ASSOCIATION OF BASELINE GLYCOSYLATED HEMOGLOBIN WITH EARLY WOUND HEALING IN WAGNER GRADE 1-2 DIABETIC FOOT ULCERS: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Diabetic foot ulceration (DFU) is a prevalent, debilitating complication of diabetes, characterized by the interaction of neuropathy, ischemia, infection and persistent hyperglycaemia compromising tissue repair. Even though glycated haemoglobin (HbA1c) is a biologically valid marker of delayed healing, the strength of this association clinically varies across cohorts. In this study we assessed whether baseline HbA1c was related to short-term healing in patients with uncomplicated DFUs.

Methods: A hospital-based prospective observational study was conducted at S.N. Medical College and H.S.K. Hospital and Research Centre from March 2024 to May 2026. Fifty adults with type 2 diabetes and Wagner grade 1 or 2 DFUs were enrolled consecutively. Baseline HbA1c was determined by high-performance liquid chromatography and was classified as <7.0%, 7.0-8.0%, and >8.0%. Standardized calibrated wound pictures were analysed with ImitoMeasure at baseline and Day 14. The principal outcome was wound-healing rate in cm2/day; secondary outcomes were percentage wound area reduction and achievement of >=50% healing by Day 14.

Results: Thirty-one individuals had HbA1c <=8.0% and 19 had HbA1c >8.0%. Baseline age, ulcer duration, and ulcer area were similar between groups, whereas multiple ulcers were more frequent with HbA1c >8.0% (p=0.011), and low educational attainment was more common in the poorly controlled group (57.9% compared with 25.8%, p=0.023). The percentage wound area reduction was significantly lower in the HbA1c >8.0% group than in the HbA1c <=8.0% group (39.2% vs 54.7%, p=0.017), and fewer patients achieved >=50% healing by Day 14 (26.3% vs 54.8%, p=0.049). Continuous HbA1c correlated inversely with percentage area reduction (Spearman rho = -0.361, p=0.010). However, HbA1c was not an independent predictor in adjusted regression models.

Conclusion: More baseline HbA1c was related with reduced early relative wound contraction in Wagner grade 1-2 DFUs, particularly when healing was operationalized as percentage area reduction. The lack of a single independent multivariable marker in the study indicates that glycaemic burden may act in concert with wound burden and other host factors rather than in isolation. HbA1c is still useful as a stratification marker, but broader multicentre studies are required to arrive at clinically relevant thresholds.