{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T02:43:11Z","timestamp":1788316991280,"version":"build-2803163510"},"reference-count":41,"publisher":"American Diabetes Association","issue":"7","license":[{"start":{"date-parts":[[2018,6,22]],"date-time":"2018-06-22T00:00:00Z","timestamp":1529625600000},"content-version":"vor","delay-in-days":67,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"funder":[{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["T32-DK-062707"],"award-info":[{"award-number":["T32-DK-062707"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["P30-DK-079637"],"award-info":[{"award-number":["P30-DK-079637"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","award":["5KL2-TR-001077-02"],"award-info":[{"award-number":["5KL2-TR-001077-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,7,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>This study evaluated the association between hemoglobin A1c (A1C) and wound outcomes in patients with diabetic foot ulcers (DFUs).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>We conducted a retrospective analysis of an ongoing prospective, clinic-based study of patients with DFUs treated at an academic institution during a 4.7-year period. Data from 270 participants and 584 wounds were included in the analysis. Cox proportional hazards regression was used to assess the incidence of wound healing at any follow-up time in relation to categories of baseline A1C and the incidence of long-term (\u226590 days) wound healing in relation to tertiles of nadir A1C change and mean A1C change from baseline, adjusted for potential confounders.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Baseline A1C was not associated with wound healing in univariate or fully adjusted models. Compared with a nadir A1C change from baseline of \u22120.29 to 0.0 (tertile 2), a nadir A1C change of 0.09 to 2.4 (tertile 3) was positively associated with long-term wound healing in the subset of participants with baseline A1C &amp;lt;7.5% (hazard ratio [HR] 2.07; 95% CI 1.08\u20134.00), but no association with wound healing was seen with the mean A1C change from baseline in this group. Neither nadir A1C change nor mean A1C change were associated with long-term wound healing in participants with baseline A1C \u22657.5%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>There does not appear to be a clinically meaningful association between baseline or prospective A1C and wound healing in patients with DFUs. The paradoxical finding of accelerated wound healing and increase in A1C in participants with better baseline glycemic control requires confirmation in further studies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc17-1683","type":"journal-article","created":{"date-parts":[[2018,4,16]],"date-time":"2018-04-16T13:30:18Z","timestamp":1523885418000},"page":"1478-1485","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":61,"title":["Association of Hemoglobin A1c and Wound Healing in Diabetic Foot Ulcers"],"prefix":"10.2337","volume":"41","author":[{"given":"Betiel K.","family":"Fesseha","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Abularrage","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn F.","family":"Hines","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Sherman","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priscilla","family":"Frost","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Langan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Canner","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendall C.","family":"Likes","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sayed M.","family":"Hosseini","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendolyne","family":"Jack","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin W.","family":"Hicks","sequence":"additional","affiliation":[{"name":"Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swaytha","family":"Yalamanchi","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0210-655X","authenticated-orcid":false,"given":"Nestoras","family":"Mathioudakis","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Johns Hopkins University, Baltimore, MD"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2018,4,16]]},"reference":[{"key":"2022031301142695800_B1","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1001\/jama.293.2.217","article-title":"Preventing foot ulcers in patients with diabetes","volume":"293","author":"Singh","year":"2005","journal-title":"JAMA"},{"key":"2022031301142695800_B2","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1002\/1520-7560(200009\/10)16:1+<::AID-DMRR139>3.0.CO;2-8","article-title":"What is the most effective way to reduce incidence of amputation in the diabetic foot","volume":"16","author":"Apelqvist","year":"2000","journal-title":"Diabetes Metab Res Rev"},{"key":"2022031301142695800_B3","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.diabres.2007.01.005","article-title":"Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older","volume":"77","author":"Gregg","year":"2007","journal-title":"Diabetes Res Clin Pract"},{"key":"2022031301142695800_B4","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.2337\/diacare.22.7.1036","article-title":"A prospective study of risk factors for diabetic foot ulcer. The Seattle Diabetic Foot Study","volume":"22","author":"Boyko","year":"1999","journal-title":"Diabetes Care"},{"key":"2022031301142695800_B5","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.ejvs.2013.03.024","article-title":"Short and long term mortality rates after a lower limb amputation","volume":"46","author":"Fortington","year":"2013","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"2022031301142695800_B6","doi-asserted-by":"crossref","first-page":"491","DOI":"10.2337\/diacare.26.2.491","article-title":"Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology","volume":"26","author":"Moulik","year":"2003","journal-title":"Diabetes Care"},{"key":"2022031301142695800_B7","first-page":"CD008143","article-title":"Targeting intensive glycaemic control versus targeting conventional glycaemic control for type 2 diabetes mellitus","author":"Hemmingsen","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2022031301142695800_B8","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1056\/NEJMoa0706245","article-title":"Effect of a multifactorial intervention on mortality in type 2 diabetes","volume":"358","author":"Gaede","year":"2008","journal-title":"N Engl J Med"},{"issue":"2","key":"2022031301142695800_B9","doi-asserted-by":"crossref","first-page":"22S","DOI":"10.1016\/j.jvs.2015.10.005","article-title":"A systematic review and meta-analysis of glycemic control for the prevention of diabetic foot syndrome","volume":"63","author":"Hasan","year":"2016","journal-title":"J Vasc Surg"},{"key":"2022031301142695800_B10","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1097\/01.ASW.0000358639.45784.cd","article-title":"The relationship between hemoglobin A(1c) values and healing time for lower extremity ulcers in individuals with diabetes","volume":"22","author":"Markuson","year":"2009","journal-title":"Adv Skin Wound Care"},{"key":"2022031301142695800_B11","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1038\/jid.2011.176","article-title":"Hemoglobin A1c predicts healing rate in diabetic wounds","volume":"131","author":"Christman","year":"2011","journal-title":"J Invest Dermatol"},{"key":"2022031301142695800_B12","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.pcd.2012.02.004","article-title":"Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany","volume":"6","author":"Pscherer","year":"2012","journal-title":"Prim Care Diabetes"},{"key":"2022031301142695800_B13","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1016\/j.diabres.2005.07.005","article-title":"Risk factors for major limb amputations in diabetic foot gangrene patients","volume":"71","author":"Miyajima","year":"2006","journal-title":"Diabetes Res Clin Pract"},{"key":"2022031301142695800_B14","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.2337\/dc06-0912","article-title":"Poor glucose control in the year before admission as a powerful predictor of amputation in hospitalized patients with diabetic foot ulceration","volume":"29","author":"Lepore","year":"2006","journal-title":"Diabetes Care"},{"key":"2022031301142695800_B15","first-page":"197","article-title":"Glycosylated hemoglobin and hyperbaric oxygen coverage denials","volume":"42","author":"Moffat","year":"2015","journal-title":"Undersea Hyperb Med"},{"key":"2022031301142695800_B16","doi-asserted-by":"crossref","first-page":"286","DOI":"10.14310\/horm.2002.1245","article-title":"Predictors of amputation in diabetics with foot ulcer: single center experience in a large Turkish cohort","volume":"8","author":"Yesil","year":"2009","journal-title":"Hormones (Athens)"},{"key":"2022031301142695800_B17","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s00508-014-0630-5","article-title":"The major predictors of amputation and length of stay in diabetic patients with acute foot ulceration","volume":"127","author":"Tabur","year":"2015","journal-title":"Wien Klin Wochenschr"},{"key":"2022031301142695800_B18","doi-asserted-by":"crossref","first-page":"852","DOI":"10.2337\/dc14-1598","article-title":"Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer","volume":"38","author":"Pickwell","year":"2015","journal-title":"Diabetes Care"},{"key":"2022031301142695800_B19","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1001\/archderm.136.12.1531","article-title":"Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis","volume":"136","author":"Margolis","year":"2000","journal-title":"Arch Dermatol"},{"key":"2022031301142695800_B20","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1016\/j.jvs.2016.12.123","article-title":"The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting","volume":"65","author":"Mathioudakis","year":"2017","journal-title":"J Vasc Surg"},{"key":"2022031301142695800_B21","first-page":"220","article-title":"The Society for Vascular Surgery lower extremity threatened limb classification system: risk stratification based on Wound, Ischemia, and foot Infection (WIfI)","volume-title":"J Vasc Surg","author":"Mills","year":"2014"},{"key":"2022031301142695800_B22","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1016\/j.jvs.2016.01.011","article-title":"Society for Vascular Surgery limb stage and patient risk correlate with outcomes in an amputation prevention program","volume":"63","author":"Causey","year":"2016","journal-title":"J Vasc Surg"},{"key":"2022031301142695800_B23","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jvs.2014.11.045","article-title":"The Society for Vascular Surgery lower extremity threatened limb classification system based on Wound, Ischemia, and foot Infection (WIfI) correlates with risk of major amputation and time to wound healing","volume":"61","author":"Zhan","year":"2015","journal-title":"J Vasc Surg"},{"key":"2022031301142695800_B24","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/cis346","article-title":"2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky","year":"2012","journal-title":"Clin Infect Dis"},{"key":"2022031301142695800_B25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4158\/EP15672.GLSUPPL","article-title":"American Association of Clinical Endocrinologists and American College of Endocrinology--clinical practice guidelines for developing a diabetes mellitus comprehensive care plan--2015","volume":"21","author":"Handelsman","year":"2015","journal-title":"Endocr Pract"},{"key":"2022031301142695800_B26","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1093\/ptj\/88.11.1436","article-title":"Comprehensive foot examination and risk assessment. A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists","volume":"88","author":"Boulton","year":"2008","journal-title":"Phys Ther"},{"key":"2022031301142695800_B27","doi-asserted-by":"crossref","first-page":"S48","DOI":"10.2337\/dc17-S009","article-title":"Glycemic targets. Sec 6","volume":"40","author":"American Diabetes Association","year":"2017","journal-title":"Diabetes Care"},{"key":"2022031301142695800_B28","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.2337\/dc15-0187","article-title":"Clinical assessment of individualized glycemic goals in patients with type 2 diabetes: formulation of an algorithm based on a survey among leading worldwide diabetologists","volume":"38","author":"Cahn","year":"2015","journal-title":"Diabetes Care"},{"key":"2022031301142695800_B29","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1046\/j.1524-475X.1994.20305.x","article-title":"Definitions and guidelines for assessment of wounds and evaluation of healing","volume":"2","author":"Lazarus","year":"1994","journal-title":"Wound Repair Regen"},{"key":"2022031301142695800_B30","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1046\/j.1524-475X.1996.40309.x","article-title":"Interobserver agreement, sensitivity, and specificity of a \u201chealed\u201d chronic wound","volume":"4","author":"Margolis","year":"1996","journal-title":"Wound Repair Regen"},{"key":"2022031301142695800_B31","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"Harrell","year":"1996","journal-title":"Stat Med"},{"key":"2022031301142695800_B32","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1016\/S0140-6736(05)67700-8","article-title":"Wound healing and its impairment in the diabetic foot","volume":"366","author":"Falanga","year":"2005","journal-title":"Lancet"},{"key":"2022031301142695800_B33","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S1479-666X(07)80007-2","article-title":"Diabetic foot ulcers--a comprehensive review","volume":"5","author":"Leung","year":"2007","journal-title":"Surgeon"},{"key":"2022031301142695800_B34","doi-asserted-by":"crossref","first-page":"2937","DOI":"10.2337\/db12-0227","article-title":"Mechanisms involved in the development and healing of diabetic foot ulceration","volume":"61","author":"Dinh","year":"2012","journal-title":"Diabetes"},{"key":"2022031301142695800_B35","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1016\/S0140-6736(95)92899-5","article-title":"Slowing of wound healing by psychological stress","volume":"346","author":"Kiecolt-Glaser","year":"1995","journal-title":"Lancet"},{"key":"2022031301142695800_B36","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1097\/00006842-199805000-00025","article-title":"Mucosal wound healing is impaired by examination stress","volume":"60","author":"Marucha","year":"1998","journal-title":"Psychosom Med"},{"key":"2022031301142695800_B37","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.12968\/bjon.2003.12.21.11883","article-title":"The effects of stress on wound healing and leg ulceration","volume":"12","author":"Norman","year":"2003","journal-title":"Br J Nurs"},{"key":"2022031301142695800_B38","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1007\/s11481-006-9036-0","article-title":"Stress-induced immune dysregulation: implications for wound healing, infectious disease and cancer","volume":"1","author":"Godbout","year":"2006","journal-title":"J Neuroimmune Pharmacol"},{"key":"2022031301142695800_B39","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1093\/brain\/awu307","article-title":"Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes","volume":"138","author":"Gibbons","year":"2015","journal-title":"Brain"},{"key":"2022031301142695800_B40","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1002\/ana.21952","article-title":"Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy","volume":"67","author":"Gibbons","year":"2010","journal-title":"Ann Neurol"},{"key":"2022031301142695800_B41","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/S0006-8993(02)02910-4","article-title":"Hypoglycaemic neuropathy: microvascular changes due to recurrent hypoglycaemic episodes in rat sciatic nerve","volume":"947","author":"Ohshima","year":"2002","journal-title":"Brain Res"}],"container-title":["Diabetes Care"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/care.diabetesjournals.org\/syndication\/doi\/10.2337\/dc17-1683","content-type":"unspecified","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/41\/7\/1478\/527714\/dc171683.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/diabetesjournals.org\/care\/article-pdf\/41\/7\/1478\/527714\/dc171683.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,13]],"date-time":"2022-03-13T04:56:32Z","timestamp":1647147392000},"score":1,"resource":{"primary":{"URL":"https:\/\/diabetesjournals.org\/care\/article\/41\/7\/1478\/36420\/Association-of-Hemoglobin-A1c-and-Wound-Healing-in"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,16]]},"references-count":41,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2018,4,16]]},"published-print":{"date-parts":[[2018,7,1]]}},"URL":"https:\/\/doi.org\/10.2337\/dc17-1683","relation":{},"ISSN":["0149-5992","1935-5548"],"issn-type":[{"value":"0149-5992","type":"print"},{"value":"1935-5548","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,4,16]]}}}