Vitamin D and diabetes mellitus: an update 2013

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Abstract

Vitamin D deficiency and diabetes mellitus are two common conditions and they are widely prevalent across all ages, races, geographical regions, and socioeconomic conditions. Epidemiologic studies have shown association of vitamin D deficiency and increased risk of chronic diseases, such as cancer, cardiovascular disease, type 2 diabetes, and autoimmune diseases, such as multiple sclerosis and type 1 diabetes mellitus. The identification of 1,25(OH)2D receptors and 1-α-hydroxilase expression in pancreatic beta cells, in cells of the immune system, and in various others tissues, besides the bone system support the role of vitamin D in the pathogenesis of type 2 diabetes. Observational studies have revealed an association between 25(OH) D deficiency and the prevalence of type 1 diabetes in children and adolescents. This review will focus on the concept of vitamin D deficiency, its prevalence, and its role in the pathogenesis and risk of diabetes mellitus and cardiovascular diseases.

Translated abstract

A deficiência de vitamina D e o diabetes melito são enfermidades comuns na população e são altamente prevalentes em todas as raças, idades, regiões geográficas e situação socioeconômica. Estudos epidemiológicos mostram uma associação entre hipovitaminose D com o aumento do risco de doenças crônicas, tais como câncer, doença cardiovascular, diabetes melito do tipo 2 e doenças autoimunes como a esclerose múltipla e o diabetes mellitus do tipo 1. A identificação de receptores da 1,25(OH)2 D e da expressão da 1 α-hidroxilase nas células betapancreáticas, em células do sistema imunológico e em uma variedade de células do organismo além do tecido ósseo, suporta o papel da vitamina D na patogênese do diabetes tipo 2 e do tipo 1. Esta revisão apresenta e discute o conceito de deficiência de vitamina D, sua prevalência e seu papel na patogênese e no risco de desenvolvimento do diabetes melito e doenças cardiovasculares.

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Most cited references 58

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Putting cardiovascular disease and vitamin D insufficiency into perspective.

Stefanie S Schleithoff, Armin Zittermann, Reiner Koerfer (2005)

The aetiology of CVD is still not completely understood. The present review article summarises data supporting the hypothesis that an insufficient vitamin D status may contribute to the worldwide high prevalence of CVD. Human vitamin D status primarily depends on skin exposure to the UVB spectrum of the sunlight. Epidemiological data indicate that geographic latitude, altitude, season, and the place of residence (urban or rural) are associated with CVD mortality. Interestingly, all these factors also have an influence on human UVB exposure and thus on vitamin D status. Several mechanisms might be responsible for a protective role of vitamin D in CVD. These mechanisms include the inhibition of vascular smooth muscle proliferation, the suppression of vascular calcification, the down regulation of pro-inflammatory cytokines, the up regulation of anti-inflammatory cytokines, and the action of vitamin D as a negative endocrine regulator of the renin-angiotensin system. The first intervention trials indicate that vitamin D may suppress cardiovascular risk markers. However, more controlled clinical trials are needed to investigate whether optimal oral vitamin D supplementation is able to reduce CVD morbidity and mortality.

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No Effect of the 1α,25-Dihydroxyvitamin D3 on β-Cell Residual Function and Insulin Requirement in Adults With New-Onset Type 1 Diabetes

Markus Walter, Thomas Kaupper, Kerstin Adler … (2010)

OBJECTIVE To determine whether daily intake of 1α,25-dihydroxyvitamin D3 [1,25(OH)2D3] is safe and improves β-cell function in patients with recently diagnosed type 1 diabetes. RESEARCH DESIGN AND METHODS Safety was assessed in an open study of 25 patients aged 18–39 years with recent-onset type 1 diabetes who received 0.25 μg 1,25(OH)2D3 daily for 9 months. An additional 40 patients were randomly assigned to 0.25 μg 1,25(OH)2D3 or placebo daily for 9 months and followed for a total of 18 months for safety, β-cell function, insulin requirement, and glycemic control. RESULTS Safety assessment showed values in the normal range in nearly all patients, regardless of whether they received 1,25(OH)2D3 or placebo. No differences in AUC C-peptide, peak C-peptide, and fasting C-peptide after a mixed-meal tolerance test between the treatment and placebo groups were observed at 9 and 18 months after study entry, with ∼40% loss for each parameter over the 18-month period. A1C and daily insulin requirement were similar between treatment and placebo groups throughout the study follow-up period. CONCLUSIONS Treatment with 1,25(OH)2D3 at a daily dose of 0.25 μg was safe but did not reduce loss of β-cell function.

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The prevalence of vitamin D abnormalities in South Asians with type 2 diabetes mellitus in the UK.

A Tahrani, A. Ball, L. Shepherd … (2010)

The high prevalence of both hypovitaminosis D and type 2 diabetes (T2DM) in the Asian community is well recognised, but the impact of diabetes on vitamin D status and vice versa, has not been well reported. To determine the prevalence of hypovitaminosis D in Asian patients with T2DM and its impact on glycaemic control. A cross-sectional study was conducted in a tertiary referral centre in the UK. Two hundred and ten Asian patients aged more than 40 years were included (170 with and 40 without T2DM). Each had a standard bone profile (serum calcium, phosphate and alkaline phosphatase), serum parathyroid hormone and 25-hydroxycholecalciferol. The prevalence of low serum 25-hydroxyvitamin D ( 80%) and more common in diabetics compared with controls (83% vs. 70%; p = 0.07). This was particularly so in men (82.5% vs. 57.9%; p = 0.02). HbA1c was higher in women with vitamin D deficiency (< 12.5 nmol/l) (8.11 +/- 1.11% vs. 7.33 +/- 1.32%, p = 0.046). In logistic regression analysis, T2DM was an independent predictor of hypovitaminosis D. In linear regression analysis, vitamin D deficiency was independently related to HbA1c in women with T2DM. Hypovitaminosis D remains a major public health issue in the Asian population and is exaggerated in patients with T2DM. The fact that vitamin D deficient women had higher HbA1c levels raises the possibility that vitamin D replacement may improve glycaemic control.

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Author and article information

Contributors

Luiz Henrique Maciel Griz: Role: ND

Francisco Bandeira: Role: ND

Mônica Andrade Lima Gabbay: Role: ND

Sergio Atala Dib: Role: ND

Eduardo Freese de Carvalho: Role: ND

Journal

Journal ID (publisher): abem

Title: Arquivos Brasileiros de Endocrinologia & Metabologia

Abbreviated Title: Arq Bras Endocrinol Metab

Publisher: Sociedade Brasileira de Endocrinologia e Metabologia (São Paulo )

ISSN: 1677-9487

Publication date (Print): February 2014

Volume: 58

Issue: 1

Pages: 1-8

Affiliations

[1 ] Universidade Federal de Pernambuco Brazil

[2 ] Universidade Federal de São Paulo Brazil

[3 ] Universidade Federal de Pernambuco Brazil

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Publisher ID: S0004-27302014000100001

DOI: 10.1590/0004-2730000002535

SO-VID: 876687ce-429e-4801-ba19-34bc1531c211

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http://creativecommons.org/licenses/by/4.0/

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Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0004-2730&lng=en

Vitamin D and diabetes mellitus: an update 2013 Translated title: Vitamin D e diabetes melito: uma atualização 2013

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Most cited references 58

Putting cardiovascular disease and vitamin D insufficiency into perspective.

No Effect of the 1α,25-Dihydroxyvitamin D3 on β-Cell Residual Function and Insulin Requirement in Adults With New-Onset Type 1 Diabetes

The prevalence of vitamin D abnormalities in South Asians with type 2 diabetes mellitus in the UK.

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