Advances in the Application of Responsive Hydrogels for Diabetic Wound Therapy

Diabetic wound healing is critically impaired by multifaceted pathological disturbances, notably persistent hyperglycemia, recurrent infection, and local ischemia-a process distinct from the reparative process in normal wounds. The wound microenvironment undergoes dynamic and phase-dependent fluctuations in key biochemical markers such as pH, glucose, and reactive oxygen species (ROS). These variations render conventional dressings inadequate, often necessitating frequent changes that exacerbate patient discomfort and impose a substantial economic burden. Hydrogels, characterized by high hydration, biocompatibility, and intrinsic extracellular matrix-mimetic properties, have emerged as a highly promising platform for diabetic wound management. Recent research has advanced toward "smart" stimuli-responsive hydrogels capable of sensing subtle pathological cues and responding through physicochemical transformations-including swelling/deswelling, degradation, or morphological remodeling-thereby enabling spatiotemporal control over on-demand therapeutic release for precise, personalized treatment. This review systematically categorizes and evaluates intelligent hydrogel systems according to four stimuli-responsive modalities-chemical, physical, biological, and multi-stimuli. We critically discuss their design rationales, underlying mechanisms, and functional performance, while also addressing persistent translational challenges and future directions, ultimately providing a forward-looking perspective to guide clinical adoption.