Association between vitamin D status and diabetic foot in patients with type 2 diabetes mellitus

Tang, Weiwei; Ma, Wanxia; Chen, Fan; Wang, Chun; Gao, Yun; Ran, Xingwu

doi:10.1111/jdi.13776

Cited by 21 publications

(20 citation statements)

References 49 publications

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“…The observed correlation between vitamin D deficiency and DM has received a lot of attention in recent years. 21 Tang et al 22 found that the vitamin D levels in the DF group were significantly lower than that in the non-DF group. Dai et al 23 involving 51 patients investigated the relationship between 25-OH-vitamin D and DFU, and the results showed that 25-OH-vitamin D levels in DFU group were significantly lower than non-DFU group.…”

Section: Discussionmentioning

confidence: 98%

A Retrospective Analysis of the Relationship Between 25-OH-Vitamin D and Diabetic Foot Ulcer

Wang¹,

Zhou²,

Zhu³

et al. 2022

DMSO

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Background The fat-soluble molecule vitamin D has attracted much attention since its pleiotropism was discovered. Its effectiveness can be attributed to the presence of vitamin D receptors in most of the body’s tissues. Based on the classical role of vitamin D in regulating calcium and phosphorus metabolism and maintaining bone health, the role of vitamin D in immunity, type 2 diabetes mellitus (T2DM), tumor and cardiovascular diseases has been further discovered. Some experiments have shown that vitamin D can restore the production of antimicrobial peptides (AMP) in primary diabetic foot ulcer (DFU) cells, which can improve in vitro wound healing, indicating its potential therapeutic use in DFU therapy. In addition, vitamin D can also inhibit the secretion of T-helper type 1 (Th1) cytokines IFN-Y and IL-2 while stimulating the production of Th2 cytokines, thereby promoting wound healing. Objective To investigate the relationship between 25-OH-vitamin D level and DFU in diabetes mellitus (DM) patients, and to provide a theoretical basis for the early prevention and treatment of DFU. Methods The clinical data of 429 hospitalized patients with DM were retrospectively analyzed in this case–control study. The patients were divided into the DFU group (n = 242) and non-DFU group (n = 187). Fasting venous blood was drawn from all subjects to detect serum 25-OH-vitamin D levels and blood biochemical parameters, the difference of parameters between DFU group and non-DFU group were analyzed, and the risk factors of DFU were analyzed by logistic regression. Results The difference between the two groups in age, DM duration, gender, diastolic blood pressure, serum creatinine, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, aspartate aminotransferase, albumin, white blood cell count, hemoglobin, hematocrit, 25-OH-vitamin D was statistically significant (p < 0.05). Multivariate logistic regression analysis showed that 25-OH-vitamin D is an independent protective factor for DFU [OR 95%, CI 0.984 (0.969, 0.998), p < 0.05]. 25-OH-vitamin D nutrition status distribution was different between non-DFU group and DFU group (P < 0.05). Vitamin D deficiency (< 50 nmol/L) accounted for 86.78% of all DFU patients, which was only 74.33% in non-DFU patients. The 25-OH-vitamin D levels of DFU patients from Wagner Grades 1 to 5 showed a downward trend (p < 0.01). Conclusion In conclusion, our study confirms that 25-OH-vitamin D is closely correlated with DFU and that 25-OH-vitamin D is an independent protective factor for DFU. Therefore, vitamin D screening or supplementation might be beneficial to prevent DFU and improve the prognosis of DM patients.

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Section: Discussionmentioning

confidence: 98%

A Retrospective Analysis of the Relationship Between 25-OH-Vitamin D and Diabetic Foot Ulcer

Wang¹,

Zhou²,

Zhu³

et al. 2022

DMSO

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“…A total of 12 studies reported between 2013 and 2022 satisfied the inclusion criteria for the meta‐analysis among the 573 distinctive reports. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 This meta‐analysis study included 7586 subjects with diabetes mellitus at the beginning of the study; 1565 were using diabetic subjects with foot ulcer wounds, and 6021 were non‐ulcerated diabetic subjects. All studies evaluated the association between vitamin D deficiency and diabetic foot ulcer wounds in diabetic subjects.…”

Section: Resultsmentioning

confidence: 99%

Association between vitamin D deficiency and diabetic foot ulcer wound in diabetic subjects: A meta‐analysis

Lin

Yang

et al. 2022

International Wound Journal

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A meta‐analysis was performed to evaluate the association between vitamin D deficiency and diabetic foot ulcer wounds in diabetic subjects. A systematic literature search up to March 2022 incorporated 7586 subjects with diabetes mellitus at the beginning of the study; 1565 were using diabetic subjects with foot ulcer wounds, and 6021 were non‐ulcerated diabetic subjects. Statistical tools like the dichotomous and contentious method were used within a random or fixed‐influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the influence of vitamin D deficiency in managing diabetic foot ulcer wound. Diabetic subjects with foot ulcer wounds had significantly lower vitamin D levels (MD, −6.48; 95% CI, −10.84 to −2.11, P < .004), higher prevalence of vitamin D deficiency (<50 nmoL/L) (OR, 1.82; 95% CI, 1.32‐2.52, P < .001), and higher prevalence of severe vitamin D deficiency (OR, 2.53; 95% CI, 1.65‐3.89, P < .001) compared with non‐ulcerated diabetic subjects. Diabetic subjects with foot ulcer wounds had significantly lower vitamin D levels, higher prevalence of vitamin D deficiency, and higher prevalence of severe vitamin D deficiency compared with non‐ulcerated diabetic subjects. Further studies are required to validate these findings.

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“…-3 of 8 mutual relationship between vitamin D levels and DFU, reporting that vitamin D may represent a risk factor for DFU, which, in turn, may determine a worsening of vitamin D levels. 27 On the other hand, PTH levels have never been investigated in people with DFU and OM. Our findings hence contribute to the definition of PTH as a biomarker of chronic OM in diabetic patients with DFU.…”

Section: Discussionmentioning

confidence: 99%

“…This result may be related to the high rate of vitamin D deficiency/insufficiency in patients with diabetes 26 . Moreover, a recent study investigated the mutual relationship between vitamin D levels and DFU, reporting that vitamin D may represent a risk factor for DFU, which, in turn, may determine a worsening of vitamin D levels 27 . On the other hand, PTH levels have never been investigated in people with DFU and OM.…”

Section: Discussionmentioning

confidence: 99%

Biochemical predictors of diabetic foot osteomyelitis: A potential diagnostic role for parathormone

Caruso

Maiorino

Scappaticcio

et al. 2022

Diabetes Metabolism Res

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Aims The aims of this study were to evaluate parathormone (PTH) levels in people with diabetic foot ulcers (DFU) and investigate the relationship between PTH levels and osteomyelitis (OM) in this population. Materials and Methods Eighty‐eight patients were admitted for DFU in a tertiary‐care centre from October 2021 to May 2022. OM was diagnosed by clinical, laboratory, and radiological evaluations. Laboratory measurements and clinical parameters were collected from medical records. Participants in the study were divided into two groups according to the diagnosis of OM (patients with OM, group 1 [n = 54] and patients without OM, group 2 [n = 34]). Results Compared with group 2, patients in group 1 were younger and had a longer duration of diabetes. Erythrocyte sedimentation rate and fibrinogen were significantly higher in group 1 compared with group 2. PTH levels were significantly lower (group 1 vs. group 2, median [interquartile range] 16.2 (11.6, 31.0) vs. 23.7 (17.0, 38.1), p = 0.008) and alkaline phosphatase was significantly higher (97.0 (79.0, 112.0) vs. 88.0 (63.0, 107.0), p = 0.031) in group 1. In multiple linear regression analysis, the only independent predictors of PTH concentrations were alkaline phosphatase levels (β‐coefficient 0.441, p < 0.001) and the presence of OM (β‐coefficient −0.290, p = 0.038). Conclusions In a population of patients with diabetes and OM admitted to a tertiary university centre, PTH levels were lower as compared with diabetic individuals without OM. The OM and alkaline phosphatase levels were independent predictors of PTH levels in this selected population.

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Association between vitamin D status and diabetic foot in patients with type 2 diabetes mellitus

Cited by 21 publications

References 49 publications

A Retrospective Analysis of the Relationship Between 25-OH-Vitamin D and Diabetic Foot Ulcer

A Retrospective Analysis of the Relationship Between 25-OH-Vitamin D and Diabetic Foot Ulcer

Association between vitamin D deficiency and diabetic foot ulcer wound in diabetic subjects: A meta‐analysis

Biochemical predictors of diabetic foot osteomyelitis: A potential diagnostic role for parathormone

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