Multifunctional hydrogels-based dressings for diabetic chronic wounds: Mechanisms and clinical translation

Diabetic Foot Ulcers (DFUs) represent a severe chronic complication of diabetes. Characterized by a complex pathological microenvironment feature, including intensified oxidative stress, persistent inflammation, impaired angiogenesis, and bacterial biofilm colonization. These factors render conventional dressings inadequate to achieve synergistic multi-targeted therapy. Hydrogel-based materials have become core candidates for DFU wound management due to their high moisture retention, excellent biocompatibility, and tunable physicochemical properties. Hydrogel-based materials have emerged as leading candidates for DFU management due to their high moisture retention, excellent biocompatibility, and tunable physicochemical properties, enabling the integration of multiple therapeutic functions. This review aims to establish a systematic framework that directly correlates the design principles of multifunctional hydrogels with the specific pathological mechanisms of DFUs. We critically evaluate the latest preclinical advances, highlighting synergistic strategies such as dual antioxidant systems and combined antimicrobial/anti-inflammatory approaches. Finally, we propose a prioritized pathway for clinical adoption based on pathological target matching, material safety, and clinical demand, and point out future directions including long-term biosafety verification and the integration of intelligent monitoring functions.