Prevalence of vitamin D3 deficiency in patients with type 2 diabetes and proteinuria

Tatjana  Stojšić Vuksanović; Violeta  Knežević

doi:10.2298/VSP200220064S

Tatjana Stojšić Vuksanović General Hospital Subotica, Department of Nephrology, Subotica, Serbia
Violeta Knežević University Clinical Center of Vojvodina, Clinic for Nephrology and Clinical Immunology, Novi Sad, Serbia; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia

DOI: https://doi.org/10.2298/VSP200220064S

Keywords: cholecalciferol;, deficiency;, diabetes mellitus;, prevalence;, proteinuria;, seasons

Abstract

Background/Aim. Vitamin D3 plays an important role in glucose metabolism, with influence on insulin secretion and sensitivity. Low grade inflammation is present in patients with diabetes type 2 and it is a known fact that vitamin D has an anti-inflammatory effect. Vitamin D deficiency is particularly pronounced in patients with diabetic nephropathy. Vitamin D3 levels during the year are associated with seasonal changes primarily influenced by UV radiation. The aim of the study was to examine the prevalence of vitamin D3 deficiency in patients with diabetic nephropathy. Methods. Patients with type 2 diabetes and diabetic nephropathy were included in the study after the vitamin D3 levels were established. The results were classified according to a lower limit level given for each month being reduced or normal values. For the purpose of further research, patients with low vitamin D3 levels were divided into two groups, study and control group, each including 45 patients. The study group received cholecalciferol at the dose necessary to achieve the intended optimal vitamin D3 blood level of 90–100 nmol/L. Results. At the beginning of the study, vitamin D3 value for all patients with vitamin D3 deficiency (n = 90) was 45.1 ± 15.6 nmol /L. Vitamin D3 deficiency in the study sample (n = 109) was found in 82.56% of participants, while the normal values of vitamin D3 were found in 17.43% of patients. There is a statistically significant difference in the deviation of vitamin D3 levels from the lower normal values in the whole group of subjects between winter and summer, with the deviation being more pronounced in summer. There is no gender difference in these values, although in both men and women there is a more pronounced deviation in summer. Conclusion. Vitamin D3 deficiency is significantly represented in patients with type 2 diabetes and diabetic nephropathy.

References

Shaheen S, Chauhan H , Mishra N. Association between type 2 diabetes mellitus and hypovitaminosis D. Int J Clin Biochem Res 2017; 4(4): 413‒5.

Xuan Y, Zhao HY, Liu JM. Vitamin D and type 2 diabetes mellitus (D2). J Diabetes 2013; 5(3): 261–7.

Aljack HA, Abdalla MK, Idris OF, Ismail AM. Vitamin D defi-ciency increases risk of nephropathy and cardiovascular diseas-es in Type 2 diabetes mellitus patients. J Res Med Sci 2019; 24: 47.

Xiao X, Wang Y, Hou Y, Han F, Ren J, Hu Z. Vitamin D defi-ciency and related risk factors in patients with diabetic nephropathy. J Int Med Res 2016; 44(3): 673–84.

Al-Timimi DJ, Ali AF. Serum 25(OH) D in Diabetes Mellitus Type 2: Relation to Glycaemic Control. J Clin Diagn Res 2013; 7(12): 2686–8.

Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endo-crinol 2010; 2010: 351385.

de Boer IH. Vitamin D and glucose metabolism in chronic kid-ney disease. Curr Opin Nephrol Hypertens 2008; 17(6): 566‒72.

Wang Y, Zhu J, DeLuca HF. Where is the vitamin D recep-tor? Arch Biochem Biophys 2012; 523(1): 123–33.

Buhary BM, Almohareb O, Aljohani N, Alrajhi S, Elkaissi S, Sherbeeni S, et al. Association of Glycosylated Hemoglobin Levels With Vitamin D Status. J Clin Med Res 2017; 9(12): 1013–8.

Zhong J, Gong Q, Mima A. Inflammatory regulation in diabetes and metabolic dysfunction. J. Diabetes Res 2017; 2017: 5165268.

Ponda MP, Huang X, Odeh MA, Breslow JL, Kaufman HW. Vit-amin d may not improve lipid levels: a serial clinical laboratory data study. Circulation 2012; 126(3): 270–7.

Ponda MP, Dowd K, Finkielstein D, Holt PR, Breslow JL. The short-term effects of vitamin D repletion on cholesterol: a randomized, placebo-controlled trial. Arterioscler Thromb Vasc Biol 2012; 32(10): 2510‒5.

Ramiro-Lozano JM, Calvo-Romero JM. Effects on lipid profile of supplementation with vitamin D in type 2 diabetic patients with vitamin D deficiency. Ther Adv Endocrinol Metab 2015; 6(6): 245–8.

Klingberg E, Oleröd G, Konar J, Petzold M, Hammarsten O. Sea-sonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort. Endocrine 2015; 49(3): 800–8.

Isaia G, Giorgino R, Adami S. High prevalence of hypovita-minosis D in female type 2 diabetic population. Diabetes Care 2001; 24(8): 1496.

Zoppini G, Galletti A, Targher G, Brangani C, Pichiri I, Trombetta M, et al. Lower levels of 25-hydroxyvitamin D3 are associated with a higher prevalence of microvascular complications in pa-tients with type 2 diabetes. BMJ Open Diabetes Res Care 2015; 3(1): e000058.

Maiti S, Lochan Das K. The assessment of vitamin D status in the patient of diabetic nephropathy: a case controletertary in-stitutional based study. Asian J Sci Technol 2015; 6(9): 1794‒8.

Holick MF. Vitamin D deficiency. N Engl J Med 2007; 357(3): 266–81.

Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, Gam-ble GD, et al. The effects of seasonal variation of 25-hydroxyvitamin D and fat mass on a diagnosis of vitamin D sufficiency. Am J Clin Nutr 2007; 86(4): 959‒64.

Bayani MA, Akbari R, Banasaz B, Saeedi F. Status of Vitamin-D in diabetic patients. Caspian J Intern Med 2014; 5(1): 40–2.

Maggio D, Cherubini A, Lauretani F, Russo RC, Bartali B, Pierandrei M, et al. 25(OH)D Serum levels decline with age earlier in women than in men and less efficiently prevent compensatory hyperparathyroidism in older adults.J Gerontol A Biol Sci Med Sci 2005; 60(11): 1414‒9.

Aljabri KS. Vitamin D Deficiency in Saudi Men with Type 2 Diabetes Mellitus. Ann Short Reports 2019; 2: 1037

Carnevale V, Modoni S, Pileri M, Di Giorgio A, Chiodini I, Mini-sola S, et al. Longitudinal evaluation of vitamin D status in healthy subjects from southern Italy: seasonal and gender dif-ferences. Osteoporos Int 2001; 12(12): 1026‒30.

Lucas JA, Bolland MJ, Grey AB, Ames RW, Mason BH, Horne AM, et al. Determinants of vitamin D status in older women livingin a subtropical climate. Osteoporos Int 2005; 16: 1641–8.

Bredella MA. Sex Differences in Body Composition. Adv Exp Med Biol 2017; 1043: 9‒27.

Bruce AF, Theeke L, Mallow J. A state of the science on influ-ential factors related to sun protective behaviors to prevent skin cancer in adults. Int J Nurs Stud 2017; 4(3): 225‒35.

Sanghera DK, Sapkota BR, Aston CE, Blackett PR. Vitamin D Status, Gender Differences, and Cardiometabolic Health Dis-parities. Ann Nutr Metab 2017; 70(2): 79–87.

Hashemipour S, Larijani B, Adibi H, Sedaghat M, Pajouhi M, Bas-tan-Hagh MH, et al. The Status of Biochemical Parameters in Varying Degrees of Vitamin D Deficiency J Bone Miner Metab 2006; 24(3): 213‒8.

Kennel KA, Drake MT, Hurley DL. Vitamin D deficiency in adults: when to test and how to treat? Mayo Clin Proc 2010; 85(8): 752‒7.

Heaney RP, Dowell MS, Bierman J, Hale CA, Bendich A. Absorb-ability and cost effectiveness in calcium supplementation. J Am Coll Nutr 2001; 20(3): 239‒46.

Malihi Z, Wu Z, Stewart AW, Lawes CM, Scragg R. Hyper-calcemia, hypercalciuria, and kidney stones in long-term stud-ies of vitamin D supplementation: a systematic review and meta-analysis. Am J Clin Nutr 2016; 104(4): 1039‒51.

Taheri M, Tavasoli S, Shokrzadeh F, Amiri FB, Basiri A. Effect of vitamin D supplementation on 24-hour urine calcium in patients with calcium Urolithiasis and vitamin D deficiency. Int Braz J Urol 2019; 45(2): 340‒6.

Letavernier E, Daudon M. Vitamin D, Hypercalciuria and Kid-ney Stones. Nutrients 2018; 10(3): 366.

Leaf DE, Korets R, Taylor EN, Tang J, Asplin JR, Goldfarb DS, et al. Effect of Vitamin D Repletion on Urinary Calcium Ex-cretion among Kidney Stone Formers. CJASN 2012; 7(5): 829‒34.