Correlation between haemoglobin, leukocytes, HbA1c, and albumin levels with diabetic foot ulcer severity: a cross-sectional study

Nur Anna Chalimah Sadyah*  -  Doctoral Study Program of Medical and Health Science, Universitas Diponegoro, Semarang Department of Internal Medicine, Sultan Agung Islamic Hospital, Semarang Department of Internal Medicine, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
Heri Nugroho  -  Department of Internal Medicine, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
Agung Putra  -  Stem Cell and Cancer Research, Semarang, Department of Postgraduate Biomedical Science, Faculty of Medicine, Universitas Islam Sultan Agung, Semarang, Indonesia
Ignatius Riwanto  -  Department of Surgery, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia

(*) Corresponding Author
DOI: 10.30659/sainsmed.v16i1.41423
Diabetic foot ulcers (DFUs) represent a serious complication of diabetes mellitus, associated with significant morbidity and healthcare costs. The progression of DFUs is influenced by systemic and local factors, including haemoglobin levels, leukocyte count, glycated haemoglobin (HbA1c), and serum albumin. This study aims to explore the relationship between these clinical parameters and the severity of DFUs. We enrolled 62 patients with DFUs and classified ulcer severity as mild, moderate, or severe according to the Wagner classification system. Using Spearman’s rank correlation, we found significant associations: lower hemoglobin and albumin levels correlated with more severe ulcers (ρ = -0.34, p= 0.0065; ρ = -0.41, p = 0.00084, respectively), while higher HbA1c and leukocyte counts were associated with increased ulcer severity (ρ = 0.62, p = 0.000; ρ = 0.40, p = 0.0013, respectively). These findings suggest that hematologic and biochemical markers may serve as valuable indicators of DFU progression, potentially guiding clinical decision-making and improving patient outcomes. Further research is needed to elucidate the underlying mechanisms and evaluate targeted interventions for this high-risk population.

Keywords: Diabetic foot ulcer; Haemoglobin; Leukocytes; HbA1c; Albumin

  1. Akkus, G., & Sert, M. (2022). Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities. World Journal of Diabetes, 13(12): 1106–1121. https://doi.org/10.4239/wjd.v13.i12.1106
  2. Albright, R. H., & Fleischer, A. E. (2021). Association of select preventative services and hospitalization in people with diabetes. Journal of Diabetes and Its Complications, 35(5): 1-5. https://doi.org/10.1016/j.jdiacomp.2021.107903
  3. Ammar, A. S., Khalid, R., Malik, U., Zeb, M., Abbas, H. M., & Khattak, S. B. (2021). Predictors of lower limb amputations in patients with diabetic foot ulcers presenting to a tertiary care hospital of Pakistan. The Journal of the Pakistan Medical Association, 71(9): 2163–2166. https://doi.org/10.47391/JPMA.06-932
  4. Bezerra, C. B., de Lima Saintrain, M. V., Lima, A. O. P., Nobre, M. A., E Silva Pesenti Sandrin, R. L., Braga, D. R. A., & Doucet, J. (2020). Clinical and epidemiological differences in diabetes: A cross-sectional study of the Brazilian population compared with the French GERODIAB cohort. Diabetes Research and Clinical Practice, 159(107945): 1-7. https://doi.org/10.1016/j.diabres.2019.107945
  5. Casadei, G., Filippini, M., & Brognara, L. (2021). Glycated Hemoglobin (HbA1c) as a biomarker for diabetic foot peripheral neuropathy. Diseases, 9(1): 1-18. https://doi.org/10.3390/diseases9010016
  6. Feng, X., Yang, Y., Zhuang, S., Fang, Y., Dai, Y., Fu, Y., Hu, Q., Yuan, Q., Tang, H., & Tang, L. (2021). Influence of serum albumin on HbA1c and HbA1c-defined glycemic status: A retrospective study. Frontiers in Medicine, 8(May), 1–10. https://doi.org/10.3389/fmed.2021.583093
  7. Huang, Z.-H., Li, S.-Q., Kou, Y., Huang, L., Yu, T., & Hu, A. (2019). Risk factors for the recurrence of diabetic foot ulcers among diabetic patients: A meta-analysis. International Wound Journal, 16(6): 1373–1382. https://doi.org/10.1111/iwj.13200
  8. Jiménez-García, J. F., Jiménez-Abad, J. F., López, L. A., & García-Fernández, F. P. (2024). Diabetic foot ulcers: evaluating the role of the specialist advanced practice nurse in complex chronic wounds. British Journal of Nursing, 33(15): S4–S15. https://doi.org/10.12968/bjon.2024.0006
  9. Kateel, R., Augustine, A. J., Prabhu, S., Ullal, S., Pai, M., & Adhikari, P. (2018). Clinical and microbiological profile of diabetic foot ulcer patients in a tertiary care hospital. Diabetes & Metabolic Syndrome, 12(1): 27–30. https://doi.org/10.1016/j.dsx.2017.08.008
  10. Leal de Araújo, A., Negreiros, F. D. da S., Florêncio, R. S., Garces, T. D. S., Cestari, V. R. F., Mattos, S. M., Marques, S. J. S., Albuquerque, F. E. F., Araújo, W. C. O., Poveda, V. de B., & Moreira, T. M. M. (2024). Preventive interventions for diabetic foot ulcer adopted in different healthcare settings: A scoping review protocol. PloS One, 19(10): 1-10. https://doi.org/10.1371/journal.pone.0306486
  11. Matheson, E. M., Bragg, S. W., & Blackwelder, R. S. (2021). Diabetes-related foot infections: Diagnosis and treatment. American Family Physician, 104(4), 386–394. https://www.aafp.org/pubs/afp/issues/2021/1000/p386.html
  12. Mendivil, J. M., Henderson, L. C., Olivas, O. S., Deanda, M. A., & Johnson, M. L. (2023). Retrospective data analysis of the use of an autologous multilayered leukocyte, platelet, and fibrin patch for diabetic foot ulcers treatment in daily clinical practice. Advances in Skin & Wound Care, 36(11): 579–585. https://doi.org/10.1097/ASW.0000000000000054
  13. Nano, J., Carinci, F., Okunade, O., Whittaker, S., Walbaum, M., Barnard-Kelly, K., Barthelmes, D., Benson, T., Calderon-Margalit, R., Dennaoui, J., Fraser, S., Haig, R., Hernández-Jimenéz, S., Levitt, N., Mbanya, J. C., Naqvi, S., Peters, A. L., Peyrot, M., Prabhaharan, M., … Massi-Benedetti, M. (2020). A standard set of person-centred outcomes for diabetes mellitus: results of an international and unified approach. Diabetic Medicine : A Journal of the British Diabetic Association, 37(12): 2009–2018. https://doi.org/10.1111/dme.14286
  14. Pemayun, T. G. D., & Naibaho, R. M. (2017). Clinical profile and outcome of diabetic foot ulcer, a view from a tertiary care hospital in Semarang, Indonesia. Diabetic Foot & Ankle, 8(1): 1-8. https://doi.org/10.1080/2000625X.2017.1312974
  15. Peng, B., & Min, R. (2023). Development of predictive nomograms for clinical use to quantify the risk of diabetic foot in patients with type 2 diabetes mellitus. Frontiers in Endocrinology, 14 (1186992): 01-08. https://doi.org/10.3389/fendo.2023.1186992
  16. Shabhay, A., Horumpende, P., Shabhay, Z., Mganga, A., Van Baal, J., Msuya, D., Chilonga, K., & Chugulu, S. (2021). Clinical profiles of diabetic foot ulcer patients undergoing major limb amputation at a tertiary care centre in North-eastern Tanzania. BMC Surgery, 21(34): 1-7. https://doi.org/10.1186/s12893-021-01051-3
  17. Shah, P., Inturi, R., Anne, D., Jadhav, D., Viswambharan, V., Khadilkar, R., Dnyanmote, A., & Shahi, S. (2022). Wagner’s classification as a tool for treating diabetic foot ulcers: Our observations at a Suburban Teaching Hospital. Cureus, 14(1): 1-11. https://doi.org/10.7759/cureus.21501
  18. Sharma, A., Srivastava, V., Shankar, R., Yadav, A. K., Ansari, M. A., & Gupta, S. K. (2024). Epidemiological profile of chronic wounds in an Indian Population: A community-based cross-sectional observational study. Cureus, 16(9): 1-19. https://doi.org/10.7759/cureus.68684
  19. Tong, T., Yang, C., Tian, W., Liu, Z., Liu, B., Cheng, J., Cheng, Q., & Zhou, B. (2020). Phenotypes and outcomes in middle-aged patients with diabetic foot ulcers: A retrospective cohort study. Journal of Foot and Ankle Research, 13(1): 1-8. https://doi.org/10.1186/s13047-020-00386-z
  20. Yu, X., Wu, Z., & Zhang, N. (2024). Machine learning-driven discovery of novel therapeutic targets in diabetic foot ulcers. Molecular Medicine, 30(1): 1-15. https://doi.org/10.1186/s10020-024-00955-z
  21. Ziegler, D., Papanas, N., Schnell, O., Nguyen, B. D. T., Nguyen, K. T., Kulkantrakorn, K., & Deerochanawong, C. (2021). Current concepts in the management of diabetic polyneuropathy. Journal of Diabetes Investigation, 12(4): 464–475. https://doi.org/10.1111/jdi.13401

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ISSN: 2339-093X (Online) | 2085-1545 (Print)
DOI : 10.30659/sainsmed

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