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Elevated HbA1c level associated with disease severity and surgical extension in diabetic foot patients
Simay Akyüz1, Adile Begüm Bahçecioğlu Mutlu2, H Erhan Guven1
1Department of General Surgery Diabetic Foot, University of Health Sciences, Gulhane Research and Training Hospital, Ankara-Türkiye.
Insights
High glycated hemoglobin (HbA1c) levels at diagnosis correlate with increased diabetic foot ulcer severity and amputation risk. Maintaining good glycemic control is crucial for preventing severe outcomes in diabetic patients.
Area of Science:
- Endocrinology
- Vascular Surgery
- Diabetology
Background:
- Diabetic foot is a serious complication of diabetes mellitus (DM), often linked with peripheral arterial disease and neuropathy.
- Optimizing plasma glucose and glycated hemoglobin (HbA1c) are cornerstone treatments for diabetes management.
- This study investigates the link between initial HbA1c levels and diabetic foot disease severity in Type 2 DM patients.
Purpose of the Study:
- To evaluate the relationship between HbA1c levels at diagnosis and the severity of diabetic foot disease.
- To assess the correlation between HbA1c levels and the extent of surgical intervention required for diabetic foot complications.
- To analyze treatment outcomes in relation to glycemic control at the time of diabetic foot diagnosis.
Main Methods:
- A cohort of 301 patients diagnosed with diabetic foot and requiring surgery was analyzed.
- HbA1c levels were correlated with the Wagner and PEDIS (Perfusion, Extent, Depth, Infection, Sensation) classification systems.
- Surgical procedures, treatment outcomes, and amputation levels were evaluated against patient HbA1c values.
Main Results:
- A significant correlation (90%) was found between HbA1c ≥10.1% and Wagner Grade 4 diabetic foot ulcers (DFU).
- An 85% significant relationship was observed between HbA1c ≥10.1% and PEDIS Grade 3 ulcers.
- Increasing HbA1c levels showed a statistically significant association with higher PEDIS grades and a potential increase in amputation levels.
Conclusions:
- Elevated HbA1c levels at diagnosis are associated with increased diabetic foot disease severity (Wagner/PEDIS grades), surgical extent, and amputation risk.
- Higher HbA1c values correlate with greater tissue loss in diabetic foot patients.
- Enhanced adherence to diabetes treatment and improved glycemic control are essential to mitigate diabetic foot disease severity and prevent amputations.
Background:
Diabetic foot is a complex syndrome that is associated with other diabetic complications, such as peripheral arte-rial disease and peripheral neuropathy. Optimization of plasma glucose and glycated hemoglobin (HbA1c) is one of the main principles of standard care and treatment approaches in individuals with diabetes mellitus (DM). In this study, the relationship of HbA1c level at the time of diagnosis was evaluated with diabetic foot disease severity score and surgical extension in patients with Type 2 DM.
Methods:
This study included 301 consecutive patients who were diagnosed with diabetic foot in the general surgery diabetic foot clinic and were hospitalized for surgery. The relationships between the HbA1c levels of the patients with the Wagner and PEDIS (Perfusion, Extent, Dept, Infection, Sensation) classification system grades, and the surgical procedures performed were analyzed and the treatment outcomes were evaluated.
Results:
It was determined that there was a 90% statistically significant relationship between HbA1c values of ≥10.1% and the de-velopment of Wagner Grade 4 diabetic foot ulcer (DFU) (P=0.037). A strong statistically significant relationship at the rate of 85% was determined between HbA1c values of ≥10.1% and the development of PEDIS Grade 3 ulcers. As the HbA1c values increased, so there was determined to be a statistically significant relationship with the development of PEDIS Grade 3 ulcer (P=0.003). In the comparison of the HbA1c values according to the type of surgery performed, a weak relationship was determined at the rate of 26%, and it was determined that as the HbA1c values increased, so there could be an increase in the amputation level.
Conclusion:
The results of this study showed that as HbA1c values at diagnosis increased in patients with diabetic foot; Wagner/PEDIS grades, disease severity, surgical extension, amputation level, and tissue loss increased. To reduce the severity of diabetic foot disease and prevent amputation, compliance with diabetic treatment and glycemic control should be increased.
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