Aim: The aim of our study was to evaluate the impact of metabolic derangement on healing chances in a cohort of severely involved DF patients. Methods: We retrospectively analysed the data of all patients admitted to our department for DF in 2021 and divided them into two groups according to whether they achieved complete healing within 6 months (group A) or not (group B). We compared the groups for clinical and demographic characteristics, blood chemistry and parameters of metabolic severity [Fibrosis 4 (FIB4) index, triglyceride/glucose ratio (TYG) and albuminuria/creatinuria ratio]. Results: Data were obtained from 280 patients: 195 patients in Group A [69.6%; age 68.3±9.5 years; male/female 71.7/28.3%; DM1/2 11.7/88.3%; BMI 28.8±6.3 kg/m2; Hba1c 59.3±21.5 mmol/mol; diabetes duration (DD) 16.8±10.8 years] and 85 in Group B (30.4%; age 70.2±10.3 years; male/female 75.2/24.8%; DM1/2 9.4/90.6%; BMI 29.1±5.7 kg/m2; Hba1c 60.6±20.0 mmol/mol; DD 20.9±11.8 years). Group B had a longer (p<0.04) disease duration and a higher prevalence of ischaemic cardiopathy (46.3 vs 37.1%, p<0.05), hypertension (67.3 vs 58.1, p<0.05) and encephalopathy (19.4 vs 11.2%, p<0.05). Group B had higher levels of FIB4 (1.88±1.63 vs 1.34±1.08, p<0.002), TYG (9.36±0.71 vs 8.77±0.64, p<0.002) and triglycerides (155±72 vs 131±74, p<0.05) and lower levels of total haemoglobin (11.4±1.5 vs 12.6±1.8). In Cox logistic multivariate regression analysis, healing was negatively influenced by FIB4 (HR 0.48, CI 95% 0.26-0.61, p=0.0017) and TYG (HR 0.51, CI 95% 0.30-0.79, p=0.0022) and positively influenced by higher total haemoglobin (HR 1.59, CI 95% 1.24-1.86, p=0.023). The same three parameters are also associated with healing time (FIB 4 p<0.001, TYG p<0.001 and total haemoglobin p<0.02). Conclusions: Metabolic decompensation and anemia, when adequately detected, associated to a worse clinical outcomes in DF patients.