Skeletal Status, Body Composition, and Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus

Wierzbicka, Elżbieta; Świercz, Anna; Płudowski, Paweł; Jaworski, Maciej; Szalecki, Mieczysław

doi:10.1155/2018/8121634

Cited by 50 publications

(42 citation statements)

References 83 publications

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“…The indicators of fat metabolism, such as triglyceride and cholesterol levels, were higher than normal in patients with combined endocrine disorders compared to those in DM patients. Similar results were noted in other papers (21, 22). …”

Section: Discussionsupporting

confidence: 93%

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Vitamin D Deficiency and Immune Disorders in Combined Endocrine Pathology

Komisarenko

Bobryk

2018

Front. Endocrinol.

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Introduction: Combined endocrine pathology is a serious healthcare problem in Ukraine. This prospective study assessed the blood levels of 25-hydroxyvitamin D [25(OH)D] and markers of immune function in response to vitamin D intervention in patients with type 1 and type 2 diabetes mellitus (T1DM and T2DM, respectively) and autoimmune thyroiditis (AIT).Objective: This study evaluated the relationship between the metabolic and immune status of DM + AIT patients with respect to their vitamin D status and changes after vitamin D3 supplementation.Material and Methods: Patients with type 1 or type 2 DM in combination with AIT and decreased circulating levels of 25(OH)D were divided into two groups of 30 patients each. All patients with AIT were euthyroid and receiving hormonal replacement therapy. The levels of carbohydrate and fat metabolism markers, Immunologic markers, namely, Th1-type cytokines [interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-2, IL-6, IL-12], Th2-type cytokines (IL-4, IL-5), IL-10, and IL-17 were measured before and after vitamin D3 supplementation. The vitamin D status was assessed according to the level of 25(OH)D.Results: Patients with combined endocrine disorders (DM and AIT) with a decreased vitamin D status had significantly increased background concentrations of Th1-type cytokines and reduced concentrations of Th2-type cytokines (IL-4 and IL-5), IL-10, and IL-17. The results of our study showed that vitamin D3 supplementation in patients with T1DM and T2DM reduced the concentrations of the inflammatory Th1-type cytokines and increased the levels of Th2-type cytokines.Conclusion: The presence of two endocrine diseases, aggravated by decreased circulating levels of 25(OH)D, leads to disorders wherein the immune status is markedly changed. These decreased levels of 25(OH)D contribute to an autoimmune inflammatory process and to the progression of complications in addition to the metabolic disorders. A vitamin D intervention resulted in significant changes in the blood levels of 25(OH)D that are related to parameters of autoimmunity and glucose metabolism. Vitamin D3 supplementation should be considered for the prevention and treatment of combined endocrine pathology.

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Section: Discussionsupporting

confidence: 93%

“…In addition, a compensatory increased PTH level was observed in patients with DM + AIT with coinciding reduced 25(OH)D concentration (less than 75.0 nmol/L). Some authors have postulated the possibility of a relationship with coexisting 25(OH)D concentrations (3, 15, 21). …”

Section: Discussionmentioning

confidence: 99%

Vitamin D Deficiency and Immune Disorders in Combined Endocrine Pathology

Komisarenko

Bobryk

2018

Front. Endocrinol.

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“…In addition, the potential health benefits of vitamin D sufficiency remain unknown in our population; however, the problem of vitamin D deficiency has been recently highlighted in Polish patients suffering from multiple sclerosis, 32 systemic lupus erythematosus, 33 metabolic syndrome, 34 primary hypertension, 35 or type 1 diabetes. 36 Moreover, the distribution of 25(OH)D levels related to age, sex, place of residence, and anthropometric characteristics has not yet been investigated. The aim of this cross-sectional study was to determine the current vitamin D status in a representative sample of men and women living in the urban areas of various regions of Poland, based on an assessment of the serum 25(OH)D level.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D status in Poland

Płudowski¹,

Ducki²,

Konstantynowicz³

et al. 2016

Polish Archives of Internal Medicine

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102

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functions of vitamin D seem to be higher (30-50 ng/ml; 75-125 nmol/l), 25 but still are considered uncertain. Some authors, however, argue that even for proper bone mineralization, levels higher than 30 ng/ml (75 nmol/l) are necessary. 26 Indisputably, low 25(OH)D levels (below 20 ng/ml) are common and were reported worldwide, 1-7 and this is a drawback because epidemiological data underlined an association between vitamin D deficit and a higher risk for chronic conditions and multimorbidity, including musculoskeletal disorders, cancer, autoimmune diseases, cardiovascular disease, diabetes, and infectious diseases. 1,3,[27][28][29][30] One of the countries with limited data on vitamin D status is Poland (49-54°N; Central Europe). Results of studies carried out in our country indicated that the problem of vitamin D deficiency considerably affects the Polish population. In a study of 448 adult residents of urban areas INTRODUCTION Vitamin D is an important prohormone that can be synthesized by the skin exposed to sunlight (UVB) or ingested with food. However, low outdoor activity, sun protection, and low vitamin D content of staple foods reduce the significance of sun and diet as natural sources for efficacy of vitamin D metabolism and related health effects. In consequence, evidence from various populations highlighted vitamin D deficiency as a public health problem with high prevalence.1-17 The prevalence of vitamin D deficiency depends on diagnostic thresholds defining vitamin D status that is determined by total serum 25(OH)D levels, 18 and the recommended levels of 25(OH)D are still an issue of debate.19-22 Currently, it is accepted that maintaining serum 25(OH) D at a level of 20 ng/ml (50 nmol/l) or above is beneficial at least for bone health and calcium homeostasis.23,24 Levels required for noncalcemic PATIENTS AND METHODSThis cross-sectional study included a total of 5775 adult volunteers (4464 women; 1311 men; mean age, 54.0 ±15.9 years; range, 15.6-89.8 years), who were enrolled and examined through late winter and spring 2014. Serum concentrations of 25(OH)D were determined using the Liaison XL system (DiaSorin; CLIA method). Demographic and anthropometric data were also analyzed. RESULTSThe mean 25(OH)D concentration in the studied population was 18.0 ±9.6 ng/ml; 65.8% of the patients had 25(OH)D levels of less than 20 ng/ml; 24.1% had suboptimal levels of 20 to 30 ng/ml; and only 9.1% demonstrated the optimal levels of 30 to 50 ng/ml. In 89.9% of the studied population, 25(OH)D levels of less than 30 ng/ml were found. Obesity, defined as body mass index (BMI) over 30 kg/m 2 , was associated with lower 25(OH)D levels compared with normal weight (15.8 ±8.5 vs 18.5 ±9.7 ng/ml; P <0.0001). Lower 25(OH)D levels were observed in men, younger individuals, and individuals with excess body weight and higher BMI. CONCLUSIONSThe results of our study, which involved the most representative sample size of Polish adults, support the previously reported data on vitamin D status. The levels of 25(OH)D determined f...

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“…Several studies have shown that cholecalciferol supplementation is associated with an improved glycaemic control in T1D [16][17][18][19]. Conversely, VDD is associated with poor control [22]. Improvement in vitamin D status improves endogenous insulin secretion and insulin sensitivity of target tissues, thereby contributing to an improved insulin action [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Sustained serum 25-hydroxyvitamin D concentrations for one year with cholecalciferol supplementation improves glycaemic control and slows the decline of residual β cell function in children with type 1 diabetes

Panjiyar¹,

Dayal²,

Attri³

et al. 2018

pedm

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Sustained serum 25-hydroxyvitamin D concentrations for one year with cholecalciferol supplementation improves glycaemic control and slows the decline of residual β cell function in children with type 1 diabetes Utrzymywane przez rok stężenie 25-hydroksywitaminy D w surowicy poprzez suplementację cholekalcyferolem poprawia kontrolę glikemii i spowalnia zanik resztkowej funkcji komórek β u dzieci z cukrzycą typu 1 Abstract Introduction: Studies using vitamin D for preservation of residual β-cell function (RBCF) and improvement of glycaemic control in type 1 diabetes (T1D) have shown inconsistent results. The possible causes of the discrepancies in the results are related to the dosage, type, and duration of vitamin D supplementation, C-peptide concentration at entry into the study, and the influence of glycaemic control on RBCF during supplementation. Aim of study: To evaluate the effect of cholecalciferol supplementation on RBCF and glycaemic control in children with T1D. Material and methods: Forty-two children aged 6-12 years and within 1-2 years of diagnosis of T1D received cholecalciferol 3000 IU/day for one year (Group A). Thirty patients were recruited as controls (Group B). The mean changes in stimulated C-peptide levels, HbA 1c , fasting blood glucose (FBG), mean blood glucose (MBG), and mean total daily insulin (TDI) dose from baseline to the study endpoint were calculated. Results: Children in Group A showed lower mean FBG, MBG, HbA 1c , and lesser TDI as compared to Group B at all follow-up visits. However, the differences in these parameters between the two groups reached statistical significance towards the study endpoint. Within group A, the decline in C-peptide levels from baseline to the endpoint was minor (-0.13 ±0.11, p-value = 0.16) as compared to a substantial decline in Group B (-0.41 ±0.07, p-value = 0.00). Comparison of the mean decrease in stimulated C-peptide levels from baseline to the endpoint between the two groups was also statistically significant (-0.13 ±0.11 vs. -0.41 ±0.07, p-value = 0.00). The mean decrease in FBG and MBG in Group A were greater, whereas the comparison of the mean decrease in HbA 1c between the groups reached statistical significance at the study endpoint (p-value = 0.04). The decrease in the TDI was, however, similar in the two groups (p-value = 0.10). Conclusions: Sustained serum 25-(OH)D concentrations with cholecalciferol supplementation for one year improves metabolic control and slows the decline of RBCF in children with T1D. Larger studies with longer duration and cholecalciferol dosage stratification are suggested. StreszczenieWprowadzenie: Badania z zastosowaniem witaminy D dla zachowania resztkowej funkcji komórek β (residual β-cell function -RBCF) i poprawy kontroli glikemicznej w cukrzycy typu 1 (type 1 diabetes -T1D) wykazały niespójne wyniki. Możliwe przyczyny rozbieżności w wynikach są związane z dawką, rodzajem i czasem trwania suplementacji witaminą D, stężeniem peptydu C na początku badania oraz wpływem kontroli glikemii na RBCF podczas suplement...

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Skeletal Status, Body Composition, and Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus

Cited by 50 publications

References 83 publications

Vitamin D Deficiency and Immune Disorders in Combined Endocrine Pathology

Vitamin D Deficiency and Immune Disorders in Combined Endocrine Pathology

Vitamin D status in Poland

Sustained serum 25-hydroxyvitamin D concentrations for one year with cholecalciferol supplementation improves glycaemic control and slows the decline of residual β cell function in children with type 1 diabetes

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