Vitamin D Deficiency and Microalbuminuria in Patients with Diabetes Mellitus

Öz

Aim: As diabetes mellitus and its complications become more prevalent in the world, it is becoming an important public health problem. Previous studies have investigated vitamin D in the context of diabetes mellitus and its complications.. Microalbuminuria is important as the initial level of diabetic nephropathy. In this context, we aimed to investigate the level and deficiency of vitamin D in diabetic patients with microalbuminuria. Material and Methods: 52 type 1 (20.1%) and 206 (79.9%) type 2 diabetes patients who applied to the outpatient Endocrinology and Metabolic Diseases clinic between April 2019 and December 2020 were included in the study. Patients were classified according to microalbuminuria. Fasting glucose, HbA1c, duration of diabetes, and 25 (OH) Vitamin D levels and mean waist circumference were compared between the groups. Finally, the groups were compared according to diabetes type and microalbuminuria. Results: Urinary albumin/creatinine rates (UAC) in 159 (42.7%) diabetic patients were in normal range, and 65 (17.5%) diabetics had UAC between 30-300 mcg. 12 (3.2%) had UAC >300 mcg. 22 (5.9%) had chronic renal failure. Vitamin D deficiency was 61.6% and vitamin D insufficiency was 28.6% in all study groups. Median GFR was 98 (38-136) ml/dk and median 25 (OH) D level was 17.1 (5.0- 44.2)mg/dl. 25 (OH) Vitamin D levels and GFR were found to be significantly lower in the microalbuminuria group (p<0.01). 25 (OH) D levels were found to be low in both type 1 and type 2 diabetes patients with the complication of microalbuminuria, however only in type 1 diabetes patients low vitamin D this was found significant (p=0.01) Conclusion: 25 (OH) vitamin D deficiency and insufficiency were found to be more common in patients with diabetes. with microalbuminuria, which was more significant in type 1 diabetes patients The underlying mechanisms and potential therapeutic effect of vitamin D should be further investigated.

Anahtar Kelimeler

• Diabetes
• Microalbuminuria
• Vitamin D

Diabetes Mellituslu Hastalarda Mikroalbuminüri ve D Vitamini

Öz

Amaç: Dünyada giderek artan sıklığı ile diyabet, komplikasyonları yolu ile önemli bir halk sağlığı sorunu olarak karşımıza çıkmaktadır. Önceki çalışmalar vitamin D için hem diyabet hem de komplikasyonları ile ilişkili olarak değerlendirmiştir. Mikroalbuminüri diyabetik nefropatinin başlangıç düzeyi olarak önem arz etmektedir. Bu bağlamda mikroalbuminürisi olan diyabetik hastalarda D vitamini düzeyini ve eksikliğini araştırmayı amaçladık. Gereç ve Yöntemler: Çalışmaya Nisan 2019 ve Aralık 2020 tarihleri arasında Endokrinoloji ve Metabolizma Hastalıkları polikliniğine başvuran 52 tip 1 (%20,1) ve 206 (%79,9) tip 2 diyabet hastası dahil edildi. Hastalar mikroalbüminüriye göre sınıflandırıldı. Açlık glikozu, HbA1c, diyabet süresi, 25 (OH) Vitamin D düzeyleri ve ortalama bel çevresi gruplar arasında karşılaştırıldı. Son olarak gruplar diyabet tipi ve mikroalbüminüriye göre karşılaştırıldı. Bulgular: 159 (%42,7) hastada normal idrar albümin / kreatinin oranı (UAC) vardı. 65 (%17,5) hastada 30-300 mcg arasında UAC vardı. 12 (%3,2) UAC> 300 mcg'ye sahipti. 22'sinde (%5,9) kronik böbrek yetmezliği vardı. Tüm çalışma gruplarında D vitamini eksikliği %61,6, D vitamini yetmezliği %28.6 olarak bulundu. Mikroalbüminüri grubunda ortanca GFR 98 (38-136) ml/dk)idi ve ortanca 25 (OH) D düzeyi 17.1 (5,0-44,2)mg/dl idi. GFR ve 25 (OH) D düzeyleri anlamlı olarak düşük bulundu (p<0,01). 25 (OH) D seviyeleri hem tip 1 hem de tip 2 diyabet hastalarında düşük saptandı. Ancak bu düşüklük sadece tip 1 diyabet hastaları için anlamlı bulundu. (p=0,01) Sonuç: 25 (OH) D vitamini eksikliği ve yetersizliği, özellikle tip 1 diyabette daha belirgin olmak üzere diyabet ve mikroalbüminürili hastalarda daha yaygın olarak saptandı. Komplikasyonların gelişmesinde D vitamininin diyabet tiplerine göre etki mekanizması ve potansiyel terapötik etkisi daha kapsamlı bir şekilde araştırılmalıdır

Anahtar Kelimeler

• diyabet
• mikroalbuminüri
• d vitamini

Kaynakça

1. 1. Association, A. D. (2021). 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2021. Diabetes Care, 44(Supplement 1), S151–S167. https://doi.org/10.2337/dc21-S011
2. 2. Svensson MK, Cederholm J, Eliasson B, Zethelius B, Gudbjörnsdottir S, Register SND. Albuminuria and renal function as predictors of cardiovascular events and mortality in a general population of patients with type 2 diabetes: a nationwide observational study from the Swedish National Diabetes Register. Diab Vasc Dis Res. 2013;10(6):520–529. doi:10.1177/1479164113500798.
3. 3. Yuyun MF, Dinneen SF, Edwards OM, Wood E, Wareham NJ. Absolute level and rate of change of albuminuria over 1 year independently predict mortality and cardiovascular events in patients with diabetic nephropathy. Diabet Med. 2003;20(4):277–282. doi:10.1046/j.1464-5491.2003.00940.x.
4. 4. Briet, C., Piffaretti, C., Fosse, S., Denis, P., Allix, I., Campagna, A. F., & Coutant, R. (2018). [Epidemiology of type 1 diabetes and its complications]. La Revue Du Praticien, 68(6), 607–610.
5. 5. Sana, M. A., Chaudhry, M., Malik, A., Iqbal, N., Zakiuddin, A., & Abdullah, M. (2020). Prevalence of Microalbuminuria in Type 2 Diabetes Mellitus. Cureus, 12(12), e12318. https://doi.org/10.7759/cureus.12318.
6. 6. Asadujjaman, M., Kashem, A., Chowdhury, A. A., Roy, A. S., Muqueet, M. A., Fazilatunnasa, M., Ahammed, S. U., Rabbani, M. G., Rahman, M. A., Kabir, M. S., Hossain, M. B., Islam, M. S., Das, S. K., Khan, E. H., Borman, G. C., & Khatun, N. (2018). Prevalence of Microalbuminuria and Overt Proteinuria İn Diabetes Mellitus and their Association with Renal Function. Mymensingh Medical Journal: MMJ, 27(3),467–474.
7. 7. Wimalawansa, S.J. (2016) Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome. J. Steroid Biochem. Mol.Biol. pii: S0960-0760(16)30253-9. doi:10.1016/j.jsbmb.2016.09.017
8. 8. Gulseth HL,Wium C, Angel K, Eriksen EF, Birkeland KI. Effects of vitamin D supplementation on insulin sensitivity and insulin secretion in subjects with type 2 diabetes and vitamin D deficiency:a randomized controlled trial. Diabetes Care. 2017;40(7):872–8

9. 9. Nazarian S, St Peter JV, Boston RC, Jones SA, Mariash CN. Vitamin D3 supplementation improves insulin sensitivity in subjects with impaired fasting glucose. Transl Res. 2011 Nov;158(5):276–81
10. 10. Kuhlmann, A., Haas, C. S., Gross, M.-L., Reulbach, U., Holzinger, M., Schwarz, U., Ritz, E., & Amann, K.(2004). 1,25-Dihydroxyvitamin D3 decreases podocyte loss and podocyte hypertrophy in the Subtotally nephrectomized rat. American Journal of Physiology. Renal Physiology, 286(3), F526-533. https://doi.org/10.1152/ajprenal.00316.2003.
11. 11. Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1, 25-Dihydroxyvitamin D (3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest. 2002;110:229–38.
12. 12. Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., Murad, M. H., Weaver, C. M., & Endocrine Society. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 96(7), 1911–1930. https://doi.org/10.1210/jc.2011-0385.
13. 13. Sezgin, G., Ozturk, G., Turkal, R., & Caykara, B. (2019). Vitamin D Levels of Outpatients Admitted to a University Hospital in the Marmara Region of Turkey Over 3 Years. Journal of Medical Biochemistry,38(2), 181–187. https://doi.org/10.2478/jomb-2018-0027.
14. 14. Hekimsoy, Z., Dinç, G., Kafesçiler, S., Onur, E., Güvenç, Y., Pala, T., Güçlü, F., & Ozmen, B. (2010). Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health, 10, 782. https://doi.org/10.1186/1471-2458-10-782
15. 15. Johnson, J.A.; Grande, J.P.; Roche, P.C.; Kumar, R. Immunohistochemical localization of the 1,25(OH)2D3 receptor and calbindin D28k in human and rat pancreas. Am. J. Physiol. 1994, 267, E356–E360.
16. 16. Altieri, B.; Grant,W.B.; Della Casa, S.; Orio, F.; Pontecorvi, A.; Colao, A.; Sarno, G.; Muscogiuri, G. Vitamin D and pancreas: The role of sunshine vitamin in the pathogenesis of diabetes mellitus and pancreatic cancer.Crit. Rev. Food Sci. Nutr. 2017, 57, 3472–3488.
17. 17. Berridge M.J. Vitamin D cell signalling in health and disease. Biochem. Biophys. Res. Commun. 2015;460:53–71. doi: 10.1016/j.bbrc.2015.01.008.
18. 18. George N., Kumar T.P., Antony S., Jayanarayanan S., Paulose C.S. Effect of vitamin D3 in reducing metabolic and oxidative stress in the liver of streptozotocin-induced diabetic rats. Br. J. Nutr. 2012;108:1410–1418
19. 19. Casteels K., Waer M., Bouillon R., Depovere J., Valckx D., Laureys J., Mathieu C. 1,25-Dihydroxyvitamin D3 restores sensitivity to cyclophosphamide-induced apoptosis in non-obese diabetic (NOD) mice and protects against diabetes.1998
20. 20. Van Halteren A.G., Tysma O.M., van Etten E., Mathieu C., Roep B.O. 1alpha,25-dihydroxyvitamin D3 or analogue treated dendritic cells modulate human autoreactive T cells via the selective induction of apoptosis. J. Autoimmun. 2004;23:233–239. doi: 10.1016/j.jaut.2004.06.004.
21. 21. Levin, A., Bakris, G. L., Molitch, M., Smulders, M., Tian, J., Williams, L. A., & Andress, D. L. (2007).Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic Kidney disease: Results of the study to evaluate early kidney disease. Kidney International, 71(1), 31–38. ://doi.org/10.1038/sj.ki.5002009
22. 22. Forman, J. P., Williams, J. S., & Fisher, N. D. L. (2010). Plasma 25-hydroxyvitamin D and regulation Of the renin-angiotensin system in humans. Hypertension (Dallas, Tex.: 1979), 55(5), 1283–1288. https://doi.org/10.1161/HYPERTENSIONAHA.109.148619
23. 23. Agarwal, R., Acharya, M., Tian, J., Hippensteel, R. L., Melnick, J. Z., Qiu, P., Williams, L., & Batlle, D. (2005). Antiproteinuric effect of oral paricalcitol in chronic kidney disease. Kidney International, 68(6),2823–2828. https://doi.org/10.1111/j.1523-1755.2005.00755.x
24. 24.Momeni, A., Mirhosseini, M., Kabiri, M., & Kheiri, S. (2017). Effect of vitamin D on proteinuria in type 2 diabetic patients. Journal of Nephropathology, 6(1), 10–14. https://doi.org/10.15171/jnp.2017.03