Background: Higher HbA1c on admission is associated with increased amputation risk in patients with diabetic foot ulcers (DFUs) ; however, the impact of long-term glycemic control and glycemic variability after hospital discharge on amputation risk is unclear.

Methods: We performed retrospective analyses of hospitalized patients with a DFU who were followed for >1 year after index admission with at least two HbA1c measurements and > 1-year follow-up (n=479) . Using multivariable logistic regression analysis, we examined the associations of HbA1c measures [HbA1c nadir change (difference between the baseline HbA1c and the single lowest prospective HbA1c level during the follow-up) , standard deviation (SD-HbA1c) , mean HbA1c change, and HbA1c variability score (HVS) ] with a composite outcome [minor and major lower extremity amputations (LEA) and mortality].

Results: The median age was 55.3 (IQR: 47.9, 62.8) years. During a mean follow-up of 2.4 years, 250 (52.2%) patients had a LEA or death [minor LEA: 116 (24.2%) ; major LEA: 113 (23.4%) ; death: 21 (4.4%) ]. In the fully adjusted model, HbA1c variability metrics were significantly associated with higher LEA and/or death rates, except HVS (Table) .

Conclusion: Our findings indicate that visit-to-visit HbA1c variability, especially HbA1c nadir change, and SD-HbA1c are independent biomarkers of LEA risk in patients with DFU.


R.Jagannathan: None. M.Schechter: None. J.A.Alvarez: None. G.Blanco: None. R.Rajani: None. G.Santamarina: None. G.E.Umpierrez: Research Support; AstraZeneca, Dexcom, Inc., Novo Nordisk. M.Fayfman: None.


Emory Medical Care Foundation to MCS and MF

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