Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 18, 2023; 11(5): 218-227
Published online Jun 18, 2023. doi: 10.13105/wjma.v11.i5.218
Vitamin D deficiency among outpatients and hospitalized patients with diabetic foot ulcers: A systematic review and meta-analysis
Hyder Osman Mirghani
Hyder Osman Mirghani, Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Saudi Arabia, Tabuk 3378, Saudi Arabia
Author contributions: Mirghani HO contributed to the concept and design, literature search, data analysis and interpretation, and manuscript drafting.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The author has read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hyder Osman Mirghani, MD, Professor, Internal Medicine, Faculty of Medicine, University of Tabuk, Saudi Arabia, Prince Fahd Bin Sultan Street, Tabuk 3378, Saudi Arabia. s.hyder63@hotmail.com
Received: December 24, 2022
Peer-review started: December 24, 2022
First decision: February 28, 2023
Revised: March 27, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: June 18, 2023
Processing time: 173 Days and 19.1 Hours
ARTICLE HIGHLIGHTS
Research background

Vitamin D deficiency is associated with various disorders ranging from glycemic control to cancer and suicide. Diabetic foot syndrome (DFS) is a common disorder with high morbidity and mortality. The association of DF ulcers (DFUs) with vitamin D deficiency was documented. However, the available meta-analyses were limited by bias and few included studies.

Research motivation

Diabetes mellitus (DM) is approaching an epidemic, the disease is associated with vascular and neuropathic complications. Most people with diabetes are not approaching the recommended targets for cardiovascular risk factors with increasing FUs. DFUs are a preventable disease and vitamin D deficiency is promising. Despite the association of vitamin D deficiency and DM and its complications. However, a cause and effect were not confirmed. In addition, vitamin D supplementation is not without complications and vitamin D is readily synthesized by sun exposure. We included vitamin D supplementation to address this issue.

Research objectives

To assess vitamin D levels among patients with diabetic septic foot and the role of vitamin D supplementation in the treatment of DFS.

Research methods

We searched four databases and included studies other than case reports, perspectives, opinions, and editorials. The studies were included if they assessed the relationship between diabetic foot ulcers and vitamin D levels. The most recent RevMan system was used for data analysis.

Research results

Evidence from observational studies confirmed the association between vitamin D deficiency and diabetic foot ulcers, both among outpatients and hospitalized patients, the associations remained robot after controlling for demographic factors, the duration since the diagnosis of type 2 diabetes, and glycated hemoglobin (odds ratio: -6.32, 95% confidence interval: -923 to -3.42).

Research conclusions

Vitamin D deficiency was associated with DFUs, and vitamin D supplementation was effective in slowing the progress. Various therapies along the RANK-osteoprotegerin pathway are promising.

Research perspectives

The question of vitamin D and the optimal effective dose is elucidated. In addition, future therapies along the RANK-osteoprotegerin might address this dangerous diabetes complication.