HbA1c as a Determinant of Severity and Microbial Profile in Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis
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Abstract
Background: Diabetic foot ulcers (DFUs) represent one of the most severe complications of diabetes mellitus and are caused by neuropathy, vascular insufficiency, and infection. Glycemic control as evidenced by glycated hemoglobin (HbA1c) has been proposed to affect ulcer severity and microbial colonization but the overall evidence has stayed fragmented. Objective: The entire objective of the systematic review and meta-analysis was to answer the query: "Is there a significant relation amongst levels of HbA1c, microbial spectrum, and severity in Wagner grade of diabetic foot ulcer patients?" Methods: A systematic review and meta-analysis was carried out in accordance with PRISMA guidance. Databases like PubMed, Embase, Scopus, Web of Science, and Cochrane Library were used to determine studies released from January 2016 to September 2025. Eligible studies were observational studies reporting HbA1c levels alongside Wagner grades and/or microbiological profiles. Data extraction was achieved using Microsoft Excel 2016 and then analysis in RStudio. A random-effects method was used to calculate pooled estimates on the odds of having severe diabetic foot ulcers (Wagner grade ≥3). Results: Thirteen studies in 1,976 patients were considered. There were four studies to be considered in meta-analysis. The overall percentage of patients with severe DFUs was 0.538 (95% CI: 0.430-0.645; p < 0.001). There was significant heterogeneity (I² = 73.7%, p = 0.034). Staphylococcus aureus and Pseudomonas aeruginosa were the predominant isolates and polymicrobial and resistant organisms were prevalent in advanced Wagner grades in the included studies. There was no visible publication bias by the funnel plot and Egger's regression test (p = 0.389). Conclusion: High HbA1c has strong correlation with greater severity of DFU (Wagner grade ≥3) and shifts in microbial spectrum towards resistant and polymicrobial infections. The findings highlight the need for strict glycemic control, early microbial profiling, and interdisciplinary management in the management of DFUs.
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Copyright (c) 2025 S Pravin Dass, Meghna Mohan, V. Balaji Tulse Dass, Swathi N
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S Pravin Dass, Faculty of Department of Urology, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
Faculty of Department of Urology, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
Meghna Mohan, Faculty of Department of General Medicine, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
Faculty of Department of General Medicine, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
V. Balaji Tulse Dass, Faculty of Department of General Medicine, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
Faculty of Department of General Medicine, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
Swathi N, Data Analyst and Statistician, Department of Medical Research, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
Data Analyst and Statistician, Department of Medical Research, Karuna Medical College, Vilayodi, Chittur, Palakkad, Kerala, India.
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