The impact of glycaemic variability on wound healing in the diabetic foot – a retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic

Dhatariya, Ketan K, Li Ping Wah-Pun Sin, Edwin, Oi Suet Cheng, Joyce, Yan Nok Li, Francesca, Yue Wei Yue, Anson, Gooday, Catherine and Nunney, Ian (2018) The impact of glycaemic variability on wound healing in the diabetic foot – a retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic. Diabetes Research and Clinical Practice, 135. pp. 23-29. ISSN 0168-8227

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    Abstract

    Aims: Glycaemic variability – the visit-to-visit variation in HbA1c – plays a possible role in the development of micro and macrovascular disease in patients with diabetes. Whether HbA1c variability is a factor determining wound healing in diabetic foot ulcers remains unknown. We aimed to determine whether HbA1c variability is associated with foot ulcer healing time. Methods: A retrospective analysis of patients presenting to our specialist multidisciplinary foot clinic between July 2013 and March 2015, with at least three HbA1c measurements within five years of presentation and more than two follow-up reviews. HbA1c variation was measured by magnitude of standard deviation. Results: 629 new referrals were seen between July 2013 and March 2015. Of these, 172 patients had their number of days to healing recorded and sufficient numbers of HbA1c values to determine variability. The overall geometric mean days to heal was 91.1 days (SD 80.8 to 102.7). In the low HbA1c variability group the geometric mean days to heal was 78.0 days (60.2 to 101.2) vs 126.9 days (102.0 to 158.0) in the high Hb1Ac variability group (p=0.032). Those with low HbA1c (< 58 mmol/mol) and low variability healed faster than those with high HbA1c and high variability (73.5 days [59.5 to 90.8] vs 111.0 days [92.0 to 134.0], p=0.007). Additionally, our results show that time to healing is more dependent on the mean HbA1c than the variability in HbA1c (p=0.007). Conclusions/interpretation: Our data suggest that there was a significant association between HbA1c variability and healing time in diabetic foot ulcers.

    Item Type: Article
    Uncontrolled Keywords: glycaemic variability,hba1c variability,ulcers,wound healing
    Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
    Faculty of Medicine and Health Sciences > School of Health Sciences
    Related URLs:
    Depositing User: Pure Connector
    Date Deposited: 07 Nov 2017 06:05
    Last Modified: 09 Apr 2019 12:45
    URI: https://ueaeprints.uea.ac.uk/id/eprint/65353
    DOI: 10.1016/j.diabres.2017.10.022

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