Is High Level of Hemoglobin A1C an Indicator for Extended Period of Antibiotherapy in Diabetic Foot Ulcers?

Objective: Diabetic foot ulcers are the most common cause of hospitalization among the diabetic complications. Hemoglobin A1C (HbA1C) has a critical role in medical follow-up of diabetic patients. In fact, the role of HbA1C and related clinical parameters has been investigated in literature there are only a few studies investigating the relationship between HbA1C and the prolonged antibiotherapy. We aim to reveal the reciprocal relationship between this two parameters.

Methods: The clinical data of 139 patients who admitted with diabetic foot ulcers are analyzed retrospectively. Besides the demographic information, the levels of HbA1C wound localizations, the degree of the wounds regarding the Wagner classification, culture antibiogram, and the duration of the antibiotic agents. The data have been analyzed with IBM SPSS Statistics (IBM Statistical Package for the Social Sciences) for Windows 22.0.

Results: The clinical data of the 139 diabetic foot patients are retrospectively assessed. The mean age was 56.50 (±4.12). There were 81 male (58.27%) and 58 (41.73%) female patients. The distal type diabetic foot ulcers were found to be the most frequent type (n=83, 59.71% [±3.12]). The mean HbA1C level was 9.60 (±1.10). The "7-15%" subgroups of HbA1C level patients showed statistically significant prolongation of the antibiotherapy time (p<0.01).

Conclusion: The results showed that the higher levels of HbA1C have a significant effect on treatment duration and formation of deeper and larger wounds with advanced stages of Wagner classification. This result may reveal the importance of the exact starting time of the treatment besides the proper glycemic control. Lager scaled studies may clarify the credited parameters related to diabetic foot ulcers for a reinterpretation of the issue.