Wound Chronicity, Impaired Immunity and Infection in Diabetic Patients.

Area of Science:

• Diabetic complications and wound healing
• Immunopathology of diabetes
• Microbial biofilms in chronic wounds

Background:

• Diabetic foot ulcers are a major cause of amputation, disability, and mortality.
• The diabetic environment promotes wound chronicity and infection susceptibility.
• Infections in diabetic foot ulcers can lead to biofilm formation, worsening prognosis.

Purpose of the Study:

• To overview cellular and molecular changes in diabetic wound healing.
• To describe diabetic immune dysfunction and its role in infection.
• To conceptualize diabetic foot ulcer infection, biofilm dynamics, and systemic effects.

Main Methods:

• Literature review of 683 articles from major databases.
• Selection and discussion of 280 relevant articles.
• Organization of findings into four subheadings: normal healing, impaired healing, dysimmunity, and infection.

Main Results:

• Diabetic healing is impaired, leading to chronic wounds with senescent cells and prolonged inflammation.
• Diabetes compromises immune response, facilitating microbial colonization and biofilm formation.
• Biofilms hinder treatment, worsen inflammation, and perpetuate wound chronicity, impacting host homeostasis.

Conclusions:

• Diabetic foot ulcer healing is heterogeneous and delayed, contributing to wound chronicity.
• Immune dysfunction in diabetes increases susceptibility to infection and biofilm development.
• Targeting molecular drivers of healing failure and infection is crucial for effective therapeutic strategies.