A Multifaceted Approach to Diabetic Foot Ulcer Healing Beyond HbA1c: A Prospective Observational Study in a Tertiary Care Hospital in Chennai.

BACKGROUND

Diabetic foot ulcers (DFUs) are among the most debilitating complications of diabetes mellitus, often leading to delayed healing, infections, and potential limb loss. While glycemic control, typically measured by HbA1c, has been a primary focus in DFU management, recent evidence suggests that healing outcomes are influenced by a broader range of factors.

OBJECTIVE

To evaluate the predictive role of clinical, biochemical, and inflammatory parameters beyond HbA1c in the healing of DFUs.

METHODOLOGY

This longitudinal observational study included 220 patients with DFUs treated at a tertiary care hospital in Chennai. Data were collected on demographics, ulcer severity (Wagner Grade), glycemic status (HbA1c), biochemical markers (C-reactive protein [CRP], interleukin-6 [IL-6], tumor necrosis factor-alpha [TNF-α], and serum albumin), and clinical outcomes. Statistical analyses were performed using regression and correlation models to assess associations with time to ulcer healing.

RESULTS

HbA1c showed a significant correlation with Wagner Grade but did not independently predict healing time. Serum albumin and Wagner Grade emerged as significant predictors of healing duration ( < 0.05). Although inflammatory markers such as CRP, IL-6, and TNF-α were elevated in many patients, they did not show a statistically significant correlation with healing outcomes.

CONCLUSIONS

DFU healing is a multifactorial process influenced by nutritional status and ulcer severity in addition to glycemic control. Integrating assessments such as Wagner Grade and serum albumin with traditional glycemic markers can enhance the prediction of healing outcomes and guide more effective management strategies.