ENHANCING RECOVERY IN ATHLETES WITH DIABETIC FOOT ULCERS THROUGH VITAMIN D SUPPLEMENTATION: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Abstract

Objective To systematically evaluate the potential impact of vitamin D supplementation on clinical parameters related to patients with diabetic foot ulcers (DFU). Methods The medical literature databases Embase, PubMed, Cochrane Library, Scopus, Wanfang, CNKI, and VIP were searched using computer technology.The deadline is from the establishment of the database until January 2024. Randomized controlled trials (RCT) were screened for vitamin D supplementation in the treatment of DFU patients, and the required clinical indicators before and after medication were extracted. Including: diabetes ulcer wound area (cm2), wound depth (cm), wound score (points); glucose metabolism indicators: fasting blood sugar (FBS), 2h postprandial blood sugar (2h PG), glycosylated hemoglobin (HbA1c), fasting insulin level (FINS), insulin resistance index (HOMA-IR); lipid metabolism indicators: cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL); inflammation and oxidative stress indicators: C-reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP), erythrocyte sedimentation rate (ESR), malondialdehyde (MDA), total antioxidant capacity (TAC), nitric oxide (NO), glutathione (GSH).Numerical results are presented as mean ± standard deviation (Mean ± SD). R 4.3.2 software was used for meta-analysis, sensitivity grading, and publication bias assessment. Results this study included a total of 10 RCT studies, with a total of 781 cases. Compared to the control group, vitamin D as a supplementary treatment can significantly improve the wound area, depth, and wound score of DFU patients. The differences in means were [weighted mean difference (WMD) = -2.22cm2, 95% CI -3.21~-1.24 cm2, I2=84%, P<0.01], [weighted mean difference (WMD) = -0.26cm, 95% CI -0.49~-0.03 cm, I2=76%, P=0.02], and [weighted mean difference (WMD) = -1.45cm, 95% CI -2.37~-0.53 cm, I2=98%, P<0.01]; Significantly reduced the glycemic parameters FBS, 2h PG, HbA1c, FINS, HOMA-IR, with [weighted mean difference (WMD) = -0.56mmol/L, 95%CI -0.91~- -0.22mmol/L, I2=78%, P<0.01], [WMD = -0.86mmol/L, 95%CI -0.64~- -0.22mmol/L, I2=0%, P<0.01], [WMD = -0.76%, 95%CI -1.09~- -0.43%, I2=89%, P<0.01], [WMD = -3.31μU/ml, 95%CI -4.35~- -2.26μU/ml, I2=0%, P<0.01], and [WMD = -1.46, 95%CI -2.63~- -0.29%, I2=95%, P=0.01]; Reduced lipid metabolism-related indicators TC, TG levels, respectively were [mean difference (WMD) = -0.32mmol/L, 95%CI -0.46~- -0.17mmol/L, I2=46%, P<0.01], [mean difference (WMD)=-0.36mmol/L, 95%CI -0.55~- -0.16mmol/L, I2=68%, P<0.01]; Decrease the levels of inflammation-related indicators, CRP [Standard mean difference (SMD) = -0.82, 95% CI -1.14~-0.49, I2=0%, P<0.01], hs-CRP [Standard mean difference (SMD) = -0.83, 95% CI -1.06~-0.59, I2=0%, P<0.01], and ESR [Standard mean difference (SMD) = -0.62, 95% CI -0.86~-0.39, I2=0%, P<0.01]; Reduce MDA levels [mean difference (WMD) = -0.45 μmol/L, 95% CI -0.64 to -0.26 μmol/L, I2=0%, P<0.01]; Increase NO levels [mean difference (WMD) = 1.78 μmol/L, 95% CI 0.01 to 3.55 μmol/L, I2=0%, P=0.05]; No significant differences were found between the two groups in indicators such as LDL-C, HDL-C, GSH, and TAC. Conclusion Vitamin D preparations have the potential to assist in the treatment of DFU, effectively promoting wound healing in DFU patients, improving patients' glucose and lipid metabolism levels, suppressing inflammation in DFU patients, and reducing oxidative stress.