Glycosylated Hemoglobin in Diabetic Foot and its Correlation with Clinical Variables in a North Indian Tertiary Care Hospital

Abstract

HbA1c reflects glycemia over 2-3 months and is the standard measure used to monitor glycemia in diabetic patients, but studies have not shown an association of HbA1c with DFU. We hypothesized that elevated HbA1c would be most associated with extremity of DFU/DFI. To test this hypothesis we conducted a prospective study of 161 DFU individuals treated at the R G Centre for Diabetes & Endocrinology, AMU. 64.8% were males and the 37.0% had ulcer >1 month. The majority of ulcer was neuropathic (50%) and amputation was done in 28.4%. HbA1c >6.5% were significantly associated with Wagner grades, UTG, BMI, retinopathy, nephropathy, hypertension, neuropathy and smoking. A significant correlation was found between UTG (r=-0.219, p=0.005), ulcer duration >1 month (r=-0.233, p=0.002), BMI (r=0.154, p=0.05), ESR (r=-0.169, p=0.031), Neuropathy (r=-0.007, p=0.048), nephropathy (r=-0.165, p=0.036), hypertension (r=0.207, p=0.007), retinopathy (r= 0.167, p=0.037) and smoking (r=0.164, p=0.034) with HbA1c >6.5%. The diabetic patients with A1c>6.5% showed a high risk of ulcer development in their foot. A significant correlation was observed with the clinical variables (ulcer duration >1 month, BMI, ESR, Neuropathy, nephropathy, hypertension, retinopathy and smoking with A1c>6.5% which is independent of concomitant infections in DFU patients.