Application of Smart Hydrogels in Diabetic Wound Management: Microenvironment-Responsive Strategies and Clinical Translation Challenges.

Diabetic wounds (DWs), characterized by pathological features of healing stagnation and limited regeneration, pose significant clinical challenges in chronic wound management and contribute to substantial consumption of healthcare resources. Although current clinical interventions heavily rely on debridement, offloading, and traditional wound dressings, their therapeutic efficacy often falls short of expectations due to limitations in providing only a physical barrier function. Furthermore, the pathogenesis of DWs involves a complex interplay of multiple pathological factors, including peripheral neuropathy, peripheral arterial disease, and foot infections, which further complicates wound management. In recent years, hydrogels have demonstrated significant potential in the biomedical field of DW management due to their biological versatility, tunable physicochemical properties, and excellent hydrophilicity. By loading specific therapeutic agents, hydrogels can achieve on-demand drug release tailored to the unique physiological microenvironment of DWs and optimize the microenvironment across different stages of wound healing. This study systematically evaluates smart hydrogel-based integrated diagnosis and therapy strategies by analyzing pathological characteristics and clinical limitations of DWs (particularly diabetic foot ulcers), aiming to provide references for developing clinically translatable dressing systems and establish theoretical frameworks with practical guidelines for next-generation intelligent dressings incorporating AI-driven data and clinical stability.