The effect of different doses of vitamin D3 on markers of vascular health in patients with type 2 diabetes: a randomised controlled trial

Witham, Miles D.; Dove, Fiona; Dryburgh, Moira; Sugden, Jacqui; Morris, Andrew D.; Struthers, Allan D.

doi:10.1007/s00125-010-1838-1

Cited by 234 publications

(218 citation statements)

References 35 publications

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“…Funnel plots examining fasting glucose (the most commonly measured outcome) for the normal fasting glucose and abnormal glucose tolerance subgroups revealed no asymmetry to suggest publication bias (see also Supporting Information, Figures S1 and S2). We used individual patient level data from two studies [3,22] to confirm that the standard deviation of change in fasting glucose and HbA 1c imputed from the start and finish standard deviation was similar to or greater than the real standard deviation for each treatment group, thus confirming that this approach did not overstate the precision of effect estimates.…”

Section: Study Quality and Biasmentioning

confidence: 98%

Effect of vitamin D supplementation on glycaemic control and insulin resistance: a systematic review and meta‐analysis

2012

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Aims To systematically review the evidence for the effect of vitamin D supplementation on glycaemia, insulin resistance, progression to diabetes and complications of diabetes.Methods Systematic review and meta-analysis. We searched databases including MEDLINE, EMBASE and the Cochrane Library for randomized controlled trials comparing vitamin D or analogues with placebo. We extracted data on fasting glucose, glycaemic control, insulin resistance, insulin ⁄ C-peptide levels, micro-and macrovascular outcomes and progression from non-diabetes to diabetes. Studies were assessed independently by two reviewers according to a pre-specified protocol.Results Fifteen trials were included in the systematic review. Trial reporting was of moderate, variable quality. Combining all studies, no significant improvement was seen in fasting glucose, HbA 1c or insulin resistance in those treated with vitamin D compared with placebo. For patients with diabetes or impaired glucose tolerance, meta-analysis showed a small effect on fasting glucose ()0.32 mmol ⁄ l, 95% CI )0.57 to )0.07) and a small improvement in insulin resistance (standard mean difference )0.25, 95% CI )0.48 to )0.03). No effect was seen on glycated haemoglobin in patients with diabetes and no differences were seen for any outcome in patients with normal fasting glucose. Insufficient data were available to draw conclusions regarding micro-or macrovascular events; two trials failed to show a reduction in new cases of diabetes in patients treated with vitamin D.Conclusions There is currently insufficient evidence of beneficial effect to recommend vitamin D supplementation as a means of improving glycaemia or insulin resistance in patients with diabetes, normal fasting glucose or impaired glucose tolerance.Diabet. Med. 29, e142-e150 (2012)

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Section: Study Quality and Biasmentioning

confidence: 98%

Effect of vitamin D supplementation on glycaemic control and insulin resistance: a systematic review and meta‐analysis

2012

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“…The quality assessment of the studies resulted in 14 out of 23 studies having a good quality (Appendix 1, see section on Appendix given at the end of this article) (12,19,20,21,22,23,24,25,26,27,28,29,30,31). The main characteristics and main outcomes of the included studies are given in Table 1.…”

Section: Description Of the Studiesmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: The effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Krul-Poel

Wee

Lips

et al. 2017

European Journal of Endocrinology

101

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Objective: Epidemiologic studies suggest that vitamin D status plays a role in glycaemic control in patients with type 2 diabetes. However, intervention studies yielded inconsistent results. The aim of this study is to systematically review the effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes. Methods: Systematic review and meta-analysis. We searched Medline, Embase and the Cochrane Library for RCTs examining the effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes. A random-effects model meta-analysis was performed to obtain a summarized outcome of vitamin D supplementation on HbA 1c , fasting glucose and homeostasis model assessment -insulin resistance (HOMA-IR). Results: Twenty-three RCTs were included in this systematic review representing a total of 1797 patients with type 2 diabetes. Mean (± s.d.) change in serum 25-hydroxyvitamin D varied from 1.8 ± 10.2 nmol/L to 80.1 ± 54.0 nmol/L. Nineteen studies included HbA 1c as outcome variable. Combining these studies no significant effect in change of HbA 1c was seen after vitamin D intervention compared with placebo. A significant effect of vitamin D supplementation was seen on fasting glucose in a subgroup of studies (n = 4) with a mean baseline HbA 1c ≥ 8% (64 mmol/mol) (standardized difference in means: 0.36; 95% CI: 0.12-0.61, P = 0.003). Conclusions: Current evidence of RCTs does not support short-term vitamin D supplementation in a heterogeneous population with type 2 diabetes. However, in patients with poorly controlled diabetes, a favourable effect of vitamin D is seen on fasting glucose.

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“…A meta-analysis of four prospective and fourteen cross-sectional studies found a pooled OR of 0·73 (95 % CI 0·63, 0·84) for hypertension in participants in the highest 25(OH)D category compared with those in the lowest category (73) . A number of RCT have measured changes in BP (primarily clinic BP) in response to vitamin D supplementation and shown mixed results (74)(75)(76)(77)(78)(79)(80) .…”

Section: Blood Pressurementioning

confidence: 99%

“…A couple of cross-sectional studies in healthy adults show lower serum levels of 25(OH)D to be associated with endothelial dysfunction (91,92) . A few trials show an improvement in flow-mediated dilation with vitamin D supplementation (93)(94)(95) , but most show no effect (79,(96)(97)(98) ( Table 2).…”

Section: Endothelial Functionmentioning

confidence: 99%

Vitamin D and risk of CVD: a review of the evidence

Fry

Sanders

2015

Proc. Nutr. Soc.

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This review summarises evidence for an association between vitamin D status and CVD and the mechanisms involved. Vitamin D 3 is predominantly provided by the action of UVB from sunlight on skin. Average UK diets supply 2-3 μg/d vitamin D but diets containing at least one portion of oily fish per week supply about 7 μg/d. Pharmacological doses of vitamin D 2 (bolus injection of 7500 μg or intakes >50 μg/d) result in a smaller increase in plasma 25 (OH)D than those of D 3 but physiological doses 5-25 μg/d seem equivalent. Plasma 25 (OH)D concentrations are also influenced by clothing, obesity and skin pigmentation. Up to 40 % of the population have plasma 25(OH)D concentrations <25 nmol/l in the winter compared with <10 % in the summer. The relative risk of CVD death is 1·41 (95 % CI 1·18, 1·68) greater in the lowest quintile of plasma 25(OH)D according to meta-analysis of prospective cohort studies. Acute deficiency may inhibit insulin secretion and promote inflammation thus increasing the risk of plaque rupture and arterial thrombosis. Chronic insufficiency may increase arterial stiffness. There is no evidence to support claims of reduced CVD from existing trials with bone-related health outcomes where vitamin D was usually co-administered with calcium. Although several trials with cardiovascular endpoints are in progress, these are using pharmacological doses. In view of the potential toxicity of pharmacological doses, there remains a need for long-term trials of physiological doses of D 2 and D 3 with CVD incidence as the primary outcome. Ergocalciferol: Cholecalciferol: Cardiovascular riskVitamin D deficiency causes rickets in children and osteomalacia in adults and may contribute to the causation of CVD. Cholecalciferol (vitamin D 3 ) is made by the action of UVB light on the skin but is also provided in the diet from foods of animal origin (eggs, oily fish and meat). Ergocalciferol (vitamin D 2 ) is present in fungi that have been exposed to UVB irradiation. Both forms of vitamin D undergo 25-hydroxylation in the liver to form 25(OH) metabolites, most of which circulate in plasma bound to the vitamin D binding protein (VDBP). In the kidney, 25 hydroxyvitamin D (25(OH)D) is converted to the biologically active metabolite 1,25 dihydroxyvitamin D (1,25 (OH) 2 D) by the action of 1α-hydroxylase (Fig. 1). This then binds to the vitamin D receptor, which is a highaffinity nuclear hormone receptor that regulates gene expression (1) . Measurement of serum 25(OH)D to assess vitamin D status has predominantly used immunoassays, which show lower sensitivity (about 30 %) to D 2 metabolites than gold-standard methods such as HPLC/tandem MS. Formerly, a lack of standardisation of methods and appropriate quality control made comparisons between studies difficult (2) . The situation has been remedied by the availability (3) of standard reference serum (SRM 972, National Institute of Standards and Technology) and a quality control programme in the UK organised by the Vitamin D External Quality Assessment Scheme (4) . It has...

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The effect of different doses of vitamin D3 on markers of vascular health in patients with type 2 diabetes: a randomised controlled trial

Cited by 234 publications

References 35 publications

Effect of vitamin D supplementation on glycaemic control and insulin resistance: a systematic review and meta‐analysis

Effect of vitamin D supplementation on glycaemic control and insulin resistance: a systematic review and meta‐analysis

MANAGEMENT OF ENDOCRINE DISEASE: The effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Vitamin D and risk of CVD: a review of the evidence

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