Published: 2019-04-29

A study of the prevalence and severity of vitamin D deficiency in patient with diabetic foot and its association with vascular calcification and effect on healing

Ajonish Kamble, Manish Swarnkar


Background: With the increasing prevalence of diabetes mellitus (DM), vitamin D (vit D) deficiency and vascular calcification is frequently observed in DM and is an indicator of diabetic peripheral vascular disease with variable implications. Due to the current limited understanding, this research was initiated. Aims and objective was to critically assess the prevalence and severity of vitamin D deficiency in patients with diabetic foot infection, the association between vascular calcification and vitamin D deficiency and effect on healing in diabetic foot patient with and without vitamin D deficiency.

Methods: This observational study was conducted on 50 patients with diabetes mellitus. A detailed clinical history was recorded. Infection was confirmed by culture positivity and Doppler was used to detect vascular calcification. A follow-up for 3 weeks was done after which wound healing rate was assessed by change in wound surface area. Data was analyzed by Chi-square test and multivariate regression analysis.

Results: 58% patients were diagnosed with vitamin D deficiency. 40% of patients found to have VC associated with DM. 100 % association of VC was found in patients with severe vitamin D deficiency. Vitamin D deficiency significantly correlated with vascular calcification (p=0.0001). A significant difference was observed in wound healing between the patients with and without vitamin D deficiency i.e.  3.14±2.04mm.sq and 4.36±1.39mm.sq.

Conclusions: This study opens up an issue of recognizing vitamin D deficiency as a possible risk factor for diabetic foot infections and suggests the need for vitamin D supplementation.


Diabetic foot infection, Vascular calcification, Vitamin D deficiency, Wound healing

Full Text:



Tiwari S, Pratyush DD, Gupta B, Dwivedi A, Chaudhary S, Rayicherla RK, et al. Prevalence and severity of vitamin D deficiency in patients with diabetic foot infection. Br J Nutr. 2013 Jan;109(01):99-102.

Swain J, Tiwari S, Dd P, Dwivedi A, Gupta B, Shukla RC, et al. Vascular calcification in diabetic foot and its association with calcium homeostasis. Indian J Endocrinol Metab. 2012;16:S450-2.

Baeke F, Etten EV, Overbergh L, Mathieu C. Vitamin D3 and the immune system: maintaining the balance in health and disease. Nutr Res Rev. 2007 Jun;20(1):106-18.

Cantorna MT, Zhu Y, Froicu M, Wittke A. Vitamin D status, 1,25-dihydroxyvitamin D3, and the immune system. Am J Clin Nutr. 2004;80(6 Suppl):1717S-20S.

Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004 May;79(5):820-5.

Veldman CM, Cantorna MT, DeLuca HF. Expression of 1,25-dihydroxyvitamin D(3) receptor in the immune system. Arch Biochem Biophys. 2000 Feb 15;374(2):334-8.

Kawaura A, Takeda E, Tanida N, Nakagawa K, Yamamoto H, Sawada K, et al. Inhibitory effect of long term 1α-hydroxyvitamin D3 administration on Helicobacter pylori infection. J Clin Biochem Nutri. 2006;38(2):103-6.

Sabetta JR, DePetrillo P, Cipriani RJ, Smardin J, Burns LA, Landry ML. Serum 25-hydroxyvitamin d and the incidence of acute viral respiratory tract infections in healthy adults. PloS one. 2010;5(6):e11088.

Pfeifer M BJ. Levin and O’Neal’s The Diabetic Foot. 7th ed. Elsevier; 2007:203-205.

Jeffcoate WJ, Rasmussen LM, Hofbauer LC, Game FL. Medial arterial calcification in diabetes and its relationship to neuropathy. Diabetologia. 2009;52(12):2478-88.

Hofbauer LC, Heufelder AE. Role of receptor activator of nuclear factor-kappaB ligand and osteoprotegerin in bone cell biology. J Mol Med Berl Ger. 2001;79(5-6):243-53.

Hsu JJ, Tintut Y, Demer LL. Vitamin D and osteogenic differentiation in the artery wall. Clin J Am Soci Nephrol. 2008;3(5):1542-7.

Margolis DJ, Kantor J, Santanna J, Strom BL, Berlin JA. Risk factors for delayed healing of neuropathic diabetic foot ulcers: a pooled analysis. Arch Dermatol. 2000;136(12):1531-5.

Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers: the association of wound size, wound duration, and wound grade on healing. Diabetes Care. 2002 Oct;25(10):1835-9.

Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Armstrong DG, Harkless LB, et al. The effects of ulcer size and site, patient’s age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med J Br Diabet Assoc. 2001;18(2):133-8.

Sharma A, Scammell BE, Fairbairn KJ, Seagrave MJ, Game FL, Jeffcoate WJ. Prevalence of Calcification in the Pedal Arteries in Diabetes Complicated by Foot Disease. Diabetes Care. 2010;33(5):e66-e66.

Moon JS. A controlled study of medial arterial calcification of legs: implications for diabetic polyneuropathy. Arch Neurol. 2011;68(10):1290.

Akther JM, Khan IA, Shahpurkar VV, Khanam N, Syed ZQ. Evaluation of the diabetic foot according to Wagner’s classification in a rural teaching hospital. Br J Diabetes Vasc Dis. 2011;11(2):74-9.

Zhou W, Ye SD. relationship between serum 25-hydroxyvitamin d and lower extremity arterial disease in type 2 diabetes mellitus patients and the analysis of the intervention of vitamin D. J Diabetes Res. 2015;2015:1-6.