Smart responsive materials for diabetic foot ulcer therapy: from passive coverage to active healing

Diabetic foot ulcers (DFUs) are caught in a vicious cycle of impaired healing driven by hyperglycemia-induced persistent inflammation, reactive oxygen species (ROS) accumulation, tissue hypoxia, and increased susceptibility to infection. This paper reviews the pathological microenvironmental characteristics of DFUs, the design strategies of smart materials, and their integration with artificial intelligence (AI). Given the complex pathological microenvironment of DFUs, traditional passive dressings have been shown to be inadequate, whereas smart responsive materials show great potential by dynamically sensing and actively modulating the wound microenvironment. Furthermore, the paper highlights four key design strategies for smart responsive materials: using glucose-responsive smart materials to alleviate local hyperglycemia at the wound site; using ROS-scavenging smart materials to eliminate ROS and restore redox homeostasis; applying oxygen-generating materials to relieve hypoxia and promote angiogenesis; and utilizing smart antibacterial materials to combat biofilms and achieve potent bactericidal effects. Currently, the development trend of smart materials has shifted from single-function systems to integrated multifunctional systems. The paper further discusses the potential of integrating AI into material design, preparation optimization, and wound monitoring and treatment decision-making. Although most smart materials are still at the experimental stage and face challenges related to cost and manufacturing processes, next-generation smart materials are expected to achieve dynamic monitoring and autonomous treatment through interdisciplinary innovation, significantly improving DFU healing rates and reducing the risk of amputation.