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
Abstract
BACKGROUND

The definition of diabetic foot syndrome (DFS) varies depending on the location and resources. Few classifications are available according to the indication. DF ulcers and vitamin D deficiency are common diseases among patients with diabetes. Previous literature has shown an association between DF ulcer (DFU) and vitamin D deficiency. However, the available meta-0analysis was limited by substantial bias.

AIM

To investigate the association between DFUs and vitamin D levels.

METHODS

We searched PubMed, MEDLINE, and Cochrane Library, EBSCO, and Google Scholar for studies comparing vitamin D levels and DF. The keywords DFU, DFS, diabetic septic foot, vitamin D level, 25-hydroxy vitamin D, vitamin D status, and vitamin D deficiency were used. The search engine was set for articles published during the period from inception to October 2022. A predetermined table was used to collect the study information.

RESULTS

Vitamin D level was lower among patients with DFU compared to their counterparts [odds ratio (OR): -5.77; 95% confidence interval (CI): -7.87 to -3.66; χ2 was 84.62, mean difference, 9; I2 for heterogeneity, 89%; P < 0.001 and P for overall effect < 0.001]. The results remained robust for hospitalized patients (OR: -6.32 95%CI: -11.66 to -0.97; χ2 was 19.39; mean difference, 2; I2 for heterogeneity, 90%; P = 0.02).

CONCLUSION

Vitamin D was lower among outpatients and hospitalized patients with DFUs. Further larger randomized controlled trials are needed.

Keywords: Vitamin D deficiency, Diabetic foot ulcer, Outpatient, Hospitalized patients, Diabetic foot syndrome

Core Tip: This is the first study to assess the relationship between diabetic foot ulcer and vitamin D deficiency, avoiding the bias of the two published meta-analyses.