Low vitamin D Levels linked to Diabetic foot ulcer in elderly diabetics

China: Vitamin D is closely correlated with Diabetic foot ulcers(DFU) and is an independent protective factor for DFU in elderly patients, shows a study presented in preprint under review at BMC Endocrine Disorders. Vitamin D screening or supplementation through diet or other methods might be beneficial to prevent DFU and improve the prognosis of DM patients.

Diabetic foot ulcers (DFU) are one of the severe and costly chronic complications of diabetes, which can lead to amputation and death in severe cases. Few experiments have indicated vitamin D, a fat-soluble molecule can be a potential therapy for DFU, as it can restore the antimicrobial peptides (AMP) production in primary diabetic foot ulcer (DFU) cells and improve in vitro wound healing.

Fenglin Wang, Department of Endocrinology, china conducted a study to investigate the relationship between the level of 25-OH-vitamin D [25 (OH) D] and diabetic foot ulcers (DFU) in aged Diabetes Mellitus (DM) patients.

Investigators conducted a retrospective analysis on 339 elderly DM inpatients(aged 60- 90 years old), including 204 patients with DFU (DFU group) and 135 patients without DFU (DM group), at the endocrinology department of the Air Force Medical Center, PLA(January 2020 - March 2022). The team compared the clinical and biochemical characteristics of the two groups and analyzed the change of 25 (OH) Vitamin D and its relationship with DFU. Inclusion was done based on 1999 diagnostic criteria of the WHO for diabetes and DFU and exclusion was based on intake of an agent affecting serum vitamin D or having acute diabetic complications.

Key Results of the study,

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

• There was a statistically significant (p < 0.05) difference in age, DM duration, gender, diastolic blood pressure, serum creatinine, total cholesterol, triglyceride, HDL-C, LDL-C, ALT, AST, albumin, 25-OH-vitamin D between the two groups.

• Multivariate logistic regression analysis showed that 25-OH-vitamin D is an independent protective factor for DFU.

• 25-OH-vitamin D nutrition status distribution was different between both groups(P < 0.05). Vitamin D deficiency (< 50 nmol/L) accounted for 86.78% of all DFU patients, which was only 74.33% in non-DFU patients.

• The 25-OH-vitamin D levels of DFU patients from Wagner Grades 1 to 5 showed a downward trend (p < 0.01). People with the lowest grade DFU had on an average more than twice the serum level of 25-OH-D compared to those with the most severe DFU.

From the data analysis, the investigators confirmed that 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-OH-vitamin D steadily decreased as the severity of diabetic foot ulcers increased, as measured by the Wagner classification.

Fenglin Wang, Jia Xu, Di Zhu et al. Correlation between serum 25-OH-vitamin DLevel and diabetic foot ulcer in elderly diabetic patients, 18 May 2022, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-1613316/v1]