Relationship of serum vitamin D levels with diabetic microvascular complications in patients with type 2 diabetes mellitus

Abstract

Background: Vitamin D deficiency has been reported to be associated with diabetic microvascular complications, but previous studies have only focused on the relationship between vitamin D and specific complications. Therefore, we aimed to explore the relationship between vitamin D level and diabetic microvascular complications in general, including diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN). Methods: This was a cross-sectional study of 815 patients with type 2 diabetes mellitus (T2DM). Clinical information and laboratory results were collected from the medical records. The relationship between vitamin D and the three diabetic microvascular complications was investigated. Results: The serum 25-hydroxyvitamin D (25 [OH] D) level of patients with DPN and/or DN was significantly lower than that of T2DM patients without any microvascular complications ( P < 0.01). Univariate analysis showed that the 25 (OH) D level was related to DPN and DN, but not DR. After adjustment, the 25 (OH) D level was confirmed to be an independent protective factor for DPN (odds ratio [OR]: 0.968, P = 0.004]) and DN (OR: 0.962, P = 0.006). The prevalence of DPN and DN increased significantly as the serum 25 (OH) D levels decreased. Furthermore, patients with both DPN and DN had the lowest concentration of serum 25 (OH) D ( P < 0.001), and the prevalence of macroalbuminuria increased more abruptly than that of microalbuminuria across the 25 (OH) D tertiles. Among the patients with vitamin D insufficiency, those with DPN presented more comorbid macroalbuminuria than those without DPN (15.32% vs. 4.91%; P = 0.001). Conclusions: Vitamin D deficiency is independently associated with higher risk of DPN and DN, but not DR, in T2DM patients. Further, it may be a potential predictor for both the occurrence and severity of DPN and DN.

The Relationship Between Triglyceride Glucose Index and Vitamin D in Type 2 Diabetes Mellitus

“… 17 Moreover, vitamin D deficiency is independently associated with the high risk of diabetic peripheral neuropathy (DPN) and diabetic nephropathy (DN) in patients with T2DM. It can be a potential predictor of the occurrence and severity of DPN and DN, 18 and it might be responsible for elevated cancer risk development in T2DM patients. Vitamin D alleviates insulin resistance, hyperglycemia, oxidative stress, and inflammation reduces diabetes-driven cancer risk factors.…”

The Role of Vitamin D in Diabetic Nephropathy: A Translational Approach

“…Patients with CKD produce less 1,25(OH) 2 D 3 due to impaired 1α-hydroxylase activity [ 110 , 111 ]. In patients with T1DM or T2DM, vitamin D deficiency increases the risk of developing DKD [ 28 , 35 , 40 , 44 , 46 , 47 , 48 , 49 , 50 , 51 ], possibly due to the direct cellular effects, leading to podocyte loss and glomerulosclerosis [ 53 ].…”

“…The association between vitamin D deficiency and microvascular complications in diabetic patients is significantly higher than that in non-diabetics [ 25 , 29 , 30 , 32 , 34 , 41 , 42 , 43 , 44 , 45 ]. There is an increased risk for DN in patients with a vitamin D deficiency [ 28 , 35 , 40 , 44 , 46 , 47 , 48 , 49 , 50 , 51 ]. A cohort study of 1193 participants in the Diabetes Control and Complications Trial (DCCT) showed that type 1 diabetics with a 25(OH)D 3 concentration less than 20 ng/mL had a 65% higher risk for the development of microalbuminuria (95% CI: 1.07–2.54; p = 0.03) compared to patients with a 25(OH)D 3 concentration at a minimum of 30 ng/mL [ 40 ].…”

“…Several studies have indicated that 25(OH)D 3 concentrations seem to be significantly lower in DN patients, indicating that vitamin D deficiency is more prevalent in DN patients [ 25 , 30 , 33 , 34 , 35 , 42 , 49 , 50 , 51 , 52 , 53 , 54 ]. In a retrospective observational study ( n = 300), patients with T2DM and CKD were 1.7-times more likely to have a vitamin D deficiency when compared to the diabetics without CKD [ 42 ].…”

Associations of serum amyloid A and 25‐hydroxyvitamin D with diabetic nephropathy: A cross‐sectional study

“…In addition, the research conducted by Xie et al33 reported that the prevalence of 25(OH)VD insufficiency in T2DM patients with microalbuminuria was significantly higher than that in T2DM patients with normoalbuminuria, and low 25(OH)VD levels were associated with DN. Zhao et al34 also demonstrated that 25(OH)VD was confirmed to be an independent protective factor for DN (OR = 0.962), which also means that 25(OH)VD deficiency is independently associated with a higher risk of DN. The above results were very consistent with the present study, and all fully confirmed that SAA promotes kidney function damage in diabetic patients by upregulating the expression of certain inflammatory factors.…”