Advertisement

25-Hydroxyvitamin D and glycemic control: A cross-sectional study of children and adolescents with type 1 diabetes

      Highlights

      • To our knowledge this is the first study that has been adequately-powered to examine the association between 25-hydroxyvitamin D and HbA1c in children and adolescents with T1DM.
      • The association between 25-hydroxyvitamin D and HbA1c was not positive, calling for longitudinal studies to confirm these findings.
      • This study demonstrated the high prevalence of patients with low levels of 25-hydroxyvitamin D specifically in healthy weight and Caucasian children and adolescents with T1DM.
      • These data suggest the need for monitoring of 25-hydroxyvitamin D in all youth with T1DM.

      Abstract

      Aim

      The objective of this study was to describe the vitamin D status of children and adolescents with type 1 diabetes and to evaluate whether levels of 25-hydroxyvitamin D are significantly associated with HbA1c in this population.

      Methods

      197 children and adolescents from a diabetes center in a children's hospital were recruited during regular follow up visit. Non-fasting blood samples were collected to measure 25-hydroxyvitamin D and blood glucose levels. HbA1c and other key variables were abstracted from patients’ medical records.

      Results

      Of the 197 children and adolescents, more than half were adolescents, males, and Caucasian. 23% were overweight, while 13% were obese. Mean HbA1c was 8.6 ± 1.4% (70 ± 15.3 mmol/mol). 40.6% of patients had 25-hydroxyvitamin D levels ≤50 nmol/L; 49.2% had 25-hydroxyvitamin D levels between 51 and 75 nmol/L and 10.2% had 25-hydroxyvitamin D levels >75 nmol/L. The bivariate relationship between 25-hydroxyvitamin D and HbA1c almost reached statistical significance (P = 0.057), while no significance was established in the multivariate model.

      Conclusions

      To the best of our knowledge this is the first study that has been adequately-powered to examine the association between 25-hydroxyvitamin D and HbA1c in children and adolescents with T1DM. This study demonstrated the high prevalence of patients with low levels of 25-hydroxyvitamin D specifically in healthy weight and Caucasian children and adolescents with T1DM. These data suggest the need for monitoring of 25-hydroxyvitamin D in all youth with T1DM.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bouillon R.
        • Carmeliet G.
        • Verlinden L.
        • van Etten E.
        • Verstuyf A.
        • Luderer H.F.
        • et al.
        Vitamin D and human health: lessons from vitamin D receptor null mice.
        Endocr Rev. 2008; 29: 726-776https://doi.org/10.1210/er.2008-0004
        • Holick M.F.
        Vitamin D: a D-lightful health perspective.
        Nutr Rev. 2008; 66: S182-S194https://doi.org/10.1111/j.1753-4887.2008.00104.x
        • Scragg R.
        • Sowers M.
        • Bell C.
        Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey.
        Am J Hypertens. 2007; 20: 713-719https://doi.org/10.1016/j.amjhyper.2007.01.017
        • Kumar J.
        • Muntner P.
        • Kaskel F.J.
        • Hailpern S.M.
        • Melamed M.L.
        Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004.
        Pediatrics. 2009; 124: e362-e370https://doi.org/10.1542/peds.2009-0051
        • Au L.E.
        • Rogers G.T.
        • Harris S.S.
        • Dwyer J.T.
        • Jacques P.F.
        • Sacheck J.M.
        Associations of vitamin D intake with 25-hydroxyvitamin D in overweight and racially/ethnically diverse US children.
        J Acad Nutr Diet. 2013; 113: 1511-1516https://doi.org/10.1016/j.jand.2013.05.025
        • Holick M.F.
        • Binkley N.C.
        • Bischoff-Ferrari H.A.
        • Gordon C.M.
        • Hanley D.A.
        • Heaney R.P.
        • et al.
        Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.
        J Clin Endocrinol Metab. 2011; 96: 1911-1930https://doi.org/10.1210/jc.2011-0385
        • Joergensen C.
        • Hovind P.
        • Schmedes A.
        • Parving H.H.
        • Rossing P.
        Vitamin D levels, microvascular complications, and mortality in type 1 diabetes.
        Diabetes Care. 2011; 34: 1081-1085https://doi.org/10.2337/dc10-2459
        • Mohr S.B.
        • Garland C.F.
        • Gorham E.D.
        • Garland F.C.
        The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide.
        Diabetologia. 2008; 51: 1391-1398https://doi.org/10.1007/s00125-008-1061-5
        • Brekke H.K.
        • Ludvigsson J.
        Vitamin D supplementation and diabetes-related autoimmunity in the ABIS study.
        Pediatr Diabetes. 2007; 8: 11-14https://doi.org/10.1111/j.1399-5448.2006.00223.x
        • Hypponen E.
        • Laara E.
        • Reunanen A.
        • Jarvelin M.R.
        • Virtanen S.M.
        Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study.
        Lancet. 2001; 358: 1500-1503https://doi.org/10.1016/S0140-6736(01)06580-1
        • Delvin E.E.
        • Lambert M.
        • Levy E.
        • O’Loughlin J.
        • Mark S.
        • Gray-Donald K.
        • et al.
        Vitamin D status is modestly associated with glycemia and indicators of lipid metabolism in French-Canadian children and adolescents.
        J Nutr. 2010; 140: 987-991https://doi.org/10.3945/jn.109.112250
        • Lévy-Marchal C.
        • Patterson C.
        • Green A.
        Variation by age group and seasonality at diagnosis of childhood IDDM in Europe. The EURODIAB ACE Study Group.
        Diabetologia. 1995; 38: 823-830
        • Gysemans C.A.
        • Cardozo A.K.
        • Callewaert H.
        • Giulietti A.
        • Hulshagen L.
        • Bouillon R.
        • et al.
        1,25-Dihydroxyvitamin D3 modulates expression of chemokines and cytokines in pancreatic islets: Implications for prevention of diabetes in nonobese diabetic mice.
        Endocrinology. 2005; 146: 1956-1964https://doi.org/10.1210/en.2004-1322
        • Mathieu C.
        • Laureys J.
        • Sobis H.
        • Vandeputte M.
        • Waer M.
        • Bouillon R.
        1,25-Dihydroxyvitamin D3 prevents insulitis in NOD mice.
        Diabetes. 1992; 41: 1491-1495
        • Giulietti A.
        • Gysemans C.
        • Stoffels K.
        • van Etten E.
        • Decallonne B.
        • Overbergh L.
        • et al.
        Vitamin D deficiency in early life accelerates type 1 diabetes in non-obese diabetic mice.
        Diabetologia. 2004; 47: 451-462https://doi.org/10.1007/s00125-004-1329-3
        • Gregori S.
        • Giarratana N.
        • Smiroldo S.
        • Uskokovic M.
        • Adorini L.
        A 1alpha,25-dihydroxyvitamin D(3) analog enhances regulatory T-cells and arrests autoimmune diabetes in NOD mice.
        Diabetes. 2002; 51: 1367-1374
        • Mathieu C.
        • Waer M.
        • Laureys J.
        • Rutgeerts O.
        • Bouillon R.
        Prevention of autoimmune diabetes in NOD mice by 1,25-dihydroxyvitamin D3.
        Diabetologia. 1994; 37: 552-558
        • Johnson M.D.
        • Nader N.S.
        • Weaver A.L.
        • Singh R.
        • Kumar S.
        Relationships between 25-hydroxyvitamin D levels and plasma glucose and lipid levels in pediatric outpatients.
        J Pediatr. 2010; 156: 444-449https://doi.org/10.1016/j.jpeds.2009.09.070
        • Scragg R.
        • Sowers M.
        • Bell C.
        • Third National Health and Nutrition Examination Survey
        Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the third national health and nutrition examination survey.
        Diabetes Care. 2004; 27: 2813-2818
        • Chiu K.C.
        • Chu A.
        • Go V.L.
        • Saad M.F.
        Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction.
        Am J Clin Nutr. 2004; 79: 820-825
        • Knekt P.
        • Laaksonen M.
        • Mattila C.
        • Härkänen T.
        • Marniemi J.
        • Heliövaara M.
        • et al.
        Serum vitamin D and subsequent occurrence of type 2 diabetes.
        Epidemiology. 2008; 19: 666-671https://doi.org/10.1097/EDE.0b013e318176b8ad
        • Mutlu A.
        • Mutlu G.Y.
        • Ozsu E.
        • Cizmecioglu F.M.
        • Hatun S.
        Vitamin D deficiency in children and adolescents with type 1 diabetes.
        J Clin Res Pediatr Endocrinol. 2011; 3: 179-183
        • Tunc O.
        • Cetinkaya S.
        • Kizilgun M.
        • Aycan Z.
        Vitamin D status and insulin requirements in children and adolescents with type 1 diabetes.
        J Pediatr Endocr Met. 2011; 24: 1037-1041
        • Ordooei M.
        • Shojaoddiny-Ardekani A.
        • Hoseinipoor S.H.
        • Soleimanizad R.
        • Miroliai M.
        • Zare-Zardini H.
        Effect of vitamin D on HbA1c levels of children and adolescents with diabetes mellitus type 1.
        Minerva Pediatr. 2014; ([Epub ahead of print])
        • Eisman J.A.
        • Shepard R.M.
        • DeLuca H.F.
        Determination of 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 in human plasma using high-pressure liquid chromatography.
        Anal Biochem. 1977; 80: 298-305
        • Petitti D.B.
        • Klingensmith G.J.
        • Bell R.A.
        • Andrews J.S.
        • Dabelea D.
        • Imperatore G.
        • et al.
        Glycemic control in youth with diabetes: the SEARCH for diabetes in youth study.
        J Pediatr. 2009; 155 (668–72.e1-3)https://doi.org/10.1016/j.jpeds.2009.05.025
        • Kelly A.
        • Brooks L.J.
        • Dougherty S.
        • Carlow D.C.
        • Zemel B.S.
        A cross-sectional study of vitamin D and insulin resistance in children.
        Arch Dis Child. 2011; 96: 447-452https://doi.org/10.1136/adc.2010.187591
        • Weng F.L.
        • Shults J.
        • Leonard M.B.
        • Stallings V.A.
        • Zemel B.S.
        Risk factors for low serum 25-hydroxyvitamin D concentrations in otherwise healthy children and adolescents.
        Am J Clin Nutr. 2007; 86: 150-158
        • Svoren B.M.
        • Volkening L.K.
        • Wood J.R.
        • Laffel L.M.
        Significant vitamin D deficiency in youth with type 1 diabetes mellitus.
        J Pediatr. 2009; 154: 132-134https://doi.org/10.1016/j.jpeds.2008.07.015
        • Simmons J.H.
        • Raines M.
        • Ness K.D.
        • Hall R.
        • Gebretsadik T.
        • Mohan S.
        • et al.
        Metabolic control and bone health in adolescents with type 1 diabetes.
        Int J Pediatr Endocrinol. 2011; 2011: 13https://doi.org/10.1186/1687-9856-2011-13
        • Mansbach J.M.
        • Ginde A.A.
        • Camargo Jr., C.A.
        Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D?.
        Pediatrics. 2009; 124: 1404-1410https://doi.org/10.1542/peds.2008-2041
        • Holick M.F.
        Vitamin D deficiency.
        N Engl J Med. 2007; 357: 266-281https://doi.org/10.1056/NEJMra070553
        • Alemzadeh R.
        • Kichler J.
        • Babar G.
        • Calhoun M.
        Hypovitaminosis D in obese children and adolescents: relationship with adiposity, insulin sensitivity, ethnicity, and season.
        Metabolism. 2008; 57: 183-191https://doi.org/10.1016/j.metabol.2007.08.023