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The Relationship between Hemoglobin A1c Values and Healing Time for Lower Extremity Ulcers in Individuals with Diabetes

Markuson, Melanie RN, BSN; Hanson, Darlene RN, MS; Anderson, Julie RN, PhD, CCRC; Langemo, Diane RN, PhD, FAAN; Hunter, Susan RN, MSN; Thompson, Pat RN, MS; Paulson, Rolf MD; Rustvang, Dan FNP

Advances in Skin & Wound Care: August 2009 - Volume 22 - Issue 8 - p 365-372
doi: 10.1097/01.ASW.0000358639.45784.cd
FEATURES: ORIGINAL INVESTIGATIONS
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PROBLEM: The diabetic population is at an increased risk, up to 15% over a lifetime, to develop leg and foot ulcers due to such factors as neuropathy, ischemia, and infection. The tight control of glucose levels as possible is necessary to prevent the diabetic complications by preventing microvascular changes that predispose the patient to neuropathy, ischemia, and infection. Although it is clear from the literature review that tight glucose control prevents complications, the relationship between HgbA1c values and healing times of ulcers is less well defined. This study explored the relationship between HgbA1c values and healing times of leg and foot ulcers.

THEORETICAL/CONCEPTUAL FRAMEWORK: The theoretical framework used was Orem's self-care deficit theory of nursing, which focuses on self-care of patients and nursing intervention if self-care is inadequate.

SUBJECTS: Forty-one male and 22 female patients having either type 1 or type 2 diabetes were considered in this study. Of these 63 patients, 9 had type 1 and 54 had type 2 diabetes. Ages ranged from 33 to 94 years (mean, 67.7 years [SD, 14.98 years]). Weight ranged from 122 to 402 lb (mean, 221.84 lb [SD, 58.79 lb]).

METHODOLOGY: As part of a larger study, a retrospective chart review was performed on 63 patients with diabetes served by a Midwestern outpatient wound care clinic from July 2001 to July 2004. Approval for this study was granted through the local institutional review board. No data collected required the consent of the individual or included any identifying data, thus protecting the privacy of the individuals whose charts were reviewed. A tool was developed by the researchers through literature review to gather needed information. The data collection tool included demographics, medical diagnoses, wound size at presentation, and most recent wound size, as well as the HgbA1c results closest to admission and closest to time of wound closure. Statistics were generated using the SPSS program.

RESULTS: Of the 63 ulcers, 36 healed, 26 did not heal, and it was not possible to determine if healing occurred for 1 ulcer. Admission HgbA1c values ranged from 4.5 to 15.4 (mean, 8.05 [SD, 2.29]). HgbA1c values closest to ulcer closure ranged from 5.3 to 12.3 (mean, 7.68 [SD, 1.81]). It was found that patients with higher HgbA1c levels did experience wound healing, but in a significantly longer period than those with lower HgbA1c. Individuals with type 1 diabetes had a higher healing rate (77.8%) than individuals with type 2 diabetes (53.7%), whereas 40% of all closed ulcers reopened. A significant correlation was also noted between a history of smoking and increased HgbA1c levels.

IMPLICATIONS: Healing times were decreased in those individuals who had lower HgbA1c values. Decreased healing times result in lower cost for the patient, decreased chance of infection due to lack of portal of entry, and increased quality of life. Patient education may increase self-care practices in the diabetic population regarding better glucose control.

The focus of this study is on ulcers of the lower extremities in individuals with diabetes mellitus.

Melanie Markuson, RN, BSN, is Intensive Care Unit Staff Nurse, Sentara Virginia Beach General Hospital, Virginia Beach, Virginia; Darlene Hanson, RN, MS, is Clinical Associate Professor; Julie Anderson, RN, PhD, CCRC, is Associate Professor; Diane Langemo, RN, PhD, FAAN, is Professor Emeritus, Nurse Consultant; Susan Hunter, RN, MSN, is Associate Professor; and Pat Thompson, RN, MS, is Clinical Associate Professor, all at the University of North Dakota College of Nursing, Grand Forks, North Dakota; Rolf Paulson, MD, is Director, and Dan Rustvang, FNP, is Technical Director, Altru Wound Care Clinic, Grand Forks, North Dakota. Submitted July 15, 2008; accepted October 6, 2008.

© 2009 Lippincott Williams & Wilkins, Inc.