Tip 1 Diyabetli Yetişkinlerde 25-Hidroksivitamin D Durumu Ve Glisemik Kontrol ile İlişkisi

Yıl 2024, Cilt: 10 Sayı: 2, 284 - 288, 01.05.2024

Burak Andaç , Buket Yılmaz Bülbül , Mehmet Oğulcan Tezel , Mine Okur , Serpil Yanık Çolak , Buse Ekici , Mehmet Celik

https://doi.org/10.53394/akd.1255947

Öz

Amaç: Tip 1 diabetes mellituslu erişkinler ile sağlıklı kontrol grubu arasında D vitamini düzeylerini karşılaştırmak ve diyabetik grupta HbA1c ile D vitamini düzeyleri arasındaki ilişkiyi değerlendirmek amaçlanmıştır.
Yöntemler: Kesitsel, tanımlayıcı tipteki çalışmamıza Endokrinoloji Polikliniği'ne başvuran 18 yaş üstü, 98 tip 1 diyabetli hasta ile yaş ve cinsiyet olarak eşleştirilmiş, kronik hastalığı olmayan 95 kişi dahil edildi. İleri derecede böbrek veya karaciğer hastalığı, primer hiperparatiroidizmi, metabolik kemik hastalığı olan veya vitamin D konsantrasyonlarını değiştirebilecek ilaç kullanan hastalar çalışma dışı bırakıldı. HbA1c ve 25(OH) Vitamin-D3 düzeyleri 9 aylık dönemde 3 kez ölçüldü ve ölçümlerin ortalaması kullanıldı. Diyabetik hastalar ve kontrol grubu D vitamini düzeylerine göre; eksiklik (<12 ng/ml), yetersizlik (12-20 ng/ml) ve yeterlilik (>20 ng/ml) olmak üzere üç gruba ayrıldı.
Bulgular: Diyabetik hastaların serum 25 (OH) D vitamini düzeyleri sağlıklı bireylerden anlamlı olarak daha düşüktü (p=0,024). Ancak, diyabetik erişkinler 25(OH) D vitamini düzeylerine göre 3 gruba ayrıldığında HbA1c düzeyleri açısından anlamlı fark yoktu (p=0,905).
Sonuç: Preklinik veriler, tip 1 diabetes mellitus etiyopatogenezinde düşük serum D vitamini düzeylerinin rolünü desteklese de, düşük serum D vitamini düzeyleri ile tip 1 diyabet prevalansı veya glisemik kontrol arasındaki bağlantıyı inceleyen çalışmalar, bizim çalışmamız da dahil olmak üzere, net bir sonuca ulaşmak için yeterli değildir.

Anahtar Kelimeler

tip 1 diabetes mellitus, D vitamini, glisemik kontrol.

25-Hydroxyvitamin D Status In Type 1 Diabetic Adults And Its Relationship With Glycemic Control

Öz

Objective: To assess the vitamin D levels between adults with type 1 diabetes mellitus and the healthy control group and evaluate the relationship between HbA1c levels and vitamin D status in the diabetic group.
Methods: Our cross-sectional, descriptive study included 98 type 1 diabetic patients over 18 years old who applied to the Endocrinology Outpatient Clinic and 95 age- and sex-matched individuals without chronic disease. Patients with advanced renal or liver disorders, primary hyperparathyroidism, metabolic bone disorders, or using medications that might change vitamin D concentrations were excluded from the study. HbA1c and 25(OH) Vitamin-D3 levels were measured three times in 9 months, and the average of the measurements was used. Diabetic patients and control individuals were separated into three groups according to their vitamin D levels as follows: deficiency (<12 ng/ml), insufficiency (12-20 ng/ml), and sufficiency (> 20 ng/ml).
Results: Serum 25 (OH) vitamin D levels of diabetic patients were significantly lower than in healthy individuals (p=0.024). However, when diabetic adults were separated into three groups according to 25(OH) vitamin D levels, there was no significant difference regarding HbA1c levels (p=0.905).
Conclusion: Although preclinical data support the role of low serum vitamin D levels in the etiopathogenesis of type 1 diabetes mellitus, studies examining the connection between low serum vitamin D levels and the prevalence of type 1 diabetes or glycemic control are not sufficient to reach a clear conclusion, including our study.

Anahtar Kelimeler

type 1 diabetes mellitus, vitamin D, glycemic control

Kaynakça

• 1.Rewers M, Ludvigsson J. Environmental risk factors for type 1 diabetes. Lancet 2016; 387(10035):2340-8.
• 2. Rak K, Bronkowska M. Immunomodulatory Effect of Vitamin D and Its Potential Role in the Prevention and Treatment of Type 1 Diabetes Mellitus-A Narrative Review. Molecules 2018; 24(1):53.
• 3. Norman AW, Frankel JB, Heldt AM, Grodsky GM. Vitamin D deficiency inhibits pancreatic secretion of insulin. Science 1980; 209(4458):823-5.
• 4. Littorin B, Blom P, Schölin A, Arnqvist HJ, Blohmé G, Bolinder J, Ekbom-Schnell A, Eriksson JW, Gudbjörnsdottir S, Nyström L, Ostman J, Sundkvist G. Lower levels of plasma 25-hydroxyvitamin D among young adults at diagnosis of autoimmune type 1 diabetes compared with control subjects: results from the nationwide Diabetes Incidence Study in Sweden (DISS). Diabetologia 2006; 49(12):2847-52.
• 5. Federico G, Genoni A, Puggioni A, Saba A, Gallo D, Randazzo E, Salvatoni A, Toniolo A. Vitamin D status, enterovirus infection, and type 1 diabetes in Italian children/adolescents. Pediatr Diabetes 2018;19(5):923-9.
• 6. Sørensen IM, Joner G, Jenum PA, Eskild A, Torjesen PA, Stene LC. Maternal serum levels of 25-hydroxy-vitamin D during pregnancy and risk of type 1 diabetes in the offspring. Diabetes 2012; 61(1):175-8.
• 7. Jacobsen R, Moldovan M, Vaag AA, Hypponen E, Heitmann BL. Vitamin D fortification and seasonality of birth in type 1 diabetic cases: D-tect study. J Dev Orig Health Dis 2016;7(1):114-9. Erratum in: J Dev Orig Health Dis 2016; 7(4):429. 8. Svoren BM, Volkening LK, Wood JR, Laffel LM. Significant vitamin D deficiency in youth with type 1 diabetes mellitus. J Pediatr 2009; 154(1):132-4.
• 9. Tunc O, Cetinkaya S, Kizilgun M, Aycan Z. Evaluation of the relation between vitamin D and insulin requirements and frequency of osteopenia/osteoporosis in childhood with type 1 diabetes. 49th Annual Meeting of the ESPE September 22-25,2010. Espe; 2010.
• 10. Gogas Yavuz D, Keskin L, Kıyıcı S, Sert M, Yazıcı D, Şahin İ, Yüksel M, Deyneli O, Aydın H, Tuncel E, Akalın S. Vitamin D receptor gene BsmI, FokI, ApaI, TaqI polymorphisms and bone mineral density in a group of Turkish type 1 diabetic patients. Acta Diabetol 2011; 48(4):329-36.
• 11. Bierschenk L, Alexander J, Wasserfall C, Haller M, Schatz D, Atkinson M. Vitamin D levels in subjects with and without type 1 diabetes residing in a solar rich environment. Diabetes Care 2009; 32(11):1977-9.
• 12. Massé PG, Pacifique MB, Tranchant CC, Arjmandi BH, Ericson KL, Donovan SM, Delvin E, Caissie M. Bone metabolic abnormalities associated with well-controlled type 1 diabetes (IDDM) in young adult women: a disease complication often ignored or neglected. J Am Coll Nutr 2010; 29(4):419-29.
• 13. Miettinen ME, Reinert L, Kinnunen L, Harjutsalo V, Koskela P, Surcel HM, Lamberg-Allardt C, Tuomilehto J. Serum 25-hydroxyvitamin D level during early pregnancy and type 1 diabetes risk in the offspring. Diabetologia 2012; 55(5):1291-4.
• 14. Mutlu A, Mutlu GY, Özsu E, Çizmecioğlu FM, Hatun Ş. Vitamin D deficiency in children and adolescents with type 1 diabetes. J Clin Res Pediatr Endocrinol 2011; 3(4):179-83.
• 15. Janner M, Ballinari P, Mullis PE, Flück CE. High prevalence of vitamin D deficiency in children and adolescents with type 1 diabetes. Swiss Med Wkly. 2010; 140:w13091.
• 16. Giustina A, Adler RA, Binkley N, Bouillon R, Ebeling PR, Lazaretti-Castro M, Marcocci C, Rizzoli R, Sempos CT, Bilezikian JP. Controversies in Vitamin D: Summary Statement From an International Conference. J Clin Endocrinol Metab 2019; 104(2):234-40.
• 17. Cooper JD, Smyth DJ, Walker NM, Stevens H, Burren OS, Wallace C, Greissl C, Ramos-Lopez E, Hyppönen E, Dunger DB, Spector TD, Ouwehand WH, Wang TJ, Badenhoop K, Todd JA. Inherited variation in vitamin D genes is associated with predisposition to autoimmune disease type 1 diabetes. Diabetes 2011; 60(5):1624-31.
• 18. Dong JY, Zhang WG, Chen JJ, Zhang ZL, Han SF, Qin LQ. Vitamin D intake and risk of type 1 diabetes: a meta-analysis of observational studies. Nutrients 2013; 5(9):3551-62.