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Reasons to suspect Diabetes is related to low vitamin D – Jan 2018

Associations of vitamin D with insulin resistance, obesity, type 2 diabetes, and metabolic syndrome

The Journal of Steroid Biochemistry and Molecular Biology, Vol 175, Jan 2018, Pages 177-189. https://doi.org/10.1016/j.jsbmb.2016.09.017
Sunil J.Wimalawansa MD, PhD, MBA, FRCP, FACP, FRCPath, Dsc (Professor of Medicine)
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Highlights

  • Hypovitaminosis D: is inversely correlates with obesity and stroke.
  • Associate with increased CVD, myocardial infarction, diabetes, and mortality.
  • Associate with metabolic syndrome (hypertension, low HDL, and insulin resistance).
  • Sunscreen with greater than 12 sun protection factor (SPF), prevents generation of vitamin D.
  • Increased safe exposure to sun and consuming vitamin D-fortified foods are encouraged.
  • Supplements are necessary however, for those who cannot obtain adequate amounts.
VitaminDWiki

Overview Diabetes and vitamin D contains the following summary

  • Diabetes is 5X more frequent far from the equator
  • Children getting 2,000 IU of vitamin D are 8X less likely to get Type 1 diabetes
  • Obese people get less sun / Vitamin D - and also vitamin D gets lost in fat
  • Sedentary people get less sun / Vitamin D
  • Worldwide Diabetes increase has been concurrent with vitamin D decrease and air conditioning
  • Elderly get 4X less vitamin D from the same amount of sun
        Elderly also spend less time outdoors and have more clothes on
  • All items in category Diabetes and Vitamin D 443 items: both Type 1 and Type 2

Vitamin D appears to both prevent and treat diabetes

  • Appears that >2,000 IU will Prevent
  • Appears that >4,000 IU will Treat , but not cure
  • Appears that Calcium and Magnesium are needed for both Prevention and Treatment
    • which are just some of the vitamin D cofactors

Number of articles in both categories of Diabetes and:

  • Dark Skin 22;   Intervention 47;   Meta-analysis 28;   Obesity 26;  Pregnancy 39;   T1 (child) 33;  Omega-3 10;  Vitamin D Receptor 17;  Genetics 9;  Magnesium 18    Click here to see details

Diabetes category starts with the following

443 items In Diabetes category

see also Overview Diabetes and vitamin D  Overview Metabolic Syndrome and vitamin D

Autoimmune category listing has 162 items along with related searches

T1 diabetes OR type1 diabetes in title 107 as of April 2018
prediabetes OR prediabetic 336 items as of Jan 2018
Search VitaminDWiki for Peripheral Neuropathy 238 items April 2018

 Download the PDF from VitaminDWiki

The aim of this study is to determine the relationships of vitamin D with diabetes, insulin resistance obesity, and metabolic syndrome. Intra cellular vitamin D receptors and the 1-α hydroxylase enzyme are distributed ubiquitously in all tissues suggesting a multitude of functions of vitamin D. It plays an indirect but an important role in carbohydrate and lipid metabolism as reflected by its association with type 2 diabetes (T2D), metabolic syndrome, insulin secretion, insulin resistance, polycystic ovarian syndrome, and obesity. Peer-reviewed papers, related to the topic were extracted using key words, from PubMed, Medline, and other research databases. Correlations of vitamin D with diabetes, insulin resistance and metabolic syndrome were examined for this evidence-based review. In addition to the well-studied musculoskeletal effects, vitamin D decreases the insulin resistance, severity of T2D, prediabetes, metabolic syndrome, inflammation, and autoimmunity. Vitamin D exerts autocrine and paracrine effects such as direct intra-cellular effects via its receptors and the local production of 1,25(OH)2D3, especially in muscle and pancreatic β-cells. It also regulates calcium homeostasis and calcium flux through cell membranes, and activation of a cascade of key enzymes and cofactors associated with metabolic pathways. Cross-sectional, observational, and ecological studies reported inverse correlations between vitamin D status with hyperglycemia and glycemic control in patients with T2D, decrease the rate of conversion of prediabetes to diabetes, and obesity.
However, no firm conclusions can be drawn from current studies, because

  • (A) studies were underpowered;
  • (B) few were designed for glycemic outcomes,
  • (C) the minimum (or median) serum 25(OH) D levels achieved are not measured or reported;
  • (D) most did not report the use of diabetes medications;
  • (E) some trials used too little
  • (F) others used too large, unphysiological and infrequent doses of vitamin D; and
  • (G) relative paucity of rigorous clinical data on the effects of vitamin D sufficiency on non-calcium endpoints.

Although a large number of observational studies support improving T2D, insulin resistance, obesity, and metabolic syndrome with vitamin D adequacy, there is a lack of conclusive evidence from randomized control clinical trials that, these disorders are prevented following optimization of serum levels of 25(OH)D. However, none of the currently conducted clinical studies would resolve these issues. Thus, specifically designed, new clinical studies are needed to be conducted in well-defined populations, following normalizing the serum vitamin D levels in vitamin D deficient prediabetes subjects, to test the hypothesis that hypovitaminosis D worsens these disorders and correction would alleviate it.

Table 1 Relationships between vitamin D and diabetes

Scientific correlations between vitamin D and diabetes:

  • Beta-cells contain vitamin D receptors
  • 1,25(OH)2D stimulates insulin release
  • Insulin “release” is reduced in vitamin D-deficient animals (and in humans)
  • 1,25(OH)2D prevents development of diabetes in the NOD mouse
  • Recent meta-analyses show association of low vitamin D status with increased risk of BOTH type 1 and type 2 diabetes

Vitamin D and function of pancreatic b-cells:

  • Association between vitamin D and physiological functions of pancreatic b-cells
  • b-cells possess VDRs, and 1a-hydroxylase is expressed in pancreatic islet tissues
  • Vitamin D deficiency impairs glucose-mediated insulin release
  • Insulin secretion is calcium dependent and calcium homeostasis depends on vitamin D
  • Vitamin D supplements improve insulin release in response to oral glucose load and reduce free fatty acid levels

Vitamin D deficiency worsens diabetes:

  • Diabetes is 5 times more common in non-equatorial areas
  • Children getting 2000 IU of vitamin D are 8 times less likely to develop type 1 diabetes
  • Sedentary and obese people get less sun exposure and thus have less vitamin D
  • Worldwide, diabetes increases in parallel with vitamin D deficiency
  • Elderly and those with dark skin get 3-6 times less vitamin D from the same amount of sun exposure

Concerns related to clinical study data:

  • Lack of adequately powered, randomized controlled, clinical studies
  • Among the vitamin D intervention studies done, virtually none were designed for glycemic outcomes
  • Measurements of minimum (or median) serum 25(OH)D levels achieved were not reported;
  • Most did not report the use of diabetes (or even other) concomitant use of medications
  • Some trials used too little doses of vitamin D (e.g., <800 IU) above to bring serum vitamin D levels beyond 30ng/mL
  • Others studies used too large, unphysiological and infrequent doses of vitamin D that will not maintain serum 25(OH)D concentrations throughout the study period
  • Even the larger studies that are currently done are poorly designed to test vitamin D related hypotheses and hard endpoints
  • Relative paucity of rigorous clinical data on the effects of vitamin D sufficiency on non-calcium endpoints.

Created by admin. Last Modification: Tuesday March 20, 2018 17:40:17 GMT-0000 by admin. (Version 3)

Attached files

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9556 Diabetes, Meta Synd Wimalawansa.pdf PDF 2018 admin 20 Mar, 2018 17:28 2.12 Mb 62
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