Effectiveness of a digital health application (levidex) on quality of life in people with multiple sclerosis: A pragmatic, randomized controlled trial (LAMONT).

Diabetes‐related foot disease (DFD) encompasses peripheral neuropathy, peripheral artery disease, ulceration, infection, gangrene, amputation and/or Charcot neuro‐osteoarthropathy []. DFD affects ∼200 million people worldwide and accounts for 2% of the global disease burden [, ], ranking it the 13th largest cause of the world's total disease burden [, , , ]. Diabetes‐related foot ulceration (DFU) is a common and serious complication of diabetes with a global prevalence of 6.3% []. Given that around 50% of DFUs will become infected [, , ] and 20% will result in lower limb amputation [, ], this makes DFU a leading cause of disability and hospitalisation [, , , ]. The condition significantly impacts a person's quality of life [, , , ] and places a substantial financial burden on healthcare systems and society [, , , ]. Therefore, new evidence‐based therapies to complement current standard care are urgently needed. Vitamin C is a co‐factor required for collagen formation and thus plays an essential role in wound healing []. Vitamin C is also a potent antioxidant and supports various cellular functions of the immune system, both of which are important for healing and the prevention and management of infection, respectively []. In high‐income countries, the intake of vitamin C is generally thought to be more than adequate, and low or deficient levels of vitamin C are assumed to be rare []. However, recent evidence suggests there is a high prevalence of vitamin C deficiency in various adult hospitalised patient populations, some of which are likely to include people at risk of DFUs []. Furthermore, we [] and others [, ] have reported that 50%–60% of patients with foot ulcers attending high‐risk foot services located in several major Australian cities are deplete or deficient in vitamin C. Despite the strong association between low vitamin C levels and high levels of amputation in people with DFU [, ], there is a lack of high‐quality randomised controlled trials (RCTs) to support vitamin C supplementation for promoting the healing of DFUs. Indeed, a recent systematic review on the role of vitamin C supplementation in the management of DFUs found only three published human trials with the main conclusion being the need for additional human clinical trials on vitamin C supplementation in people with a DFU []. The most convincing evidence to date is by Gunton et al. [] who found vitamin C supplementation improved foot ulcer healing by ∼50% in a cohort of 16 patients, of which half in the cohort had diabetes. Although this data is promising, it is limited by the small sample size.