Is there an association between vitamin D and diabetic foot disease? A meta‐analysis

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.

Association Between Vitamin D Status and Diabetic Complications in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study in Hunan China

“…Additionally, previous studies have revealed that patients with DFU had higher prevalence of VDD and lower vitamin D levels in comparison to diabetic patients without DFU (17,20,45,54,55). We reported that the prevalence of VDD in participants with DFU was about 80%.…”

“…DR and DKD are common microvascular complications of diabetes ( 7 ). Many clinical studies have recognized VDD as the risk factor for DR ( 16 , 25 , 41 ) and DKD ( 17 , 42 ), whereas other epidemiological researches showed opposite results ( 21 , 22 , 43 ). In this study, we revealed that the correlation between VDD status and the prevalence of DR or DKD was not statistically significant after adjusting laboratory measurements, diabetic complications, related comorbidities, and medications besides the adjustment for demographics and physical measurements.…”

“…In addition to mediating bone metabolism by regulating calcium and phosphorus homeostasis, vitamin D also modulates cell proliferation, differentiation, apoptosis, immune function, inflammation response, as well as vascular and metabolic properties (e.g., insulin secretion and insulin sensitivity) ( 12 – 14 ). In the past few years, the association between vitamin D deficiency (VDD) and other nonclassical outcomes besides skeletal disorders has drawn increasing attention, especially diabetes and diabetes-related complications ( 14 – 17 ). The inverse association between vitamin D levels and risk of DR ( 18 ), DKD ( 19 ), or DFU ( 20 ) among diverse populations has been demonstrated, whereas other studies reported discordant results regarding the correlations between vitamin D status and these three complications of diabetes ( 21 – 23 ).…”

Associations between vitamin D status and diabetic complications in Chinese population with type 2 diabetes mellitus: a cross-sectional study

“…Additionally, previous studies have revealed that patients with DFU had higher prevalence of VDD and lower vitamin D levels in comparison to diabetic patients without DFU [17,22,70,[80][81][82]. We reported that the prevalence of VDD in participants with DFU was about 80%.…”

“…In addition to mediating bone metabolism by regulating calcium and phosphorus homeostasis, vitamin D also modulates cell proliferation, differentiation, apoptosis, immune function, inflammation response, as well as vascular and metabolic properties (e.g., insulin secretion and insulin sensitivity) [12][13][14]. In the past few years, the association between vitamin D deficiency (VDD) and other nonclassical outcomes besides skeletal disorders has drawn increasing attention, especially diabetes and diabetes-related complications [14][15][16][17]. Although the inverse association between vitamin D levels and risk of T2DM [18,19], DR [20], DKD [21], or DFU [22] among diverse populations has been reported, uncertainties still exist due to the discordant results [23,24].…”