Prospective study to correlate the level of glycosylated haemoglobin with wound healing, vasculopathy and neuropathy in diabetic foot patients


  • Brajkishor Kumar Department of Surgery, VMMC and Safdarjung Hospital, New Delhi, India
  • Manish Kumar Mishra Department of Surgery, VMMC and Safdarjung Hospital, New Delhi, India
  • Ajit Sinha Department of Surgery, VMMC and Safdarjung Hospital, New Delhi, India
  • Rajesh Kumar Soni Department of Surgery, VMMC and Safdarjung Hospital, New Delhi, India
  • Dharmendra Kumar Patel Department of Surgery, VMMC and Safdarjung Hospital, New Delhi, India



Diabetic foot, Foot ulcers, Glycosylated haemoglobin, Neuropathy, Vasculopathy, Wound healing, Wegner grade


Background: Diabetes mellitus is a prevalent global health problem and diabetic foot represents one of its dreadful complications. Early aggressive approach and multidisciplinary intervention prevent limb loss and disease fatality. Glycosylated haemoglobin (HbA1c) reflects long term glycaemic control and helps in prediction of complications as well as response to treatment.

Methods: A total of 50 patients with diabetic foot ulcer (Wegner grade 1, 2) made nucleus of this study.  Every patient underwent proper clinical, hematological and sonological assessment. Optimum treatment was provided and the effect of improvement in HbA1c value was correlated with duration of wound healing, vasculopathy and neuropathy over a 12 week follow uu.

Results: Mean age of presentation was 53.4 years and patients developed diabetic ulcers (Wegner grade 1, 2) at a mean HbA1c value of 6.6. Foot trauma was inciting event in 70% cases. 70% patients had neuropathy and 30% had vasculopathy at presentation. Mean duration of healing was 42.6 days. Healing was faster in the group with lower HbA1c; however there was no improvement in neuropathy or, vasculopathy in 12 weeks duration.

Conclusions: Based on the observations of present study it may be submitted that lower HbA1c value contributes to faster wound healing, however it doesn’t improve neuropathy and/or vasculopathy over duration of 12 weeks.




Hossain P, Kawar B, El Nahas M. Obesity and diabetes in developing world - a growing challenge. N Engl J Med. 2007;356(3):213-5.

Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V. The Indian council of medical research - India diabetes (ICMR - INDIAB) study: methodological details. J Diabetes Sci Technol. 2011;5(4):906-14.

Boulton AJ, Vileikyte L, Ragnarson-Tennvall G, Apelqvist J. The global burden of diabetic foot disease. Lancet. 2005;366:1719-24.

Laing P. The development and complications of diabetic foot ulcers. Am J Surg. 1998;176(2A Suppl):11S-19.

Peterson KP, Pavlovich JG, Goldstein D, Little R, England J, Peterson CM. What is hemoglobin A1c? An analysis of glycated hemoglobins by electrospray ionization mass spectrometry. Clinical Chemistry. 1998;44(9):1951-8.

American diabetic association; diagnosis and classification of diabetes mellitus. Diabet Care. 2010;33(Suppl 1):S62-69.

Patel A, MacMohan S, Chalmers J, Neal B, Billot L. The advance collaborative group. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Eng J Med. 2008;358(24):2560-72.

Christman AL, Selvin E, Margolis DJ, Lazarus GS, Garza LA. Hemoglobin A1c is a predictor of healing rate in diabetic wounds. J Invest Dermatol. 2011;13(10):2121-7.

Shahi SK, Kumar A, Kumar S, Singh SK, Gupta SK, Singh TB. Prevalence of diabetic foot ulcer and associated risk factors in diabetic patients from North India. J Diabet Foot Compli. 2012;4(3):83-91.

Hasan CMM, Parial R, Islam MM, Ahmad MNU, Kasru A. Association of HbA1c, creatinine and lipid profile in patients with diabetic foot ulcer. Middle-East J Sci Res. 2013;16(11):1508-11.

Elizabeth S, Keattiyoat W, Michael WS, Josef C, Sharrett AR. HbA1c and peripheral arterial disease in diabetes. Diabetic Care. 2006;29:877-82.

Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M. Natural history of peripheral neuropathy in patients with non-insulin dependent diabetes mellitus. N Eng J Med. 1995:333:89-94.

Bansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting. J Diabetes Investig. 2014;5(6):714-21.

Khalid AR, Mohammad AD, Samir O, Amira MY, Shazia NS. Diabetic foot complications and their risk factors from a large retrospective cohort study. PLoS ONE. 2015;10(5):e0124446.






Original Research Articles