07/09/2026
Are we looking at the wrong glycemic metric in wound care?
For decades, HbA1c has been the standard measure of glycemic control. But when it comes to diabetic foot ulcers, a growing body of evidence suggests that how glucose fluctuates may be just as important—if not more important—than the average glucose level itself.
Continuous Glucose Monitoring (CGM) gives us a different perspective by capturing:
âś… Time in Range (TIR)
âś… Time Above Range (TAR)
âś… Time Below Range (TBR)
âś… Coefficient of Variation (CV)
âś… Glucose Management Indicator (GMI)
These metrics help reveal daily glucose patterns, variability, hyperglycemic excursions, and hypoglycemic episodes that HbA1c alone may miss.
As wound specialists, we frequently see patients whose ulcers are slow to heal despite an "acceptable" HbA1c. Could unfavorable glucose patterns be part of the explanation?
The emerging literature raises some intriguing questions:
🔹 Should TIR become a routine metric in patients with diabetic foot ulcers?
🔹 Should glycemic variability be considered a modifiable risk factor for delayed healing?
🔹 Could CGM-guided management improve wound outcomes and reduce complications?
🔹 Are we missing opportunities for intervention by focusing primarily on HbA1c?
We're not yet at the point where CGM metrics replace HbA1c, but they may provide valuable insights into the metabolic environment influencing tissue repair.
I'd love to hear from the wound care, podiatry, vascular, endocrinology, and diabetes education communities.
