Smart Hydrogel Dressings for Diabetic Wound Theranostics: From Microenvironment Sensing to Signal‐Coupled Regenerative Repair

ABSTRACT Diabetic foot ulcers (DFUs) are sustained by inflammation, oxidative stress, infection, impaired angiogenesis, and defective tissue remodeling. Conventional dressings protect wounds but rarely read or respond to these dynamic pathological states. Smart hydrogel dressings provide an adaptive interface that combines tissue‐like hydration, tunable mechanics, molecular sensing, and localized therapy. This review examines how DFU cues—pH shifts, reactive oxygen species (ROS), hyperglycaemia, protease activity, microbial metabolites, and inflammatory signals—can guide hydrogel‐based diagnostic and therapeutic design. It surveys colorimetric, fluorescent, electrochemical, and wearable sensing platforms and stimuli‐responsive hydrogels for antioxidant, antibacterial, immunomodulatory, and pro‐angiogenic repair. Reported performance is compiled and benchmarked against explicit design targets, revealing that most smart dressings deliver either sensing or therapy convincingly, but rarely both with quantitative rigor. Routes to clinical manufacturability—natural bioactives, biomimetic mineralization, nanocomposites, and simplified architectures—are discussed together with translational barriers in sensing fidelity, biosafety, reproducibility, regulation, and clinically meaningful validation. Future hydrogel dressings should evolve from multifunctional material assemblies into signal‐coupled theranostic systems that dynamically interpret and remodel the diabetic wound microenvironment.