Abstract
Diabetic wounds represent a significant clinical challenge due to a complex pathological microenvironment marked by hyperglycemia, persistent inflammation, and high susceptibility to infection. Metal composite hydrogels have emerged as a next-generation therapeutic platform that uniquely combines the multifaceted capabilities of metal components, such as potent antibacterial, anti-inflammatory, and antioxidant activities, with the ideal moist healing properties of hydrogels. This review focuses on recent progress in the design strategies for these materials, including physical, chemical, and hybrid doping methods. The review then details their multimodal mechanisms of action, including direct antibacterial pathways, like reactive oxygen species generation and photothermal therapy, along with immunomodulatory interventions that regulate macrophage polarization and resolve chronic inflammation. Furthermore, their role in promoting tissue repair processes, such as angiogenesis and collagen remodeling, is discussed. Finally, the review critically examines prevailing challenges and future directions concerning biosafety, scalable fabrication, and clinical translation, with the goal of providing a comprehensive reference for advancing novel therapies for diabetic wound care.