Correlation between serum vitamin D levels, glycemic variability, and insulin resistance in prediabetic subjects. A retrospective study.

Bibhu Pada  Hota; Deepak Kumar  Naik; Duryodhan  Sahoo

doi:10.51168/sjhrafrica.v6i12.2331

Authors

Bibhu Pada Hota Assistant Professor, Department of General Medicine, Dharanidhar Medical College & Hospital, Keonjhar, Odisha
Deepak Kumar Naik Assistant Professor, Department of General Medicine, Dharanidhar Medical College & Hospital, Keonjhar, Odisha
Duryodhan Sahoo Assistant Professor, Department of Biochemistry, Dharanidhar Medical College & Hospital, Keonjhar, Odisha

DOI:

https://doi.org/10.51168/sjhrafrica.v6i12.2331

Keywords:

Serum Vitamin D, Glycemic Variability, Insulin Resistance, Prediabetic, Retrospective Study

Abstract

Background

Impaired glucose tolerance or impaired fasting glucose are hallmarks of prediabetes, a crucial transitional stage that frequently precedes Type 2 Diabetes Mellitus (T2DM). There is growing evidence that glucose homeostasis is significantly impacted by deficiencies in micronutrients, especially vitamin D (25-hydroxyvitamin D). In India, vitamin D insufficiency is still common despite the country's abundant sunshine.

Objective

In a prediabetic cohort in Keonjhar, Odisha, this study attempts to assess the relationship between serum vitamin D levels, insulin resistance (HOMA-IR), and glycemic variability.

Methods

Over the course of a year, a retrospective observational study was carried out at a tertiary medical facility in Keonjhar. 250 participants with prediabetes (HbA1c 5.7–6.4%) between the ages of 30 and 60 were enrolled in the study. Medical records were consulted for information on anthropometry, fasting plasma glucose (FPG), post-prandial glucose (PPG), HbA1c, fasting insulin, and serum 25(OH)D. The Homeostatic Model Assessment (HOMA-IR) was used to calculate insulin resistance. The standard deviation of FPG (SD-FPG) over the follow-up period was used to measure glycemic variability (GV).

Results

Widespread insufficiency was shown by the mean blood vitamin D level of
. Vitamin D levels and HOMA-IR showed a significant inverse connection
Additionally, glycemic variability (SD-FPG) was considerably higher in patients with severe vitamin D insufficiency () than in those with sufficient levels ().

Conclusion

In prediabetic individuals in Keonjhar, vitamin D deficiency is substantially linked to increased insulin resistance and unstable glycemic control. In this area, treating hypovitaminosis D may be a good way to postpone the onset of type 2 diabetes.

Recommendation

Given the significant frequency of vitamin D insufficiency and its correlation with metabolic dysregulation in prediabetes, including vitamin D status assessment into standard prediabetes screening techniques may provide a cost-effective means for early metabolic risk stratification. Additional prospective studies are necessary.

References

Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. The Lancet. 2012 Jun 16;379(9833):2279-90.

Misra A, Khurana L. The metabolic syndrome in South Asians: epidemiology, determinants, and prevention. Metabolic syndrome and related disorders. 2009 Dec 1;7(6):497-514.

Wolden-Kirk H, Overbergh L, Christesen HT, Brusgaard K, Mathieu C. Vitamin D and diabetes: its importance for beta cell and immune function. Molecular and cellular endocrinology. 2011 Dec 5;347(1-2):106-20.

Draznin B, Sussman KE, Eckel RH, Kao M, Yost T, Sherman NA. Possible role of cytosolic free calcium concentrations in mediating insulin resistance of obesity and hyperinsulinemia. The Journal of clinical investigation. 1988 Dec 1;82(6):1848-52.

Alvarez JA, Ashraf A. Role of vitamin D in insulin secretion and insulin sensitivity for glucose homeostasis. International journal of endocrinology. 2010;2010(1):351385.

Harinarayan CV, Ramalakshmi T, Prasad UV, Sudhakar D. Vitamin D status in Andhra Pradesh: A population based study. 1. Indian Journal of Medical Research. 2008 Mar 1;127(3):211-8.

Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, Colette C. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. Jama. 2006 Apr 12;295(14):1681-7.

American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2021. Diabetes care. 2021 Jan 1;44(Supplement_1):S15-33.

Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of clinical endocrinology & metabolism. 2011 Jul 1;96(7):1911-30.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner R. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. diabetologia. 1985 Jul;28(7):412-9.

Marwaha RK, Tandon N, Reddy DR, Aggarwal R, Singh R, Sawhney RC, Saluja B, Ganie MA, Singh S. Vitamin D and bone mineral density status of healthy schoolchildren in northern India. The American journal of clinical nutrition. 2005 Aug 1;82(2):477-82.

Rattan R, Sahoo D, Mahapatra S. Prevalence of Vitamin D deficiency in adults in the coastal regions of Odisha, India. IOSR J Pharm Biol Sci. 2016;11(6):49-52.

Dutta D, Maisnam I, Shrivastava A, Sinha A, Ghosh S, Mukhopadhyay P, Mukhopadhyay S, Chowdhury S. Serum vitamin-D predicts insulin resistance in individuals with prediabetes. Indian Journal of Medical Research. 2013 Dec 1;138(6):853-60.

Park S, Kim DS, Kang S. Vitamin D deficiency impairs glucose-stimulated insulin secretion and increases insulin resistance by reducing PPAR-γ expression in nonobese Type 2 diabetic rats. The Journal of nutritional biochemistry. 2016 Jan 1;27:257-65.

Ceriello A, Kilpatrick ES. Glycemic variability: both sides of the story. Diabetes Care. 2013 Jul 17;36(Suppl 2):S272.

Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2007 Jun 1;92(6):2017-29.