Stimuli-Responsive Chitosan Hydrogels for Diabetic Wound Management: Comprehensive Review of Emerging Strategies

Diabetic wounds remain a major clinical challenge due to impaired angiogenesis, chronic inflammation, oxidative stress, and persistent infection, all of which delay tissue repair. Conventional dressings provide only passive protection and fail to modulate the wound microenvironment effectively. Chitosan (CS) is a naturally derived polysaccharide inspired by biological structures in crustaceans and fungi. It has emerged as a multifunctional biomimetic polymer with excellent biocompatibility, antimicrobial activity, and hemostatic properties. Recent advances in biomimetic materials science have enabled the development of stimuli-responsive CS hydrogels. These systems can sense physiological cues such as pH, temperature, glucose level, light, and reactive oxygen species (ROS). These smart systems emulate natural wound healing mechanisms and adapt to environmental changes. They release bioactive agents on demand and promote tissue homeostasis through controlled angiogenesis and collagen remodeling. This review discusses the biomimetic design rationale, crosslinking mechanism, and emerging strategies underlying single and dual-responsive hydrogel systems. It further emphasizes how nature-inspired structural and functional designs accelerate diabetic wound repair and outlines the current challenges and future prospects for translating these bioinspired intelligent hydrogels into clinical wound care applications.