Meghan Keenan

Sodexo Dietetic Intern

Basic Clinical
March 14th, 2020

Journal Article: Basic Clinical

Diabetic foot ulcers (DFUs) are a serious complication of uncontrolled Type 2 Diabetes

Mellitus (T2DM), that may ultimately result in amputation if not properly treated. Previous

studies have found that diabetes affects zinc homeostasis and those with diabetes may have lower

levels of serum zinc. Zinc is known to play an important role in synthesis of immune system

cells, insulin storage and resistance, lipid profiles, and wound healing. The purpose of this study

was to examine the effects of zinc supplementation on DFU wound healing and metabolic status

of participants.

This is considered a randomized double-blind, placebo-controlled study. Participants

were between the ages of 40-85 years old and with a grade 3 DFU according to Wagner-Meggitt

criteria; all participants were recruited from the same clinic in Kashan, Iran. Participants were

excluded if they were pregnant/breastfeeding, had consumed zinc supplements within the last 3-

months, underwent changes in medication consumption during the study, and those with a

history of disease affecting DFU development. All included subjects were matched for gender,

type and dosage of medications, duration of DM, pretreatment BMI, and age. Participants were

then randomly allocated to either the intervention group or placebo group, via computer-

generated random numbers. The intervention group was prescribed 220 mg zinc sulfate daily and

this lasted for 12-weeks. All subjects completed 3-day food records and 3-physical activity

records at baseline and for various weeks throughout the study. Blood samples were obtained at

baseline and at the end of the intervention.

 Of the original 75 subjects who were assessed for eligibility, only 60 met the inclusion

criteria. There was no statistical significance between the baseline demographics, characteristics,

or mean dietary intakes of the two groups. Zinc supplementation was seen to result in a

significant rise in serum zinc levels (p<0.001) and it was associated with greater reductions in

ulcer length/width at the end of the 12-weeks (p=0.02). Subjects in the intervention group were

also observed to experience significant changes in FPG, serum insulin concentration, HbA1C,

and serum HDL, when compared to the placebo group. No significant changes in other lipid

profiles was observed. Overall, zinc supplementation was seen to cause significant

improvements in DFU wound healing after 12-weeks.

Momen-Heravi M, et al. The effects of zinc supplementation on wound healing and metabolic

status in patients with diabetic foot ulcer. Wound Repair and Regeneration. 2017;(25):512-520.

doi:10.1111.

I decided to review this article because I have come across many patients with diabetes

complications during my internship, including diabetic foot ulcers. Many of these patients have

had to face the possibility of amputation, if their wounds were unable to heal. I think this article

was interesting because it showed that supplementing vitamins/minerals facilitated wound

healing; a practical intervention that can be implemented in a hospital/clinical setting. The only

real limitations to this study was the small sample size, future studies may have to validate this

study’s findings. RDN practical applications:

 Encourage patients with diabetes to meet DRIs for zinc, educate on zinc-rich foods

 Recommend zinc supplementation (220 mg for 2-3 weeks) for non-healing wounds