Vitamin B₁₂ Deficiency and Foot Ulcers in Type 2 Diabetes Mellitus: A Case–Control Study

Abstract

Objective

To assess the association between vitamin B₁₂ deficiency and the development of diabetic foot ulcers (DFU) in type 2 diabetes mellitus (T2DM).

Methods

This is a case–control study that enrolled 323 Saudi adults with T2DM randomly selected from the Jazan Diabetes & Endocrine Center, Saudi Arabia from January 1, 2019, to July 31, 2019. The sample included 108 newly diagnosed cases with DFU and 215 control participants with T2DM unaffected by and free of foot ulcers (1:2 ratio). Logistic regression analysis was performed to determine the DFU predictors and to examine the association of DFU and vitamin B₁₂ deficiency.

Results

The highest DFU rates were found among the male participants and the participants older than 45 years. Neuropathy, vasculopathy, vitamin B₁₂ deficiency, poor glycemic control, poor feet self-care, Charcot foot, physical inactivity, and spending long time standing at work were significantly associated with DFU, and all except physical inactivity and spending long time standing at work were independent predictors of DFU. After adjustment for the covariates, vitamin B₁₂ deficiency was significantly associated with DFU (odds ratio 3.1), indicating that the patients with T2DM and vitamin B₁₂ deficiency had a three times higher risk of developing DFU than those with normal vitamin B₁₂ levels.

Conclusion

Vitamin B₁₂ deficiency had a significant association with DFU among the Saudi participants with T2DM. Establishing the causality and clarifying the biological role of vitamin B12 deficiency in DFU is important aims for future studies.

Keywords:

• vitamin B₁₂ deficiency
• foot ulcer
• type 2 diabetes mellitus
• Jazan
• Saudi Arabia

Acknowledgments

We would like to express our gratitude to the team who helped us in completing this research. To begin with, we would like to thank Jazan Diabetes Center staff; endocrinologists, podiatrists, family and community medicine consultants, nurses, and technicians in the registry department for their help. Finally, we would like to thank all participants in this study for their response and cooperation.

Data Sharing Statement

The data that support the findings of this study are available on request from the author, Mohammed Badedi.

Author Contributions

All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflict of interest in this work.