Introduction and Objective: Type 2 Diabetes (T2D) can lead to ischemic conditions in lower limbs and the following risk of diabetic foot ulcer (DFU). Data linking vitamin D and lower extremity arterial plague (LEAP) and its adverse event, i.e. DFU, are limited.Methods: We enrolled 7479 hospitalized patients (2378 men and 3105 women aged 30 to 89 yrs) with T2D. Vitamin D deficiency (VDD) and vitamin D insufficiency (VDI) were defined as serum 25(OH)D level <20 ng/mL and of 20-29.9 ng/mL, respectively. LEAP was identified by doppler ultrasonography of the lower extremity arteries. DFU was diagnosed according to IWGDF 2019 guideline. Logistic regression model and ROC curves analysis were applied to clarify the relationship between vitamin D and risk of LEAP and LEAP derived DFU.Results: Compared with non-LEAP subgroup, T2D patients with LEAP had decreased levels of 25(OH)D (19.12 v.s. 19.85ng/ml, p<0.05). Among 4,622 patients with LEAP, 2.8% of them had DFU. DFU subgroup had lower vitamin D levels than the non-DFU subgroup (14.77 v.s. 19.98 ng/mL, p<0.001). In the logistic regression model, serum 25 (OH)D was an independent protective factor for risk of LEAP in T2D patients (OR = 0.95, 95% CI 0.92-0.97) after adjusting for age, duration of diabetes, SBP, HbA1c, WBC, and ESR. Among patients with T2D in combination with LEAP, serum 25 (OH)D (OR=0.95, 95%CI 0.92-0.98, p<0.05) was also protective for DFU after multiple adjustment. ROC curve analysis showed that the AUC predicting LEAP in patients with T2D was 0.65 for 25(OH)D. Joint application of duration of Diabetes, WBC and 25(OH)D increased the AUC to 0.70 (p<0.05). In T2D patients had LEAP, the corresponding AUC predicting DFU was 0.67 for 25(OH)D with the cutoff point of 17.11ng/ml. The joint AUC increased to 0.76 (p<0.05).Conclusion: In patients with T2D, insufficient vitamin D levels is associated with risk of having LEAP and further increased risk of DFU. Whether supplement of vitamin D decrease the risk deserves future research.
L. Zhang: None. Y. Liu: None. J. Wang: None.
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