Imagine living with diabetes, and despite doing everything your doctor tells you to do, you develop a tiny blister or sore on the bottom of your foot. Strangely enough, you might not feel pain, but the sore grows larger and larger despite your every attempt to let it heal. After a short while, the sore is diagnosed as a diabetic foot ulcer (DFU), and can be quite dangerous if left untreated. This is the reality for about 25% of diabetic patients who experience DFU at some point in their lifetime.
What is a diabetic foot ulcer?
There are several signature aspects of diabetes that we must understand if we are to dig deeper into DFUs. First, let’s start with insulin. Insulin is a is a hormone which is released by the pancreas when blood sugar is high. It transports this sugar, or glucose, to the cells to be used for energy.
In those with diabetes, either the pancreas does not secrete insulin, or the insulin secreted does not do its job of transporting glucose very well. Whether it’s lack of insulin or dysfunction of insulin depends on which type of diabetes you have, type 1 or type 2. Either way, glucose does not make it into the cells as effectively, and build up of glucose in the blood has some negative consequences.
There are two main consequences related to blood sugar that contribute to poor wound healing and DFU. The presence of chronic high blood sugar can damage the nerves over time, causing diabetic neuropathy. Peripheral neuropathy is most common, and typically affects the feet and legs. Those with peripheral neuropathy might feel a slight tingling in their feet, or lack of sensation all together. Once a small cut or blister forms, an individual with diabetic neuropathy might not feel or notice until it’s much larger, and possibly infected.
Even further, high blood sugar and neuropathy can cause damage to the blood vessels, which severely impacts wound healing. These two diabetic symptoms together make a DFU, which can result in much more serious complications if left untreated.
Severe DFUs place an individual at risk for amputation and death. Approximately 85% of diabetes-related amputations are caused by a DFU. Additionally, history of DFU is associated with a 47% increased risk of mortality in diabetics. For those with DFU, it is critical to seek immediate medical care to avoid risk of infection, tissue death and amputation.
I don’t have diabetes, how does this affect me?
Diabetes is a highly common health condition worldwide, affecting more than 8% of the population. Furthermore, this number has nearly doubled since 1980. Diabetes may not affect you, but what about your mother, uncle, coworker or childhood friend? What if you could spread awareness on an easy, affordable way to improve diabetes and DFU? Turns out, there is something you can do, and the Vitamin D Council is here to help. The relationship between vitamin D and diabetes has become more clear in recent years, and research suggests that vitamin D plays a role in regulating several of the metabolic markers that are related to diabetes. This relationship is now expanding further, as a recent study suggests vitamin D could help heal DFU.
Vitamin D and diabetic foot ulcer
A randomized controlled trial discovered vitamin D supplementation helped improve disease outcome in patients with grade three moderate DFU. Researchers evaluated the effects of supplementing 30 DFU patients with 50,000 IU once every two weeks for 12 weeks in comparison to 30 DFU patients on a placebo pill. All the patients were treated for their DFU with standard diabetic medical protocol.
Several outcomes were measured to determine the effect of vitamin D. This included insulin resistance (HOMA-IR, HOMA-B, QUICKI), HbA1c (a measure of blood glucose over time), blood lipids, wound healing, inflammation (CRP), markers of oxidative stress (NO, TAC, GSH and MDA), vitamin D levels and ulcer size. After 12 weeks, this is what the researchers found:
- In the vitamin D supplement group, levels were increased by about 12.9 ± 10.0 ng/ml.
- Compared to the best standard treatment, the vitamin D supplementation group experienced a significant reduction in ulcer length (p = 0.001), width (p = 0.02) and depth (p < 0.001).
- The vitamin D supplement group experienced improved insulin sensitivity over time (HOMA-IR) compared to the placebo group (p = 0.01).
- The vitamin D supplement group experienced significant improvements in HbA1c, QUICKI, total cholesterol, LDL, total/HDL cholesterol ratio, CRP and MDA concentrations (p = 0.004, 0.03, 0.003, 0.003, 0.001, 0.01, and 0.008, respectively).
The researchers concluded:
“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.”
How you can take matters into your own hands
Past research has supported a role of vitamin D in diabetic patients, showing that supplementation can affect several of the markers mentioned above. And now, with research suggesting that vitamin D helps improve wound healing in DFU, this relationship may have significant implications for the health and quality of life in diabetic patients.
It may be too soon to claim that vitamin D can prevent DFU-related limb amputations in diabetes patients, but, when considered with previous research, it does appear to be a beneficial addition to a daily routine in those with this all-too-common health condition. Vitamin D supplementation is inexpensive and easy to administer. The Vitamin D Council recommends between 5,000 – 10,000 IU (125 to 250 mcg/day) vitamin D3 per day to ensure a healthy vitamin D status (40-80 ng/ml).
Peterson, R. & Cannell, JJ. Diabetic foot ulcer may be mediated by vitamin D supplementation. The Vitamin D Council Blog & Newsletter, 4/2018.
Razzaghi, R. et al. 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. Journal of Diabetes and Its Complications, 2018.