Elevated HbA(1c) level associated with disease severity and surgical extension in diabetic foot patients

BACKGROUND: Diabetic foot is a complex syndrome that is associated with other diabetic complications, such as peripheral arterial disease and peripheral neuropathy. Optimization of plasma glucose and glycated hemoglobin (HbA(1c)) is one of the main principles of standard care and treatment approaches in individuals with diabetes mellitus (DM). In this study, the relationship of HbA(1c) level at the time of diagnosis was evaluated with diabetic foot disease severity score and surgical extension in patients with Type 2 DM. METHODS: This study included 301 consecutive patients who were diagnosed with diabetic foot in the general surgery diabetic foot clinic and were hospitalized for surgery. The relationships between the HbA1c levels of the patients with the Wagner and PEDIS (Perfusion, Extent, Dept, Infection, Sensation) classification system grades, and the surgical procedures performed were analyzed and the treatment outcomes were evaluated. RESULTS: It was determined that there was a 90% statistically significant relationship between HbA(1c) values of ≥10.1% and the development of Wagner Grade 4 diabetic foot ulcer (DFU) (P=0.037). A strong statistically significant relationship at the rate of 85% was determined between HbA(1c) values of ≥10.1% and the development of PEDIS Grade 3 ulcers. As the HbA(1c) values increased, so there was determined to be a statistically significant relationship with the development of PEDIS Grade 3 ulcer (P=0.003). In the comparison of the HbA(1c) values according to the type of surgery performed, a weak relationship was determined at the rate of 26%, and it was determined that as the HbA(1c) values increased, so there could be an increase in the amputation level. CONCLUSION: The results of this study showed that as HbA(1c) values at diagnosis increased in patients with diabetic foot; Wagner/PEDIS grades, disease severity, surgical extension, amputation level, and tissue loss increased. To reduce the severity of diabetic foot disease and prevent amputation, compliance with diabetic treatment and glycemic control should be increased.