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

Abstract

To systematically evaluate the potential impact of vitamin D supplementation on clinical parameters related to diabetic foot ulcers (DFU) in athletes, focusing on its implications for sports recovery and performance. Methods: The medical literature databases Embase, PubMed, Cochrane Library, Scopus, Wan fang, CNKI, and VIPwere utilized. Searches were conducted using computer technology from the inception of each database until January 2024. Randomized controlled trials (RCTs) evaluating vitamin D supplementation for treating DFU in athletes were identified. Essential clinical indicators were extracted pre-and post-supplementation, including wound area (cm²), depth (cm), and score; metabolic indicators such as fasting blood sugar (FBS), 2h postprandial blood sugar (2h PG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), and insulin resistance index (HOMA-IR); lipid profile markers including cholesterol (TC), triglycerides (TG), low-density (LDL) and high-density lipoprotein (HDL); and markers of inflammation and oxidative stress such as C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), erythrocyte sedimentation rate (ESR), malondialdehyde (MDA), total antioxidant capacity (TAC), nitric oxide (NO), and glutathione (GSH). Results are presented as mean ± standard deviation (Mean ± SD). Meta-analysis, sensitivity grading, and publication bias assessment were performed using R software version 4.3.2. Results: This study included a total of 10 RCTs involving 781 athlete cases. Compared to the control group, vitamin D as a supplementary treatment significantly improved the wound area, depth, and score in DFU patients. The differences in means were [weighted mean difference (WMD) = -2.22cm², 95% 252CI -3.21~-1.24 cm², I2=84%, P<0.01], [WMD = -0.26cm, 95% CI -0.49~-0.03 cm, I2=76%, P=0.02], and [WMD = -1.45 points, 95% CI -2.37~-0.53 points, I2=98%, P<0.01]; Significant reductions were also noted in glycemic parameters FBS, 2h PG, HbA1c, FINS, HOMA-IR, with [WMD = -0.56 mmol/L, 95% CI -0.91~--0.22 mmol/L, I2=78%, P<0.01], [WMD = -0.86 mmol/L, 95% CI -0.64~--0.22 mmol/L, I2=0%, P<0.01], [WMD = -0.76%, 95% CI -1.09~--0.43%, I2=89%, P<0.01], [WMD = -3.31 μU/ml, 95% CI -4.35~--2.26 μU/ml, I2=0%, P<0.01], and [WMD = -1.46, 95% CI -2.63~--0.29%, I2=95%, P=0.01]. Lipid metabolism-related indicators such as TC and TG levels were reduced [WMD = -0.32 mmol/L, 95% CI -0.46~--0.17 mmol/L, I2=46%, P<0.01], [WMD =-0.36 mmol/L, 95% CI -0.55~--0.16 mmol/L, I2=68%, P<0.01]. Levels of inflammation-related markers CRP, hs-CRP, and ESR were significantly lowered [SMD = -0.82, 95% CI -1.14~-0.49, I2=0%, P<0.01], [SMD = -0.83, 95% CI -1.06~-0.59, I2=0%, P<0.01], [SMD = -0.62, 95% CI -0.86~-0.39, I2=0%, P<0.01]. Decreases in MDA levels [WMD = -0.45 μmol/L, 95% CI -0.64 to -0.26 μmol/L, I2=0%, P<0.01] and increases in NO levels [WMD = 1.78 μmol/L, 95% CI 0.01 to 3.55 μmol/L, I2=0%, P=0.05] were observed, supporting a role in reducing oxidative stress. No significant differences were found between the two groups in LDL-C, HDL-C, GSH, and TAC levels. Conclusion: Vitamin D supplementation holds potential as a therapeutic adjunct in the treatment of DFU in athletes, effectively promoting wound healing, improving metabolic health, suppressing inflammation, and reducing oxidative stress, thus potentially enhancing recovery and athletic performance.