Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Int J Low Extrem Wounds. 2023 Sep;22(3):578-587. doi: 10.1177/15347346211033458. Epub 2021 Jul 19.
We aimed to assess the effect of glycemic control on diabetic foot ulcer (DFU) healing. A prospective nested cohort study was employed of individuals with poorly controlled diabetes (glycated hemoglobin [HbA] >9%) and neuropathic DFU of >2-week duration. All individuals received standard diabetes and ulcer interventions for 12 weeks. Baseline demographic characteristics, ulcer area (automated assessment by wound zoom camera), and biochemical parameters were analyzed. The cohort was stratified into ulcer healed and unhealed groups. Ulcer area and glycemic parameters at 4 and 12 weeks on follow up were compared. Forty-three individuals (47 DFU) with baseline HbA 11.6% and ulcer area 9.87 cm were enrolled. After 12 weeks, mean HbA was 7.2%, 17 ulcers closed (healed group) and 30 ulcers did not close (unhealed group). The median time to ulcer healing was 10 weeks. Individuals in the healed group had lower fasting blood glucose ( = .010), postprandial blood glucose ( = .006), and HbA at 4 weeks ( = .001), and 12 weeks (0.018) compared to the unhealed group. Cox-regression analysis that revealed lower baseline ulcer area ( = .013) and HbA at 4 weeks ( = .009) significantly predicted DFU healing by 12 weeks. Baseline ulcer area of >10.58 cm and HbA at 4 weeks of >8.15% predicted delayed DFU healing. In conclusion, early and intensive glycemic control in the first 4 weeks of treatment initiation is associated with greater healing of DFU independent of initial ulcer area.
我们旨在评估血糖控制对糖尿病足溃疡（DFU）愈合的影响。采用前瞻性嵌套队列研究，纳入血糖控制不佳（糖化血红蛋白[HbA]＞9%）且伴有＞2 周病程的神经病变性 DFU 的个体。所有个体均接受标准的糖尿病和溃疡干预治疗 12 周。分析了基线人口统计学特征、溃疡面积（伤口变焦相机自动评估）和生化参数。将队列分为溃疡愈合组和未愈合组。比较了随访 4 周和 12 周时的溃疡面积和血糖参数。共纳入 43 名（47 处溃疡）基线 HbA 为 11.6%且溃疡面积为 9.87 cm 的个体。12 周后，平均 HbA 为 7.2%，17 处溃疡愈合（愈合组），30 处溃疡未愈合（未愈合组）。溃疡愈合的中位时间为 10 周。愈合组空腹血糖（ = .010）、餐后血糖（ = .006）和 4 周（ = .001）及 12 周时（0.018）的 HbA 均低于未愈合组。Cox 回归分析显示，基线时溃疡面积较小（ = .013）和 4 周时 HbA 较高（ = .009）显著预测 12 周时 DFU 愈合。基线时溃疡面积＞10.58 cm 和 4 周时 HbA＞8.15%预测 DFU 愈合延迟。结论：在治疗开始的前 4 周内，早期和强化血糖控制与 DFU 愈合率的增加相关，与初始溃疡面积无关。
