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. Continuous glucose monitoring (CGM) tracks those targets continuously rather than at single points in time.
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. At Dialine, diabetes management runs alongside wound care as one team.
References
- 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
- 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
- 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