Evaluation of Vitamin D Levels in Patients With Diabetic Foot Ulcers

Abstract

Low vitamin D levels have been associated with several diseases as its receptors are expressed in almost all tissues of the human body. Literature data have shown delayed diabetic foot ulcer (DFU) healing in patients with low vitamin D; however, data on the association between vitamin D levels and DFU in Mediterranean countries are scarce. In this cross-sectional study we examined for differences in serum vitamin D levels between patients with DFU, people with diabetes mellitus (DM) without DFU and healthy individuals in a Southern European country. A total of 96 subjects (33 patients with DFU, 35 patients without DFU and 28 healthy controls) were recruited. Medical and dietary history was obtained and total serum 25-hydroxyvitamin D [25(OH)D] levels were determined. Serum vitamin D levels differed significantly among the three groups of participants; sub-analysis showed that healthy individuals had higher vitamin D levels when compared with patients with and without DFU, while vitamin D levels did not differ between patients with and without DFU (17.9 ± 6.7 vs. 19.8 ± 8.7 ng/mL, P = 0.329, respectively). More than half of patients with DM with or without DFU had vitamin D levels <20 ng/ml. A positive correlation was found between vitamin D and sun exposure duration in participants without DFU. In conclusion, although serum vitamin D levels did not differ between people with and without DFU, the prevalence of deficiency and insufficiency was high in both groups in a Mediterranean country. This finding highlights the need for screening and supplementation with vitamin D in individuals with DM.

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

“…Also in India, the difference in the serum level of vitamin D between diabetic patients with and without foot infections was not found to be statistically significant in a cross-sectional study reported in 2019 25 . A similar conclusion has also been drawn by a recent study conducted in a Mediterranean country 26 . Nevertheless, Afarideh et al 27 came to contrary conclusions in Iranian patients.…”

“…In other words, preventing vitamin D deficiency and keeping appropriate levels of vitamin D could be helpful for the prevention and adjuvant treatment of diabetic foot. Based on the above, although there are contradictory results [25][26][27] , a large number of studies and meta-analyses still show a clear connection between low vitamin D levels, vitamin D deficiency, and diabetic foot 11,15,23,24,28,29,47,48 . Although this connection does not mean necessarily correlation or causal connection, it also has great significance for the treatment and management of diabetic foot.…”

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

“…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.…”

“…This meta‐analysis comprised 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 12‐23 . Diabetic subjects with foot ulcer wounds had significantly lower vitamin D levels, higher prevalence of vitamin D deficiency, and higher severe vitamin D deficiency compared with non‐ulcerated diabetic subjects.…”

Decreased expression of 25-hydroxyvitamin D in peripheral plasma and vitamin D receptor in wound margin tissue associated with diabetic foot ulcers in patients with type 2 diabetes mellitus

“…Vitamin D supplementation can promote wound healing in cases of DFU [21,22] . However, some studies have not reported a correlation between vitamin D de ciency and the onset of DFU [23,24] ; furthermore, serum levels of 25(OH)VD were reported to be signi cantly increased in patients with chronic active DFU [25] . Owing to the complexity of DFU pathogenesis, further investigation of the correlation between vitamin D insu ciency and DFU pathogenesis and its in uencing factors is of paramount importance.…”