Low Vitamin D Links With Increased Diabetic Foot Ulcers

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Researchers published the study covered in this summary on researchsquare.com as a preprint that has not yet been peer reviewed.

Key Takeaways

  • Low serum levels of vitamin D were significantly associated with a higher prevalence of diabetic foot ulcers in elderly patients with diabetes.

  • Average serum levels of 25-hydroxy-vitamin D (25-OH-D) (vitamin D3, the major circulating form of vitamin D in people) steadily decreased as the severity of diabetic foot ulcers increased, as measured by the Wagner classification.

  • Elderly people with diabetes should undergo routine vitamin D screening or receive vitamin D supplementation to prevent the onset or improve the prognosis of diabetic foot ulcers, the authors say.

Why This Matters

  • Vitamin D deficiency is common in elderly patients with diabetes.

  • The relationship between diabetic foot ulcers and vitamin D levels is controversial, with conflicting data. 

  • This is the first study to assess vitamin D levels in elderly patients hospitalized with a diabetic foot ulcer, the authors say.

Study Design

  • This was a retrospective analysis of 339 hospitalized patients with type 2 diabetes aged 60-90 years seen between January 2020 and March 2020, including 204 with and 135 without diabetic foot ulcers.

  • The study included patients who met the 1999 diagnostic criteria of the World Health Organization for diabetes and diabetic foot ulcers, but excluded those taking an agent that can affect serum vitamin D levels.

Key Results

  • The average age of participants was 67 years old and nearly two thirds were men.

  • In the multivariate analysis, independent significant protective factors for diabetic foot ulcer were higher levels of 25-OH-D, triglycerides, and HDL-C.

  • Factors that independently linked with an increased diabetic foot ulcer risk were prolonged diabetes duration and elevated systolic blood pressure.

  • Overall, 80.5% had vitamin D deficiency (defined as < 50 nmol/L or < 20 ng/mL).

  • Among the people without a diabetic foot ulcer, 3% had vitamin D levels that were sufficient (> 75 nmol/L or > 30 ng/mL), 24% had levels defined as insufficient (50-75 nmol/L or 20-30 ng/mL), and 73% were deficient.

  • Among those with a diabetic foot ulcer, 2% had sufficient vitamin D levels, 13% had insufficient levels, and 85% had deficient levels. The differences between these rates and those among the people without a diabetic foot ulcer were significant.

  • Level of 25-OH-D significantly decreased with increasing severity of diabetic foot ulcer based on Wagner grade. People with the lowest grade diabetic foot ulcer, Wagner 1, had on average more than twice the serum level of 25-OH-D compared to those with the most severe diabetic foot ulcer, rated as Wagner 5.

Limitations

  • The study was cross-sectional. Well-designed, prospective studies are needed to assess the causal relationship between vitamin D and diabetic foot ulcer risk, and to explore whether vitamin D supplementation has any effect on diabetic foot ulcer treatment, the authors said. The results could provide clear evidence for using vitamin D supplementation for prevention and treatment of diabetic foot ulcer in elderly people with diabetes.

Disclosures

  • The study received no commercial funding.

  • The authors reported no disclosures.

This is a summary of a preprint research study, “Correlation between serum 25-OH-vitamin D level and diabetic foot ulcer in elderly diabetic patients,” written researchers at the Air Force Medical Center, Beijing, China, and colleagues on Research Square and brought to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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