A prospective cohort study of hypoalbuminemia as risk factor of wound healing in diabetic foot: a study from tertiary hospital in south India


  • Unnikrishnan Edakkepuram Department of General Surgery, Kozhikode Government Medical College, Kozhikode, Kerala, India
  • Sheeja P. C. Department of General Surgery, Kozhikode Government Medical College, Kozhikode, Kerala, India
  • Ellikunnel Vithon Gopi Department of General Surgery, Kozhikode Government Medical College, Kozhikode, Kerala, India




Diabetic foot ulcer, Factors affecting wound healing, Normal wound healing pattern


Background: Diabetic foot ulcers is a major complication of diabetes mellitus, and precedes >80% of all diabetes related lower leg amputations. One of the risk factors in non-healing diabetic ulcer is low serum albumin level. The objectives of this study were to study the effect of low serum albumin level in patients with diabetic foot ulcer and to study the factors affecting wound healing in diabetic ulcer.

Methods: Prospective cohort study in a tertiary hospital.

Results: The mean age among study was 57.8 out of which 68.3% were males and 31.7% were females. 55% patients presented with slough over ulcer, 29.2% patients presented with healthy granulation and 15.8% patients presented with extensive wound infection. Among study group 50% patients had good glycaemic control and 50% patients had poor glycaemic control.

Conclusions: Low serum albumin level is one of the attributable risk factor of non-healing ulcers in diabetic foot. Poor glycaemic status is also a risk factor for non-healing ulcer.


Boulton AJ. The diabetic foot: a global view. Diabetes Metab Res Rev. 2000;16:S2-5.

Frykberg RG. Diabetic foot ulcers: current concepts. J Foot Ankle Surg. 1998;37:440–6.

Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: National Diabetes Data Group (U.S.). Diabetes in America. 2d ed. Bethesda, Md.: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. NIH publication. 1995;95-1468.

Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S, et al. Diabetic foot disorders: a clinical practice guideline. American college of foot and ankle surgeons. J Foot Ankle Surg. 2000;39(5):S1-60.

Pecoraro RE, Reiber GE, Burgess EM. Pathways to diabetic limb amputation: basis for prevention. Diabetes Care. 1990;13:513-21.

American Diabetes Association. Consensus Development conference on diabetic foot. Wound Care: 7-8 April 1999. Boston, Massachusetts. Diabetes Care. 1999;22:1354-60.

Boyko EJ, Ahroni JH, Stensel V, Forsberg RC, Davignon DR, Smith DG. A prospective study of risk factors for diabetic foot ulcer: the Seattle diabetic foot study. Diabetes Care. 1999;22:1036-42.

Reiber GE, Vileikyte L, Boyko EJ, del Aguila M, Smith DG, Lavery LA, et al. Causal pathways for incident lower-extremity ulcers in patients with diabetes from two settings. Diabetes Care. 1999;22:157-62.

Armstrong DG, Lavery LA. Diabetic foot ulcers: prevention, diagnosis and classification. Am Fam Phy. 1998;57:1325-32.

McNeely MJ, Boyko EJ, Ahroni JH, Stensel VL, Reiber GE, Smith DG, et al. The independent contributions of diabetic neuropathy and vasculopathy in foot ulceration. How great are the risks? Diabetes Care. 1995;18:216-9.

Grayson ML, Gibbons GW, Balogh K, Levin E, Karchmer AW. Probing to bone in infected pedal ulcers: a clinical sign of underlying osteomyelitis in diabetic patients. JAMA. 1995;273:721-3.

Frykberg RG. Diabetic foot ulcerations. In: Frykberg RG, ed. The high risk foot in diabetes mellitus. New York: Churchill Livingstone; 1991:151-95.






Original Research Articles