The aim of the present research was to study the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection. Patients were enrolled in two groups: diabetic patients with foot infection (n 125) as cases and diabetic patients without the infection as controls (n 164). Serum 25-hydroxyvitamin D (25(OH)D) was measured by RIA. Data were presented as means and standard deviations unless otherwise indicated and were analysed by SPSS. Results revealed that 25(OH)D (nmol/l) was significantly lower (40·25 (SD 38·35) v. 50·75 (SD 33·00); P, 0·001) in cases than in controls. Vitamin D inadequacy (25(OH)D , 75 nmol/l) was equally common in cases and controls (OR 1·45, 95 % CI 0·8, 3·0; P¼ 0·32), but cases had a greater risk of vitamin D deficiency (25(OH)D , 50 nmol/l) than controls (OR 1·8, 95 % CI 1·1, 3·0; P¼ 0·02). Risk of severe vitamin D deficiency (25(OH)D , 25 nmol/l) was significantly higher in cases than in controls (OR 4·0, 95 % CI 2·4, 6·9; P, 0·0001). Age, duration of diabetes and HbA1c were significantly higher in cases than in controls and therefore adjusted to nullify the effect of these variables, if any, on study outcome. The study concluded that vitamin D deficiency was more prevalent and severe in patients with diabetic foot infection. This study opens up the issue of recognising severe vitamin D deficiency (,25 nmol/l) as a possible risk factor for diabetic foot infections and the need for vitamin D supplementation in such patients for a better clinical outcome. This could be substantiated by similar data from future studies.

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In addition to macro and micro vascular complication, hyperglycemia also causes dysfunction of immune system that protects the individuals against infection. Vitamin D deficiency, which has very high prevalence among the diabetic population, might contribute to impairment of macrophage dysfunction. The present study aimed to accesses the effect of vitamin D on phagocytic activity of macrophages in patients with diabetic foot infection in an in-vitro experimental model. The subjects included in the study were divided in to three groups. Serum vitamin D level of all groups was measured by Radioimmunoassay methods. Human PBMC were isolated by densitygradient centrifugation and cultured for 5 days in presence and absence of vitamin D. Phagocytosis was assessed by Confocal and fluorescent microscopy. Comparisons were performed using ANOVA and data were expressed as mean ± SD. The increased percentage of phagocytosis was observed in macrophages treated with 1X10 -7 M concentration of vitamin D3 in comparison to untreated sample among the diabetic foot group. In conclusion this study demonstrated that vitamin D deficiency lead to impaired phagocytosis of macrophages from diabetic subjects. Addition of vitamin D in culture medium of the macrophages improves phagocytosis significantly. This remarkable observation strengthens the concept of vitamin D supplementation to the diabetic foot for improving innate immunity.Copy Right, IJAR, 2016,. All rights reserved.

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