Diabetic Foot Ulcer patients had low vitamin D (half had less than 10 ng)

Severe Vitamin D3 Deficiency in the Majority of Patients with Diabetic Foot Ulcers.

Horm Metab Res. 2018 Jul 5. doi: 10.1055/a-0648-8178. [Epub ahead of print]

Feldkamp J1, Jungheim K1, Schott M2, Jacobs B3, Roden M2,4,5.

1 Klinikum Bielefeld, Department of Endocrinology and Diabetes, Bielefeld, Germany.

2 Division for Specific Endocrinology, Medical Faculty, U. Hospital Duesseldorf, Duesseldorf, Germany.

3 Medicover Osnabrück, Osnabrück, Germany.

4 Deutsches Diabetes Zentrum, Düsseldorf, Germany.

5 German Center for Diabetes Research, München-Neuherberg, Germany.

* Diabetic foot ulcer associated with extremely low vitamin D levels – Sept 2013 * Diabetic Foot Ulcers helped by Vitamin D - meta-analyses many studies * Diabetic foot ulcer 1.7 times more likely if poor Vitamin D Receptor – Jan 2017 * Diabetes treated if given enough vitamin D (example: 50,000 IU weekly) – review of RCT - Jan 2017 * The worse the diabetic foot, the lower the vitamin D level – Nov 2019 * Diabetic Foot Ulcer patients had low vitamin D (half had less than 10 ng) – July 2018 1. Overview Diabetes and vitamin D contains the following summary {include} 1. Diabetes category starts with the following {include} --- 1. A diabetic foot severity grade from the web

Diabetic foot ulcers are a severe complication in patients with diabetes mellitus. Vitamin D is associated with impaired β-cell function and insulin resistance, and is necessary for wound healing and bone metabolism. We measured the serum concentrations of 25-hydroxyvitamin D3 in 104 patients (63 inpatients, 41 outpatients) with diabetic foot ulcers and compared them to 99 healthy humans (control) and 103 patients with diabetes mellitus type 2 without diabetic foot ulcers. Calcium, creatinine, and parathyroid hormone were measured in patients with diabetic foot ulcers. The data were analysed together with glycosylated hemoglobin A1c and the severity of diabetic foot lesions according to the Armstrong classification. Levels of 25-hydroxyvitamin D3 were lower (11.8±11.3 ng/ml, p<0.001) in patients with diabetic foot ulcers (mean age 70±12 years) than in the control group (27.2±12.2 ng/ml). No difference was found between in- and outpatients.

Fifty-eight (55.8%) of patients with diabetic foot ulcers had a severe 25-hydroxyvitamin D3 deficiency with levels below 10 ng/ml.

Only 12% of the patients had 25-hydroxyvitamin D3 levels above 20 ng/ml. Secondary hyperparathyroidism was found in 27.9% of patients and 11.5% of the patients were hypocalcemic. There was a negative correlation (r=-0.241) (p<00.1) between Armstrong classification and 25-hydroxyvitamin D3 status. In conclusion, patients with diabetic foot syndrome are at high risk of 25-hydroxyvitamin D3 deficiency. Thus, any patient with diabetic foot syndrome should undergo 25-hydroxyvitamin D3 measurement and supplementation, if values are found to be decreased.

PMID: 29975973 DOI: 10.1055/a-0648-8178