Glycemic Management in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adults With Type 1 and Type 2 Diabetes

Abstract

Objective

Our aim in this study was to determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a multidisciplinary diabetic foot and wound clinic from 2012 to 2019.

Methods

We conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers were observed during at least one wound period and one wound-free period and had at least one glycated hemoglobin (A1C) measurement in both a wound period and a wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test.

Results

Two hundred six eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free periods, with median values of 7.6% (interquartile range [IQR] 6.6% to 9.1%) and 7.5% (IQR 6.6% to 9.1%) for mean A1C (p=0.43), 6.9% (IQR 6.0% to 8.0%) and 6.8% (6.0% to 8.1%) for minimum A1C (p=0.78), and 8.6% (IQR 7.1% to 10.9%) and 8.5% (IQR 7.0% to 10.7%) for maximum A1C (p=0.06) in the wound and wound-free periods, respectively.

Conclusions

This retrospective study shows similar levels of A1C during wound and wound-free periods; however, given the limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring are needed to determine whether glycemia worsens in the setting of a DFU.