Open Access Journals Promotions 2
Abstract

Background: Some authors evaluated the effect of VD on hyperglycemia in T1DM, but the results remain controversial. This study aims to analyze the effects of high-dose VD supplementation on T1DM patients’ glycemic levels, maintaining stable doses of insulin.

Methods: Prospective, 12-week clinical trial including 67 T1DM patients, supplemented with high doses of cholecalciferol according to participants' VD value. Patients with VD levels below 30 ng/mL received 10,000 IU/day; those with levels between 30-60 ng/mL received 4,000 IU/day. Patients who had not achieved 25(OH)D levels > 30 ng/ml or presented insulin dose variation during the study were not analyzed.

Results: Only 46 out of 67 patients accomplished the criteria at the end of the study. There was no general improvement in the glycemic control evaluated by HbA1c (9.4 ± 2.4 vs 9.4 ± 2.6, p=NS) after VD supplementation. However, a post-hoc analysis, based on HbA1c variation, identified patients who had HbA1c reduced at least 0.6% (group 1, N = 13 (28%)). In addition, a correlation between 25(OH)D levels with HbA1c and total insulin dose at the end of the study was observed (r = -0.3, p<0.05; r=-0.4, p<0.05, respectively), and a regression model demonstrated that 25(OH)D was independent of BMI, duration of T1DM and final total insulin dose, being capable of determining 9.2% of HbA1c final levels (Unstandardized B coefficient = −0.033 (CI 95%: −0.064 to −0.002), r2 = 0.1, p <0.05).

Conclusion: Our data suggest that VD is not widely recommended for glycemic control. Nevertheless, specific patients might benefit from this approach.

Keywords: Diabetes mellitus, type 1, vitamin D, cholecalciferol, glycated hemoglobin A, glycemic control, insulin.

[1]
Gerstein HC. Diabetes: Dysglycaemia as a cause of cardiovascular outcomes. Nat Rev Endocrinol 2015; 11(9): 508-10.
[http://dx.doi.org/10.1038/nrendo.2015.118] [PMID: 26215261]
[2]
Nathan DM. DCCT/EDIC Research Group. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014; 37(1): 9-16.
[http://dx.doi.org/10.2337/dc13-2112] [PMID: 24356592]
[3]
American diabetes association. 5. Facilitating behavior change and well-being to improve health outcomes: standards of medical care in diabetes-2020. Diabetes Care 2020; 43(Suppl. 1): S48-65.
[http://dx.doi.org/10.2337/dc20-S005] [PMID: 31862748]
[4]
Gallagher JC. Vitamin D and falls - the dosage conundrum. Nat Rev Endocrinol 2016; 12(11): 680-4.
[http://dx.doi.org/10.1038/nrendo.2016.123] [PMID: 27494391]
[5]
Hansen KE, Johnson MG. An update on vitamin D for clinicians. Curr Opin Endocrinol Diabetes Obes 2016; 23(6): 440-4.
[http://dx.doi.org/10.1097/MED.0000000000000288] [PMID: 27653000]
[6]
Mohammadian S, Fatahi N, Zaeri H, Vakili MA. Effect of vitamin d3 supplement in glycemic control of pediatrics with type 1 diabetes mellitus and vitamin d deficiency. J Clin Diagn Res 2015; 9(3): SC05-7.
[http://dx.doi.org/10.7860/JCDR/2015/10053.5683] [PMID: 25954674]
[7]
Aljabri KS, Bokhari SA, Khan MJ. Glycemic changes after vitamin D supplementation in patients with type 1 diabetes mellitus and vitamin D deficiency. Ann Saudi Med 2010; 30(6): 454-8.
[http://dx.doi.org/10.4103/0256-4947.72265] [PMID: 21060157]
[8]
Bizzarri C, Pitocco D, Napoli N, et al. IMDIAB Group. No protective effect of calcitriol on beta-cell function in recent-onset type 1 diabetes: the IMDIAB XIII trial. Diabetes Care 2010; 33(9): 1962-3.
[http://dx.doi.org/10.2337/dc10-0814] [PMID: 20805274]
[9]
Pitocco D, Crinò A, Di Stasio E, et al. IMDIAB Group. The effects of calcitriol and nicotinamide on residual pancreatic beta-cell function in patients with recent-onset Type 1 diabetes (IMDIAB XI). Diabet Med 2006; 23(8): 920-3.
[http://dx.doi.org/10.1111/j.1464-5491.2006.01921.x] [PMID: 16911633]
[10]
Hafez M, Hassan M, Musa N, Abdel Atty S, Azim SA. Vitamin D status in Egyptian children with type 1 diabetes and the role of vitamin D replacement in glycemic control. J Pediatr Endocrinol Metab 2017; 30(4): 389-94.
[http://dx.doi.org/10.1515/jpem-2016-0292] [PMID: 27997353]
[11]
Institute of medicine (IOM). Dietary reference intakes for calcium and vitamin D. Pediatrics 2012; 130: e1424-4.
[http://dx.doi.org/10.1542/peds.2012-2590]
[12]
Munns CF, Shaw N, Kiely M, et al. Global consensus recommendations on prevention and management of nutritional rickets. J Clin Endocrinol Metab 2016; 101(2): 394-415.
[http://dx.doi.org/10.1210/jc.2015-2175] [PMID: 26745253]
[13]
Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011; 96(7): 1911-30.
[http://dx.doi.org/10.1210/jc.2011-0385] [PMID: 21646368]
[14]
Neves Marques de Queiroz N, Trindade Cunha de Melo F, de Souza Resende F, et al. Vitamin D and PTH: data from a crosssectional study in an equatorial population. Endocr Connect 2020; 9(7): 667-75.
[http://dx.doi.org/10.1530/EC-20-0206] [PMID: 32567548]
[15]
Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord 2017; 18(2): 153-65.
[http://dx.doi.org/10.1007/s11154-017-9424-1] [PMID: 28516265]
[16]
Felício JS, de Oliveira AF, Peixoto AS, et al. Albuminuria reduction after high dose of vitamin D in patients with type 1 diabetes mellitus: a pilot study. Front Endocrinol (Lausanne) 2017; 8: 199.
[http://dx.doi.org/10.3389/fendo.2017.00199] [PMID: 28855892]
[17]
de Queiroz NNM, de Melo FTC, Resende FS, et al. High-dose cholecalciferol supplementation reducing morning blood pressure in normotensive DM1 patients. Curr Diabetes Rev 2020.
[http://dx.doi.org/10.2174/1573399816999200729131508] [PMID: 32729423]
[18]
Felício KM, de Souza ACCB, Neto JFA, et al. Glycemic variability and insulin needs in patients with type 1 diabetes mellitus supplemented with vitamin D: a pilot study using continuous glucose monitoring system. Curr Diabetes Rev 2018; 14(4): 395-403.
[http://dx.doi.org/10.2174/1573399813666170616075013] [PMID: 28618984]
[19]
Felício JS, Luz RM, de Melo FT, et al. Vitamin D on early stages of diabetic kidney disease: a cross-sectional study in patients with type 1 diabetes mellitus. Front Endocrinol (Lausanne) 2016; 7: 149.
[http://dx.doi.org/10.3389/fendo.2016.00149] [PMID: 28018288]
[20]
Baker C, Wason S, Banks P, et al. Dose-dependent glycometabolic effects of sotagliflozin on type 1 diabetes over 12 weeks: The inTandem4 trial. Diabetes Obes Metab 2019; 21(11): 2440-9.
[http://dx.doi.org/10.1111/dom.13825] [PMID: 31264767]
[21]
DiaSorin. LIAISON 25 OH Vitamin D TOTAL Assay https://www.diasorin.com/en/node/8476
[22]
Levey AS, Stevens LA, Schmid CH, et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009; 150(9): 604-12.
[http://dx.doi.org/10.7326/0003-4819-150-9-200905050-00006] [PMID: 19414839]
[23]
Pimazoni Netto Augusto, Adagmar Andriolo, Fadlo Fraige Filho, et al. Atualização sobre hemoglobina glicada (HbA1C) para avaliação do controle glicêmico e para o diagnóstico do diabetes: aspectos clínicos e laboratoriais. J Bras Patol Med Lab 2009; 45(1): 31-48.
[24]
Sharma S, Biswal N, Bethou A, Rajappa M, Kumar S, Vinayagam V. Does vitamin d supplementation improve glycaemic control in children with type 1 diabetes mellitus? - a randomized controlled trial. J Clin Diagn Res 2017; 11(9): SC15-7.
[http://dx.doi.org/10.7860/JCDR/2017/27321.10645] [PMID: 29207798]
[25]
Sneve M, Figenschau Y, Jorde R. Supplementation with cholecalciferol does not result in weight reduction in overweight and obese subjects. Eur J Endocrinol 2008; 159(6): 675-84.
[http://dx.doi.org/10.1530/EJE-08-0339] [PMID: 19056900]
[26]
Evert AB, Dennison M, Gardner CD, et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 2019; 42(5): 731-54.
[http://dx.doi.org/10.2337/dci19-0014] [PMID: 31000505]
[27]
Mitri J, Pittas AG. Vitamin D and diabetes. Endocrinol Metab Clin North Am 2014; 43(1): 205-32.
[http://dx.doi.org/10.1016/j.ecl.2013.09.010] [PMID: 24582099]
[28]
Nissen J, Rasmussen LB, Ravn-Haren G, et al. Common variants in CYP2R1 and GC genes predict vitamin D concentrations in healthy Danish children and adults. PLoS One 2014; 9(2)
[http://dx.doi.org/10.1371/journal.pone.0089907] [PMID: 24587115]
[29]
Bouillon R. Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol 2017; 13(8): 466-79.
[http://dx.doi.org/10.1038/nrendo.2017.31] [PMID: 28387318]
[30]
McKeigue PM, Spiliopoulou A, McGurnaghan S, et al. Persistent C-peptide secretion in Type 1 diabetes and its relationship to the genetic architecture of diabetes. BMC Med 2019; 17(1): 165.
[http://dx.doi.org/10.1186/s12916-019-1392-8] [PMID: 31438962]
[31]
Maestro B, Dávila N, Carranza MC, Calle C. Identification of a Vitamin D response element in the human insulin receptor gene promoter. J Steroid Biochem Mol Biol 2003; 84(2-3): 223-30.
[http://dx.doi.org/10.1016/S0960-0760(03)00032-3] [PMID: 12711007]
[32]
Mishra A, Dayal D, Sachdeva N, Attri SV. Effect of 6-months’ vitamin D supplementation on residual beta cell function in children with type 1 diabetes: a case control interventional study. J Pediatr Endocrinol Metab 2016; 29(4): 395-400.
[http://dx.doi.org/10.1515/jpem-2015-0088] [PMID: 26244673]
[33]
Lemieux P, Weisnagel SJ, Caron AZ, et al. Effects of 6-month vitamin D supplementation on insulin sensitivity and secretion: a randomised, placebo-controlled trial. Eur J Endocrinol 2019; 181(3): 287-99.
[http://dx.doi.org/10.1530/EJE-19-0156] [PMID: 31344685]
[34]
Hirsch IB. Glycemic variability and diabetes complications: does it matter? of course it does! Diabetes Care 2015; 38(8): 1610-4.
[http://dx.doi.org/10.2337/dc14-2898] [PMID: 26207054]
[35]
Gorst C, Kwok CS, Aslam S, et al. Long-term glycemic variability and risk of adverse outcomes: a systematic review and meta-analysis. Diabetes Care 2015; 38(12): 2354-69.
[http://dx.doi.org/10.2337/dc15-1188] [PMID: 26604281]
[36]
Unger RH, Zhou YT. Lipotoxicity of beta-cells in obesity and in other causes of fatty acid spillover. Diabetes 2001; 50(Suppl. 1): S118-21.
[http://dx.doi.org/10.2337/diabetes.50.2007.S118] [PMID: 11272168]
[37]
Schaffer JE. Lipotoxicity: many roads to cell dysfunction and cell death: introduction to a thematic review series. J Lipid Res 2016; 57(8): 1327-8.
[http://dx.doi.org/10.1194/jlr.E069880] [PMID: 27260998]
[38]
Ye R, Onodera T, Scherer PE. Lipotoxicity and β cell maintenance in obesity and type 2 diabetes. J Endocr Soc 2019; 3(3): 617-31.
[http://dx.doi.org/10.1210/js.2018-00372] [PMID: 30834357]
[39]
Pavlíková N, Daniel P, Šrámek J, et al. Upregulation of vitamin D-binding protein is associated with changes in insulin production in pancreatic beta-cells exposed to p,p′-DDT and p,p′-DDE. Sci Rep 2019; 9(1): 18026.
[http://dx.doi.org/10.1038/s41598-019-54579-z] [PMID: 31792309]
[40]
Găman MA, Epîngeac ME, Diaconu CC, Găman AM. Evaluation of oxidative stress levels in obesity and diabetes by the free oxygen radical test and free oxygen radical defence assays and correlations with anthropometric and laboratory parameters. World J Diabetes 2020; 11(5): 193-201.
[http://dx.doi.org/10.4239/wjd.v11.i5.193] [PMID: 32477455]
[41]
Zhang Y, Jiang X, Li X, et al. Serum vitamin d levels and risk of liver cancer: a systematic review and dose-response meta- analysis of cohort studies. Nutr Cancer 2020; 1-9.
[http://dx.doi.org/10.1080/01635581.2020.1797127] [PMID: 32705896]

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