Hemoglobin A1c Unrelated to Diabetic Foot Ulcer Healing

A new study concludes that there is no clinically meaningful association between hemoglobin A1c (HbA1c) levels and wound healing in patients with diabetic foot ulcers (DFUs).

Researchers at Johns Hopkins University (JHU; Baltimore, MD, USA) conducted a retrospective study involving 270 patients with a total of 584 DFUs treated at JHU during a 4.7-year period. The analysis assessed incidence of wound healing at any follow-up time, in relation to categories of baseline HbA1c and the incidence of long-term (over 90 days) wound healing. Tertiles of nadir HbA1c change and mean HbA1c change from baseline were measured, adjusting for potential confounders.

The results revealed that baseline HbA1c was not associated with wound healing. While a nadir change of 0.09 to 2.4 (third tertile) was positively associated with long-term wound healing in study participants with baseline HbA1c lower than 7.5%, no such association was seen with mean HbA1c change. Neither nadir HbA1c change nor mean HbA1c change were associated with long-term wound healing in participants with a baseline HbA1c higher than 7.5%. The study was published on April 16, 2018, in Diabetes Care.

“There does not appear to be a clinically meaningful association between baseline or prospective A1c and wound healing in patients with DFUs,” concluded lead author Betiel Fesseha, MD, of the JHU division of endocrinology, diabetes and metabolism, and colleagues. “The paradoxical finding of accelerated wound healing and increase in hemoglobin A1c in participants with better baseline glycemic control requires confirmation in further studies.”

HbA1c refers to glycated hemoglobin, and is used to identify the average plasma glucose concentration over prolonged periods of time. For people without diabetes, the normal HbA1c range is 4-5.6%. HbA1c levels between 5.7% and 6.4% indicate increased risk of diabetes, and levels of 6.5% or higher indicate diabetes. The goal for diabetics is HbA1c levels lower than 7%, which should be retested every three months to determine target level control.

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