Novel Relationship Between Hemoglobin A1c Levels and Foot Ulcer Development Among Patients With Type 2 Diabetes Mellitus Admitted at Tupua Tamasese Meaole Hospital

Background: Diabetes mellitus is one of the leading chronic conditions worldwide. One of its most debilitating complications is diabetic foot ulcers (DFUs), which appear to have an increased incidence in the Pacific Islands. However, this report has not been studied extensively in Samoa. Nevertheless, DFUs may be prevented through strict glycemic control by hemoglobin A1c (HbA1c) level monitoring. Objective: This study aimed to identify a specific cutoff point for HbA1C to reduce the occurrence of DFUs in patients with type 2 diabetes mellitus (T2DM) admitted to an internal medicine ward in Samoa. Increased HbA1c levels are hypothesized to be strongly associated with DFU development. Methods: A retrospective unmatched case-control study examined 100 patients with T2DM (50 patients with DFUs [case] and 50 patients without DFUs [control]) over four months. Participants were selected by convenience sampling. Results: The HbA1c results were available in 32 cases and 29 controls. The receiver operating characteristic curve showed that the area under the curve was 51% (95% CI, 36%-66%; standard error, 0.075; P = 0.8966), and no cutoff point could be established. Conclusion: The HbA1c is not an ideal test to readily predict DFUs in patients with T2DM.