[Evolution of DFU treatment strategies: from simple coverage with traditional dressings to active modulation with...

Diabetic foot ulcers (DFUs) fall into a vicious cycle of difficulty healing due to hyperglycemia-induced persistent inflammation, accumulation of reactive oxygen species (ROS), tissue hypoxia, and susceptibility to infection. This paper reviews the pathological microenvironmental characteristics of DFUs, the design strategies of smart materials, and their integration with artificial intelligence (AI). Given the complex pathological microenvironment of DFUs, traditional dressings that provide simple coverage are no longer adequate, whereas responsive smart materials that are capable of dynamically sensing and actively modulating the wound microenvironment have demonstrated great potential. Furthermore, the paper highlights four key design strategies for responsive smart materials: using glucose-responsive smart materials to improve local hyperglycemia at the wound site; using ROS-scavenging smart materials to eliminate ROS and restore redox homeostasis; applying oxygen-generating materials to relieve hypoxia and to promote angiogenesis; and utilizing smart antibacterial materials to combat microbial biofilms and achieve potent bactericidal effects. Currently, the development trend of smart materials has shifted from single functionality towards integrated multifunctional synergistic systems. The paper further discusses the potential of integrating AI into material design, preparation optimization, and wound monitoring and treatment decision-making. Although most smart materials are still at the experimental stage and face challenges related to cost and manufacturing processes, next-generation smart materials are expected to achieve dynamic monitoring and autonomous treatment through interdisciplinary innovation, thereby fundamentally improving DFU healing rates and reducing the risk of amputation in patients.