{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T11:08:19Z","timestamp":1784545699466,"version":"3.55.0"},"reference-count":10,"publisher":"Pan African Medical Journal","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pan Afr Med J"],"abstract":"<jats:p>Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus and a leading cause of lower-limb amputation. Poor glycemic control has been implicated in DFU development and progression. This study explored the relationship between HbA1c levels and DFU severity using Wagner\u2019s classification among patients with type 2 diabetes. In this cross-sectional study conducted over six months at Liaquat University of Medical and Health Sciences, Jamshoro, 64 patients aged 40-80 years with type 2 diabetes for &gt;5 years and HbA1c &gt;6.5% were enrolled. DFU severity was graded using Wagner\u2019s classification (grades 1-5). Glycated hemoglobin (HbA1c) levels were categorized into four groups. Associations were assessed using chi-square tests. Mean age was 59.8 \u00b1 8.7 years, with 60.9% males. Mean HbA1c was 8.9 \u00b1 1.3%. Advanced ulcers (Wagner grades 4-5) were present in 51.5% of patients. Patients with HbA1c &gt;8.5% accounted for 76.9% of those with grade 4-5 ulcers. HbA1c levels were significantly associated with DFU severity (\u03c72= 28.6, p = 0.002). Higher HbA1c levels were significantly associated with more severe DFUs. Optimizing long-term glycemic control may reduce ulcer severity and related complications.<\/jats:p>","DOI":"10.11604\/pamj.2026.53.4.50436","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:36:46Z","timestamp":1784543806000},"source":"Crossref","is-referenced-by-count":0,"title":["Severity of diabetic foot ulcers at various levels of HbA1c"],"prefix":"10.11604","author":[{"given":"Lakhveer","family":"Rathi","sequence":"first","affiliation":[{"name":"Department of Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafique","family":"Hussain","sequence":"additional","affiliation":[{"name":"University Hospital Limerick, Limerick, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adnan","family":"Abdalla","sequence":"additional","affiliation":[{"name":"University Hospital Limerick, Limerick, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahnawaz","family":"Shahnawaz","sequence":"additional","affiliation":[{"name":"Department of Medicine, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musab","family":"Suliman","sequence":"additional","affiliation":[{"name":"University Hospital Limerick, Limerick, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hina","family":"Ismail","sequence":"additional","affiliation":[{"name":"Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4870","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Akkus G, Sert M. Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities. World J Diabetes. 2022 Dec 15;13(12):1106-1121. PubMed | Google Scholar DOI: 10.4239\/wjd.v13.i12.1106","DOI":"10.4239\/wjd.v13.i12.1106"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Parveen K, Hussain MA, Anwar S, Elagib HM, Kausar MA. Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management. World J Diabetes. 2025 Mar 15;16(3):100329. PubMed | Google Scholar DOI: 10.4239\/wjd.v16.i3.100329","DOI":"10.4239\/wjd.v16.i3.100329"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Edmonds M, Manu C, Vas P. The current burden of diabetic foot disease. J Clin Orthop Trauma. 2021 Feb 8;17:88-93. PubMed | Google Scholar DOI: 10.1016\/j.jcot.2021.01.017","DOI":"10.1016\/j.jcot.2021.01.017"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Bonnet JB, Sultan A. Social Deprivation, Healthcare Access and Diabetic Foot Ulcer: A Narrative Review. J Clin Med. 2022 Sep 15;11(18):5431. PubMed | Google Scholar DOI: 10.3390\/jcm11185431","DOI":"10.3390\/jcm11185431"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes. 2022 Dec 15;13(12):1049-1065. PubMed | Google Scholar DOI: 10.4239\/wjd.v13.i12.1049","DOI":"10.4239\/wjd.v13.i12.1049"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Dasari N, Jiang A, Skochdopole A, Chung J, Reece EM, Vorstenbosch J, Winocour S. Updates in Diabetic Wound Healing, Inflammation, and Scarring. Semin Plast Surg. 2021 Aug;35(3):153-158. PubMed | Google Scholar DOI: 10.1055\/s-0041-1731460","DOI":"10.1055\/s-0041-1731460"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in Diagnosis and Prognosis of Diabetic Patients. Biomark Insights. 2016 Jul 3;11:95-104. PubMed | Google Scholar DOI: 10.4137\/BMI.S38440","DOI":"10.4137\/BMI.S38440"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Aky\u00fcz S, Bah\u00e7ecio\u011flu Mutlu AB, Guven HE, Ba\u015fak AM, Yilmaz KB. Elevated HbA1c level associated with disease severity and surgical extension in diabetic foot patients. Ulus Travma Acil Cerrahi Derg. 2023 Sep;29(9):1013-1018. PubMed | Google Scholar DOI: 10.14744\/tjtes.2023.08939","DOI":"10.14744\/tjtes.2023.08939"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Shah P, Inturi R, Anne D, Jadhav D, Viswambharan V, Khadilkar R, Dnyanmote A, Shahi S. Wagner's Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital. Cureus. 2022 Jan 22;14(1):e21501. PubMed | Google Scholar DOI: 10.7759\/cureus.21501","DOI":"10.7759\/cureus.21501"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Farooque U, Lohano AK, Hussain Rind S, Rind MS Sr, Karimi S, Jaan A, Yasmin F, Cheema O. Correlation of Hemoglobin A1c With Wagner Classification in Patients With Diabetic Foot. Cureus. 2020 Jul 15;12(7):e9199. PubMed | Google Scholar DOI: 10.7759\/cureus.9199","DOI":"10.7759\/cureus.9199"}],"container-title":["Pan African Medical Journal"],"original-title":[],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T10:52:38Z","timestamp":1784544758000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.panafrican-med-journal.com\/content\/article\/53\/4\/full\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":10,"URL":"https:\/\/doi.org\/10.11604\/pamj.2026.53.4.50436","relation":{},"ISSN":["1937-8688"],"issn-type":[{"value":"1937-8688","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]},"article-number":"50436"}}