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

## TL;DR

This study shows that factors like ulcer severity and nutrition, not just blood sugar control, affect how quickly diabetic foot ulcers heal.

## Contribution

The study identifies serum albumin and Wagner Grade as independent predictors of DFU healing time beyond HbA1c.

## Key findings

- HbA1c did not independently predict healing time, despite correlating with ulcer severity.
- Serum albumin and Wagner Grade were significant predictors of healing duration (P < 0.05).
- Inflammatory markers like CRP, IL-6, and TNF-α were not significantly correlated with healing outcomes.

## Abstract

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 (P < 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.