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Glycaemic Control and Wound Healing

Uncontrolled blood glucose disrupts every phase of wound healing. We explain why HbA1c and daily glucose variability matter, and which targets are reasonable during active wound treatment.

Published7 min read

Wound healing is a four-phase process — haemostasis, inflammation, proliferation and remodelling. Each phase is impaired in hyperglycaemia, which is why glycaemic control is the foundation of any diabetic wound programme.

How hyperglycaemia disrupts healing

  • Increased advanced glycation end products (AGEs) stiffen collagen.
  • Neutrophil and macrophage function is impaired.
  • Growth factor and angiogenic signalling is reduced.
  • Oxidative stress accelerates tissue damage.
  • Microvascular disease lowers tissue oxygen delivery.

HbA1c and healing rate

Higher HbA1c is associated with slower wound closure (Christman et al., Diabetes 2011). The ADA recommends individualised HbA1c targets — typically <7% in most adults, 7.5–8% in frail older adults.

Insulin during active wounds

Patients with moderate-to-severe wounds or diabetic foot infection often need temporary insulin even if previously controlled on oral agents — a recommendation echoed in IDSA/IWGDF guidance.

References

  1. ADA. 6. Glycemic Targets: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S111–S125. https://doi.org/10.2337/dc24-S006
  2. Christman AL, et al. Hemoglobin A1c predicts healing rate in diabetic wounds. Diabetes. 2011;60(6):1753–1760. https://doi.org/10.2337/db10-1672
  3. Senneville É, et al. IWGDF/IDSA 2023 guideline on diabetes-related foot infections. Clin Infect Dis. 2024;78:e1–e42. https://doi.org/10.1093/cid/ciad527
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