Pena G, Kuang B, Cowled P, Howell S, Dawson J, Philpot R, Fitridge R, et al.
Advances in wound care. Date of publication 2020 Jan 1;volume 9(1):9-15.
1. Adv Wound Care (New Rochelle). 2020 Jan 1;9(1):9-15. doi:
10.1089/wound.2019.0973. Epub 2019 Dec 6.
Micronutrient Status in Diabetic Patients with Foot Ulcers.
Pena G(1)(2), Kuang B(1)(2), Cowled P(2), Howell S(3), Dawson J(1)(2), Philpot
R(4), Fitridge R(1)(2).
Author information:
(1)Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital,
Adelaide, Australia.
(2)Discipline of Surgery, The University of Adelaide, Adelaide, Australia.
(3)Data Management and Analysis Centre, School of Population Health, The
University of Adelaide, Adelaide, Australia.
(4)Department of Infectious Disease, The Queen Elizabeth Hospital, Adelaide,
Australia.
Comment in
Adv Wound Care (New Rochelle). 2021 Jan;10(1):49-50.
Objective: To explore the prevalence of micronutrient deficiencies in patients
with diabetic foot ulcers and correlate this with foot disease severity and other
clinical factors. Approach: Prospective cohort study of diabetic patients with
foot ulcers seen in multidisciplinary foot clinics across Adelaide or admitted to
the Vascular Surgery Unit at the Royal Adelaide Hospital between February 2017
and September 2018. A total of 131 patients were included in the study. Plasma
serum levels of vitamins A, C, D, and E, copper, zinc, and ferritin were
measured. Demographic and clinical data, including BMI, smoking status, duration
of diabetes, HbA1c, and WIfI score, were obtained. Results: The most prevalent
nutritional deficiency found was vitamin D affecting 55.7% of patients.
Suboptimal levels of vitamin C affected 73% of patients, comprising marginal
levels in 22.2% and deficient levels in 50.8%. Zinc deficiency, vitamin A
deficiency, and low ferritin levels were present in 26.9%, 10.9%, and 5.9% of
patients, respectively. There was no correlation between BMI, grip strength,
duration of diabetes, HbA1c, or smoking status with micronutrient deficiency.
Increased severity of diabetic foot disease was associated with lower vitamin C
levels (p = 0.02). Innovation: This study has demonstrated that the deficiency of
micronutrients, especially vitamin D, vitamin C, zinc, and vitamin A, is common
in diabetic patients with foot ulcers. Conclusions: The prevalence of
micronutrient deficiency is high in a diabetic population with foot
ulcers/wounds. Special concerns regarding the high prevalence of vitamin C and
zinc deficiency, given their roles in wound healing. Although further research
needs to be performed to determine the clinical implications of our findings,
micronutrient deficiency should be considered in diabetic patients with foot
wounds.
Copyright 2020, Mary Ann Liebert, Inc., publishers.
DOI: 10.1089/wound.2019.0973
PMCID: PMC6918841
PMID: 31871826 [Indexed for MEDLINE]
