Hydrogel-Based Treatment of Diabetic Wounds: From Smart Responsive to Smart Monitoring

Diabetic wounds are characterized by a refractory healing cycle resulting from the synergistic effects of hyperglycemic microenvironment, oxidative stress, bacterial infection, and impaired angiogenesis. Conventional hydrogel dressings, with limited functionality, struggle to address the complexities of chronic diabetic ulcers. Smart hydrogels, possessing biocompatibility, porous architectures mimicking extracellular matrix, and environmental responsiveness, have emerged as promising biomaterials for diabetic wound management. This review systematically elucidates the specific response mechanisms of smart hydrogels to wound microenvironmental stimuli, including pH, matrix metalloproteinase-9 (MMP-9), reactive oxygen species (ROS), and glucose levels, enabling on-demand release of antimicrobial agents and growth factors through dynamic bond modulation or structural transformations. Subsequently, the review highlights recent advances in novel hydrogel-based sensors fabricated via optical (photonic crystal, fluorescence) and electrochemical principles for real-time monitoring of glucose levels and wound pH. Finally, critical challenges in material development and scalable manufacturing of multifunctional hydrogel components are discussed, alongside prospects for precision diagnostics and therapeutics in diabetic wound care.