Utility Of Hba1c, Ankle-Brachial Pressure Index and Doppler Scan to Predict Amputation in Diabetic Foot

Abstract

Introduction: Diabetes mellitus (DM) is a chronic metabolic disorder associated with microvascular and macrovascular complications, among which diabetic foot ulcers (DFUs) are particularly disabling. Peripheral arterial disease (PAD) contributes significantly to the development of chronic wounds, infections, and amputations in diabetic patients. Glycated hemoglobin (HbA1c) remains a reliable marker for long-term glycaemic control and may also reflect vascular compromise. This study aimed to evaluate the relationship between HbA1c levels, ankle-brachial pressure index (ABPI), and Doppler findings with the severity of vasculopathy in patients with DFUs, while also assessing the prognostic role of HbA1c in wound healing and risk of amputation.

Materials and Methods: A cross-sectional observational study was conducted at Adichunchanagiri Institute of Medical Sciences, Adichunchanagiri University, B.G. Nagara, Mandya, over 18 months. A total of 87 patients with diabetic foot ulcers were enrolled. Clinical evaluation included peripheral pulse assessment, ABPI measurement, and arterial Doppler examination. HbA1c levels were stratified as <7.5% and >7.5%. Statistical analysis was performed using SPSS version 26.0.

Results: The cohort had a mean age of 60.48 ± 12.65 years, with male predominance (80.5%). Poor glycaemic control (HbA1c >9%) was observed in 58.6% of patients. ABPI indicated claudication in 60.9% and severe arterial disease in 2.3%. Higher HbA1c levels were significantly associated with greater PAD severity (p < 0.05), delayed wound healing, and higher amputation risk.

Conclusion: Elevated HbA1c correlates strongly with worsening PAD and poor wound healing in diabetic foot patients. Early vascular assessment and strict glycaemic control are essential to improve outcomes and reduce amputations.