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Does Baseline Hemoglobin A1c Level Predict Diabetic Foot Ulcer Outcome or Wound Healing Time?

Lourdes Vella Department of Health, Msida, Malta.

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Alfred Gatt Faculty of Health Sciences, University of Malta, Msida, Malta.

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Cynthia Formosa Faculty of Health Sciences, University of Malta, Msida, Malta.

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Background:

We sought to evaluate the relationship between baseline hemoglobin A1c (HbA1c) level and clinical outcomes, including foot ulcer outcome (resolved versus unresolved) and wound-healing time, in individuals with type 2 diabetes.

Methods:

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.

Results:

After 1 year of follow-up, 77% of ulcers healed and 23% did not heal. Although this study demonstrated that the baseline HbA1c reading was not a significant predictor of foot ulcer outcome (P = .603, resolved versus amputated), on further statistical analyses, when HbA1c was compared with the time taken for complete ulcer healing in the resolved group (n = 77), it proved to be significant (P = .009).

Conclusions:

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.

Corresponding author: Cynthia Formosa, PhD, Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, msd 2080, Malta. (E-mail: Cynthia.formosa@um.edu.mt)