Correlation of HbA1c levels and neutrophil-to-lymphocyte ratio (NLR) with wagner grade of diabetic foot ulcers in type ii diabetes mellitus patients undergoing treatment at Ibnu Sina Hospital in 2023
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Sep 30, 2025
Keywords:
Diabetes Mellitus (DM), Diabetic Foot Ulcer, HbA1c Levels, Neutrophil-to-Lymphocyte Ratio (NLR), Wagner Grading
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Abstract
Diabetes Mellitus (DM) is a metabolic disorder characterized by hyperglycemia due to impaired insulin secretion or insulin resistance. HbA1c levels can reflect long-term glycemic control, while the neutrophil-to-lymphocyte ratio (NLR) serves as an inflammatory biomarker associated with disease severity in type II DM, including diabetic foot. This study is a descriptive analytic observational study with a cross-sectional design aimed at analyzing the relationship between HbA1c levels and NLR with Wagner’s grading of diabetic foot ulcers in type II diabetes mellitus patients. Among 34 diabetic foot patients, the majority were over 50 years old (94.1%), with a higher proportion of females (55.9%), an average HbA1c level of 9.33, and an average NLR of 9.31, indicating variations in glycemic control and systemic inflammation in ibnu sina Hospitak in januari until september 2023. Wagner's ulcer grade ranged from 2 to 4, with an average of 2.82, reflecting moderate to severe severity. Correlation analysis showed that HbA1c levels (r = 0.523, p = 0.002) and NLR (r = 0.602, p = 0.000) had a significant and positive relationship with diabetic ulcer severity. The study results indicate a significant correlation between HbA1c levels and NLR with Wagner’s grading of diabetic foot ulcers, where higher ulcer severity is associated with increased HbA1c and NLR levels due to greater insulin resistance.
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Putri, A. I. T. ., Sommeng, F. ., Nur, M. J. ., Kartika, I. D. ., & Purnamasari, R. (2025). Correlation of HbA1c levels and neutrophil-to-lymphocyte ratio (NLR) with wagner grade of diabetic foot ulcers in type ii diabetes mellitus patients undergoing treatment at Ibnu Sina Hospital in 2023 . Journal of Midwifery and Nursing, 7(3), 375-381. https://doi.org/10.35335/jmn.v7i3.6617
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Zulri, M. O., Puspawani, Y., & Dewani, Y. (2023). Gambaran HbA1c Pada Pasien Penderita Diabetes Mellitus Tipe 2 Dengan Komplikasi Ulkus Diabetikum Di RSU Adam Malik Medan Tahun 2022. Jurnal Multidisiplin Indonesia, 2(8). https://jmi.rivierapublishing.id/index.php/rp
Fan, W., Pang, H., Pang, Z., Huang, G., & Zhou, Z. (2022). Circular RNAs In Diabetes Mellitus And Its Complications. 13. https://doi.org/10.3389/fendo.2022.885650
Farhan, A. R. (2024). RELATIONSHIP BETWEEN NEUTROPHIL LYMPHOCYTE RATIO (NLR) AND THE SEVERITY OF DIABETIC ULCERS IN TYPE-2 DIABETES MELLITUS PATIENTS.
Farooque, U., Lohano, A. K., Hussain Rind, S., Rind, M. S., Karimi, S., Jaan, A., Yasmin, F., & Cheema, O. (2020). Correlation of Hemoglobin A1c With Wagner Classification in Patients With Diabetic Foot. Cureus. https://doi.org/10.7759/cureus.9199
Hu, X., Kang, R., Chen, L., & Hu, X. (2024). Gender difference as the risk of diabetic foot ulcers in T2DM patients: a meta-analysis. In Journal of Men’s Health (Vol. 20, Issue 1, pp. 1–6). MRE Press. https://doi.org/10.22514/jomh.2024.002
Indriyani, E., Ludiana, & Dewi, T. K. (2023). Penerapan Senam Kaki Diabetes Melitus Terhadap Kadar Glukosa Darah Pada Penderita Diabetes Mellitus Di Puskesmas Yosomulyo. Jurnal Cendikia Muda, 3(2).
Kalsum, T. P., Lestari, I., Kanang, D., Kuswardhana, H., Kartini, A., Yanti, E., & Arsyad, N. N. (2024). Hubungan Antara Profil Glukosa Darah dengan Derajat Ulkus Kaki Diabetik pada Pasien Kaki Diabetik. Fakumi Medical Journal, 4(5).
Kartadinata, L., Dwipayana, I. M. P., Saraswati, T., & Rena, N. M. R. A. (2023). Hubungan Kadar HbA1c Dan Lamanya Diabetes Dengan Rasio Neutrofil Limfosit Darah Pada Penderita Diabetes Melitus Tipe 2 Di Poliklinik Endokrin Dan Diabetes Rsup Prof. DR. I.G.N.G. Ngoerah Denpasar. Jurnal Medika Udayana, 12(3). https://doi.org/10.24843.MU.2023.V12.i3.P09
Kirana Dela Rosa, S., Udiyono, A., Kusariana, N., Dian Saraswati Bagian Epidemiologi dan Penyakit Tropik, L., & Kesehatan Masyarakat, F. (2019). FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN TIMBULNYA GANGREN PADA PASIEN DIABETES MELLITUS DI RSUD K.R.M.T. WONGSONEGORO SEMARANG (Vol. 7, Issue 1). http://ejournal3.undip.ac.id/index.php/jkm
Nisak, R. (2021). Evaluasi Kejadian Dan Klasifikasi Ulkus Diabetikum Menurut Wagner Pada Penderita Diabetes Mellitus. Jurnal Ilmiah Keperawatan, 7(2).
Nurdin N, Kalma K, Hasnawati H, & Nasir H. (2021). Profil Nilai Neutrophil Lymphocyte Ratio (Nlr) Pada Penderita Diabetes Melitus Tipe-2. Jurnal Media Analis Kesehatan, 12(1).
Raharjo, M. A., Indah, D., Pratiwi, N., & Fajari, N. M. (2020). Korelasi Rasio Neutrofil-Limfosit Terhadap Derajat Keparahan Kaki Diabetes. Homeostasis Jurnal Mahasiswa Pendidikan Kedokteran, 3(3).
Salsabila K, & Kamila Salsabila B. (2023). Hubungan Kadar HbA1c Dengan Derajat Ulkus Diabetik Menurut Klasifikasi Meggitt-Wagner Pada Pasien Diabetes Melitus Tipe 2 Di RSUD Dr. H. Abdul Moeloek Bandar Lampung Periode Januari-Juli 2022. Digital Repository Unila.
Sapra, A., & Bhandari, P. (2023). Diabetes.
Speksnijder, E. M., ten Noever de Brauw, G. V., Malekzadeh, A., Bisschop, P. H., Stenvers, D. J., & Siegelaar, S. E. (2023). Effect of Postmenopausal Hormone Therapy on Glucose Regulation in Women With Type 1 or Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care, 46(10), 1866–1875. https://doi.org/10.2337/dc23-0451
Suastidewi, P. A., & Dwipayana, I. M. P. (2020). Hubungan Kadar HbA1c Terhadap Derajat Kaki Diabetik Pada Pasien Kaki Diabetik Di RSUP Sanglah Tahun 2015-2016. Jurnal Medika Udayana, 9(12). https://doi.org/10.24843.MU.2020.V9.i12.P09
Sukmana, M., Sianturi, R., & Aminuddin, M. (2019). Pengkajian Luka Menurut Meggit-Wagner dan Pedis Pada Pasien Ulkus Diabetikum. Jurnal Kesehatan Pasak Bumi Kalimantan, 2(2). http://e-journals.unmul.ac.id/index.php/JKPBK
Syauta, D., Mulawardi, Prihantono, Hendarto, J., Mariana, N., Sulmiati, Kusumanegara, J., & Faruk, M. (2021). Risk factors affecting the degree of diabetic foot ulcers according to Wagner classification in diabetic foot patients. Medicina Clinica Practica, 4. https://doi.org/10.1016/j.mcpsp.2021.100231
Sylvana, D., & Santi Syafril. (2024). The Association of the Neutrophil-Lymphocyte Ratio With Diabetes Mellitus and Diabetic Foot Ulcer: A Review Article. Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI), 4(4), 166–175. https://doi.org/10.32734/jetromi.v4i4.14689
Wahyuni, S. (2023). HUBUNGAN USIA DAN JENIS KELAMIN TERHADAP DERAJAT LUKA KAKI DIABETIK PADA PENDERITA DM DI KOTA MAKASSAR. Healthy Tadulako Journal (Jurnal Kesehatan Tadulako), 9(2), 194–198.
Waspadji, S. (2015). Buku Ajar Ilmu Penyakit Dalam (S. Setiati, I. Alwi, A. W. Sudoyo, M. Simadibrata, B. Setiyohadi, & A. F. Syam, Eds.; VI). InternaPublishing.
Zulri, M. O., Puspawani, Y., & Dewani, Y. (2023). Gambaran HbA1c Pada Pasien Penderita Diabetes Mellitus Tipe 2 Dengan Komplikasi Ulkus Diabetikum Di RSU Adam Malik Medan Tahun 2022. Jurnal Multidisiplin Indonesia, 2(8). https://jmi.rivierapublishing.id/index.php/rp
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