Importance of Sustained Glycemic Control During Wound Healing

Objective: The primary aim of this study was to evaluate the relationship of glycemic control, as measured by hemoglobin A1c and wound healing in diabetic foot ulcers. Research Design and Methods: Raw data from several multi-center, randomized, FDA approved, clinical trials with similar patient populations, treatment protocols, and outcome interests were pooled to evaluate the association between hemoglobin A1c and wound healing in 411 subjects with neuropathic diabetic foot ulcers. Results: Multivariate logistic regression analysis was utilized to examine the relationship of hemoglobin A1c and complete wound healing after 12 weeks of standardized treatment. Variables considered for model inclusion were diabetes type and duration, age, gender, race, history of previous foot ulcer, BMI, albumin, creatinine levels, tobacco or alcohol use, off-weighting method, wound age, and initial wound size. Standard methods for model building were used and resulted in an acceptable model fit (likelihood ratio test = 56.81, P<0.0001). The final regression model found an inverse relationship between hemoglobin A1c levels and odds of wound healing by 12 weeks (OR=0.857, [95% CI = 0.748-0.982], P=0.064). Conclusions: Based on the data analyzed in this study, the odds of healing a diabetic foot ulcer decreased 14.3% for every 1% increase in hemoglobin A1c during the healing period. These results provide support that wound healing may be adversely affected in the setting of higher hemoglobin A1c levels.