www.idosr.

org Kibibi, 2024

International Digital Organization for Scientific Research IDOSRJAS9.3.4852000

Exploration of Management Strategies for Type 2

ABSTRACT
The management of type 2 diabetes mellitus (T2DM) in patients with wounds posed a complex challenge,
requiring a multifaceted approach to optimize glycemic control and improve healing outcomes. T2DM impaired
the body's natural healing processes, increasing the risk of chronic wounds, particularly diabetic foot ulcers
(DFUs), which can lead to severe complications such as infections and amputations. This review explored
various management strategies tailored for wounded patients with T2DM, including the importance of
maintaining optimal glycemic levels, dietary interventions, pharmacological treatments, and multidisciplinary
care approaches. The review was conducted by synthesizing current research findings, clinical studies, and
systematic reviews on glycemic control, dietary interventions, pharmacological treatments, and
multidisciplinary approaches in managing wounds among patients with T2DM. Key findings indicate that tight
glycemic control, particularly with target hemoglobin A1c (HbA1c) levels between 7.0% and 8.0%, enhances
wound healing, while overly aggressive management may have adverse effects. Nutritional strategies like
Mediterranean and low-carbohydrate diets improve insulin sensitivity and reduce inflammation, while
pharmacological treatments like metformin, GLP-1 receptor agonists, and SGLT-2 inhibitors improve glycemic
control and overall health outcomes. A multidisciplinary team (MDT) approach is highlighted as a critical factor
in improving patient care, with evidence showing significant reductions in HbA1c levels among patients treated
by MDTs. Future research should focus on standardizing protocols, leveraging emerging technologies, and
assessing the long-term effects of integrated management strategies on wound healing and quality of life.
Keywords: Type 2 Diabetes Management, Glycemic Control, Wound Healing, Dietary Interventions,
Multidisciplinary Care.

INTRODUCTION
The management of type 2 diabetes among patients and poor circulation exacerbate the risks associated
with wounds presents a complex challenge that with diabetic wounds, making early detection and
necessitates a multifaceted approach. Diabetes intervention essential[4]. This review will explore
significantly impairs the body's natural healing various management strategies tailored for
processes, leading to a higher incidence of chronic wounded patients with type 2 diabetes,
wounds, particularly foot ulcers[1, 2]. These emphasizing the importance of individualized care
wounds not only prolong recovery times but also plans that incorporate dietary modifications,
increase the risk of severe complications, including pharmacological treatments, and advanced wound
infections and amputations. Understanding the care techniques. By synthesizing current research
interplay between glycemic control, nutritional findings and clinical practices, this exploration aims
status, and wound care is crucial for optimizing to provide insights into improving outcomes for
treatment strategies. Recent literature highlights this vulnerable patient population.
that effective management of blood glucose levels is GLYCEMIC CONTROL AND WOUND
paramount in promoting wound healing and HEALING
minimizing complications[3]. Elevated blood Glycemic control plays a critical role in the wound
sugar can hinder immune function, reduce blood healing process, particularly for patients with
flow, and disrupt the inflammatory response, all of diabetes. Maintaining optimal glycemic control is
which are critical for effective wound repair. critical for promoting wound healing in patients
Furthermore, factors such as peripheral neuropathy with T2DM. Hyperglycemia can impair leukocyte
48
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.
www.idosr.org Kibibi, 2024
function, delay collagen synthesis, and increase the studies have shown that a modest weight loss of
risk of infections[5]. Several studies have approximately 7% can substantially reduce the risk
demonstrated that tight glycemic control can of developing diabetes among high-risk
significantly improve wound healing rates. Chronic individuals[14].
hyperglycemia is associated with delayed wound Types of Dietary Interventions
healing and an increased risk of complications, such Several dietary approaches have been recognized
as infections and amputations[6, 7]. Elevated blood for their effectiveness in managing T2D:
glucose levels can impair various physiological Mediterranean Diet: This diet emphasizes whole
processes essential for healing, including grains, healthy fats (such as olive oil), fruits,
inflammation, angiogenesis, and cellular migration. vegetables, and lean protein sources. It has been
Research indicates that maintaining optimal associated with improved cardiovascular health and
glycemic levels significantly enhances healing better glycemic control[15, 16].
outcomes in diabetic foot ulcers (DFUs)[8]. A Low-Carbohydrate Diets: These diets restrict
systematic review highlighted that worsening carbohydrate intake, which can lead to rapid
glycemic control during DFU treatment markedly improvements in blood sugar levels. However,
decreased the odds of wound healing, emphasizing caution is advised as overly restrictive diets may
the necessity of managing blood glucose levels limit the intake of important nutrients found in
effectively throughout the treatment process[6, 9]. fruits and whole grains[17, 18].
Additionally, a study found that a target Mechanisms of Action
hemoglobin A1c (HbA1c) level between 7.0% and The effectiveness of these dietary interventions can
8.0% during treatment was associated with be attributed to several mechanisms [19, 20]:
improved healing rates compared to lower or Improved β-cell Function: Nutritional strategies
higher HbA1c levels[10, 11]. This suggests that may enhance the function and mass of pancreatic β-
while tight glycemic control is beneficial, overly cells, which are crucial for insulin production.
aggressive management may not yield additional Weight Management: Effective dietary
benefits and could potentially lead to adverse interventions often lead to weight loss, which is
outcomes. Moreover, studies have shown that directly linked to improved insulin sensitivity and
diabetic patients with HbA1c levels above 7.0% are better glycemic control.
at a higher risk for postoperative complications, Reduction of Inflammation: Certain diets,
including slower wound healing and increased particularly those rich in anti-inflammatory foods
infection rates[12, 13]. These findings underscore like fruits, vegetables, and healthy fats, can help
the importance of personalized glycemic mitigate the chronic inflammation associated with
management strategies that consider individual T2D.
patient characteristics and the specific context of PHARMACOLOGICAL TREATMENTS
their wounds. Effective glycemic control is essential Pharmacological treatments for diabetes are
for optimizing wound healing in diabetic patients. essential components of comprehensive
It not only facilitates the healing process but also management strategies aimed at achieving optimal
reduces the risk of complications associated with glycemic control and preventing complications.
impaired wound recovery. Future research should The landscape of diabetes medications has evolved
focus on establishing standardized protocols for significantly, with various classes of drugs available
glycemic management tailored to the needs of to address the unique needs of patients with type 2
patients with diabetic wounds to further enhance diabetes (T2D)[21, 22].
clinical outcomes. Key Classes of Medications
DIETARY INTERVENTIONS Metformin: As the first-line treatment for T2D,
Dietary interventions are pivotal in the metformin is widely prescribed due to its efficacy in
management of type 2 diabetes (T2D), influencing lowering blood glucose levels by reducing hepatic
glycemic control, weight management, and overall glucose production and enhancing insulin
health outcomes. The increasing prevalence of T2D sensitivity. It is particularly favored for its
globally necessitates effective nutritional strategies cardiovascular benefits and low risk of
to mitigate its impact on individuals and healthcare hypoglycemia.
systems. Sulfonylureas: These medications stimulate
Importance of Dietary Interventions insulin secretion from pancreatic beta cells. While
Dietary modifications can significantly improve effective in lowering blood sugar, they carry a risk
insulin sensitivity and lower blood glucose levels, of hypoglycemia and weight gain, necessitating
which are crucial for managing T2D. Research careful patient selection.
indicates that structured dietary programs focusing GLP-1 Receptor Agonists: This class includes
on moderate caloric restriction and balanced injectable medications that enhance insulin
macronutrient distribution can lead to weight loss secretion in response to meals, slow gastric
and improved metabolic parameters. For instance, emptying, and promote satiety. They are associated
49
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.
www.idosr.org Kibibi, 2024
with weight loss and improved cardiovascular effects. For instance, pairing metformin with a
outcomes, making them a valuable option for GLP-1 receptor agonist or an SGLT-2 inhibitor
overweight patients with T2D. can yield synergistic effects on blood glucose levels
SGLT-2 Inhibitors: These drugs work by and weight management. Early intervention with
preventing glucose reabsorption in the kidneys, combination therapies is recommended to prevent
leading to increased glucose excretion in urine. progression of the disease and reduce the risk of
They have shown benefits in reducing complications[23]. Pharmacological treatments
cardiovascular events and managing heart failure in for diabetes encompass a diverse array of
diabetic patients. medications that target different mechanisms
Insulin Therapy: For patients with advanced T2D involved in glucose regulation. The choice of
or those who cannot achieve adequate control with therapy should be individualized based on patient
oral agents, insulin therapy becomes necessary. It characteristics, preferences, and specific health
can be administered as basal insulin or as part of a needs. Ongoing research continues to refine these
more complex regimen involving rapid-acting treatment options, aiming for improved outcomes
insulins around mealtimes. in the management of diabetes and its associated
Combination Therapy complications[24].
Combination therapy is often employed to
maximize glycemic control while minimizing side
CONCLUSION
The management of type 2 diabetes among T2DM continues to rise, addressing its impact on
wounded patients presents unique challenges that wound healing will remain a critical area of focus in
require a multifaceted approach. Optimizing clinical practice. Future research should aim to
glycemic control, implementing dietary establish standardized protocols for managing
interventions, utilizing pharmacological T2DM in wounded patients, incorporating
treatments, and fostering a multidisciplinary team emerging technologies such as artificial intelligence
can significantly improve healing outcomes. in glycemic monitoring and individualized
Continued research is necessary to identify the treatment plans. Additionally, longitudinal studies
most effective strategies for this population, as well assessing the long-term effects of integrated
as to explore the long-term implications of various management strategies on wound healing and
management techniques. As the prevalence of quality of life will be invaluable.
REFERENCES
1. Al-Farabi Kazakh National University, https://doi.org/10.12968/bjcn.2022.27.S
Duisenbek, A.A., Ablaikhanova, N.T., Al- up6.S12
Farabi Kazakh National University, 4. Posthauer, M.E.: Diet, Diabetes, and
Kaldykaraeva, A.T., Al-Farabi Kazakh Wound Management: How Important is
National University, Yessenbekova, A.Y., Glycemic Control? The Nurse
Al-Farabi Kazakh National University, Practitioner. 29, 48–49 (2004).
Mukhitdin, B., Al-Farabi Kazakh National https://doi.org/10.1097/00006205-
University, Esymsiitova, Z.B., Al-Farabi 200408000-00010
Kazakh National University, 5. Endocrine Unit, Department of Medicine,
Kozhamzharova, L.S., Al-Farabi Kazakh Hospital Putrajaya, Putrajaya, Malaysia,
National University: Vascular Lim, K.P., Nasruddin, A.B., Rani, N.M.:
complications in combination with The Effect of Individualised Glycemic
endothelial dysfunction in patients with Intervention on Wound Healing Rate in
type 2 diabetes. Bul. Kar.Univ. Diabetic Foot Ulcer (The EIGIFU Study).
“BioMedGeo” Ser. 107, 176–184 (2022). JAFES. 33, 22–27 (2018).
https://doi.org/10.31489/2022BMG3/1 https://doi.org/10.15605/jafes.033.01.04
76-184 6. Xiang, J., Wang, S., He, Y., Xu, L., Zhang,
2. Uti, D., Igile, G., Omang, W., Umoru, G., S., Tang, Z.: Reasonable Glycemic Control
Udeozor, P., Obeten, U., Ogbonna, O., Would Help Wound Healing During the
Ibiam, U., Alum, E., Ohunene, R., Mordi, Treatment of Diabetic Foot Ulcers.
J., Oplekwu, R., Obio, W.: Anti-Diabetic Diabetes Ther. 10, 95–105 (2019).
Potentials of Vernonioside E Saponin; A https://doi.org/10.1007/s13300-018-
Biochemical Study. 8, 14234–14254 (2022) 0536-8
3. Winterbottom, C.: Diabetic leg and foot 7. Swoboda, L., Held, J.: Impaired wound
ulcers: how district nurses can promote healing in diabetes. J Wound Care. 31,
wound healing through blood glucose 882–885 (2022).
control. Br J Community Nurs. 27, S12– https://doi.org/10.12968/jowc.2022.31.1
S18(2022). 0.882
50
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.
www.idosr.org Kibibi, 2024
8. Patil, M.D., Gunasekaran, U., Fontaine, Diet, its Components, and cardiovascular
J.L., Meneghini, L.: Does Improving disease.” Am J Med. 128, 229–238 (2015).
Glycemic Control Accelerate Healing of https://doi.org/10.1016/j.amjmed.2014.1
Diabetic Foot Ulcers? Diabetes. 67, 2218- 0.014
PUB (2018). 16. Diab, A., Dastmalchi, L.N., Gulati, M.,
https://doi.org/10.2337/db18-2218-PUB Michos, E.D.: A Heart-Healthy Diet for
9. Lane, K.L., Abusamaan, M.S., Voss, B.F., Cardiovascular Disease Prevention:
Thurber, E.G., Al-Hajri, N., Gopakumar, Where Are We Now? Vascular Health and
S., Le, J.T., Gill, S., Blanck, J., Prichett, L., Risk Management. 19, 237 (2023).
Hicks, C.W., Sherman, R.L., Abularrage, https://doi.org/10.2147/VHRM.S37987
C.J., Mathioudakis, N.N.: Glycemic 4
control and diabetic foot ulcer outcomes: A 17. Oh, R., Gilani, B., Uppaluri, K.R.: Low-
systematic review and meta-analysis of Carbohydrate Diet. In: StatPearls.
observational studies. J Diabetes StatPearls Publishing, Treasure Island
Complications. 34, 107638 (2020). (FL) (2024)
https://doi.org/10.1016/j.jdiacomp.2020. 18. Kirkpatrick, C.F., Bolick, J.P., Kris-
107638 Etherton, P.M., Sikand, G., Aspry, K.E.,
10. Végh, D., Bencze, B., Banyai, D., Vegh, A., Soffer, D.E., Willard, K.-E., Maki, K.C.:
Rózsa, N., Nagy Dobó, C., Biczo, Z., Review of current evidence and clinical
Kammerhofer, G., Ujpal, M., Díaz Agurto, recommendations on the effects of low-
L., Pedrinaci, I., Peña Cardelles, J.F., carbohydrate and very-low-carbohydrate
Magrin, G.L., Padhye, N.M., Mente, L., (including ketogenic) diets for the
Payer, M., Hermann, P.: Preoperative management of body weight and other
HbA1c and Blood Glucose Measurements cardiometabolic risk factors: A scientific
in Diabetes Mellitus before Oral Surgery statement from the National Lipid
and Implantology Treatments. Int J Association Nutrition and Lifestyle Task
Environ Res Public Health. 20, 4745 Force. Journal of Clinical Lipidology. 13,
(2023). 689-711.e1 (2019).
https://doi.org/10.3390/ijerph20064745 https://doi.org/10.1016/j.jacl.2019.08.00
11. Christman, A.L., Selvin, E., Margolis, D.J., 3
Lazarus, G.S., Garza, L.A.: Hemoglobin 19. Wei, S., Li, C., Wang, Z., Chen, Y.:
A1c Predicts Healing Rate in Diabetic Nutritional strategies for intervention of
Wounds. Journal of Investigative diabetes and improvement of β-cell
Dermatology. 131, 2121–2127 (2011). function. Bioscience Reports. 43,
https://doi.org/10.1038/jid.2011.176 BSR20222151 (2023).
12. Duggan, E.W., Carlson, K., Umpierrez, https://doi.org/10.1042/BSR20222151
G.E.: Perioperative Hyperglycemia 20. Lv, C., Sun, Y., Zhang, Z.Y., Aboelela, Z.,
Management: An Update. Anesthesiology. Qiu, X., Meng, Z.-X.: β-cell dynamics in
126, 547–560 (2017). type 2 diabetes and in dietary and exercise
https://doi.org/10.1097/ALN.00000000 interventions. J Mol Cell Biol. 14, mjac046
00001515 (2022).
13. Dasari, N., Jiang, A., Skochdopole, A., https://doi.org/10.1093/jmcb/mjac046
Chung, J., Reece, E.M., Vorstenbosch, J., 21. Weinberg Sibony, R., Segev, O., Dor, S.,
Winocour, S.: Updates in Diabetic Wound Raz, I.: Drug Therapies for Diabetes.
Healing, Inflammation, and Scarring. IJMS. 24, 17147 (2023).
Semin Plast Surg. 35, 153–158 (2021). https://doi.org/10.3390/ijms242417147
https://doi.org/10.1055/s-0041-1731460 22. Wang, X., Kang, J., Liu, Q., Tong, T.,
14. Ahmed, S., Ripon, M.S.H., Islam, M.F., Quan, H.: Fighting Diabetes Mellitus:
Ullah, A., Sultan, S., Sajid, M., Rahman, T.: Pharmacological and Non-
Association of dietary intake and nutrition pharmacological Approaches. CPD. 26,
knowledge with diabetes self-management 4992–5001 (2020).
behavior among Bangladeshi type 2 https://doi.org/10.2174/1381612826666
diabetes mellitus adults: A multi-center 200728144200
cross-sectional study. Endocrine and 23. Olanrewaju, O.A., Sheeba, F., Kumar, A.,
Metabolic Science. 14, 100156 (2024). Ahmad, S., Blank, N., Kumari, R., Kumari,
https://doi.org/10.1016/j.endmts.2023.1 K., Salame, T., Khalid, A., Yousef, N.,
00156 Varrassi, G., Khatri, M., Kumar, S.,
15. Widmer, R.J., Flammer, A.J., Lerman, Mohamad, T.: Novel Therapies in
L.O., Lerman, A.: “The Mediterranean Diabetes: A Comprehensive Narrative
51
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.
www.idosr.org Kibibi, 2024
Review of GLP-1 Receptor Agonists, combination therapy for diabetes mellitus
SGLT2 Inhibitors, and Beyond. Cureus. and its complications: a comprehensive
(2023). review. Front. Endocrinol. 14, 1301093
https://doi.org/10.7759/cureus.51151 (2023).https://doi.org/10.3389/fendo.20
24. Xie, X., Wu, C., Hao, Y., Wang, T., Yang, 23.1301093
Y., Cai, P., Zhang, Y., Huang, J., Deng, K.,
Yan, D., Lin, H.: Benefits and risks of drug

CITE AS: Kibibi Muthoni L. (2024). Exploration of Management Strategies for Type 2
Diabetes among Wounded Patients: A Review. IDOSR JOURNAL OF APPLIED SCIENCES
9(3):48-52. https://doi.org/10.59298/IDOSRJAS/2024/9.3.4852000

52
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction
in any medium, provided the original work is properly cited.