Does vitamin D level affect insulin resistance?

Yıl 2020, , 124 - 130, 01.03.2020

Medine Şişman , Betül Erişmiş , Meral Mert

https://doi.org/10.21601/ortadogutipdergisi.666978

Öz

Purpose: The most important effect of vitamin D (vit D) is on calcium, phosphorus metabolism and bone mineralization. However, in recent years, vit D deficiency has been found to be associated with many chronic diseases. In this study, we aimed to investigate the relationship between insulin resistance and vit D levels.
Patients and methods: The records of 302 patients were evaluated retrospectively. Thyroid stimulating hormone (TSH), insulin, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), anti-thyroglobulin antibody, anti-thyroid peroxidase antibody, Homeostasis Model Assessment-Insulin Resistance (HOMA-IR), vitamin B₁₂, folate levels of patients were recorded. Analyzes were made with SPSS version 24.0 and significance level was considered as 0.05.
Results: Of the 302 patients, 256 (84.7%) were female and 46 (15.2%) were male. Patients were divided into 2 groups as vitamin D deficiency/insufficiency and normal vitamin D levels. There was a significant correlation between vitamin D levels and FBG, HOMA-IR, HbA1c and thyroid immunity status (p <0.05), but was no significant relationship with sex, age, folate, vitamin B₁₂ and TSH (p≥0.05). HOMA-IR was associated with; HbA1c with a positive correlation of 15.9%, thyroid immunity with a positive correlation of 8.2%, FBG with a positive correlation of 28%. HbA1c was not associated with thyroid immunity but was 22.1% positively associated with FBG.
Discussion: Insulin resistance should be predicted in patients with vitamin D deficiency. The importance of vitamin D in providing metabolic control, insulin resistance and related pathologies in primary care should be remembered.

Anahtar Kelimeler

vitamin D, diabetes, insulin resistance

D vitamini düzeyi insülin direncini etkiler mi?

Öz

Amaç: D vitamini, en önemli etkisi kalsiyum, fosfor metabolizması ve kemik mineralizasyonu üzerine olan bir vitamindir. Ancak son yıllarda D vitamininin, malinite, kardiyovasküler hastalıklar, metabolik sendrom, enfeksiyöz ve otoimmün hastalıklar gibi birçok kronik hastalıkla ilişki içinde olduğu tespit edilmiştir. Bu çalışmamızda diyabet ve obeziteye sıklıkla eşlik eden insülin direnci ile D vitamini düzeyi arasındaki ilişkiyi araştırmayı amaçladık.
Gereç ve Yöntem: 2015-2017 yılları arasında, Bakırköy Dr. Sadi Konuk SUAM poliklinik takipli 302 hastanın kayıtları retrospektif olarak incelendi. Hastaların tiroit uyarıcı hormon, insülin, açlık kan şekeri, hemoglobin A1c, anti tiroglobulin antikoru, anti tiroit peroksidaz antikoru, vitamin B₁₂, folat düzeyleri kaydedildi. Hastalar vitamin D yetersiz grup (vitamin D eksikliği olanlar da dahil) ve vitamin D normal grup şeklinde ikiye ayrıldı. İstatistiksel analizler SPSS 24.0 sürümü ile yapıldı ve anlamlılık düzeyi 0,05 olarak ele alındı.
Bulgular: Çalışmaya alınan 302 hastanın 256’sı (%84,7) kadın, 46’sı (%15,2) erkekti. Vitamin D düzeyine göre iki gruba ayrılan hastaların; vitamin D düzeyi ile AKŞ, HOMA-IR, HbA1c ve tiroit immünitesi arasında anlamlı ilişki (p<0,05) saptanırken; cinsiyet, yaş, folat, vitamin B₁₂, TSH arasında anlamlı ilişki saptanmadı (p≥0,05). Korelasyon analizine göre HOMA-IR; HbA1c ile %15,9, tiroit immünitesiyle %8,2 ve AKŞ ile %28 pozitif ilişkili saptandı. HbA1c ise tiroit immünitesiyle ilişkili bulunmazken AKŞ ile %22,1 pozitif ilişkili saptandı.
Sonuç: Vitamin D eksikliği, yetersizliği saptanan hastalarda insülin direnci olabileceği de öngörülmelidir. Birinci basamakta metabolik kontrolün sağlanması, insülin direnci ve ilişkili patolojilerin önlenmesinde vitamin D’nin önemine dikkat çekilmelidir.

Anahtar Kelimeler

vitamin D, diyabet, insülin direnci

Kaynakça

• Tao S, Yuan Q, Mao L, Chen F-L, Ji F, Cui Z-H. Vitamin D deficiency causes insulin resistance by provoking oxidative stress in hepatocytes. Oncotarget 2017; 8: 67605-13.
• Satman I, Yılmaz T, Sengul A, ve ark. The TURDEP Group: Population based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002; 25(9): 1551-6.
• Wang H, Chen W, Li D, Yin X, Zhang X, Olsen N, Zheng SG. Vitamin D and Chronic Diseases. Aging Dis. 2017; 8: 346-53.
• Szymczak-Pajor I, Śliwińska A. Analysis of Association between Vitamin D Deficiency and Insulin Resistance. Nutrients. 2019 Apr; 11(4): 794. (doi: 10.3390/nu11040794).
• Tabesh M, Azadbakht L, Faghihimani E, Tabesh M, Esmaillzadeh A. Effects of calcium-vitamin D co-supplementation on metabolic profiles in vitamin D in suffcient people with type 2 diabetes: A randomised controlled clinical trial. Diabetologia 2014; 57: 2038-47.
• Upreti V, Maitri V, Dhull P, Handa A, Prakash MS, Behl A. Affect of oral vitamin D supplementation on glycemic control in patients with type 2 diabetes mellitus with coexisting hypovitaminosis D: A parellel group placebo controlled randomized controlled pilot study. Diabetes Metab. Syndr. 2018; 12: 509-12.
• Barzegari M, Sarbakhsh P, Mobasseri M, Noshad H, Esfandiari A, Khodadadi B, Gargari BP. The effects of vitamin D supplementation on lipid profiles and oxidative indices among diabetic nephropathy patients with marginal vitamin D status. Diabetes Metab. Syndr. 2019; 13: 542-7.
• Mirhosseini N, Vatanparast H, Mazidi M, Kimball SM. The Effect of Improved Serum25-Hydroxyvitamin D Status on Glycemic Control in Diabetic Patients: AMeta-Analysis. J. Clin. Endocrinol. Metab. 2017; 102: 3097-110.
• El Hajj C, Chardigny J-M, Boirie Y, Yammine K, Helou M, Walrand S. Effect of Vitamin D Treatment on Glucose Homeostasis and Metabolism in Lebanese Older Adults: A Randomized Controlled Trial. J. Nutr. Health Aging 2018; 22: 1128-32.
• Abbas MA. Physiological functions of Vitamin D in adipose tissue. J. Steroid Biochem. Mol. Biol. 2017; 165: 369-81.
• Heaney RP. Serum 25-hydroxyvitamin D is a reliable indicator of vitamin D status. Am. J. Clin. Nutr. 2011; 94: 619-20.
• Matyjaszek-Matuszek B, Lenart-Lipinska M, Wozniakowska E. Clinical İmplications of vitamin d deficiency. Prz Menopauzalany 2015; 14: 75-82.
• Öngen B, Kabaroğlu C, Parıldar Z. D vitaminin biyokimyasal ve laboratuar değerlendirmesi. Türk klinik biyokimya dergisi 2008; 6(1): 23-31.
• Türkiye Endokrinoloji ve Metabolizma Derneği. Metabolik Sendrom Kılavuzu. Tuna Matbaacılık, Ankara 2009.
• Öngen B, Kabaroğlu C, Parıldar Z. D vitaminin biyokimyasal ve laboratuar değerlendirmesi. Türk klinik biyokimya dergisi 2008; 6(1): 23-31.
• Bolluk S, Akbulut G. D vitamini ve diabetes mellitus. Turkiye Klinikleri J Endocrin 2013; 8(2): 65-72.
• Analysis of Association between Vitamin D Deficiency and Insulin Resistance. Nutrients. 2019 Apr 6; 11(4). (doi: 10.3390/nu11040794).
• Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr. 2004 May; 79(5): 820-5.
• Scragg R, Holdaway I, Singh V, Metcalf P, Baker J, Dryson E. Serum 25-hydroxyvitamin D3 levels decreased in impaired glucose tolerance and diabetes mellitus. Diabetes Res Clin Pract. 1995 Mar; 27(3): 181-8.
• Liu E, Meigs JB, Pittas AG, ve ark. Plasma 25-hydroxyvitamin d is associated with markers of the insulin resistant phenotype in nondiabetic adults. J Nutr. 2009 Feb; 139(2): 329-34.
• Forouhi NG, Luan J, Cooper A, Boucher BJ, Wareham NJ. Baseline serum 25-hydroxy vitamin d is predictive of future glycemic status and insulin resistance: the Medical Research Council Ely Prospective Study 1990–2000. Diabetes. 2008 Oct; 57(10): 2619-25.
• Upreti V, Maitri V, Dhull P, Handa A, Prakash MS, Behl A. Effect of oral vitamin D supplementation on glycemic control in patients with type 2 diabetes mellitus with coexisting hypovitaminosis D: A parellel group placebo controlled randomized controlled pilot study. Diabetes Metab Syndr. 2018 Jul; 12(4): 509-12. (doi: 10.1016/j.dsx.2018.03.008).
• El Hajj C, Chardigny JM, Boirie Y, Yammine K, Helou M, Walrand S. Effect of vitamin D treatment on glucose homeostasis and metabolism in lebanese older adults: A randomized controlled trial. The journal of nutrition, health & aging 2018; 22(9): 1128-32.
• Asemi Z, Karamali M, Esmaillzadeh A. Effects of calcium-vitamin D co-supplementation on glycaemic control, inflammation and oxidative stress in gestational diabetes: a randomised placebo-controlled trial. Diabetologia. 2014 Sep; 57(9): 1798-806. (doi: 10.1007/s00125-014-3293-x).
• Mirhosseini N, Vatanparast H, Mazidi M, Kimball SM. The Effect of Improved Serum 25-Hydroxyvitamin D Status on Glycemic Control in Diabetic Patients: A Meta-Analysis. J Clin Endocrinol Metab. 2017 Sep 1; 102(9): 3097-110. (doi: 10.1210/jc.2017-01024).
• Zhang Q, Xiao-Qi Hu, Guo HX. Vıtamın d nutrıtıon status ın chınese tıbetan and han natıonalıty chıldren and adolescents. Modern preventive medicine 2010; 37: 465-7.
• Baynes KCR, Boucher BJ, Feskens EJM, ve ark. Vitamin d, glucose tolerance and insulinaemia in elderly men. Diabetologia 1997; 40(3): 344-7.
• Schöttker B, Herder C, Rothenbacher D, Perna L, Müler H, Brenner H. Serum 25- hydroxyvitamin D levels and incident diabetes mellitus type 2: a competing risk analysis in a large population-based cohort of older adults. Eur J Epidemiol 2013; 28(3): 267-75.
• Bizzaro G, Shoenfeld Y. Vitamin D and thyroid autoimmune diseases: the known and the obscure. Immunol Res 2015; 61(1-2): 107-9.
• Choi YM, Kim WG, Kim TY, ve ark. Low levels of serum vitamin D3 are associated with autoimmune thyroid disease in pre-menopausal women. Thyroid 2014; 24(4): 655-61.
• Chailurkit LO, Aekplakorn W, Ongphiphadhanakul B. High vitamin D status in younger individuals is associated with low circulating thyrotropin. Thyroid. 2013 Jan; 23(1): 25-30.
• Zhang H, Liang L, Xie Z. Low Vitamin D Status is Associated with Increased Thyrotropin-Receptor Antibody Titer in Graves Disease. Endocrine Practice. March 2015; 21(3): 258-63.