The effects of vitamin D supplementation on hepatic dysfunction, vitamin D status, and glycemic control in children and adolescents with vitamin D deficiency and either type 1 or type 2 diabetes mellitus

Benjamin Udoka Nwosu, Louise Maranda, Benjamin Udoka Nwosu, Louise Maranda

Abstract

Background: The effects of vitamin D supplementation on mild hepatic dysfunction and glycemic control are unclear in children and adolescents with either type 1 (T1D) or type 2 diabetes (T2D).

Hypothesis: Vitamin D supplementation will improve hepatic dysfunction and glycemic control.

Aim: To determine the effect of vitamin D supplementation on alanine transaminase (ALT), hemoglobin A1c (HbA1c), and serum 25-hydroxyvitamin D [25(OH)D] concentration.

Subjects and methods: A retrospective study of 131 subjects with either T1D (n = 88 ∶ 46 females, 42 males), or T2D (n = 43 ∶ 26 females, 17 males) of ages 3-18 years between 2007-2013. All subjects had (1) a diagnosis of diabetes for > 12 mo, (2) received vitamin D supplementation for the management of vitamin D deficiency (3) had baseline and subsequent simultaneous measurements of HbA1c, ALT, and 25(OH)D. Vitamin D deficiency was defined as 25(OH)D concentration of < 50 nmol/L (20 ng/mL).

Results: At baseline, vitamin D deficiency occurred in 72.1% of patients with T2D and in 37.5% of T1D patients (p < 0.001). Patients with T2D had significantly higher values for BMI SDS (p < 0.001), alanine transaminase (ALT) (p = 0.001), but lower 25(OH)D p < 0.001), and no difference in HbA1c (p = 0.94), and total daily dose (TDD) of insulin per kg body weight (p = 0.48) as compared to T1D patients. After 3 months of vitamin D supplementation, there was a significant increase in 25(OH)D in both T2D (p = 0.015), and T1D patients (p < 0.001); significant reduction in BMI SDS (p = 0.015) and ALT (p = 0.012) in T2D, but not in T1D. There was a clinically-significant decrease in HbA1c in T2D from 8.5 ± 2.9% at baseline to 7.7 ± 2.5 at 3 mo, but not in T1D, 8.5 ± 1.2 to 8.53 ± 1.1%.

Conclusions: Vitamin D supplementation in subjects with T2D was associated with statistically significant decreases in BMI SDS, ALT, and a clinically-significant decrease in HbA1c.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Graph showing a rise in…
Figure 1. Graph showing a rise in the serum concentrations of 25-hydroxyvitamin D [25(OH)D] during vitamin D supplementation in patients with either type 1 diabetes or type 2 diabetes.
In patients with type 1 diabetes, 25(OH)D rose from a baseline of 53.3±14.6 nmol/L to a peak of 67.6±20.6 at 3 mo, and then decreased to 62.4±18.4 (ANOVA p

Figure 2. Bar graph showing the temporal…

Figure 2. Bar graph showing the temporal change in the levels of alanine transaminases (ALT)…

Figure 2. Bar graph showing the temporal change in the levels of alanine transaminases (ALT) following vitamin D supplementation.
ALT decreased from 18.0±6.0 U/L to 15.7±2.0 (p = 0.46) in patients with type 1 diabetes; and from 50.7±50.9 to 35.0±31.0 (p = 0.012) in those with type 2 diabetes.

Figure 3. A 9-month analysis of the…

Figure 3. A 9-month analysis of the changes in hemoglobin A1c (HbA1c) level following a…

Figure 3. A 9-month analysis of the changes in hemoglobin A1c (HbA1c) level following a three-month vitamin D supplementation in patients with either type 1 diabetes or type 2 diabetes.
There was a statistically-significant, but clinically non-significant rise in HbA1c level over 9 months in T1D (8.5±1.2 through 8.9±1.2%, ANOVA p = 0.001). In T2D, there was a clinically significant decrease in HbA1c in the first 3 months (during the period of vitamin D supplementation) from 8.5±2.9% at baseline through 7.7±2.5% at 3 mo, followed by a slow return to pretreatment values of 8.2±2.3% at 9 mo. There was however, no statistical significant difference in HbA1c between the time points (ANOVA p = 0.52).
Figure 2. Bar graph showing the temporal…
Figure 2. Bar graph showing the temporal change in the levels of alanine transaminases (ALT) following vitamin D supplementation.
ALT decreased from 18.0±6.0 U/L to 15.7±2.0 (p = 0.46) in patients with type 1 diabetes; and from 50.7±50.9 to 35.0±31.0 (p = 0.012) in those with type 2 diabetes.
Figure 3. A 9-month analysis of the…
Figure 3. A 9-month analysis of the changes in hemoglobin A1c (HbA1c) level following a three-month vitamin D supplementation in patients with either type 1 diabetes or type 2 diabetes.
There was a statistically-significant, but clinically non-significant rise in HbA1c level over 9 months in T1D (8.5±1.2 through 8.9±1.2%, ANOVA p = 0.001). In T2D, there was a clinically significant decrease in HbA1c in the first 3 months (during the period of vitamin D supplementation) from 8.5±2.9% at baseline through 7.7±2.5% at 3 mo, followed by a slow return to pretreatment values of 8.2±2.3% at 9 mo. There was however, no statistical significant difference in HbA1c between the time points (ANOVA p = 0.52).

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