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Patients having both Diabetes and TB treated by vitamin D – June 2012

Response to Vitamin D Supplementation in Type 2 Diabetes Patients with Pulmonary Tuberculosis

Endocr Rev, Vol. 33 (03_MeetingAbstracts): SAT-168
Copyright © 2012 by The Endocrine Society ENDO 2012: June 23-26, 2012, Houston, Texas
Sunil K Kota, MD1, Siva K Kota, MD, DNB2, Svs Krishna, MD1, Lalit K Meher, MD3 and Kirtikumar D Modi, DM, DNB1
1 Endocrinology, Medwin Hospital Hyderabad, India
2 Anesthesia, Central Security Hospital Riyadh, Saudi Arabia
3 Medicine, MKCG Medical College Berhampur, India

Objective:To evaluate effects of vitamin D supplementation on type 2 diabetes mellitus (T2DM) patients with pulmonary tuberculosis(PTB).

Methods:45 subjects (M:F= 34: 1) were screened.Inclusion criteria :Age>15 years,newly diagnosed PTB cases with uncontrolled T2DM, serum vitamin D<20 ng/ml.
The patients were randomly assigned to 2 groups.
Group 1 subjects received oral cholecalceferol (60000 units/week) and calcium carbonate (1 gm/day) along with anti tubercular treatment(ATT),
while group 2 subjects did not.

Sputum was checked at interval of 2 weeks for 12 weeks.
Primary end point was time to achieve sputum smear conversion.
Secondary end points were reduction in ESR and improvement in glycemic parameters.

Results:15 patients with vitamin D>20 ng/ml were excluded.So the prevalence of vitamin D deficiency in T2DM with PTB was 30/45 (66.66 %),with 25/34 males (73.5%)and 5/11 females (45.5%)were vitamin D deficient.
Mean age of patients (30) was 39.5±18.9 years with FBS 230.5±30.3 mg/dl,PLBS 320.5±45.6 mg/dl,HbA1C 10.4±4.4 % and 25(OH)D 12.1±4.3 ng/ml.
At end of 12 weeks, group 1 patients had significantly higher levels of serum 25(OH)D (25.4±6.9 ng/ml in group 1 versus 10.2±0.9 ng/ml in group 2).
Sputum smear conversion was 6 weeks in group 1 versus 8 weeks in group 2(p= 0.067).
Reduction in ESR was significant in group 1 vs group 2 (39.6 ± 12.4 mm/1st hr vs 24.0 ± 14.9, p-0.004).
Difference in the reduction in FBS, PLBS and HbA1C in the 2 groups did not attain statistical significance.

Discussion:Correlations exist between low vitamin D levels with PTB and T2DM separately.Calcitriol modulates response to mycobacterial infection by induction of reactive nitrogen and oxygen intermediate, suppression of matrix metalloproteinase enzymes implicated in pulmonary cavitation, and induction of antimicrobial peptide cathelicidin.Calcitriol modulates immune responses by binding vitamin D receptors expressed by antigen presenting cells and activated lymphocytes.

Several case series have reported utility of 25000 IU to 100000 IU vitamin D in improving patients' response to ATT (1). Vitamin D supplementation also increases lymphocyte to monocyte ratio, a biomarker of disease resolution.We provided vitamin D at the dosage of 60000 IU/week, and report a 2 weeks reduction in sputum smear conversion.Conclusion: Vitamin D may be the missing link between emerging epidemic of tuberculosis & diabetes.It can serve as adjuvant treatment of tuberculosis in diabetics with vitamin D deficiency.

1. Martineau AR, et al., J Steroid Biochem Mol Biol 2007; 103: 793.

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