From the Guidelines
Good blood glucose control is crucial for proper wound healing as it significantly reduces the risk of complications and promotes a faster recovery. When blood glucose remains high, it causes blood vessel damage, reduces blood flow to wounded areas, and impairs the function of white blood cells that fight infection, as noted in the 2023 International Working Group on the Diabetic Foot (IWGDF) evidence-based guideline on wound healing interventions 1. High glucose levels also cause inflammation and oxidative stress, which further delay healing. Additionally, elevated blood sugar promotes the growth of bacteria and fungi, increasing infection risk in wounds. The body's collagen production, which is necessary for wound repair, becomes compromised when glucose levels are uncontrolled. Some key points to consider for good blood glucose control in wound healing include:
- Maintaining blood glucose levels within target ranges (typically 80-130 mg/dL before meals and less than 180 mg/dL after meals) through medication adherence, regular monitoring, proper nutrition, and exercise is crucial, as emphasized in the assessment and management of diabetes-related foot infection according to the new international working group on the diabetic foot guidelines 2023 1.
- Patients with wounds should check their glucose levels more frequently and work closely with healthcare providers to adjust their diabetes management plan as needed.
- Proper glucose control not only accelerates wound healing but also reduces complications like infections and prevents the development of chronic, non-healing wounds. It is essential to note that glycaemic control in patients with advanced diabetes must be managed carefully with strict monitoring, and too rapid reduction in HbA1c can have detrimental effects, such as treatment-induced neuropathy 1. Therefore, a balanced approach to blood glucose control, considering both the benefits of good control and the risks of overly aggressive management, is essential for optimal wound healing outcomes.
From the Research
Importance of Blood Glucose Control in Wound Healing
Good blood glucose control is crucial for wound healing, as uncontrolled blood glucose levels can lead to further circulatory damage, impeding the wound healing process and often resulting in chronic wounds that do not heal 2.
Key Factors in Wound Healing
Some key factors that highlight the importance of good blood glucose control in wound healing include:
- Hyperglycemia leading to osmotic diuresis and subsequent decreased oxygenation and perfusion, limiting PMN functioning and producing malnutrition by increasing hormones that cause catabolism 3
- Improved glycemic control playing a significant role in lowering the risk of wound healing complications 4
- The need for meticulous monitoring of blood glucose levels and intensive insulin therapy to reduce hyperglycemia and promote wound healing 3
Experimental Evidence
Experimental studies have demonstrated the impact of diabetes on acute wound healing, suggesting that tight glycaemic control is a key factor in wound healing enhancement strategies in an experimental diabetes mellitus model 5.
Clinical Implications
In clinical practice, district nursing teams can improve wound healing for patients with diabetic ulcers by regularly monitoring blood glucose levels and supporting patients to adapt best practice 2. Additionally, controlling blood glucose levels can help reduce the risk of wound healing complications, particularly in patients with diabetes 6, 4.