Why do wounds heal slowly in patients with diabetes?
KUSAM SRIKANTH REDDY
Guntur, Andhra Pradesh
Diabetes makes it harder to heal wounds for several reasons: These include the following:
1) Poor circulation (atherosclerosis/peripheral vascular disease) due to fatty deposits in the arteries slows down blood flow, thereby limiting the amount of oxygen, antibiotics and healing nutrients that reach the wound.
2) Microangiopathy (damage to small blood vessels) due to diabetes results in impaired tissue perfusion which delays healing.
3) Delayed and inefficient immune system response is seen in diabetes. High blood sugar impairs enzyme activity, leukocyte adherence, bactericidal activity and phagocytosis (process by which our immune cell engulfs the bacteria).
High blood sugar diminishes chemotaxis (movement of white blood cells to site of injury to help fight infection) and causes defective diapedesis (passage of white blood cells, through intact capillary walls to the site of tissue damage). There is delay in formation of mature granulation tissue due to altered protein and lipid metabolism and parallel reduction in wound tensile strength.
4) When wounds remain open and healing is delayed, it further increases the risk of recurrent fungal and bacterial infections.
5) Smoking, alcohol abuse, malnutrition, dehydration, vascular insufficiency, and neuropathy are the other factors associated with delayed healing in diabetics.
In diabetes, the wound not only heals slowly but can worsen rapidly, requiring early treatment and close monitoring.
Dr. V. BALAJI
Director & Senior Consultant Diabetologist
Dr. Balaji Diabetes Care Centre