HbA1c in Patients with Diabetic Foot: A Prognostic Index


ABSTRACT:BACKGROUND:Diabetes mellitus (DM) is a common worldwide disease; which if poorly controlled, would be associated with high risk of complications, and diabetic foot is one of them.Glycated hemoglobin A1c (HbA1c) is an important control index of DM, and nowadays it is used as a diagnostic test.OBJECTIVE:To assess the benefit of HbA1c as a prognostic index in patients presented with diabetic foot.PATIENTS AND METHODS:This study included 176 patients presented to Al-Hilla Teaching Hospital with diabetic foot during a period of 38 months from 1st March 2007 to 1st May 2010.HbA1c was measured for all patients at time of enrollment which is mostly day of presentation. Level of 8 was considered a separation control point between good and bad control, and patients were classified into two groups; good control group (GCG) where HbA1c levels < 8, and bad control group (BCG) where levels ≥ 8.The end points for the study were determined as death, amputation, surgical wound excision without amputation, improvement on medical treatment only. Death and amputation were considered bad prognosis group (BPG), while others were considered good prognosis group (GPG).Statistical analysis was done using means, independent t-test and F-test.RESULTS:One hundred seventy six patients were studied with age range of 35-76 years, 60.15% (107/176) of them were males.At the end of follow up; 47.7% (84/176) of patients were found in BPG and 52.3% (92/176) in GPG as the following: death (11 patients), amputation (73 patients), wound excision without amputation (52 patients) and medical treatment only (40 patients); while 64.2% (113/176) of patients were found in BCG (HbA1c ≥ 8) and 35.8% (63/176) in GCG (HbA1c ˂ 8).61.1% (69/113) of BCG patients had bad prognosis; whereas only 23.8% (15/63) of GCG patients had bad prognosis, a statistically significant difference (P-value 0.001);Higher HbA1c levels were seen in patients with bad prognosis as mean HbA1c was 8.97 in BPG and 7.79 in GPG; a difference that is statistically significant (P-value ˂ 0.001)CONCLUSION:HbA1c is a significant prognostic index in patients presented with diabetic foot. Levels greater than 8 were associated with poor prognosis and longer hospitalization. So; diabetic control is a very important factor in preventing and alleviating diabetic complication