Efektivitas Suplementasi Vitamin D Oral sebagai Terapi Adjuvan Ulkus Kaki Diabetikum
DOI:
https://doi.org/10.55175/cdk.v49i7.259Keywords:
Kaki diabetik, vitamin DAbstract
Ulkus kaki diabetikum (UKD), salah satu komplikasi terberat dari diabetes melitus (DM) dengan angka amputasi dan mortalitas tinggi. Penyembuhan luka tidak hanya mengandalkan perfusi jaringan, tetapi juga dari perspektif imunologi. Beberapa studi telah menunjukkan asosiasi vitamin D dan UKD serta peran vitamin D dalam menurunkan inflamasi. Studi ini bertujuan untuk menelaah bukti terkait efektivitas suplementasi vitamin D per oral dalam penyembuhan luka pasien UKD. Penelusuran literatur menggunakan 4 database: PubMed, Scopus, Cochrane, dan EBSCO Host. Dari 645 studi yang teridentifikasi pada awal penelusuran, 3 artikel dipilih untuk telaah kritis. Studi Kamble menunjukkan pengurangan luas permukaan luka lebih signifikan di kelompok vitamin D (8,06±6,82 cm2; p=0,02) dibandingkan di kelompok kontrol (3,76±1,73 cm2; p=0,28). Studi Razzaghi menunjukkan hasil signifikan terkait pengurangan panjang luka (−2,1±1,1 vs −1,1±1,1 cm; p=0,001), lebar luka (−2,0±1,2 vs −1,1±1,0 cm, p=0,02), kedalaman luka (−1,0±0,5 vs −0,5±0,5 cm; p<0,001), dan persentase eritema (100% vs 80%; p=0,01). Studi Rahman menunjukkan persentase penurunan luas luka yang lebih signifikan di kelompok vitamin D dibandingkan di kelompok kontrol (71,86±4,79% vs 32,06±4,28%; p<0,01). Suplementasi vitamin D per oral dapat membantu penyembuhan UKD.
Diabetic foot ulcer (DFU) is one of the most devastating complications of diabetes mellitus, associated with high amputation rate and mortality. Previous studies have shown association between vitamin D and DFU, also the promising role of vitamin D in reducing inflammation. This study aims to appraise the current evidence regarding effectiveness of oral vitamin D supplementation on wound healing in DFU. Literature search was carried out using 4 databases: PubMed, Scopus, Cochrane, and EBSCOHost. From 645 studies identified at the start of the search, 3 articles were selected for critical appraisal. The study by Kamble shows significant wound surface area reduction in vitamin D group (8.06±6.82 cm2; p = 0.02) compared to the control group (3.76±1.73 cm2; p=0.28). The study by Razzaghi shows significant results regarding reduction in ulcer length (−2.1±1.1 vs −1.1±1.1 cm; p = 0.001), width (−2.0±1.2 vs −1.1±1.0 cm; p = 0.02), depth (−1.0±0.5 vs −0.5±0.5 cm; p < 0.001), and erythema rate (100% vs 80%; p = 0.01). The study by Rahman shows significant percentage of ulcer area reduction between vitamin D group and control group (71.86±4.79% vs 32.06±4.28%; p<0.01). Oral vitamin D supplementation can be used to aid wound healing in DFU.
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References
World Health Organization. 10 facts on noncommunicable diseases [Internet]. 2013 [cited 2021 Jul 21]. Available from: http://www.who.int/features/factfiles/noncommunicable_diseases/en/
World Health Organization. Diabetes [Internet]. 2020 June 08 [cited 2021 Jul 21]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
Boulton AJM, Armstrong DG, Kirsner RS, Attinger CE, Lavery LA, Lipsky BA, et al. Diagnosis and management of diabetic foot complications. Arlington (VA): American Diabetes Association [Internet]. 2018 Oct. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538977/
Zhang P, Lu J, Jing Y, Tang S, Zhu D, Bi Y. Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Ann Med. 2016;49(2):106–16.
Begun A, Morbach S, Rümenapf G, Icks A. Study of disease progression and relevant risk factors in diabetic foot patients using a multistate continuous-time Markov chain model. PLoS One 2016;11(1):0147533.
Muduli IC, Ansar PP, Panda C, Behera NC. Diabetic foot ulcer complications and its management - a medical college-based descriptive study in Odisha, an Eastern State of India. Indian J Surg. 2015;77(Suppl 2):270-4.
Schaper NC, van Netten JJ, Apelqvist J, Bus SA, Hinchliffe RJ, Lipsky BA. IWGDF guidelines on the prevention and management of diabetic foot disease. Maastricht: IWGDF; 2019.
Palmieri B, Vadalà M, Laurino C. Nutrition in wound healing: Investigation of the molecular mechanisms, a narrative review. J Wound Care. 2019;28(10):683–93
Sizar O, Khare S, Goyal A, Givler A. Vitamin D deficiency. StatPearls [Internet]. 2020 Jan [cited 2021 Feb 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532266/
Martens PJ, Gysemans C, Verstuyf A, Mathieu AC. Vitamin D's effect on immune function. Nutrients. 2020;12(5):1248.
Howick J, Chalmers I, Lind J, Glasziou P, Greenhalgh T, Heneghan C, et al. Oxford Centre for evidence-based medicine 2011 levels of evidence [Internet]. [cited 2020 Apr 5]. Available from: http://www.cebm.net/index.aspx?o=5653
Kamble A, Ambad RS, Padamwar M, Kakade A, Yeola M. To study the effect of oral vitamin D supplements on wound healing in patient with diabetic foot ulcer and its effect on lipid metabolism. IJRPS. 2020;11(2):2701–6.
Razzaghi R, Pourbagheri H, Momen-Heravi M, Bahmani F, Shadi J, Soleimani Z, et al. The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. J Diabetes and its Complications. 2017;31(4):766–72.
Rahmed NMA, Al-Shamma’a K, Al-Ahmady SK. Study the effect of zinc/or vit.D3 on percentage of healing of diabetic foot ulcer in Iraqi patients. IJAPBC. 2013;2(4):600-4
Yammine K, Hayek F, Assi C. Is there an association between vitamin D and diabetic foot disease? A meta-analysis. Wound Rep Reg. 2019;28(1):90–6.
Feldkamp J, Jungheim K, Schott M, Jacobs B, Roden M. Severe vitamin D3 deficiency in the majority of patients with diabetic foot ulcers. Horm Metab Res. 2018;50(08):615–9.
Tiwari S, Pratyush DD, Gupta SK, Singh SK. Vitamin D deficiency is associated with inflammatory cytokine concentrations in patients with diabetic foot infection. Br J Nutr. 2014;112(12):1938–43.
Kurian SJ, Miraj SS, Benson R, Munisamy M, Saravu K, Rodrigues GS, et al. Vitamin D supplementation in diabetic foot ulcers: A current perspective. CDR. 2020;16:512-21
Trujillo V, Marín-Luevano P, González-Curiel I, Rodríguez-Carlos A, Ramírez-Reyes M, Layseca-Espinosa E, et al. Calcitriol promotes proangiogenic molecules in keratinocytes in a diabetic foot ulcer model. J Steroid Biochemistr Mol Biol. 2017;174:303–11.
Gonzalez-Curiel I, Trujillo V, Montoya-Rosales A, Rincon K, Rivas-Calderon B, deHaro-Acosta J, et al. 1,25-dihydroxyvitamin D3 induces LL-37 and HBD-2 production in keratinocytes from diabetic foot ulcers promoting wound healing: An in vitro model. PLoS ONE. 2014;9(10):111355.
Vila Cuenca M, Ferrantelli E, Meinster E, Pouw SM, Kovačević I, de Menezes RX, et al. Vitamin D attenuates endothelial dysfunction in uremic rats and maintains human endothelial stability. J Am Heart Assoc. 2018;7(17):008776. doi: 10.1161/JAHA.118.008776.
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