<b>Introduction</b>: <span style="font-size: 12.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: black; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Diabetic foot ulcers (DFUs) has become a serious public health problem due to its high prevalence and complications. Advanced treatment for DFU is often delayed while blood glucose (HbA1c) is elevated as one of the underlying factors for impaired wound healing. There are currently no studies on the association of HbA1c levels on the efficacy of treatment of DFUs using skin substitutes. Acellular fish skin (AFS) has proven to be effective in treating DFUs compared to SOC. This is a retrospective review exploring the effect of HbA1c levels on DFUs healing for type II diabetes patients treated with AFS. </span><br/><br/><b>Methods</b>: <span style="font-size: 12.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: black; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">This study reviewed 20 cases of chronic DFUs (defined as DFUs that did not show improvement after 30 days of standard of care treatment). Patients were treated with AFS once a week for 4 weeks, and the wound size was recorded at the beginning and end of this process. Patients were broken into two groups (n= 10 patients/group) with HbA1c level between 6-8 and the other is HbA1c >8. Wound size reduction was calculated and compared between two groups.</span><br/><br/><b>Results</b>: <span style="font-size: 12.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: black; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">The group with HbA1c 6-8 showed an average of -41.30% decrease in wound size. The HbA1c >8 group had an average of -30.41% wound size reduction. After performing an independent <em>t</em>-test, <em>t</em>-value: -0.56, <em>p</em>-value: 0.299 larger than 0.05. This indicated that the HbA1c levels do not have a statistically significant effect on wound healing time. </span><br/><br/><b>Discussion</b>: <span style="font-size: 12.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Advanced therapeutics for DFUs are often delayed while HbA1c levels are corrected because of belief that the wound will not respond to advanced therapy. This delay in treatment can lead to deterioration in the wound and leave the wound at risk of infection. The study findings suggest that AFS is an effective treatment for chronic DFU despite elevated baseline HbA1c levels. The study findings indicate that advanced therapy could be applied concurrently to HbA1c management as the primary treatment for DFUs. Limitations of the current study is sample size and powered. A larger study is warranted to test the hypothesis.</span><br/><br/><b>Trademarked Items</b>: *KerecisTM, Kerecis, Isafjordur, Iceland<br/><br/><b>References</b>: <br/><br/>
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