LETTER TO THE EDITOR
The protectiveness of the treatment of vitamin D insufficiency in the development of diabetes
O efeito protetor do tratamento da insuficiência de vitamina D no desenvolvimento do diabetes
Omer KurtI; Sevket BaltaII; Mustafa CakarI; Erol ArslanI; Murat UnluII; Sait DemirkolII
IGulhane Medical Academy, Department of Internal Medicine, Ankara, Turkey
IIGulhane Medical Academy, Department of Cardiology, Ankara, Turkey
We read the article "High prevalence of vitamin D deficiency among newly diagnosed youth-onset diabetes mellitus in north India" written by Daga and cols. with interest (1). We find it is very valuable for the literature, as the study design was a prospective one. The authors showed that vitamin D levels were lower in patients with young-onset diabetes compared with healthy controls. They also showed the relationship between vitamin D deficiency and the development of diabetes.
Vitamin D is a major regulator of mineral homeostasis by means of its action in the kidneys, intestines, bones, and parathyroid glands. Apart from its traditional actions related to calcium, vitamin D and its synthetic analogs are being increasingly recognized for their anti-proliferative, pro-differentiative, insulin-secretagogue, and immunomodulatory activities (2). Vitamin D insufficiency has now reached epidemic proportions, even in healthy individuals living in tropical regions. Recent data suggest association of hypovitaminosis D with metabolic syndrome, immune diseases, inflammatory bowel diseases, hypertension and diabetes (3-5).
Accurate measurement of vitamin D levels is of great importance in such studies. Radioimmunoassay (RIA) was chosen in the study to measure vitamin D levels. The gold standard test for measuring vitamin D levels is liquid chromatography-tandem mass spectrometry (LC-MS/MS). In a study about the consistency of measurement methods of vitamin D, the accuracy of the RIA was determined as insufficient compared with LC-MS/MS, and HPLC was found to be adequate (6). We think that measuring the levels with HPLC instead of RIA could contribute to the study.
In addition, while converting to the active form, vitamin D gets hydroxylated in the liver and kidneys. Therefore, liver diseases, renal failure, and use of anticonvulsant drugs may affect the levels of vitamin D (7). In the present study, there was no exclusion criteria or basal characteristics defined for these situations. It would be better if these conditions were excluded from the study.
Finally, diabetes became a widespread, insidious, progressive epidemic disease, and has a high mortality and morbidity. We think that the best way to prevent this high mortality is to prevent diabetes from developing. Although many studies have been made about the protectiveness of the treatment of vitamin D insufficiency/deficiency in the development of diabetes, results is not clear yet. More comprehensive studies may be needed in this respect (8).
Disclosure: no potential conflict of interest relevant to this article was reported.
Received on Nov/25/2012
Accepted on Jan/10/2013
- 1. Daga RA, Laway BA, Shah ZA, Mir SA, Kotwal SK, Zargar AH. High prevalence of vitamin D deficiency among newly diagnosed youth-onset diabetes mellitus in north India. Arq Bras Endocrinol Metabol. 2012;56(7):423-8.
- 2. Muszkat P, Camargo MBR, Griz LHM, Lazaretti-Castro M. Evidence-based non-skeletal actions of vitamin D. Arq Bras Endocrinol Metabol. 2010;54(2):110-7.
- 3. Conrado T, Miranda-Filho D de B, Bandeira F. Vitamin D deficiency in HIV-infected individuals: one more risk factor for bone loss and cardiovascular disease? Arq Bras Endocrinol Metabol. 2010;54(2):118-22.
- 4. Peters BSE, Roque JP, Fisberg M, Martini LA. [There are no association between vitamin D metabolites and blood pressure in adolescents]. Arq Bras Endocrinol Metabol. 2009;53(4):416-24.
- 5. Souza HN de, Lora FL, Kulak CAM, Mañas NCP, Amarante HMB, Borba VZC. [Low levels of 25-hydroxyvitamin D (25OHD) in patients with inflammatory bowel disease and its correlation with bone mineral density]. Arq Bras Endocrinol Metabol. 2008;52(4):684-91.
- 6. Maunsell Z, Wright DJ, Rainbow SJ. Routine isotope-dilution liquid chromatography-tandem mass spectrometry assay for simultaneous measurement of the 25-hydroxy metabolites of vitamins D2 and D3. Clin Chem. 2005;51(9):1683-90.
- 7. Nwosu BU, Stavre ZG, Maranda L, Cullen K, Lee MM. Hepatic dysfunction is associated with vitamin D deficiency and poor glycemic control in diabetes mellitus. J Pediatr Endocrinol Metab. 2012;25(1-2):181-6.
- 8. Yilmaz H, Kaya M, Sahin M, Delibasi T. Is vitamin D status a predictor glycaemic regulation and cardiac complication in type 2 diabetes mellitus patients? Diabetes Metab Syndr. 2012;6(1):28-31.
Correspondence to:Sevket BaltaDepartment of CardiologyGulhane School of Medicine,Tevfik Saglam St.06018 Etlik-Ankara, Turkey
Publication in this collection
19 Mar 2013
Date of issue