Serum vitamin D and diabetic foot complications

Abstract

Background : Foot complications such as ulceration and neuropathy are common complications of diabetes mellitus (DM). Previous reports have demonstrated a possible increased risk of these complications in diabetic patients with low levels of serum vitamin D. Objectctive : The purpose of this study is to compare serum vitamin D levels in diabetic patients with and without Charcot neuroarthropathy (CN), peripheral arterial disease (PAD), infection (DFI), ulceration (DFU), and peripheral neuropathy (DPN). Design : A retrospective chart review of all patients undergoing foot and ankle surgery with a history of DM over a 13 month period was performed. From this cohort, fifty subjects with CN were matched with 50 without CN and preoperative lab values were compared. A secondary evaluation was performed on the subjects’ other comorbidities including PAD, DFI, DFU, and DPN. Results : Seventy-eight percent of our patients had vitamin D deficiency or insufficiency. Preoperative serum vitamin D levels were not significantly different between diabetic patients with and without CN (p = 0.55). Diabetic patients with PAD (p = 0.03), DFI (p = 0.0006), and DFU (p = 0.04) were all found to have significantly lower serum vitamin D levels than diabetic patients without these complications. Lower levels of serum albumin and higher serum creatinine were also noted with subjects with PAD, DFI, DPN, and DFU. While seasonal serum vitamin D level fluctuation was noted, this difference did not reach statistical significance with the numbers available. Conclusion : We found various lower extremity complications to be associated with low serum vitamin D including PAD, DFI, and DFU. While other studies have questioned the role of vitamin D and CN, we were unable to identify any significant difference between diabetic patients with and without Charcot neuroarthropathy. Level of evidence : Level 2

Serum Albumin Was Negatively Associated With Diabetic Peripheral Neuropathy in Chinese Population: A Cross-sectional Study

“…ABI, a useful marker for detection of peripheral artery disease (PAD) or atherosclerosis at other vascular sites [34], has been demonstrated to be independently associated with DPN [35]. In the present study, we have revealed that the T2DM subjects in the higher serum albumin quartiles exhibited higher levels of DBP, eGFR, ABI, and lower Cr, CysC, and ACR compared with subjects in the lowest quartile, and serum albumin levels were positively associated with DBP, and negatively with Cr, CysC, and ACR after the adjustments, indicating that serum albumin may be associated with DN and PAD as diabetic micro-and macrovascular complications, respectively, which are consistent with those of many previous reports [15,[36][37][38]. Zhang et al conducted a study of 188 patients with T2DM and biopsy-proven DN followed up for at least one year, and found that serum albumin level was signi cantly associated with proteinuria, renal function, and glomerular lesions, and hypoalbuminemia was associated with a poorer renal prognosis [36].…”

“…Changes of plasma concentration and structural modi cation of albumin induced by high glucose or free radicals impair its antioxidant properties and aggravate oxidative stress [19]. Several previous studies have explored the association of serum albumin with the development of DPN, and provided inconsistent results [12][13][14][15]. Iwasaki et al reported that serum albumin was independently related to the median motor nerve conduction velocity and minimum F-wave latency in 130 Japanese patients with T2DM, and was signi cantly inversely associated with the presence of DPN [12].…”

“…Recently reported data from the Saudi study, which included 2,906 hospitalized adult diabetics, demonstrated that DPN cases had a signi cantly lower serum albumin levels compared with those without DPN [14]. However, no statistically signi cant association between serum albumin and DPN in US patients undergoing foot and ankle surgery with a history of Type 1 and 2 diabetes mellitus over a 13 month period [15]. In the present study, we observed that patients in the highest quartile of serum albumin had lower VPT, an useful and reliable method for early screening DPN and re ecting the clinical severity of DPN [16], and prevalence of DPN compared with subjects in the lowest quartile, and serum albumin was negatively associated with VPT and prevalence of DPN after adjustments for age, gender, BMI, and diabetic duration, demonstrating the potential neuroprotective actions of serum albumin in the pathogenesis of DPN.…”

“…There is considerable evidence indicated that serum albumin has a wide range of physiological functions, including antioxidant, anti-in ammatory, anticoagulant, antiplatelet aggregation activity, regulating immune response, preventing endothelial cell, Schwann cells and neuronal apoptosis, dilating blood vessel, protecting against neuronal injury from ischemia and reperfusion, and improving neuronal functional recovery [4][5][6][7][8][9][10][11], suggesting that albumin may confer robust neuroprotection, and lower levels of serum albumin may be involved in the development of DPN. Although few observations have suggested presence of such a link [12][13][14], others have reported the lack of an independent association [15]. Such discrepancy in the literature may be due to differences in study population, diabetic duration, a limitation in the diversity of selected participants, diagnostic methods for DPN, variation in design, limitations in sample size, and a limited range in which serum albumin has been studied.…”

Vitamin D and diabetic foot ulcer: a systematic review and meta-analysis

“…A single high dose of oral vitamin D could substantially improve the brachial artery flow-mediated vasodilatation by 2.3%. Moreover, vitamin D has been suggested as an immune stimulant 25 . Urashima et al 26 suggested that vitamin D supplementation can reduce the risk of influenza A in schoolchildren.…”