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Tang W, Chen D, Chen L, Liu G, Sun S, Wang C, Gao Y, Ran X. The correlation between serum vitamin D status and the occurrence of diabetic foot ulcers: a comprehensive systematic review and meta-analysis. Sci Rep 2024; 14:21932. [PMID: 39304728 DOI: 10.1038/s41598-024-73133-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 09/13/2024] [Indexed: 09/22/2024] Open
Abstract
The association between vitamin D concentrations and the occurrence of diabetic foot ulcers (DFUs) remains a topic of ongoing debate. In order to provide a comprehensive and updated review, we conducted this meta-analysis to further investigate the relationship between vitamin D concentrations and DFUs occurrence. The following databases, including Cochrane Library, EMBASE, Web of Science, PubMed, CBM, CNKI, WANFANG DATA and VIP Database, were systematically searched for studies published up to Dec. 20th, 2023. The combined estimation was calculated using both fixed-effects and random-effects models. The overall effect size was reported as a weighted mean difference (WMD) with a corresponding 95% confidence interval (95%CI). Data analysis was performed utilizing Review Manager 5.4 and Stata 14. The Protocol has been registered in PROSPERO CRD42024503468. This updated meta-analysis, incorporating thirty-six studies encompassing 11,298 individuals with or without DFUs, demonstrated a significant association between vitamin D deficiency/insufficiency and an elevated risk of DFUs occurrence (< 25 nmol/L, OR 3.28, P < 0.00001; < 50 nmol/L, OR 2.25, P < 0.00001; < 75 nmol/L, OR 1.67, P = 0.0003). Vitamin D concentrations were significantly lower in individuals with DFUs compared to those without DFUs (P < 0.00001). Subgroup analyses consistently demonstrated this trend among the older population (> 50 years, P < 0.00001), individuals with long duration of diabetes (> 10 years, P < 0.00001), and those with poor glycemic control (mean HbA1c 8%-9% and > 9%, P < 0.00001).
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Affiliation(s)
- Weiwei Tang
- Innovation Research Center for Diabetic Foot, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Dawei Chen
- Innovation Research Center for Diabetic Foot, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Lihong Chen
- Innovation Research Center for Diabetic Foot, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Guanjian Liu
- Chinese Cochrane Centre, Chinese EBM Centre, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Shiyi Sun
- Innovation Research Center for Diabetic Foot, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Chun Wang
- Innovation Research Center for Diabetic Foot, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Yun Gao
- Innovation Research Center for Diabetic Foot, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China
| | - Xingwu Ran
- Innovation Research Center for Diabetic Foot, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37 Guo Xue Lane, Chengdu, 610041, China.
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Wang F, Zhang X, Zhang J, Xu Q, Yu X, Xu A, Yi C, Bian X, Shao S. Recent advances in the adjunctive management of diabetic foot ulcer: Focus on noninvasive technologies. Med Res Rev 2024; 44:1501-1544. [PMID: 38279968 DOI: 10.1002/med.22020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 01/29/2024]
Abstract
Diabetic foot ulcer (DFU) is one of the most costly and serious complications of diabetes. Treatment of DFU is usually challenging and new approaches are required to improve the therapeutic efficiencies. This review aims to update new and upcoming adjunctive therapies with noninvasive characterization for DFU, focusing on bioactive dressings, bioengineered tissues, mesenchymal stem cell (MSC) based therapy, platelet and cytokine-based therapy, topical oxygen therapy, and some repurposed drugs such as hypoglycemic agents, blood pressure medications, phenytoin, vitamins, and magnesium. Although the mentioned therapies may contribute to the improvement of DFU to a certain extent, most of the evidence come from clinical trials with small sample size and inconsistent selections of DFU patients. Further studies with high design quality and adequate sample sizes are necessitated. In addition, no single approach would completely correct the complex pathogenesis of DFU. Reasonable selection and combination of these techniques should be considered.
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Affiliation(s)
- Fen Wang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xiaoling Zhang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Jing Zhang
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Qinqin Xu
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Xuefeng Yu
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Anhui Xu
- Division of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengla Yi
- Division of Trauma Surgery, Tongji Hospital, Tongji Medical College, Wuhan, China
| | - Xuna Bian
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
| | - Shiying Shao
- Division of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Hubei, China
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Atoum MF, Al Shdaifat A, Al Hourani H, Al Hyari M, Zahran R, Abu Shaikh H. Relationship of Serum Vitamin D Levels With Diabetic Foot in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study. INT J LOW EXTR WOUND 2023:15347346231205641. [PMID: 37792565 DOI: 10.1177/15347346231205641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background and aims: Diabetic foot is one of the most severe complications in patients with diabetes mellitus and has been linked to 25-OH-vitamin D status. This study aims to determine the prevalence of 25-OH-vitamin D deficiency and its association with diabetic foot. Methods: Patients with type 2 diabetes mellitus were enrolled in this study. The patients were divided into the diabetic foot group (n = 95) and the non-diabetic foot group (n = 388). Weight, height, and waist circumference were measured. The 25-OH-vitamin D and the other biochemical tests were extracted from the electronic medical records. The difference in clinical parameters between the diabetic foot group and the non-diabetic foot group was analyzed, and the risk factors of the diabetic foot group were analyzed using logistic regression. Results: The prevalence of 25-OH-vitamin D deficiency was 44.6%, accounting for 57.9% of all the diabetic foot group patients and only 41.0% of the non-diabetic foot group patients. The mean serum 25-OH-vitamin D level was significantly different between the diabetic foot group and the non-diabetic foot group (19.8 ± 9.5 vs 24.1 ± 11.8; P = .011). Serum 25-OH-vitamin D and B12 were found to have a significant positive correlation (r = 0.410, P = <.01). The 25-OH-vitamin D level and body mass index were independently associated with diabetic foot (P = .043, OR = 1.21; P = .009, OR = 1.47), respectively. Conclusions: The 25-OH-vitamin D deficiency was higher in the diabetic foot group. More research is needed to understand the role of 25-OH-vitamin D in the development of diabetic foot.
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Affiliation(s)
- Manar Fayiz Atoum
- Department of Medical Laboratory Sciences, Faculty of Applied Health Sciences, The Hashemite University, Zarqa, Jordan
| | - Amjad Al Shdaifat
- Department of Internal and Family Medicine, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Huda Al Hourani
- Department of Clinical Nutrition and Dietetics, Faculty of Applied Medical Sciences, The Hashemite University, Zarqa, Jordan
| | - Muwafag Al Hyari
- Center of Diabetes and Endocrinology, Prince Hamza Hospital, Diabetic Center, Amman, Jordan
| | - Reema Zahran
- Center of Diabetes and Endocrinology, Prince Hamza Hospital, Diabetic Center, Amman, Jordan
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Hammad R, Abdel Wahab MA, Farouk N, Zakaria MY, Eldosoky MA, Elmadbouly AA, Tahoun SA, Mahmoud E, Khirala SK, Mohammed AR, Emam WA, Abo Elqasem AA, Kotb FM, Abd Elghany RAE. Non-classical monocytes frequency and serum vitamin D 3 levels are linked to diabetic foot ulcer associated with peripheral artery disease. J Diabetes Investig 2023; 14:1192-1201. [PMID: 37394883 PMCID: PMC10512914 DOI: 10.1111/jdi.14048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023] Open
Abstract
AIMS/INTRODUCTION Peripheral artery disease (PAD) serves as a risk factor for diabetic foot ulcers (DFUs). PAD pathology involves atherosclerosis and impaired immunity. Non-classical monocytes are believed to have an anti-inflammatory role. 1,25-Dihydroxy vitamin D (vitamin D3 ) is claimed to have immune-modulating and lipid-regulating roles. Vitamin D receptor is expressed on monocytes. We aimed to investigate if circulating non-classical monocytes and vitamin D3 were implicated in DFUs associated with PAD. MATERIALS AND METHODS There were two groups of DFU patients: group 1 (n = 40) included patients with first-degree DFUs not associated with PAD, and group 2 (n = 50) included patients with DFU with PAD. The monocyte phenotypes were detected using flow cytometry. Vitamin D3 was assessed by enzyme-linked immunosorbent assay. RESULTS DFU patients with PAD showed a significant reduction in the frequency of non-classical monocytes and vitamin D3 levels, when compared with DFU patients without PAD. The percentage of non-classical monocytes positively correlated with vitamin D3 level (r = 0.4, P < 0.01) and high-density lipoprotein (r = 0.5, P < 0.001), whereas it was negatively correlated with cholesterol (r = -0.5, P < 0.001). Vitamin D3 was negatively correlated with triglyceride/high-density lipoprotein (r = -0.4, P < 0.01). Regression analysis showed that a high vitamin D3 serum level was a protective factor against PAD occurrence. CONCLUSIONS Non-classical monocytes frequency and vitamin D3 levels were significantly reduced in DFU patients with PAD. Non-classical monocytes frequency was associated with vitamin D3 in DFUs patients, and both parameters were linked to lipid profile. Vitamin D3 upregulation was a risk-reducing factor for PAD occurrence.
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Affiliation(s)
- Reham Hammad
- Clinical Pathology Department, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Maisa A Abdel Wahab
- Vascular Surgery, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Nehal Farouk
- Vascular Surgery, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | | | - Mona A Eldosoky
- Clinical Pathology Department, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Asmaa A Elmadbouly
- Clinical Pathology Department, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Sara A Tahoun
- Clinical Pathology Department, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Eman Mahmoud
- Endocrinology and Metabolism Department, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Seham K Khirala
- Medical Microbiology and Immunology, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Amena Rezk Mohammed
- Biochemistry Department, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Wafaa Abdelaziz Emam
- Biochemistry Department, Faculty of Medicine (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Asmaa A Abo Elqasem
- Immunology, Zoology and Entomology Department, Faculty of Science (for Girls)Al‐Azhar UniversityCairoEgypt
| | - Fatma M Kotb
- Internal Medicine Department, Faculty of Medicine (Girls)Al‐Azhar UniversityCairoEgypt
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Chi L, Wang Q, Zhong W, Pan X, Li Y. The usefulness of platelet-rich plasma to manage skin wounds: A meta-analysis. Int Wound J 2023; 20:3123-3130. [PMID: 37128184 PMCID: PMC10502258 DOI: 10.1111/iwj.14188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023] Open
Abstract
A meta-analysis investigation to measure the usefulness of platelet-rich plasma (PRP) to manage skin wounds (SWs). A comprehensive literature inspection till February 2023 was applied and 1349 interrelated investigations were reviewed. The 22 chosen investigations enclosed animals' SWs were in the chosen investigations' starting point, 3348 of them were treated with PRP, and 2259 were control. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the usefulness of PRP to manage SWs by the dichotomous and continuous approaches and a fixed or random model. PRP significantly higher percent of decreases in open wound area (OWA) (MD, 10.07; 95% CI, 6.55-13.59, P < 0.001), and lower healing time (HT) (MD, -6.31; 95% CI, -10.69 to -1.93, P = 0.005) compared to control in animals' SWs. PRP had a significantly higher percent of decreases in OWA and lower HT compared to control in animals' SWs. However, caused of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Liqiao Chi
- Department of Dermatology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Qiang Wang
- Department of Dermatology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenjun Zhong
- Department of Dermatology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Xinfeng Pan
- Department of Dermatology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Yuanyuan Li
- Department of Dermatology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
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Li X, Kou S, Chen G, Zhao B, Xue J, Ding R, Zhao X, Ye M, Yang Y, Yue R, Li F. The relationship between vitamin D deficiency and diabetic foot ulcer: A meta-analysis. Int Wound J 2023; 20:3015-3022. [PMID: 37194326 PMCID: PMC10502267 DOI: 10.1111/iwj.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
A meta-analysis investigation to measure the relationship between vitamin D deficiency (VDD) and diabetic foot ulcer (DFU). A comprehensive literature inspection till February 2023 was applied and 1765 interrelated investigations were reviewed. The 15 chosen investigations enclosed 2648 individuals with diabetes mellitus in the chosen investigations' starting point, 1413 of them were with DFUs, and 1235 were without DFUs. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the relationship between VDD and DFU by the dichotomous and continuous approaches and a fixed or random model. Individuals with DFUs had significantly lower vitamin D levels (VDL) (MD, -7.14; 95% CI, -8.83 to -5.44, P < 0.001) compared to those without DFU individuals. Individuals with DFUs had a significantly higher number of VDD individuals (OR, 2.27; 95% CI, 1.63-3.16, P < 0.001) compared to those without DFU individuals. Individuals with DFU had significantly lower VDL and a significantly higher number of VDD individuals compared to those without DFU individuals. However, caused of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Xin Li
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Shaojie Kou
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Guo Chen
- Department of Infectious DiseasesHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Bingjie Zhao
- Department of HaematologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Jingdong Xue
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Rui Ding
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Xiaoyan Zhao
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Miaoqing Ye
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Yueqing Yang
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Rensong Yue
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Fenping Li
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
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Halschou-Jensen PM, Sauer J, Bouchelouche P, Fabrin J, Brorson S, Ohrt-Nissen S. Improved Healing of Diabetic Foot Ulcers After High-dose Vitamin D: A Randomized Double-blinded Clinical Trial. INT J LOW EXTR WOUND 2023; 22:466-474. [PMID: 34213957 DOI: 10.1177/15347346211020268] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Chronic foot ulcers are a major cause of morbidity in people with diabetes with a lifetime risk of 25%. Treatment is challenging and the recurrence rates of foot ulcers are >50% after 3 years. Vitamin D deficiency is more common in people with diabetes with chronic foot ulcers, compared to both people without diabetes as well as people with diabetes but without foot ulcers. Purpose/aim of study. To assess the efficacy of high-dose compared to low-dose Cholecalciferol vitamin D3 on healing of chronic diabetic foot ulcers. Materials and methods. We included people with diabetes with one or more foot ulcers lasting for more than 6 weeks. Patients were randomly allocated to either a daily oral intake of high-dose (170 μg) or low-dose (20 μg) vitamin D3 (Cholecalciferol). We saw patients in the outpatient clinic after 4, 12, 24, 36, and 48 weeks. At each visit, we measured the ulcer with a specialized camera, and associated software and the area (cm2) was calculated. Patients and assessors were blinded to treatment allocation. We followed all patients for 48 weeks or until wound healing or surgical treatment. Findings/results. We included 48 patients in the analysis (24 in each group), with a total of 64 ulcers. Among them 41 ulcers were followed until healing or 48-week follow-up and 20 ulcers were surgically treated during the study period. Three patients were lost for follow-up. The intention-to-treat analysis showed a significantly higher rate of ulcer healing in the high-dose group with 21 of 30 (70%) healed ulcers compared to 12 of 34 (35%) in the low-dose group (P = .012). Median ulcer reduction at final follow-up was 100% (interquartile range [IQR]: 72-100) in the high-dose group and 57% (IQR: -28 to 100) in the low-dose group. Furthermore, we found a significant effect of high-dose vitamin D on ulcer reduction in the repeated measures analysis of variance. Conclusions. We found high-dose vitamin D3 to be efficient, compared to low-dose vitamin D3, in promoting healing in chronic diabetic foot ulcers.
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Affiliation(s)
| | - Jannie Sauer
- Zealand University Hospital, Køge, Sjælland, Denmark
| | | | - Jesper Fabrin
- Zealand University Hospital, Køge, Sjælland, Denmark
| | - Stig Brorson
- Zealand University Hospital, Køge, Sjælland, Denmark
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Priyanto MH, Legiawati L, Saldi SRF, Yunir E, Miranda E. Comparison of vitamin D levels in diabetes mellitus patients with and without diabetic foot ulcers: An analytical observational study in Jakarta, Indonesia. Int Wound J 2023; 20:2028-2036. [PMID: 36647686 PMCID: PMC10333004 DOI: 10.1111/iwj.14066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 01/18/2023] Open
Abstract
Diabetic foot ulcer (DFU) is a form of chronic wound which becomes a serious complication in diabetes mellitus (DM). Recently, the role of vitamin D on T cell-mediated immunity, pancreatic insulin secretion, and its mechanism on cell growth and healing processes have been reported. This study aims to compare the vitamin D level of DM patients with DFU and without DFU to assess the duration and severity of DFU and its correlation with vitamin D levels. The sociodemographic characteristics and DFU duration were documented. The severity was examined in accordance with PEDIS classification. 25-hydroxyvitamin D (25[OH]D) was analysed using in-vitro chemiluminescent immunoassay (CLIA). Statistical analysis was performed and the P-value <.05 was considered as statistically significant. The vitamin D levels in DM patients with and without DFU were 8.90 ng/mL (6.52-10.90) and 16.25 ng/mL (13-19.59), respectively, with P < .001. There was no correlation between the duration of DFU and DFU severity by PEDIS score with vitamin D levels. Vitamin D levels in DM patients with DFU are lower than those in patients without DFU. However, there was insufficient evidence to conclude that there is no correlation between the DFU duration and DFU severity by PEDIS score with vitamin D levels.
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Affiliation(s)
- Mufqi Handaru Priyanto
- Department of Dermatology and VenereologyFaculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National HospitalCentral JakartaIndonesia
| | - Lili Legiawati
- Department of Dermatology and VenereologyFaculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National HospitalCentral JakartaIndonesia
| | - Siti Rizny F. Saldi
- Clinical Epidemiology and Evidence‐Based Medicine UnitFaculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National HospitalCentral JakartaIndonesia
| | - Em Yunir
- Department of Internal MedicineFaculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National HospitalCentral JakartaIndonesia
| | - Eliza Miranda
- Department of Dermatology and VenereologyFaculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National HospitalCentral JakartaIndonesia
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Tsitsou S, Dimosthenopoulos C, Eleftheriadou I, Andrianesis V, Tentolouris N. Evaluation of Vitamin D Levels in Patients With Diabetic Foot Ulcers. INT J LOW EXTR WOUND 2023; 22:27-35. [PMID: 33390083 DOI: 10.1177/1534734620984584] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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.
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Affiliation(s)
| | | | - Ioanna Eleftheriadou
- Laiko General Hospital, Athens, Greece.,National and Kapodistrian University, Athens, Greece
| | - Vasileios Andrianesis
- Laiko General Hospital, Athens, Greece.,National and Kapodistrian University, Athens, Greece
| | - Nikolaos Tentolouris
- Laiko General Hospital, Athens, Greece.,National and Kapodistrian University, Athens, Greece
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10
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Lin J, Mo X, Yang Y, Tang C, Chen J. Association between vitamin D deficiency and diabetic foot ulcer wound in diabetic subjects: A meta-analysis. Int Wound J 2023; 20:55-62. [PMID: 35567425 PMCID: PMC9797924 DOI: 10.1111/iwj.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 01/07/2023] Open
Abstract
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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Affiliation(s)
- Juan Lin
- Nursing School of Shaoyang UniversityHunanChina
| | - Xinxin Mo
- Nursing School of Shaoyang UniversityHunanChina
| | - Yejun Yang
- Department of PediatricShaoyang Central HospitalHunanChina
| | - Chao Tang
- Nursing School of Shaoyang UniversityHunanChina
| | - Jia Chen
- Xiangya School of Nursing School of Central South UniversityHunanChina
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11
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Kurian SJ, Baral T, Unnikrishnan MK, Benson R, Munisamy M, Saravu K, Rodrigues GS, Rao M, Kumar A, Miraj SS. The association between micronutrient levels and diabetic foot ulcer: A systematic review with meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1152854. [PMID: 37065742 PMCID: PMC10090454 DOI: 10.3389/fendo.2023.1152854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFU) are a major complication of diabetes mellitus (DM). Nutrient deficiencies are among the major risk factors in DFU development and healing. In this context, we aimed to investigate the possible association between micronutrient status and risk of DFU. METHODS A systematic review (Prospero registration: CRD42021259817) of articles, published in PubMed, Web of Science, Scopus, CINAHL Complete, and Embase, that measured the status of micronutrients in DFU patients was performed. RESULTS Thirty-seven studies were considered, of which thirty were included for meta-analysis. These studies reported levels of 11 micronutrients: vitamins B9, B12, C, D, E, calcium, magnesium, iron, selenium, copper, and zinc. DFU, compared to healthy controls (HC) had significantly lower vitamin D (MD: -10.82 14 ng/ml, 95% CI: -20.47, -1.16), magnesium (MD: -0.45 mg/dL, 95% CI: -0.78, -0.12) and selenium (MD: -0.33 µmol/L, 95% CI: -0.34, -0.32) levels. DFU, compared to DM patients without DFU, had significantly lower vitamin D (MD: -5.41 ng/ml, 95% CI: -8.06, -2.76), and magnesium (MD: -0.20 mg/dL, 95% CI: -0.25, -0.15) levels. The overall analysis showed lower levels of vitamin D [15.55ng/ml (95% CI:13.44, 17.65)], vitamin C [4.99µmol/L (95% CI:3.16, 6.83)], magnesium [1.53mg/dL (95% CI:1.28, 1.78)] and selenium [0.54µmol/L (95% CI:0.45, 0.64)]. CONCLUSION This review provides evidence that micronutrient levels significantly differ in DFU patients, suggesting an association between micronutrient status and risk of DFU. Therefore, routine monitoring and supplementations are warranted in DFU patients. We suggest that personalized nutrition therapy may be considered in the DFU management guidelines. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259817, identifier CRD42021259817.
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Affiliation(s)
- Shilia Jacob Kurian
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Tejaswini Baral
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Ruby Benson
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
| | - Murali Munisamy
- Department of Translational Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Kavitha Saravu
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Infectious Diseases, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
| | - Amit Kumar
- Department of Laboratory Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Sonal Sekhar Miraj
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of High Education, Manipal, Karnataka, India
- Manipal Centre for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
- *Correspondence: Sonal Sekhar Miraj,
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12
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Tang W, Chen L, Ma W, Chen D, Wang C, Gao Y, Ran X. Association Between Vitamin D Status and Diabetic Foot in Patients With Type 2 Diabetes Mellitus. J Diabetes Investig 2022; 13:1213-1221. [PMID: 35191197 PMCID: PMC9248421 DOI: 10.1111/jdi.13776] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 01/30/2022] [Accepted: 02/20/2022] [Indexed: 02/05/2023] Open
Abstract
Aims/Introduction To assess the association between vitamin D and diabetic foot (DF) in patients with type 2 diabetes mellitus (T2DM), in order to summarize clinical evidence in the prevention and treatment of DF. Materials and methods Between January 2012 and December 2019, a total of 1,721 hospitalized patients with type 2 diabetes mellitus were continuously enrolled in West China Hospital, Sichuan University, and divided into DF and non‐DF groups according to whether they had DF, and divided into four subgroups according to the admission season. The 25‐OH‐vitamin D levels were compared between groups and subgroups, and independent risk factors discussed for the occurrence of DF. Results The vitamin D insufficiency and deficiency rate were higher in the DF group (77.51%) than in the non‐DF group (59.2%). The 25‐OH‐vitamin D levels were lower in the DF group (35.80 nmol/L) than in the non‐DF group (45.48 nmol/L) (P < 0.001). Patients with poor glycemic control had lower 25‐OH‐vitamin D levels (P = 0.01). The levels of 25‐OH‐vitamin D were lower in winter and spring. In the same season, the levels of 25‐OH‐vitamin D in patients with DF were still lower (P < 0.001). The 25‐OH‐vitamin D levels of patients with Wagner grades 0 to 5 showed a downward trend (P = 0.114). The 25‐OH‐vitamin D level was independently associated with diabetic foot (P < 0.001, OR = 0.986). Conclusions The low serum vitamin D level was significantly associated with a higher prevalence of DF among Chinese patients with type 2 diabetes mellitus. Although vitamin D levels vary seasonally, patients with DF were always at higher risk of having vitamin D insufficiency and deficiency.
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Affiliation(s)
- Weiwei Tang
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Lihong Chen
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Wanxia Ma
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Dawei Chen
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Chun Wang
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Yun Gao
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xingwu Ran
- Innovation Center for Wound Repair, Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
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13
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Agius C, Micallef D, Brincat I, Buhagiar G, Gruppetta M, Cassar K, Boffa MJ. Plasma Total Ascorbic Acid and Serum 25-Hydroxy-Vitamin-D Status in Patients with Venous Leg Ulcers: A Case-Control Study. INT J LOW EXTR WOUND 2021:15347346211061967. [PMID: 34866446 DOI: 10.1177/15347346211061967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Venous leg ulcers (VLUs) pose a significant burden on patients, health care systems, and national economies. Nutritional health is an important determinant of wound healing. Vitamin C and D levels and additional biochemical markers, C-reactive protein, and albumin in a group of patients with VLUs, were compared with a control group without VLUs. No significant difference in either nutrient marker was found with the presence, size, or duration of VLUs. Obesity was significantly more common in the VLU group, as noted in other studies. Additional controlled studies should be performed with measures of VLU size and duration to assess long-term outcomes with nutritional therapy.
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Affiliation(s)
- Charlton Agius
- 223089Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, MSD, Malta
| | - Daniel Micallef
- 223089Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, MSD, Malta
| | - Ian Brincat
- 223089Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, MSD, Malta
| | - Gerald Buhagiar
- 223089Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, MSD, Malta
| | - Mark Gruppetta
- 223089Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, MSD, Malta
| | - Kevin Cassar
- 223089Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, MSD, Malta
| | - Michael J Boffa
- 223089Mater Dei Hospital, Triq id-Donaturi tad-Demm, Msida, MSD, Malta
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14
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Abstract
Nutrition and dietary supplements have been used to promote a youthful appearance for millennia. Despite high public demand for these products, evidence supporting their efficacy is limited and often inconsistent. We discuss the structural and functional changes that occur in the skin during the aging process. We also review evidence supporting the use of nutritional supplements commonly used to promote a youthful appearance, including essential fatty acids, coenzyme Q, collagen peptides, curcumin, polyphenols, flavonoids, probiotics, silymarin, and vitamins A, C, D, and E. We also consider the role of advanced glycosylated end products, antiinflammatory diets, and caloric restriction in delaying premature skin aging. Although evidence supporting the use of some dietary interventions is promising, further long-term studies in humans are required to fully understand their effects on the promotion of a youthful appearance.
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Affiliation(s)
- Sonal Muzumdar
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Katalin Ferenczi
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, Connecticut, USA.
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15
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Yarahmadi A, Alamdari DH, Azarpira N, Mostafavi-Pour Z. Vitamin D and diabetic foot ulcers: A missed topic. INT J VITAM NUTR RES 2021; 92:83-84. [PMID: 34587813 DOI: 10.1024/0300-9831/a000731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Amir Yarahmadi
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.,Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Daryoush Hamidi Alamdari
- Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Mostafavi-Pour
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Autophagy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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16
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Smith K, Hewlings S. Correlation between vitamin D levels and hard-to-heal wounds: a systematic review. J Wound Care 2021; 30:S4-S10. [PMID: 34120468 DOI: 10.12968/jowc.2021.30.sup6.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Hard-to-heal wounds are a major biological, psychological, social and financial burden on both individual patients and the broader health system. They are associated with a variety of comorbidities and have a complex aetiology, but are typically associated with nutritional deficiencies, such as low vitamin D levels. This systematic literature review evaluates the current research regarding the connection between inadequate vitamin D status and wound healing. METHOD PubMed and EBSCO databases were searched following PRISMA guidelines for primary research studies relating to pressure ulcers, diabetic ulcers or venous ulcers and vitamin D status. RESULTS A total of 10 studies, involving 2359 participants, met the inclusion criteria. There was a strong correlation between low levels of 25-hydroxyvitamin D and the presence of all three types of hard-to-heal wounds. CONCLUSION Research suggests a correlation between low vitamin D levels and hard-to-heal wounds. However, it is not clear if the relationship is causal or only correlational. There is also emerging evidence on the use of vitamin D supplementation for the treatment of hard-to-heal wounds. More research is needed to understand the correlation between vitamin D and hard-to-heal wounds.
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Affiliation(s)
- Karen Smith
- Central Michigan University, Mt Pleasant, MI, US
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17
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Amini MR, Aalaa M, Nasli-Esfahani E, Atlasi R, Sanjari M, Namazi N. The effects of dietary/herbal supplements and the serum levels of micronutrients on the healing of diabetic foot ulcers in animal and human models: a systematic review. J Diabetes Metab Disord 2021; 20:973-988. [PMID: 34178870 PMCID: PMC8212333 DOI: 10.1007/s40200-021-00793-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/02/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Diabetic Foot Ulcer (DFU) is one of the common and serious complications in patients with Diabetes Mellitus (DM) worldwide. Given the considerable tendency of patients suffering from DFU to use the complementary therapies, the objectives of this study were to: (i) summarize the effects of dietary and herbal supplements on DFU characteristics and metabolic parameters in both animal models and clinical trials, and (ii) evaluate any links between the serum levels of micronutrients and DFU in observational studies. METHODS A systematic search in five electronic databases including PubMed/Medline, Scopus, Web of Science, Embase, and Cochrane Library was conducted to find relevant English language published from 1990 until 31 December 2018. RESULTS Of a total of 8603 studies, 30 eligible papers including animal studies (n = 15), clinical trials (n = 7), and observational works (n = 8) were included in the systematic review. We found that some dietary/herbal supplements and micronutrients had positive effects on the wound healing. However, limited evidence is existed. Also, lower serum levels of vitamin D, C, vitamin E, and selenium in patients with DFU were likely to increase the risk of DFU, leading to impaired wound healing. CONCLUSION Findings suggested that some dietary and herbal supplements such as Vitamin D, Magnesium, Vitamin E, Probiotic, Zinc, and Pycnogenol would be effective on wound healing of DFUs. However, further high-quality randomized controlled clinical trials and prospective cohort studies are needed to clarify the roles of micronutrients and other dietary and herbal supplements on the progress and treatment of DFU.
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Affiliation(s)
- Mohammad Reza Amini
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Aalaa
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of medical Sciences, Tehran, Iran
- Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasha Atlasi
- Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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18
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Smith K, Hewlings S. Correlation between vitamin D levels and hard-to-heal wounds: a systematic review. J Wound Care 2021; 29:S24-S30. [PMID: 32654618 DOI: 10.12968/jowc.2020.29.sup7.s24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Hard-to-heal wounds are a major biological, psychological, social and financial burden on both individual patients and the broader health system. They are associated with a variety of comorbidities and have a complex aetiology, but are typically associated with nutritional deficiencies, such as low vitamin D levels. This systematic literature review evaluates the current research regarding the connection between inadequate vitamin D status and wound healing. METHOD PubMed and EBSCO databases were searched following PRISMA guidelines for primary research studies relating to pressure ulcers, diabetic ulcers or venous ulcers and vitamin D status. RESULTS A total of 10 studies, involving 2359 participants, met the inclusion criteria. There was a strong correlation between low levels of 25-hydroxyvitamin D and the presence of all three types of hard-to-heal wounds. CONCLUSION Research suggests a correlation between low vitamin D levels and hard-to-heal wounds. However, it is not clear if the relationship is causal or only correlational. There is also emerging evidence on the use of vitamin D supplementation for the treatment of hard-to-heal wounds. More research is needed to understand the correlation between vitamin D and hard-to-heal wounds.
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Affiliation(s)
- Karen Smith
- Central Michigan University, Mt Pleasant, MI, US
| | - Susan Hewlings
- Nutrition and Dietetics Faculty, Central Michigan University, Mt Pleasant, MI, US
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19
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Papaioannou I, Pantazidou G, Kokkalis Z, Georgopoulos N, Jelastopulu E. Vitamin D Deficiency in Elderly With Diabetes Mellitus Type 2: A Review. Cureus 2021; 13:e12506. [PMID: 33564514 PMCID: PMC7861114 DOI: 10.7759/cureus.12506] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Diabetes mellitus type 2 (T2DM) is an emerging public health issue with high prevalence among older adults (>60 years old). Taking into consideration the great increase in the elderly population (approximately 7.5 billion worldwide), we can easily understand the impact of this chronic disease and its complications. On the other hand, vitamin D deficiency (VDD) is also a serious public health problem with significant impacts and multiple health effects. The correlation between DM and VDD has been suggested and established from many observational studies, reviews, and meta-analyses. The literature in PubMed and Google Scholar was searched for relevant articles published up to October 2020. The keywords used were the following: vitamin D deficiency, elderly, and diabetes mellitus type 2. Among the 556 articles retrieved, 90 full texts were eligible and only 34 studies (12 retrospective studies, two prospective cohorts, three meta-analyses, seven cross-sectional studies, nine randomized control trials (RCTs), and one observational study) met the inclusion criteria for the review. The author's name, year of publication, country, type of study, and the number of patients were reported. According to this review there is adequate evidence to support the correlation between VDD and T2DM in the elderly. The results from the RCTs are more conflicting and more studies are needed to confirm the impact of vitamin D deficiency (VD) supplementation on metabolic and lipid profile, oxidative stress, and the complications of T2DM in older patients. VDD is clearly related with severe retinopathy, diabetic peripheral neuropathy, and poor cognition performance, while there is consensus about the beneficial effect of VD on peripheral artery disease, foot ulceration prevention, and wound healing. On the other hand, there is controversy about the effect of VD supplementation on cardiovascular adverse events, endothelial function, and estimated glomerular filtration rate (eGFR). Finally, the association of VDD with fragility fractures and depression in the elderly with T2DM is currently insufficiently studied and remains controversial.
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Affiliation(s)
| | - Georgia Pantazidou
- Otolaryngology - Head and Neck Surgery, General Hospital of Patras, Patras, GRC
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20
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Kurian SJ, Miraj SS, Benson R, Munisamy M, Saravu K, Rodrigues GS, Rao M. Vitamin D Supplementation in Diabetic Foot Ulcers: A Current Perspective. Curr Diabetes Rev 2021; 17:512-521. [PMID: 33045979 DOI: 10.2174/1573399816999201012195735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus, as it can physically and emotionally impact the person. Its management can be challenging and expensive, depending on the severity of the wound and the presence of infection. BACKGROUND The fat-soluble molecule, vitamin D, has gained great importance ever since its pleiotropism has been recognized. Its efficacy could be attributed to the presence of vitamin D receptors in most of the body tissues. Vitamin D plays a significant role in cell proliferation, differentiation, and immune modulation. It modulates the T and B cells resulting in the suppression of the immunoglobulins, autoimmunity, and inflammation. METHODS We performed a literature search with the objective to highlight the role of vitamin D in peripheral vascular disease and peripheral neuropathy, which are the major risk factors for DFU, as well as evidences of its role in wound healing and management of DFU. RESULTS Preclinical and clinical studies have shown that vitamin D influences multiple phases of wound healing and thereby accelerates the process. It modulates various cells involved in proliferation and remodelling phases. Vitamin D also enhances the expression of antimicrobial peptides that help to eliminate the microbes, as well as suppress the proinflammatory responses while enhancing the anti-inflammatory responses. CONCLUSION This review concludes vitamin D to have a protective role in the immune and vascular system, improve glycaemic outcomes, and wound healing. Therefore, vitamin D could be a preferred adjuvant in the management of DFU.
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Affiliation(s)
- Shilia Jacob Kurian
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Sonal Sekhar Miraj
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Ruby Benson
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Murali Munisamy
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Kavitha Saravu
- Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
| | - Gabriel Sunil Rodrigues
- Department of Surgery, Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal, Karnataka- 576104, India
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka-576104, India
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Todorova AS, Jude EB, Dimova RB, Chakarova NY, Serdarova MS, Grozeva GG, Tsarkova PV, Tankova TI. Vitamin D Status in a Bulgarian Population With Type 2 Diabetes and Diabetic Foot Ulcers. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2020; 21:506-512. [PMID: 33094656 DOI: 10.1177/1534734620965820] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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.
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Affiliation(s)
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton under Lyne, UK
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22
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Xiao Y, Wei L, Xiong X, Yang M, Sun L. Association Between Vitamin D Status and Diabetic Complications in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study in Hunan China. Front Endocrinol (Lausanne) 2020; 11:564738. [PMID: 33042022 PMCID: PMC7525149 DOI: 10.3389/fendo.2020.564738] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Vitamin D status has been linked to diabetes-related complications due to multiple extraskeletal effects. We aimed to investigate the association between vitamin D deficiency (VDD) and diabetic vascular complications, including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic foot ulcers (DFU). Methods: A total of 4,284 Chinese patients with type 2 diabetic mellitus (T2DM) were enrolled into the cross-sectional study. VDD was defined as serum 25-hydroxyvitamin D <50 nmol/L. Demographic data, physical measurements, laboratory measurements, comorbidities, and related medications were collected and analyzed by VDD status. Poisson regression with robust variance estimation and binary logistic regression were performed to explore the relationship between VDD and diabetic complications. Results: The prevalence of VDD, DR, DKD, DFU accounted to 71.7% (95% confidence intervals [CI]: 70.3-73.0%), 28.5% (95% CI: 27.2-29.9%), 28.2% (95% CI: 26.8-29.5%), and 5.7% (95% CI: 5.1-6.5%), respectively. The prevalence ratios (95% CI) for DR and DKD by VDD status, adjusted for demographics, physical measurements, laboratory measurements, related complications, and comorbidities, and medications, were 1.093 (0.983-1.215) and 1.041 (0.937-1.156), respectively. The odds ratio (95% CI) for DFU by VDD status was 1.656 (1.159-2.367) in the final adjusted model. Meanwhile, the prevalence of VDD was significantly higher in patients with DFU compared with patients without DFU. Conclusions: The present study firstly indicated that VDD was significantly associated with a higher prevalence of DFU among Chinese T2DM patients. The association between VDD status and DR or DKD was not significant when adjusting for all potential covariates. Vitamin D screening or supplementation may be beneficial to prevent DFU and improve the prognosis of T2DM patients.
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Yammine K, Hayek F, Assi C. Is there an association between vitamin D and diabetic foot disease? A meta-analysis. Wound Repair Regen 2019; 28:90-96. [PMID: 31633861 DOI: 10.1111/wrr.12762] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/06/2019] [Indexed: 12/31/2022]
Abstract
It has been demonstrated that Vitamin D (25(OH)D) deficiency is associated with diabetes and with diabetic neuropathy. Some reports stated that vitamin D deficiency is also associated with diabetic foot ulcer and/or infection. Knowing the beneficial effect of vitamin D on wound healing, a quantitative evidence synthesis is needed to look for such association. Medline, Embase, Scopus, CINAHL, Cochrane Library, and Google Scholar were searched for from inception. The outcomes were set to be either the serum 25(OH)D level or the prevalence of patients with 25(OH)D with severe deficiency. Ten studies met the inclusion criteria with 1,644 patients; 817 diabetic patients with foot ulcers and 827 patients having diabetes without foot complications. The weighted mean differences was -0.93 (95% CI = -1.684 to -0.174, I2 = 97.8%, p = 0.01). The odds ratio of having severe vitamin D deficiency was 3.6 (95% CI = 2.940 to 4.415, I2 = 40.9%, p < 0.0001), in favor of the foot group. The quality of the included studies was found to be good to excellent. Diabetic foot complications are associated with significantly lower levels of vitamin D. Patients with diabetic ulcers or diabetic infection are at higher risk of bearing severe vitamin D deficiency. Knowing the beneficial effect of vitamin D on wound healing, it is likely that recognizing and supplementing with vitamin D could prevent or improve the outcomes of diabetic foot complications.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon.,Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon.,Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
| | - Fady Hayek
- Division of Vascular Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Beirut, Lebanon.,Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Beirut, Lebanon
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Dai J, Jiang C, Chen H, Chai Y. Vitamin D and diabetic foot ulcer: a systematic review and meta-analysis. Nutr Diabetes 2019; 9:8. [PMID: 30858355 PMCID: PMC6411880 DOI: 10.1038/s41387-019-0078-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 02/13/2019] [Accepted: 02/25/2019] [Indexed: 02/06/2023] Open
Abstract
We aimed to evaluate the association between vitamin D deficiency and diabetic foot ulcer (DFU) in patients with diabetes. Pubmed, EMBASE, BIOSIS, the Cochrane Library, and Web of Knowledge, last updated in July 2018, were searched. We assessed eligible studies for the association between vitamin D deficiency and DFU in diabetic patients. The mean difference (MD) or the odds ratio (OR) was calculated for continuous or dichotomous data respectively. Data were analyzed by using the Cochrane Collaboration’s RevMan 5.0 software. Seven studies that involved 1115 patients were included in this study. There were significantly reduced vitamin D levels in DFU (MD −13.47 nmol/L, 95%CI −16.84 to −10.10; P = 0.34, I2 = 12%). Severe vitamin D deficiency was significantly associated with an increased risk of DFU (OR 3.22, 95%CI 2.42−4.28; P = 0.64, I2 = 0%). This is the first meta-analysis demonstrating the association between serum vitamin D levels and DFU. Severe vitamin D deficiency is significantly associated with an increased risk of DFU.
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Affiliation(s)
- Jiezhi Dai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chaoyin Jiang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hua Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Yimin Chai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Greenhagen RM, Frykberg RG, Wukich DK. Serum vitamin D and diabetic foot complications. Diabet Foot Ankle 2019; 10:1579631. [PMID: 30815231 PMCID: PMC6383621 DOI: 10.1080/2000625x.2019.1579631] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 02/03/2019] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- Robert M. Greenhagen
- Midwest Foot and Ankle Fellowship, Foot and Ankle Center of Nebraska, Omaha, NE, USA
| | - Robert G. Frykberg
- Midwestern University Program in Podiatric Medicine, Midwestern University, Fountain Hills, AZ, USA
| | - Dane K. Wukich
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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