SEASONAL VARIATION IN HbA1c AND 25(OH) VITAMIN D CONCENTRATIONS IN THE TURKISH POPULATION: COULD RAMADAN BE CHANGING EXPECTATIONS?

Yıl 2022, , 117 - 124, 25.01.2022

Bedia Fulya Çalıkoğlu , Hülya Hacişahinoğulları , Ahmet Faruk Kılıçarslan , Reyhan Akas , Ahmet Dirican , Ayşe Kubat Uzum , Beyhan Ömer , Sema Genc

https://doi.org/10.26650/IUITFD.915270

Öz

Objective: In this study, the seasonal variations of HbA1c and serum 25(OH) vitamin D were investigated during different seasons in Istanbul. Materials and Methods: The alterations in HbA1c and vitamin D were evaluated concerning age and sex. The study consisted of 86,835 samples, selected from the Istanbul Faculty of Medicine Electronic Medical Records. Results: LC-MS/MS quantified 25(OH)D levels, and HbA1c were measured in HPLC. The HbA1c level in women was significantly lower than in men (p<0.001), and the HbA1c level was higher in summer compared with winter (p<0.001) and autumn (p=0.005). The 25(OH)D levels of all groups was 28.2±15.5 ng/mL with no difference between men and women. The highest vitamin-D levels were in summer, and the lowest were in winter. Conclusion: Studies have shown that in both hemispheres of the world, HbA1c levels decrease when the air is warm and increase when the weather is cold. However, contrary to expectations, we witnessed that HbA1c wa s 0.3% higher in summer than in winter in Istanbul, where the temperature change over a year is 22.5°C, the coldest month is January, and the hottest month is August. A possible explanation of our findings could stem from the occurrence of Ramadan in the summer months between 2015-2017. However, variations between HbA1c and 25(OH)D related to temperature changes during the year and age groups were detected.

Anahtar Kelimeler

Diabetes mellitus, vitamin D, seasonal variation, HbA1c, Ramadan

TÜRK TOPLUMUNDA HbA1c VE 25(OH)D VİTAMİNİ KONSANTRASYONLARINDAKİ MEVSİMSEL DEĞİŞİM: RAMAZAN BEKLENTİLERİ DEĞİŞTİRİYOR OLABİLİR Mİ?

Öz

Amaç: Bu çalışmada İstanbul’da farklı mevsimlerde HbA1c ve serum 25(OH) vitamin D’nin mevsimsel değişimleri araştırılmıştır. Gereç ve Yöntem: Çalışmada kullanılan 86.835 örnek, İstanbul Tıp Fakültesi Elektronik Tıp Kayıtlarından seçilmiştir. HbA1c ve vitamin D düzeyindeki değişiklikler yaş ve cinsiyete göre değerlendirilmiştir. 25(OH)D seviyeleri LC-MS/MS, HbA1c ise HPLC yöntemleriyle ölçülmüştür. Bulgular: HbA1c düzeyi kadınlarda erkeklere göre anlamlı olarak düşük (p<0,001) ve yaz aylarında, kış (p<0,001) ve sonbahar (p=0,005) ayları ile karşılaştırıldığında daha yüksek bulunmuştur. 25(OH)D ortalaması 28,2±15,5 ng/mL olup, erkekler ve kadınlar arasında fark bulunmamıştır. En yüksek D vitamini seviyelerinin yaz aylarında, en düşük ise kış aylarında olduğu görülmüştür. Sonuç: Çalışmalar, dünyanın her iki yarım küresinde de hava ısındığında HbA1c seviyelerinin azaldığını, hava soğuk olduğunda ise arttığını göstermektedir. Ancak bir yıl içinde sıcaklık değişiminin 22,5°C olduğu, en soğuk ayın Ocak, en sıcak ayın ise Ağustos olduğu İstanbul’da HbA1c’nin beklenenin aksine yaz aylarında kış aylarına göre %0,3 daha yüksek olduğu görüldü. Bu durumun, 2015-2017 arasındaki yaz aylarında Ramazan ayının varlığından kaynaklanıyor olabileceği düşünüldü. Öte yandan HbA1c ile 25(OH)D arasında yıl ve yaş gruplarındaki sıcaklık değişimlerine bağlı farklılıklar tespit edildi

Anahtar Kelimeler

Diabetes mellitus, vitamin D, mevsimsel değişiklikler, HbA1c, Ramazan

Kaynakça

• 1. Mavri A, Guzic-Salobir B, Salobir-Pajnic B, Stare J, Stegnar M. Seasonal variation of some metabolic and haemostatic risk factors in subjects with or without coronary artery disease. Blood Coagul Fibrinolysis 2001;12(5):359-65. [CrossRef]
• 2. Kristal-Boneh E, Froom P, Harari G, Malik M, Ribak J. Summer-winter differences in 24 h variability in heart rate. J Cardiovasc Risk 2000;7(2):141-6. [CrossRef]
• 3. Woodhouse PR, Khaw KT, Plummer M. Seasonal variation of blood pressure and its relationship to ambient temperature in an elderly population. J Hypertens 1993;11(11):1267-74. [CrossRef]
• 4. Hansen AM, Garde AH, Skovgaard LT, Christensen JM. Seasonal and biological variation of urinary epinephrine, norepinephrine, and cortisol in healthy women. Clin Chim Acta 2001;309(1):25-35. [CrossRef]
• 5. Näyhä S. Cold and risk of cardiovascular diseases. A review. Int J Circumpolar Health 2002;61(4):373-80. [CrossRef]
• 6. Nagarajan V, Fonarow GC, Ju C, Pencina M, Laskey WK, Maddox TM, Hernandez A, et al. Seasonal and circadian variations of acute myocardial infarction: Findings from the Get with The Guidelines-Coronary Artery Disease (GWTGCAD) program. Am Heart J 2017;189:85-93. [CrossRef]
• 7. David MN. International Expert Committee report on the role of the HbA1c assay in the diagnosis of diabetes. Diabetes Care 2009;32(7):1327-34. [CrossRef]
• 8. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 2010;33(Suppl 1):S62- 69. [CrossRef]
• 9. Rohlfing C, Wiedmeyer HM, Little R, Grotz VL, Tennill A, England J, et al. Biological variation of glycohemoglobin. Clin Chem 2002;48(7):1116-8. [CrossRef]
• 10. Kilpatrick ES, Bloomgarden ZT, Zimmet PZ. Is haemoglobin A1C a step forward for diagnosing diabetes? BMJ 2009;339:b4432. [CrossRef] 11. Malkani S, Mordes JP. Implications of using Hemoglobin A1c for diagnosing diabetes ellitus. Am J Med 2011;124(5):395- 401. [CrossRef]
• 12. American Diabetes Association. Classification and Diagnosis of Diabetes. Diabetes Care 2016;39(Suppl 1):S13- 22. [CrossRef]
• 13. Moltchanova EV, Schreier N, Lammi N, Karvonen M. Seasonal variation of diagnosis of Type 1 diabetes mellitus in children worldwide. Diabet Med 2009;26(7):673-8. [CrossRef]
• 14. Eisenbarth GS. Type I diabetes mellitus. A chronic autoimmune disease. N Engl J Med 1986;314(21):1360-8. [CrossRef]
• 15. Zhang L, Weiyi L, Xian T, Pan Q, Li M, Guo L. Seasonal variations of hemoglobin A1c in residents of Beijing, China Int J Clin Exp Pathol 2016;9(9):9429-35.
• 16. Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc 2006;81:353-73. [CrossRef]
• 17. El Baba K, Zantout MS, Akel R, Azar ST. Seasonal variation of vitamin D and HbA1c levels in patients with type 1 diabetes mellitus. In the Middle East. Int J Gen Med 2011;4:635-8. [CrossRef]
• 18. Pilz S, Kienreich K, Stückler D, Meinitzer A, Tomaschitz A. Associations of sun exposure with 25-hydroxyvitamin D and parathormone levels in a cohort of hypertensive patients: The Graz Endocrine causes of hypertension (GECOH) Study. Int J Endocrinol 2012;2012:732636. [CrossRef]
• 19. Heidari B, Shirvani JS, Firouzjahi A, Heidari P, Hajian-Tilaki KO. Association between nonspecific skeletal pain and vitamin D deficiency. Int J Rheum Dis 2010;13:340-6. [CrossRef]
• 20. Lips P. Worldwide status of vitamin D nutrition. J Steroid Biochem Mol Biol 2010;121(1-2):297-300. [CrossRef]
• 21. Genc S, Omer B, Aycan-Ustyol E, Kumral A, Gurdol F. Bone Turnover Markers and Vitamin D Status in Postmenopausal Turkish Women Int J Vitam Nutr Res 2012;82(1):27-33. [CrossRef]
• 22. Heidari B, Haji Mirghassemi MB. Seasonal variations in serum vitamin D according to age and sex. Caspian J Inter Med 2012;3(4):535-40.
• 23. Higgins T, Saw S, Sikaris K, Wiley CL, Cembrowski GC, Lyon AW, et al. Seasonal variation in Hemoglobin A1c:Is it the same in both hemispheres? J Diabetes Sci Technol 2009;3(4):668-71. [CrossRef]
• 24. Tseng CL, Brimacombe M, Xie M, Rajan M, Wang H, Kolassa J, et al. Seasonal patterns in monthly Hemoglobin A1c values. Am J Epidemiol. 2005;161(6):565-74. [CrossRef]
• 25. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An endocrine society clinical practice guideline. J Clin Endocrinol Metab 2011;96:1911-30. [CrossRef]
• 26. Pereira MTR, Lira D, Bacelar C, Oliveira JC, Carvalho AC. Seasonal variation of haemoglobin A1c in a Portugal adult population. Arch Endocrinol Metab 2015;59:231-5. [CrossRef]
• 27. Ryu OH, Lee S, Yoo HJ, Choi MG. Seasonal variations in glycemic control of type 2 diabetes in Korean women. J Endocrinol Invest 2014;37:575-81. [CrossRef]
• 28. Bahijri SM, Ajabnoor GM, Borai A, Al-Aama JY, Chrousos GP. Effect of Ramadan fasting in Saudi Arabia on serum bone profile and immunoglobulins. Ther Adv Endocrinol Metab 2015;6(5):223-2. [CrossRef]
• 29. Boutayeb W, Boutayeb A, Lamlili M, Ben El Mostafa S, Zitouni N. Simulation of a computed HbA1c using a weighted average glucose. SpringerPlus 2016;5:226. [CrossRef]
• 30. Hawkins RC. Circannual variation in glycohemoglobin in Singapore. Clin Chim Acta 2010;411(1-2):18-21. [CrossRef]
• 31. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 2013;28(2):169-80. [CrossRef]
• 32. 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):486-94. [CrossRef]
• 33. Kayanil S, Vieth R, Retnakaran R, Knight JA, Qi Y, Gerstein HC, et al. Association of vitamin D and insulin resistance and beta-cell dysfunction in subjects at risk for type 2 diabetes. Diabetes Care 2010;33(6):1379-81. [CrossRef]
• 34. Bird ML, Hill KD, Robertson IK, Ball MJ, Pittaway J, Williams AD. Serum (25(OH)D) status, ankle strength, and activity show seasonal variation in older adults: relevance for winter falls in higher latitudes. Age Ageing 2013;42(2):181-5. [CrossRef]
• 35. Rockell JE, Skeaff CM, Venn BJ, Williams SM, Green TJ. Vitamin D insufficiency in New Zealanders during winter is associated with higher parathyroid hormone concentrations: Implications for bone health? N Z Med J 2008;121(1286)75-84.
• 36. Shoben AB, Kestenbaum B, Levin G, Hoofnagle AN, Psaty BM, Siscovick DS, et al. Seasonal variation in 25-hydroxyvitamin D concentrations in the cardiovascular health study. Am J Epidemiol 2011;174(12):1363-72. [CrossRef]
• 37. Cong E, Walker MD, Kepley A, Zhang C, McMahon DJ, Silverberg SJ. Seasonal variability in Vitamin D levels no longer detectable in primary hyperparathyroidism. J Clin Endocrinol Metab 2015;100(9);3452-9. [CrossRef] 38. Sohmiya, M, Kanazawa, I, Kato, Y. Seasonal changes in body composition and blood HbA1c levels without weight change in male patients with type 2 diabetes treated with insulin. Diabetes Care 2004;27(5):1238-9. [CrossRef]
• 39. Shea MK, Houston DK, Tooze JA, Davis CC, Johnson MA, Hausman DB, et al. Correlates and prevalence of insufficient 25-hydroxyvitamin D status in black and white older adults: the health, aging, and body composition study. J Am Geriatr Soc 2011;59(7):1165-74. [CrossRef]
• 40. Buhary BM, Almohareb O, Aljohani N, Alrajhi S, Elkaissi S, Sherbeeni S, et al. Association of glycosylated hemoglobin levels with vitamin D status. J Clin Med Res 2017;9(12):1013- 18. [CrossRef]
• 41. Van Schoor NM, Lips P. Worldwide vitamin D status. Best Pract Res Clin Endocrinol Metab 2011;25(4):671-80. [CrossRef]
• 42. Zhao LJ, Zhou Y, Bu F, Travers-Gustafson D, Ye A, Xu X, et al. Factors predicting vitamin D response variation in non- Hispanic white postmenopausal women. J Clin Endocrinol Metab 2012;97(8):2699-705. [CrossRef]