Prediyabetli Hastalarda D Vitamini Düzeyi

Yıl 2020, Cilt: 7 Sayı: 4, 538 - 543, 31.12.2020

Mehmet Gultekin Nilüfer Özdemir Ece Onur Zeliha Hekimsoy

https://doi.org/10.34087/cbusbed.797240

Öz

Amaç
D vitamini eksikliği; glukoz intoleransı, diabetes mellitus ve metabolik sendroma neden olmaktadır. Literatürde, D vitamini düzeyleri ve prediyabet arasındaki ilişkiyi gösteren veriler çelişkilidir. Bu çalışmada amacımız, prediyabetik hastalarda serum 25-hidroksivitamin D düzeyini değerlendirmek ve D vitamini eksikliğinin veya yetersizliğinin prediyabet gelişimi için bir faktör olup olmadığını belirlemektir.

Araç ve yöntemler:
Çalışmamıza, 85'i izole Bozulmuş Açlık Glukozu (BAG), 50'si izole Bozulmuş Glukoz Toleransı (BGT) ve 85'i kombine BAG ve BGT olan ve 80'i sağlıklı (benzer yaş, cinsiyet ve VKİ olan) olmak üzere toplam 220 hasta dahil edilmiştir.
Bulgular
BGT ve kombine BAG + BGT tanısı konulan hasta grubu ile kontrol grubu arasındaki ortalama D vitamini düzeyi istatistiksel olarak anlamlı derecede farklıydı (BGT: 11.69 ± 6.48 ng / ml karşı kontrol grubu: 16.63 ± 9.78 ng / ml, p <0.007, BAG + BGT: 13.22 ± 7.24 ng / ml karşı kontrol grubu 16.63 ± 9.78 ng / ml, p <0.047). Düşük 25-hidroksi D vitamini düzeyi, daha yüksek BGT riski ile ilişkili bulunmuştur (OR 2.57, % 95 GA 1.01-6.53, p = 0.043). 25-hidroksivitamin D düzeyi kontrol grubunda ve BAG grubunda benzerdi ve istatiksel olarak anlamlı bir fark gözlenmedi (13.90 ± 8.89 ng / ml karşı kontrol grubu 16.63 ± 9.78 ng / ml, p <0.158). Ayrıca BAG, BGT ve BAG + BGT grupları arasında da anlamlı bir fark gözlenmemiştir.

Sonuçlar
Bu çalışmada D vitamini yetersizliğinin ve eksikliğinin BAG, BGT ve kombine BAG ve BGT riskini arttırdığı gözlenmiştir. Ancak, bu risk, D vitamini eksikliğinde sadece bozulmuş glukoz toleransında önemlidir.

Anahtar Kelimeler

Vitamin D, Prediabetes, Glucose Intolerance

Vitamin D level in Patients with Prediabetes

Öz

Purpose
Vitamin D deficiency may cause glucose intolerance, diabetes mellitus, and metabolic syndrome. However, there are conflicting data the relationship between vitamin D levels and prediabetes in the literature. Our aim in this study is to evaluate serum 25-hydroxyvitamin D levels in prediabetic patients and to determine if vitamin D deficiency or insufficiency is a factor for developing prediabetes.
Material and Method:
Our study included a total of 220 patients, including 85 with isolated Impaired Fasting Glucose (IFG), 50 with isolated Impaired Glucose Tolerance (IGT), and 85 with combined IFG and IGT, and 80 healthy normoglycemic individuals similar in age, gender and BMI.
Results
The mean vitamin D levels between the patient group diagnosed as IGT and IFG+IGT and the control group were statistically significantly different (IGT: 11.69±6.48 ng/ml vs. control group: 16.63±9.78 ng/ml, p<0.007, IFG+IGT: 13.22±7.24 ng/ml vs. control group: 16.63±9.78 ng/ml, p<0.047, respectively). Lower 25-hydroxy vitamin D levels were associated with a higher risk of IGT (OR 2.57, 95% CI 1.01-6.53, p=0.043). 25-hydroxyvitamin D levels were similar in the control and IFG groups. No significant difference was observed between the IFG and the control group (13.90±8.89 ng/ml vs. the control group: 16.63±9.78 ng/ml, p<0.158). Moreover, no significant difference was observed between the IFG, IGT, and IFG+IGT groups, either.
Discussion
In this study, it was observed that vitamin D insufficiency and deficiency increased the risk of IFG, IGT and combined IFG and IGT. However, this risk was significant only in impaired glucose tolerance in vitamin D deficiency.

Anahtar Kelimeler

Vitamin D, Prediabetes, Glucose Intolerance

Kaynakça

• 1. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet 2012; 379:2279-2290.
• 2. Petersen JL, McGuire DK. Impaired glucose tolerance and impaired fasting glucose-a review of diagnosis, clinical implications and management. Diab Vasc Dis Res 2005; 2:9–15.
• 3. Nathan DM, Davidson MB, DeFronzo RA, Heine RJ, Henry RR, Pratley R,et al. American Diabetes Association. Impaired fasting glucose and impaired glucose tolerance: implications for care. Diabetes Care 2007; 30: 753-759.
• 4. Pittas AG, Chung M, Trikalinos T, Mitri J, Brendel M, Patel K et al. Systematic review: Vitamin D and cardiometabolic outcomes. Ann Intern Med 2010; 152:307-314.
• 5. Zhao G, Ford ES, Li C. Associations of serum concentrations of 25-hydroxyvitamin D and parathyroid hormone with surrogate markers of insulin resistance among U.S. adults without physician-diagnosed diabetes: NHANES, 2003-2006. Diabetes Care 2010; 33:344-347.
• 6. Liu E, Meigs JB, Pittas AG, Economos CD, McKeown NM, Booth SL et al. Predicted 25-hydroxyvitamin D score and incident type 2 diabetes in the Framingham Offspring Study. Am J Clin Nutr 2010; 91:1627-1633.
• 7. Tsur A, Feldman BS, Feldhammer I, Hoshen MB, Leibowitz G, Balicer RD. Decreased serum concentrations of 25-Hydroxycholecalciferol are associated with increased risk of progression to impaired fasting glucose and diabetes. Diabetes Care 2013; 36(5):1361-1367.
• 8. Guo J, Xiao Z, Xue X, Liu X, Lu Y, Yin X et al. 25-Hydroxyvitamin D is closely related with the function of the pancreatic islet β cells. Pak J Med Sci 2013; 29(3):809-813.
• 9. Shankar A, Sabanayagam C, Kalidindi S. Serum 25-Hydroxyvitamin D levels and prediabetes among subjects free of diabetes. Diabetes Care 2011; 34(5):1114-1119.
• 10. Gao Y, Zheng T, Ran X, Ren y, Chen T, Zhong L et al. Vitamin D and incidence of prediabetes or type 2 diabetes: A four-year follow-up community-based study. Dis Markers 2018:1926308
• 11. Pittas G, Hughes B. Vitamin D and diabetes. Journal of Steroid Biochemistry & Molecular Biology 2010; 121:425–1429.
• 12. Giorelli GV, Matos LN, Saado A, Soibelman VL, Dias CB. No association between 25-hydroxyvitamin D levels and prediabetes in Brazilian patients. A cross-sectional study. Sao Paulo Med. J. [online] 2015; vol.133, n.2, pp.73-77. Epub Nov 28, 2014. ISSN 1516-3180. https://doi.org/10.1590/1516-3180.2013.7180005
• 13. Modi, K.D., Ahmed, M.I., Chandwani, R, Kumar H. Prevalence of vitamin D deficiency across the spectrum of glucose intolerance. J Diabetes Metab Disord 2015; 14, 54 https://doi.org/10.1186/s40200-015-0179-5
• 14. Dusso AS, Brown AJ, Slatopolsky E. Vitamin D. Am J Physiol Renal Physiol 2005; 289:8-28.
• 15. Hekimsoy Z, Dinç G, Kafesçiler S, Onur E, Güvenç Y, Pala T et al. Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health 2010; 10:782
• 16. Pittas AG, Sun Q, Manson JE, Dawson-Hughes B, Hu FB. Plasma 25-hydroxyvitamin D concentration and risk of incident type 2 diabetes in women. Diabetes Care 2010; 33:2021-2023.
• 17. Gagnon C, Lu ZX, Magliano DJ, Dunstan DW, Shaw JE, Zimmet PZ et al. Serum 25-hydroxyvitamin D, calcium intake, and risk of type 2 diabetes after 5 years: results from a national, population-based prospective study (the Australian Diabetes, Obesity and Lifestyle study). Diabetes Care 2011; 34:1133-1138.
• 18. Grimnes G, Emaus N, Joakimsen RM, Figenschau Y, Jenssen T, Njølstad I et al. Baseline serum 25-hydroxyvitamin D concentrations in the Tromsø Study 1994-95 and risk of developing type 2 diabetes mellitus during 11 years of follow-up. Diabet Med 2010; 27:1107-1115.
• 19. Pittas AG, Dawson-Hughes B, Li T, Van Dam RM, Willett WC, Manson JE, Hu FB. Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care 2006; 29:650-656.
• 20. 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; 30:980-986.
• 21. Nikooyeh B, Neyestani TR, Farvid M, Alavi-Majd H, Houshiarrad A, Kalayi A et al. Daily consumption of vitamin D or vitamin D+calcium fortified yogurt drink improved glycemic control in patients with type 2 diabetes: a randomized clinical trial. Am J Clin Nutr 2011; 93:764-771.
• 22. Lu L, Yu Z, Pan A. Plasma 25-hydroxyvitamin D concentration and metabolic syndrome among middle-aged and elderly Chinese individuals. Diabetes Care 2009; 32(7):1278-1283.
• 23. Jia J, Ding H, Yang K, et al. Vitamin D Receptor Genetic Polymorphism Is Significantly Associated with Risk of Type 2 Diabetes Mellitus in Chinese Han Population. Arch Med Res. 2015;46(7):572-579. doi:10.1016/j.arcmed.2015.09.006
• 24. Liao S, He J, Li X, et al. Association between VDR gene polymorphisms and HOMA index for prediabetes in Ningxia. Journal of Hygiene Research. 2016;45(2):184-188.