Vitamin D Deficiency and Glycemic Status in Children and Adolescents with Type 1 Diabetes Mellitus

Silvia Savastio, Francesco Cadario, Giulia Genoni, Giorgio Bellomo, Marco Bagnati, Gioel Secco, Raffaella Picchi, Enza Giglione, Gianni Bona, Silvia Savastio, Francesco Cadario, Giulia Genoni, Giorgio Bellomo, Marco Bagnati, Gioel Secco, Raffaella Picchi, Enza Giglione, Gianni Bona

Abstract

Background: Vitamin D (25OHD) effects on glycemic control are unclear in children and adolescents with type 1 diabetes. Aims of this study were to investigate 25OHD status among children with T1DM and its relationship with insulin sensitivity and glycemic status.

Subjects and methods: A cross sectional study was carried out between 2008-2014. A total of 141 patients had a T1DM >12 months diagnosis and were enrolled in the present study. Of these 35 (24.8%) were migrants and 106 (75.2%) Italians (T2). We retrospectively analyzed data at the onset of the disease (T0)(64 subjects) and 12-24 months before the last visit (T1,124 subjects). Fasting glucose, glycated hemoglobin (HbA1c), 25OHD levels and daily insulin requirement were evaluated and Cholecalciferol 1000 IU/day supplementation for the management of vitamin D insufficiency (<75 nmol/L) was systematically added.

Results: A generalized 25OHD insufficiency was found at each study time, particularly in migrants. At T0, the 25OHD levels were inversely related to diabetic keto-acidosis (DKA) severity (p<0.05). At T1 and T2, subjects with 25OHD ≤25nmol/L (10 ng/mL) showed higher daily insulin requirement (p<0.05) and HbA1c values (p<0.01) than others vitamin D status. The 25OHD levels were negatively related with HbA1c (p<0.001) and daily insulin dose (p<0.05) during follow up. There was a significant difference in 25OHD (p<0.01) between subjects with different metabolic control (HbA1c <7.5%,7.5-8%,>8%), both at T1 and T2. In supplemented subjects, we found a significant increase in 25OHD levels (p<0.0001) and decrease of HbA1c (p<0.001) between T1 and T2, but this was not significant in the migrants subgroup. Multivariate regression analysis showed a link between HbA1c and 25OHD levels (p<0.001).

Conclusions: Children with T1DM show a generalized 25OHD deficiency that impact on metabolic status and glycemic homeostasis. Vitamin D supplementation improves glycemic control and should be considered as an additional therapy.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Vitamin D (25OHD) levels (nmol/L)…
Fig 1. Vitamin D (25OHD) levels (nmol/L) according to glycated hemoglobin (HbA1c) levels (%).
On each bar graph are reported the number of subjects (n); * = p

Fig 2. Vitamin D (25OHD, nmol/L) and…

Fig 2. Vitamin D (25OHD, nmol/L) and glycated hemoglobin (HbA1c, %) levels in the whole…

Fig 2. Vitamin D (25OHD, nmol/L) and glycated hemoglobin (HbA1c, %) levels in the whole population (ALL), in Italian (ITA) and in migrant (M) subjects according to vitamin D supplementation.
* = p

Fig 3. Correlation for Vitamin D (25OHD,…

Fig 3. Correlation for Vitamin D (25OHD, nmol/L) with metabolic/ biochemical parameters in all subjects…

Fig 3. Correlation for Vitamin D (25OHD, nmol/L) with metabolic/ biochemical parameters in all subjects at three times (T0, T1, T2).
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The paper is part of a project (RF-2010-2304835) funded by the Ministry of Health. The grant had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Fig 2. Vitamin D (25OHD, nmol/L) and…
Fig 2. Vitamin D (25OHD, nmol/L) and glycated hemoglobin (HbA1c, %) levels in the whole population (ALL), in Italian (ITA) and in migrant (M) subjects according to vitamin D supplementation.
* = p

Fig 3. Correlation for Vitamin D (25OHD,…

Fig 3. Correlation for Vitamin D (25OHD, nmol/L) with metabolic/ biochemical parameters in all subjects…

Fig 3. Correlation for Vitamin D (25OHD, nmol/L) with metabolic/ biochemical parameters in all subjects at three times (T0, T1, T2).
Fig 3. Correlation for Vitamin D (25OHD,…
Fig 3. Correlation for Vitamin D (25OHD, nmol/L) with metabolic/ biochemical parameters in all subjects at three times (T0, T1, T2).

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