, Diabetes mellitus ranks second as the largest non-communicable disease (NCD), covering 13,4% of the total NCD patients. The prevalence of diabetic ulcers is 15-25% of all diabetes mellitus patients in Indonesia, which concerns the author regarding the possible increase of the diabetic ulcer population in Central Java. The severity of diabetic ulcers depends on various factors, including infection and complications. The most common complication is sepsis, a systemic infection often arising from local infections that are not appropriately treated, causing progressive damage and increasing mortality rates. This study aims to examine the comparison of ulcer severity in diabetic ulcer patients with sepsis and non-sepsis complications using Meggitt Wagner's criteria. This study utilizes an analytic observational study using a cross-sectional approach. The author sampled 126 patients diagnosed with Diabetic Ulcers in 2022 at Dr. Moewardi General Hospital for this study, using a purposive sampling method. The research was conducted by looking at the patient's medical record data, and data analysis using SPSS software. The test used in this research includes a Parametric T-independent test and a Pearson bivariate relationship test. This study shows that the comparison of ulcer severity in diabetic ulcer patients with sepsis and without sepsis was statistically significant (p-value = 0.000002). The mean of the group with sepsis (3.4127) was greater than the group without sepsis (2.5238). In conclusion, the comparison of ulcer severity in diabetic ulcer patients with sepsis and without sepsis is significant. We recommend future researchers include patients’ comorbidities, total hospitalization time, and detailed information on drug use and patient adherence to treatment in their research for more nuanced findings.