Department of Medicine, Section of Endocrinology, Jesse Brown VA Medical Center and University of Illinois, Chicago, Illinois, USA.
Endocr Pract. 2010 May-Jun;16(3):476-85. doi: 10.4158/EP09195.RA.
To review the role of vitamin D in prediabetes on the basis of evidence from human studies.
English-language literature in MEDLINE (January 1969-July 2009) was searched for observational studies and randomized controlled trials of vitamin D deficiency and treatment in prediabetes, including impaired fasting glucose, impaired glucose tolerance, and metabolic syndrome. Search terms included hyperglycemia, glucose, glycohemoglobin, insulin resistance, diabetes, homeostasis model assessment, insulin secretion, vitamin D, and related terms. Publications were also identified from review articles and references in the found articles. Abstracts, conference proceedings, case reports, and letters were excluded. Articles concerning only type 1 and type 2 diabetes, hemodialysis, or hyperparathyroidism and studies in children were also excluded.
Vitamin D insufficiency is defined by a circulating 25-hydroxyvitamin D concentration less than 30 ng/mL, and it is prevalent in the United States (77% of the population). Most cross-sectional and prospective studies in various populations show inverse association between circulating 25-hydroxyvitamin D and fasting plasma glucose, impaired glucose tolerance, hemoglobin A1c, metabolic syndrome, and incidence of prediabetes. A few clinical trials suggest beneficial effect of vitamin D supplementation in prediabetes, including improved insulin secretion, basal fasting insulin sensitivity, and postprandial peripheral insulin resistance. The limitations of the studies are small sample size, short duration of follow-up, lack of control groups, and inability to achieve vitamin D sufficiency with treatment.
Available data suggest that achieving vitamin D sufficiency may be beneficial in patients with prediabetes, although clinical trials are needed to provide evidence-based recommendations.
根据来自人类研究的证据，综述维生素 D 在糖尿病前期中的作用。
检索 MEDLINE 中的英文文献（1969 年 1 月至 2009 年 7 月），以寻找维生素 D 缺乏和治疗糖尿病前期（包括空腹血糖受损、葡萄糖耐量受损和代谢综合征）的观察性研究和随机对照试验。检索词包括高血糖、葡萄糖、糖化血红蛋白、胰岛素抵抗、糖尿病、稳态模型评估、胰岛素分泌、维生素 D 及相关术语。还从发现的文章中的综述文章和参考文献中确定了出版物。排除了摘要、会议记录、病例报告和信件。仅涉及 1 型和 2 型糖尿病、血液透析或甲状旁腺功能亢进症以及儿童研究的文章也被排除。
循环 25-羟维生素 D 浓度＜30ng/ml 定义为维生素 D 不足，其在美国较为普遍（占总人口的 77%）。各种人群的大多数横断面和前瞻性研究显示，循环 25-羟维生素 D 与空腹血糖、葡萄糖耐量受损、糖化血红蛋白、代谢综合征和糖尿病前期的发病率呈负相关。少数临床试验表明维生素 D 补充对糖尿病前期有益，包括改善胰岛素分泌、基础空腹胰岛素敏感性和餐后外周胰岛素抵抗。研究的局限性是样本量小、随访时间短、缺乏对照组以及治疗后无法达到维生素 D 充足。
现有数据表明，使糖尿病前期患者达到维生素 D 充足可能有益，尽管还需要临床试验来提供基于证据的建议。
