Vitamin D Status in a Bulgarian Population With Type 2 Diabetes and Diabetic Foot Ulcers

Abstract

The aim of this study was to assess vitamin D status in patients with type 2 diabetes and diabetic foot ulcers (DFU). A total of 242 participants with type 2 diabetes, mean age 59.1 ± 10 years, mean body mass index 31.4 ± 6.3 kg/m2, and estimated glomerular filtration rate ≥45 mL/min/1.73m2, were divided into 2 groups: 73 with DFU (35 with and 38 without active infection) and 169 without DFU (106 with diabetic peripheral neuropathy, 63 without complications). Neuropathy was assessed by 10 g monofilament, Rydel-Seiffer 128 Hz tuning fork, and temperature discrimination. Serum 25(OH)D (25-hydroxy vitamin D) was assessed by ECLIA (electro-chemiluminescence immunoassay) method. Median 25(OH)D level was 12.6 ng/mL (IQR [interquartile range] 9.3-17.6 ng/mL) in the studied cohort. The DFU group presented with lower 25(OH)D level as compared with diabetic patients without foot ulcers (non-DFU group): 11.6 ng/mL (IQR 8.5-15.8 ng/mL) versus 13.5 ng/mL (IQR 9.6-18.6 ng/mL), P = .001; the diabetic peripheral neuropathy subgroup demonstrated lower 25(OH)D level in comparison with participants without complications: 12.5 ng/mL (IQR 9-17.2 ng/mL) versus 15.9 ng/mL (IQR 10.4-20.8 ng/mL), P = .031. This remained significantly different even after correction for age and duration of diabetes. There was no difference in 25(OH)D level between the subgroups according to the presence of active infection. In conclusion, vitamin D deficiency may play a role in the development of diabetes complications.

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

“… 27 came to contrary conclusions in Iranian patients. Similar observational studies have been done in Europe 28 , 29 and the results show that patients with diabetic foot syndrome are at high risk of low vitamin D levels. At present, there have been only two research studies conducted in China 11 , 15 , and only one had a relatively large sample capacity 11 .…”

“…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.…”

The association between micronutrient levels and diabetic foot ulcer: A systematic review with meta-analysis

“…Nine (24.32%) each were reported from India ( 18 , 25 , 26 , 30 , 40 , 47 – 50 ), and Iran ( 13 , 16 , 20 – 22 , 24 , 34 , 39 , 45 ), three (8.10%) from Turkey ( 27 , 36 , 43 ), two (5.40%) each from China ( 33 , 37 ) and Nigeria ( 41 , 42 ), and one (2.70%) each from Italy ( 19 ), Bulgaria ( 31 ), Greece ( 32 ), Pakistan ( 28 ), Bahrain ( 29 ), USA ( 15 ), Germany ( 38 ), Australia ( 35 ), Spain ( 44 ), Mexico ( 46 ), Denmark ( 17 ), and Slovakia ( 23 ). Number of DFU patients (men and women) ranged from 19 to 387.…”

“…Thirteen studies compared vitamin D levels in DFU (n= 1136) and DM (n= 5059) patients ( 24 – 26 , 31 – 33 , 36 – 40 , 47 , 48 ). Combined results showed significantly lower vitamin D levels in DFU patients (MD: -5.41 ng/ml, 95% CI: -8.06, -2.76; P <0001; I 2 = 92%).…”

“…Two studies compared calcium levels in DFU (n= 106) and DM (n= 204) patients ( 31 , 32 ). The combined results showed similar calcium levels in both groups (MD: -0.17 mg/dL, 95% CI: -0.60, 0.26; P =0.43; I 2 = 92%).…”