Issue 140 Item 6 Glycemic Control Does Not Affect Wound Healing in Diabetics

In patients diabetes, glycemic control does not influence collagen deposition during acute wound healing. That, according to a report published in the January issue of the Archives of Surgery. Findings from animal studies and in vitro experiments have suggested that improved glycemic control is associated with enhanced wound healing in diabetics. In contrast, in vivo human studies have yielded conflicting results. However, it is possible that other factors often present in diabetics, such as decreased perfusion, infection, or neuropathy, may have influenced the findings.

In the current study, Dr. Per E. Holstein, from the University of Copenhagen, and colleagues used a granulation tissue model to assess wound healing in 34 type 1 and 25 type 2 diabetic patients. None of the patients had evidence of decreased perfusion, infection, or neuropathy.

Type 1 diabetics demonstrated significantly less collagen deposition during wound healing than type 2 diabetics (p = 0.03), whose deposition capacity was similar to that of non-diabetic control subjects.

Further analysis revealed that the decreased collagen deposition seen in type 1 diabetics was not due to enhanced collagenase activity. However, type 1 diabetics were also found to have decreased fibroblast proliferation, which could explain why collagen deposition is reduced.

In both types of diabetics, the amount of collagen deposited was not related to glycemic control, as determined by glycosylated hemoglobin levels, the authors note.

The researchers note that the lack of a link between glycemic control and collage deposition should be interpreted with caution. None of the patients in the current study were severely hypo- or hyperglycemic and, therefore, immediate glycemic correction was not needed. It may be that glycemic control does affect wound healing, but only when blood glucose levels are extremely high or low, they add. Arch Surg 2003;138:34-40.