Elsevier

Journal of Diabetes and its Complications

The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial

Abstract

Objective

This study was conducted to evaluate the effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer (DFU).

Methods

This randomized, double-blind, placebo-controlled trial was performed among 60 patients with grade 3 DFU according to "Wagner–Meggitt's" criteria. Participants were randomly divided into two groups (each 30 participants) and received either 50,000   IU vitamin D supplements every 2   weeks for 12   weeks (group A) or placebo (group B). Fasting blood samples were taken at study baseline and after 12-week intervention to determine related markers.

Results

After 12   weeks of intervention, compared with the placebo, vitamin D supplementation resulted in a significant reduction in ulcer length (−   2.1   ±   1.1 vs. −   1.1   ±   1.1   cm, P   =   0.001), width (−   2.0   ±   1.2 vs. −   1.1   ±   1.0   cm, P   =   0.02) and depth (−   1.0   ±   0.5 vs. −   0.5   ±   0.5   cm, P   <   0.001), and erythema rate (100% vs. 80%, P   =   0.01). In addition, in supplemented patients changes in serum insulin concentration (−   3.4   ±   9.2 vs. +   2.8   ±   9.3 μIU/mL, P   =   0.01), homeostasis model of assessment-estimated insulin resistance (−   1.5   ±   4.1 vs. +   1.7   ±   5.1, P   =   0.01), the quantitative insulin sensitivity check index (+   0.006   ±   0.02 vs. −   0.006   ±   0.02, P   =   0.03) and HbA1c (−   0.6   ±   0.6 vs. −   0.1   ±   0.5%, P   =   0.004) were significantly different from those of patients in the placebo group. Additionally, following supplementation with vitamin D, significant reductions in serum total- (−   15.8   ±   18.9 vs. +   5.3   ±   31.8   mg/dL, P   =   0.003), LDL- (−   17.2   ±   19.8 vs. +   2.2   ±   28.6   mg/dL, P   =   0.003), total-/HDL-cholesterol ratio (−   1.1   ±   0.8 vs. −   0.2   ±   1.1, P   =   0.001), high sensitivity C-reactive protein (hs-CRP) (−   0.4   ±   2.5 vs. +   1.9   ±   4.2   μg/mL, P   =   0.01), erythrocyte sedimentation rate (ESR) (−   34.7   ±   32.4 vs. −   18.0   ±   26.6   mm/h, P   =   0.03) and plasma malondialdehyde (MDA) concentrations (−   0.7   ±   0.9 vs. −   0.2   ±   0.5   μmol/L, P   =   0.008) were seen compared with the placebo.

Conclusions

Overall, vitamin D supplementation for 12   weeks among patients with DFU had beneficial effects on glucose homeostasis, total-, LDL-, total-/HDL-cholesterol, ESR, hs-CRP and MDA levels. In addition, vitamin D may have played an indirect role in wound healing due to its effect on improved glycemic control.

Keywords

Vitamin D supplementation

Wound healing

Insulin resistance

Inflammation

Diabetic foot

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