Research Article
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The Relationship Between Orthostatic Hypotension and Vitamin D Deficiency in Patients with Uncontrolled Type 2 Diabetes Mellitus

Year 2022, Volume: 7 Issue: 2, 313 - 318, 01.06.2022
https://doi.org/10.26453/otjhs.1056045

Abstract

Objective: Vitamin D deficiency is common in diabetic patients, and studies showed that it could lead to neuropathy. Therefore, we aimed to determine relationship between 25-hydroxyvitamin D (25(OH)D) levels and orthostatic hypotension (OH) which is a component of autonomic neuropathy in diabetic patients.
Materials and Methods: A total of 118 patients with Type 2 diabetes mellitus and aged 50-65 years were included. Patients were divided into two groups as OH present and OH not present. 25(OH)D and other variable parameters were evaluated between these two groups.
Results: A total of 118 patients, 66 female and 52 male, were included in this cross-sectional study. The mean age of the patients was 56.2±3.2 years. 25(OH)D levels were found to be significantly lower in the group with OH (p<0.026). Age and sex-adjusted regression analysis were performed to examine the relationship between 25(OH)D level and OH. It was found that 25(OH)D didn’t predict the presence of OH in the univariate and multivariate analyses (p >0.05).
Conclusion: 25(OH)D levels are significantly lower in diabetic patients with OH. Although an independent relationship between them has not been demonstrated, it can be thought that correcting Vitamin D deficiency will be beneficial in the treatment of OH. 

References

  • Spallone V. Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet. Diabetes Metab J. 2019;43(1):3-30. doi:10.4093/dmj.2018.0259
  • Joseph A, Wanono R, Flamant M, Vidal-Petiot E. Orthostatic hypotension: A review. Nephrol Ther. 2017;13(Suppl 1):S55-S67. doi:10.1016/j.nephro.2017.01.003
  • Issa CM. Vitamin D and Type 2 Diabetes Mellitus. Adv Exp Med Biol. 2017;996:193-205. doi:10.1007/978-3-319-56017-5_16
  • Wadhwania R. Is Vitamin D Deficiency Implicated in Autonomic Dysfunction? J Pediatr Neurosci. 2017;12(2):119-123. doi:10.4103/jpn.JPN_1_17
  • Hansen CS, Fleischer J, Vistisen D, Ridderstråle M, Jensen JS, Jørgensen ME. High and low vitamin D level is associated with cardiovascular autonomic neuropathy in people with Type 1 and Type 2 diabetes. Diabet Med. 2017;34(3):364-371. doi:10.1111/dme.13269
  • Tran J, Hillebrand SL, Meskers CGM, Iseli RK, Maier AB. Prevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis. Age Ageing. 2021;50(5):1520-1528. doi:10.1093/ageing/afab090
  • Gilani A, Ramsay SE, Welsh P, et al. Vitamin D deficiency is associated with orthostatic hypotension in older men: a cross-sectional analysis from the British Regional Heart Study. Age Ageing. 2021;50(1):198-204. doi:10.1093/ageing/afaa146
  • Annweiler C, Schott AM, Rolland Y, Beauchet O. Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Intern Med. 2014;276(3):285-295. doi:10.1111/joim.12201
  • Zuin M, Brombo G, Capatti E, Romagnoli T, Zuliani G. Orthostatic hypotension and vitamin D deficiency in older adults: systematic review and meta-analysis. Aging Clin Exp Res. 2021. doi:10.1007/s40520-021-01994-w
  • Holick MF. The Vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153-165. doi:10.1007/s11154-017-9424-1
  • Zakin E, Abrams R, Simpson DM. Diabetic Neuropathy. Semin Neurol. 2019;39(5):560-569. doi:10.1055/s-0039-1688978
  • Vinik AI, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013;4(1):4-18. doi:10.1111/jdi.12042
  • Bakkar NZ, Dwaib HS, Fares S, Eid AH, Al-Dhaheri Y, El-Yazbi AF. Cardiac Autonomic Neuropathy: A Progressive Consequence of Chronic Low-Grade Inflammation in Type 2 Diabetes and Related Metabolic Disorders. Int J Mol Sci. 2020;21(23):9005. doi: 10.3390/ijms21239005
  • Agashe S, Petak S. Cardiac Autonomic Neuropathy in Diabetes Mellitus. Methodist Debakey Cardiovasc J. 2018;14(4):251-256. doi:10.14797/mdcj-14-4-251
  • Hartog L, Kleefstra N, Luigies R, de Rooij S, Bilo H, van Hateren K. The clinical relevance of orthostatic hypotension in elderly patients. Geriatr Gerontol Int. 2017;17(11):1881-1885. doi:10.1111/ggi.12983
  • Bo M, Brunetti E. Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study: comment. Intern Emerg Med. 2020;15(7):1355-1356. doi:10.1007/s11739-020-02327-x
  • Iseli R, Nguyen VTV, Sharmin S, Reijnierse EM, Lim WK, Maier AB. Orthostatic hypotension and cognition in older adults: A systematic review and meta-analysis. Exp Gerontol. 2019;120:40-49. doi:10.1016/j.exger.2019.02.017
  • Cigerli O, Parildar H, Unal AD, Tarcin O, Erdal R, Guvener Demirag N. Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey. Public Health Nutr. 2013;16(7):1306-13. doi:10.1017/S1368980012003588
  • Kaya T, Akçay EÜ, Ertürk Z, Ergenç H, Tamer A. The relationship between vitamin D deficiency and erythrocyte sedimentation rate in patients with diabetes. Turk J Med Sci. 2018;48(2):424-429. doi:10.3906/sag-1712-28
  • Yan X, Zhang N, Cheng S, Wang Z, Qin Y. Gender Differences in Vitamin D Status in China. Med Sci Monit. 2019;25:7094-7099. doi:10.12659/MSM.916326
  • Vallejo MS, Blümel JE, Arteaga E, et al. Gender differences in the prevalence of Vitamin D deficiency in a southern Latin American country: a pilot study. Climacteric. 2020;23(4):410-416. doi:10.1080/13697137.2020.1752171
  • Lin L, Zhang L, Li C, Gai Z, Li Y. Vitamin D and Vitamin D Receptor: New Insights in the Treatment of Hypertension. Curr Protein Pept Sci. 2019;20(10):984-995. doi:10.2174/1389203720666190807130504
  • Gouni-Berthold I, Berthold HK. Vitamin D and Vascular Disease. Curr Vasc Pharmacol. 2021;19(3):250-268. doi:10.2174/1570161118666200317151955
  • Ometto F, Stubbs B, Annweiler C, et al. Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis. J Hypertens. 2016;34(6):1036-43. doi:10.1097/HJH.0000000000000907
  • Magkas N, Tsioufis C, Thomopoulos C, et al. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens. 2019;21(5):546-554. doi:10.1111/jch.13521
  • Palma JA, Kaufmann H. Management of Orthostatic Hypotension. Continuum (Minneap Minn). 2020;26(1):154-177. doi:10.1212/CON.0000000000000816
  • Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567-1582. doi:10.1007/s00415-016-8375-x
  • Chisholm P, Anpalahan M. Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension. Intern Med J. 2017;47(4):370-379. doi:10.1111/imj.13171

Kontrolsüz Tip 2 Diabetes Mellitus Tanılı Hastalarda Ortostatik Hipotansiyon ile D Vitamini Eksikliği Arasındaki İlişki

Year 2022, Volume: 7 Issue: 2, 313 - 318, 01.06.2022
https://doi.org/10.26453/otjhs.1056045

Abstract

Amaç: D vitamini eksikliği diyabetik hastalarda sık görülmekte ve çalışmalarda nöropatiye yol açabileceği gösterilmiştir. Bu çalışmada diyabetik hastalarda otonom nöropatinin bir bileşeni olan ortostatik hipotansiyon (OH) ile 25-hidroksivitamin D (25(OH)D) seviyesi arasındaki ilişkiyi belirlemeyi amaçladık.
Materyal ve Metot: Çalışmaya 50-65 yaş arası diyabetik toplam 118 hasta dahil edildi. Hastalar OH varlığına göre iki gruba ayrıldı. 25(OH)D ve diğer değişken parametreler bu iki grup arasında değerlendirildi.
Bulgular: Bu kesitsel çalışmaya 66 kadın ve 52 erkek olmak üzere toplam 118 hasta dahil edildi. Hastaların yaş ortalaması 56,2±3,2 yıl idi. 25(OH)D düzeyleri OH olan grupta anlamlı olarak daha düşük bulundu (p <0,026). 25(OH)D düzeyi ile OH arasındaki ilişkiyi incelemek için yaş ve cinsiyete göre ayarlanmış regresyon analizi yapıldı. Tek değişkenli ve çok değişkenli analizlerde 25(OH)D'nin OH varlığını öngörmediği bulundu (p >0,05).
Sonuç: OH'li diyabetik hastalarda 25(OH)D düzeyleri anlamlı olarak daha düşüktür. Aralarında bağımsız bir ilişki gösterilemese de OH tedavisinde D vitamini eksikliğinin düzeltilmesinin faydalı olacağı düşünülebilir. 

References

  • Spallone V. Update on the Impact, Diagnosis and Management of Cardiovascular Autonomic Neuropathy in Diabetes: What Is Defined, What Is New, and What Is Unmet. Diabetes Metab J. 2019;43(1):3-30. doi:10.4093/dmj.2018.0259
  • Joseph A, Wanono R, Flamant M, Vidal-Petiot E. Orthostatic hypotension: A review. Nephrol Ther. 2017;13(Suppl 1):S55-S67. doi:10.1016/j.nephro.2017.01.003
  • Issa CM. Vitamin D and Type 2 Diabetes Mellitus. Adv Exp Med Biol. 2017;996:193-205. doi:10.1007/978-3-319-56017-5_16
  • Wadhwania R. Is Vitamin D Deficiency Implicated in Autonomic Dysfunction? J Pediatr Neurosci. 2017;12(2):119-123. doi:10.4103/jpn.JPN_1_17
  • Hansen CS, Fleischer J, Vistisen D, Ridderstråle M, Jensen JS, Jørgensen ME. High and low vitamin D level is associated with cardiovascular autonomic neuropathy in people with Type 1 and Type 2 diabetes. Diabet Med. 2017;34(3):364-371. doi:10.1111/dme.13269
  • Tran J, Hillebrand SL, Meskers CGM, Iseli RK, Maier AB. Prevalence of initial orthostatic hypotension in older adults: a systematic review and meta-analysis. Age Ageing. 2021;50(5):1520-1528. doi:10.1093/ageing/afab090
  • Gilani A, Ramsay SE, Welsh P, et al. Vitamin D deficiency is associated with orthostatic hypotension in older men: a cross-sectional analysis from the British Regional Heart Study. Age Ageing. 2021;50(1):198-204. doi:10.1093/ageing/afaa146
  • Annweiler C, Schott AM, Rolland Y, Beauchet O. Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Intern Med. 2014;276(3):285-295. doi:10.1111/joim.12201
  • Zuin M, Brombo G, Capatti E, Romagnoli T, Zuliani G. Orthostatic hypotension and vitamin D deficiency in older adults: systematic review and meta-analysis. Aging Clin Exp Res. 2021. doi:10.1007/s40520-021-01994-w
  • Holick MF. The Vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153-165. doi:10.1007/s11154-017-9424-1
  • Zakin E, Abrams R, Simpson DM. Diabetic Neuropathy. Semin Neurol. 2019;39(5):560-569. doi:10.1055/s-0039-1688978
  • Vinik AI, Erbas T, Casellini CM. Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease. J Diabetes Investig. 2013;4(1):4-18. doi:10.1111/jdi.12042
  • Bakkar NZ, Dwaib HS, Fares S, Eid AH, Al-Dhaheri Y, El-Yazbi AF. Cardiac Autonomic Neuropathy: A Progressive Consequence of Chronic Low-Grade Inflammation in Type 2 Diabetes and Related Metabolic Disorders. Int J Mol Sci. 2020;21(23):9005. doi: 10.3390/ijms21239005
  • Agashe S, Petak S. Cardiac Autonomic Neuropathy in Diabetes Mellitus. Methodist Debakey Cardiovasc J. 2018;14(4):251-256. doi:10.14797/mdcj-14-4-251
  • Hartog L, Kleefstra N, Luigies R, de Rooij S, Bilo H, van Hateren K. The clinical relevance of orthostatic hypotension in elderly patients. Geriatr Gerontol Int. 2017;17(11):1881-1885. doi:10.1111/ggi.12983
  • Bo M, Brunetti E. Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study: comment. Intern Emerg Med. 2020;15(7):1355-1356. doi:10.1007/s11739-020-02327-x
  • Iseli R, Nguyen VTV, Sharmin S, Reijnierse EM, Lim WK, Maier AB. Orthostatic hypotension and cognition in older adults: A systematic review and meta-analysis. Exp Gerontol. 2019;120:40-49. doi:10.1016/j.exger.2019.02.017
  • Cigerli O, Parildar H, Unal AD, Tarcin O, Erdal R, Guvener Demirag N. Vitamin D deficiency is a problem for adult out-patients? A university hospital sample in Istanbul, Turkey. Public Health Nutr. 2013;16(7):1306-13. doi:10.1017/S1368980012003588
  • Kaya T, Akçay EÜ, Ertürk Z, Ergenç H, Tamer A. The relationship between vitamin D deficiency and erythrocyte sedimentation rate in patients with diabetes. Turk J Med Sci. 2018;48(2):424-429. doi:10.3906/sag-1712-28
  • Yan X, Zhang N, Cheng S, Wang Z, Qin Y. Gender Differences in Vitamin D Status in China. Med Sci Monit. 2019;25:7094-7099. doi:10.12659/MSM.916326
  • Vallejo MS, Blümel JE, Arteaga E, et al. Gender differences in the prevalence of Vitamin D deficiency in a southern Latin American country: a pilot study. Climacteric. 2020;23(4):410-416. doi:10.1080/13697137.2020.1752171
  • Lin L, Zhang L, Li C, Gai Z, Li Y. Vitamin D and Vitamin D Receptor: New Insights in the Treatment of Hypertension. Curr Protein Pept Sci. 2019;20(10):984-995. doi:10.2174/1389203720666190807130504
  • Gouni-Berthold I, Berthold HK. Vitamin D and Vascular Disease. Curr Vasc Pharmacol. 2021;19(3):250-268. doi:10.2174/1570161118666200317151955
  • Ometto F, Stubbs B, Annweiler C, et al. Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis. J Hypertens. 2016;34(6):1036-43. doi:10.1097/HJH.0000000000000907
  • Magkas N, Tsioufis C, Thomopoulos C, et al. Orthostatic hypotension: From pathophysiology to clinical applications and therapeutic considerations. J Clin Hypertens. 2019;21(5):546-554. doi:10.1111/jch.13521
  • Palma JA, Kaufmann H. Management of Orthostatic Hypotension. Continuum (Minneap Minn). 2020;26(1):154-177. doi:10.1212/CON.0000000000000816
  • Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264(8):1567-1582. doi:10.1007/s00415-016-8375-x
  • Chisholm P, Anpalahan M. Orthostatic hypotension: pathophysiology, assessment, treatment and the paradox of supine hypertension. Intern Med J. 2017;47(4):370-379. doi:10.1111/imj.13171
There are 28 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Research article
Authors

Ece Yiğit 0000-0002-8293-3554

Ridvan Sivritepe 0000-0003-0547-1883

Dilay Karabulut 0000-0003-1896-0096

Umut Karabulut 0000-0002-3947-9173

Publication Date June 1, 2022
Submission Date January 10, 2022
Acceptance Date April 16, 2022
Published in Issue Year 2022 Volume: 7 Issue: 2

Cite

AMA Yiğit E, Sivritepe R, Karabulut D, Karabulut U. The Relationship Between Orthostatic Hypotension and Vitamin D Deficiency in Patients with Uncontrolled Type 2 Diabetes Mellitus. OTJHS. June 2022;7(2):313-318. doi:10.26453/otjhs.1056045

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