Vella Lourdes, Gatt Alfred, Formosa Cynthia
J Am Podiatr Med Assoc. 2017 Jul;107(4):272-279. doi: 10.7547/15-176.
We sought to evaluate the relationship between baseline hemoglobin A (HbA) level and clinical outcomes, including foot ulcer outcome (resolved versus unresolved) and wound-healing time, in individuals with type 2 diabetes.
A prospective observational study was conducted on 99 patients presenting with a diabetic foot ulceration. Patient and ulcer characteristics were recorded. Patients were followed up for a maximum of 1 year.
After 1 year of follow-up, 77% of ulcers healed and 23% did not heal. Although this study demonstrated that the baseline HbA reading was not a significant predictor of foot ulcer outcome (P = .603, resolved versus amputated), on further statistical analyses, when HbA was compared with the time taken for complete ulcer healing in the resolved group (n = 77), it proved to be significant (P = .009).
These findings have important implications for clinical practice, especially in an outpatient setting. Improving glycemic control may improve ulcer outcomes. Prediction of outcome may be helpful for health-care professionals in individualizing and optimizing clinical assessment and management of patients. Identification of determinants of outcome could result in improved health outcomes, improved quality of life, and fewer diabetes-related foot complications.
我们试图评估2型糖尿病患者的基线血红蛋白A（HbA）水平与临床结局之间的关系，包括足部溃疡结局（愈合与未愈合）及伤口愈合时间。
对99例糖尿病足溃疡患者进行了一项前瞻性观察研究。记录患者及溃疡的特征。对患者进行了最长1年的随访。
随访1年后，77%的溃疡愈合，23%未愈合。尽管本研究表明基线HbA读数并非足部溃疡结局的显著预测指标（P = 0.603，愈合与截肢），但在进一步的统计分析中，将HbA与愈合组（n = 77）溃疡完全愈合所需时间进行比较时，发现具有显著意义（P = 0.009）。
这些发现对临床实践具有重要意义，尤其是在门诊环境中。改善血糖控制可能改善溃疡结局。结局预测可能有助于医护人员对患者进行个体化和优化临床评估与管理。确定结局的决定因素可带来更好的健康结局、更高的生活质量及更少的糖尿病相关足部并发症。
