title: Hemoglobin A1c predicts healing rate in diabetic wounds.
abstract: Lower-extremity wounds are a major complication of diabetes. Hemoglobin A1c (HbA1c) reflects glycemia over 2-3 months and is the standard measure used to monitor glycemia in diabetic patients, but results from studies have not shown a consistent association of HbA1c with wound healing. We hypothesized that elevated HbA1c would be most associated with poor wound healing. To test this hypothesis, we conducted a retrospective cohort study of 183 diabetic individuals treated at the Johns Hopkins Wound Center. Our primary outcome was wound-area healing rate (cm(2) per day). Calibrated tracings of digital images were used to measure wound area. We estimated coefficients for healing rate using a multiple linear regression model controlling for clustering of wounds within individuals and other common clinic variables. The study population was 45% female and 41% African American, with a mean age of 61 years. Mean HbA1c was 8.0%, and there were 2.3 wounds per individual (310 wounds total). Of all measures assessed, only HbA1c was significantly associated with wound-area healing rate. In particular, for each 1.0% point increase in HbA1c, the daily wound-area healing rate decreased by 0.028 cm(2) per day (95% confidence interval: 0.003, 0.0054, P = 0.027). Our results suggest that glycemia, as assessed by HbA1c, may be an important biomarker in predicting wound-healing rate in diabetic patients.JID JOURNAL CLUB ARTICLE: For questions, answers, and open discussion about this article, please go to http://www.nature.com/jid/journalclub.
authors.affiliation: Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Christman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Lazarus
authors.forename: Luis A
authors.initials: LA
authors.lastname: Garza
mesh_terms: D000368:Aged; D015992:Body Mass Index; D002138:Calibration; D015331:Cohort Studies; D048909:Diabetes Complications / Q000378:metabolism; D003920:Diabetes Mellitus / Q000378:metabolism*; D017719:Diabetic Foot / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000096:biosynthesis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D014945:Wound Healing
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human