Yeni Tanı Prediyabetik ve Diyabetik Hastalarda Vitamin D Düzeyinin Değerlendirilmesi ve Glisemik Parametrelerle İlişkisinin İncelenmesi

Year 2023, , 510 - 521, 09.09.2023

İlknur Öztürk Ünsal , Murat Çalapkulu , Muhammed Erkam Sencar , Davut Sakız , Erman Çakal

https://doi.org/10.38079/igusabder.1165573

Abstract

Amaç: Tip 2 diabetes mellitus (T2DM), bozulmuş beta hücre fonksiyonu ve artan insülin direnci ile ilişkilidir ve D vitamininin bu yolları etkilediğine dair kanıtlar vardır. Prediyabet ise T2DM için ana risk faktörüdür. 25-hidroksivitamin D (25OHD) seviyeleri diabetes mellitus ve metabolik sendromu olan obez bireylerde daha düşüktür. Bu çalışmada prediyabetik ve T2DM hastalarda vitamin D düzeyinin değerlendirilmesi ve glisemik parametreler ile ilişkisinin incelenmesi amaçlanmıştır.
Yöntem: Bu çalışmada, oral glukoz tolerans testi (OGTT) yapılan 208 hasta retrospektif olarak tarandı. Bu hastalar OGTT sonucuna göre normal, prediyabet ve diyabet olarak üç gruba ayrıldı. Bu üç grup arasında 25-hidroksivitamin D [25(OH)D] düzeyi karşılaştırıldı.
Bulgular: Çalışma sonucunda Ortalama 25OHD düzeyi 15,1±6,5 ng/mL olup prediyabetik ve T2DM hastalarda serum 25OHD düzeyinin daha düşük bulundu. Serum 25OHD düzeyi ile açlık kan şekeri (r:-0,327, p:0,001) ve HbA1c (r:-0,251, p:0,012) arasında negatif korelasyon saptandı.
Sonuç: Çalışmamızda prediyabetik ve diyabetik hastalarda D vitamini düzeyinin sağlıklı gruba göre daha düşük olduğu görüldü. D vitamini desteğinin glikoz metabolizması üzerindeki etkisinin değerlendirilmesine ihtiyaç vardır.

Keywords

Hiperglisemi, diabetes mellitus, tip 2, D vitamini eksikliği

Evaluation of Vitamin D Level in New Diagnosis Prediabetic and Diabetic Patients and Investigation of Its Relationship with Glycemic Parameters

Abstract

Background: Type 2 diabetes mellitus (T2DM) is associated with impaired beta cell function and increased insulin resistance, and there is evidence that vitamin D affects these pathways. Prediabetes is the main risk factor for T2DM. 25OHD levels are lower in obese individuals with diabetes mellitus and metabolic syndrome. In this study, it was aimed to evaluate the vitamin D level in prediabetic and T2DM patients and to examine its relationship with glycemic parameters.
Method: In this study, 208 patients who underwent an oral glucose tolerance test (OGTT) were retrospectively screened. These patients were divided into three groups according to OGTT results as normal, prediabetes and diabetes. The 25-hydroxyvitamin D (25OHD) level was compared between these three groups.
Results: At the end of the study, the mean 25OHD level was 15.1±6.5 ng / mL, and serum 25OHD level was found to be lower in prediabetic and T2DM patients. Negative correlation was found between serum 25OHD level and fasting blood glucose (r= -0.327, p=0.001) and HbA1c (r= -0.251, p= 0.012).
Conclusion: In our study observed that the level of vitamin D in prediabetic and diabetic patients is lower than in the healthy group. There is a need to evaluate the effect of vitamin D supplementation on glucose metabolism.

Keywords

Hyperglycemia, diabetes mellitus, type 2, vitamin D deficiency

References

• International Diabetes Federation Atlas 9th-2019. https://diabetesatlas.org, November 2019, ISBN: 978-2-930229-87-4
• Gerstein HC, Santaguida P, Raina P, et al. Annual incidence and relative risk of diabetes in people with various categories of dysglycemia: A systematic over view and meta analysis of prospective studies. Diabetes Res Clin Pract. 2007;78(3):305-312.
• Bikle DD. Vitamin D metabolism, mechanism of action, and clinical applications. Chem. Biol. 2014;(3)21:319-329.
• Zeitz U, Weber K, Soegiarto DW, Wolf E, Balling R, Erben RG. Impaired insulin secretory capacity in mice lacking a functional vitamin D receptor. Faseb J. 2003;17(3):509–511.
• Aybal YB, Baş S, Eker P, et al. The effect of vitamin d on interferon-gamma and biochemical parameters in patients with metabolic syndrome. Haydarpasa Numune Med J. 2023;63(2):132–136.
• Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care. 2004;27:2813–2818.
• Hypponen E, Boucher BJ, Berry DJ, Power C. 25-hydroxyvitamin D, IGF-1, and metabolic syndrome at 45 years of age: A cross-sectional study in the 1958 British Birth Cohort. Diabetes. 2008;57(2):298–305.
• Lu L, Yu Z, Pan A, et al. Plasma 25-hydroxyvitamin D concentration and metabolic syndrome among middle-aged and elderly Chinese individuals. Diabetes Care. 2009;32(7):1278–1283.
• Norman AW, Frankel JB, Heldt AM, Grodsky GM. Vitamin D deficiency inhibits pancreatic secretion of insulin. Science. 1980;209(4458):823–825.
• Chertow BS, Sivitz WI, Baranetsky NG, Clark SA, Waite A, Deluca HF. Cellular mechanisms of insulin release: the effects of vitamin D deficiency and repletion on rat insulin secretion. Endocrinology. 1983;113(4):1511–1518.
• Kadowaki S, Norman AW. Dietary vitamin D is essential for normal insulin secretion from the perfused rat pancreas. J Clin Invest. 1984;73(3):759–766.
• Tanaka Y, Seino Y, Ishida M, et al. Effect of vitamin D3 on the pancreatic secretion of insulin and somatostatin. Acta Endocrinol. 1984;105(4):528–533.
• Cade C, Norman AW. Vitamin D3 improves impaired glucose tolerance and insulin secretion in the vitamin D-deficient rat in vivo. Endocrinology. 1986;119(1):84-90.
• Song Y, Wang L, Pittas AG, et al. Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes: A meta-analysis of prospective studies. Diabetes Care. 2013;36(5):1422–1428.
• Pittas AG, Jorde R, Kawahara T, Dawson-Huges B. Vitamin D Supplementation for Prevention of Type 2 Diabetes Mellitus: To D or Not to D? J Clin Endocrinol Metab. 2020;105(12):3721-3733.
• Pittas AG, Nelson J, Mitri J, et al. Diabetes Prevention Program Research Group. Plasma 25-hydroxyvitamin D and progression to diabetes in patients at risk for diabetes: An ancillary analysis in the Diabetes Prevention Program. Diabetes Care. 2012;35(3):565–573.
• Niroomand M, Fotouhi A, Irannejad N, Hosseinpanah F. Does high-dose vitamin D supplementation impact insulin resistance and risk of development of diabetes in patients with pre-diabetes? A double-blind randomized clinical trial. Diabetes Res Clin Pract. 2019;148:1-9.
• Gonzalez-Molero I, Rojo-Martinez G, Morcillo S, et al. Vitamin D and incidence of diabetes: a prospective cohort study. Clin Nutr. 2012;31(4):571-573.
• Mitri J, Dawson-Hughes B, Hu FB, Pittas AG. Effects of vitamin D and calcium supplementation on pancreatic beta cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes: the Calcium and Vitamin D for Diabetes Mellitus (CaDDM) randomized controlled trial. Am J Clin Nutr. 2011;94(2):486-494.
• Zittermann A. Vitamin D and disease prevention with special reference to cardiovascular disease. Prog Biophys Mol Biol. 2006;92(1):39-48.
• Need AG, O’Loughlin PD, Horowitz M, Nordin BEC. Relationship between fasting serum glucose, age, body mass indexand serum 25 hydroxyvitamin D in postmenopausal women. Clin. Endocrinol. 2005;62(6):738–741.
• Pittas AG, Harris SS, Stark PC, Dawson-Hughes B. The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care. 2007;30(4):980–996.
• Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.
• Lips P, Eekhoof M, Schoor VN, et al. Vitamin D and type 2 diabetes. J Steroid Biochem Mol Biol. 2017;173:280-285.
• Wimalawansa SJ. Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome. J Steroid Biochem Mol Biol. 2018;175:177-189.
• Clemente-Postigo M, Munoz-Garach A, Serrano M, et al. Serum 25-hydroxyvitamin D and adipose tissue vitamin D receptor gene expression: Relationship with obesity and type 2 diabetes. J Clin Endocrinol Metab. 2015;100(4):E591-95.