A study of the prevalence and severity of vitamin D deficiency in patient with diabetic foot and its association with vascular calcification and effect on healing

Abstract

Background: With the increasing prevalence of diabetes mellitus (DM), vitamin D (vit D) deficiency and vascular calcification is frequently observed in DM and is an indicator of diabetic peripheral vascular disease with variable implications. Due to the current limited understanding, this research was initiated. Aims and objective was to critically assess the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection, the association between vascular calcification and vitamin D deficiency and effect on healing in diabetic foot patient with and without vitamin D deficiency.Methods: This observational study was conducted on 50 patients with diabetes mellitus. A detailed clinical history was recorded. Infection was confirmed by culture positivity and Doppler was used to detect vascular calcification. A follow-up for 3 weeks was done after which wound healing rate was assessed by change in wound surface area. Data was analyzed by Chi-square test and multivariate regression analysis.Results: 58% patients were diagnosed with vitamin D deficiency. 40% of patients found to have VC associated with DM. 100 % association of VC was found in patients with severe vitamin D deficiency. Vitamin D deficiency significantly correlated with vascular calcification (p=0.0001). A significant difference was observed in wound healing between the patients with and without vitamin D deficiency i.e. 3.14±2.04mm.sq and 4.36±1.39mm.sq.Conclusions: This study opens up an issue of recognizing vitamin D deficiency as a possible risk factor for diabetic foot infections and suggests the need for vitamin D supplementation.

Comparison of vitamin D levels in diabetes mellitus patients with and without diabetic foot ulcers: An analytical observational study in Jakarta, Indonesia

“…Several studies have shown the relationship between vitamin D deficiency and the occurrence of bacterial infection in DFU which contributes 20% of hospitalizations in DM patients 42,43 . Immune cells, beta cell damage, impaired insulin production, and vitamin D deficiency are associated with susceptibility to infection in DFU 11 …”

“…The study also stated that vitamin D deficiency was more dominant in infected DFU. The optimal form of the active metabolite of vitamin D, 1,25(OH)D, is required to induce AMP production in keratinocytes in DFU 11 …”

“…42,43 Immune cells, beta cell damage, impaired insulin production, and vitamin D deficiency are associated with susceptibility to infection in DFU. 11 Low circulating levels of vitamin D cause an increase in the concentration of inflammatory cytokines in DFU patients, resulting in a prolongation of the wound healing process. 9 A study in United States found that an increase in DFU duration was significantly associated with the likelihood of DFU failure to heal.…”

“…25‐Hydroxyvitamin D decrease pro‐inflammatory cytokines and increases anti‐inflammatory responses 6,10 . It was observed that longer DFU duration and vitamin D deficiency had a significant negative effect on the rate of DFU healing, indicating DFU patients with lower serum vitamin D levels may have a higher PEDIS score 11‐13 …”

“…6,10 It was observed that longer DFU duration and vitamin D deficiency had a significant negative effect on the rate of DFU healing, indicating DFU patients with lower serum vitamin D levels may have a higher PEDIS score. [11][12][13] In recent years, more reports have been reported on the role of vitamin D on T cell-mediated immunity, pancreatic insulin secretion, and its mechanism on cell growth and healing processes. 4 However, research on vitamin D in the Indonesian population is still limited.…”