Kavarić Sreten, Vuksanović Milica, Bozović Dragica, Jovanović Marko, Jeremić Veljko, Radojicić Zoran, Pekić Sandra, Popović Vera
Clinic of Internal Medicine, Clinical Center Montenegro, Podgorica, Montenegro.
Vojnosanit Pregl. 2013 Feb;70(2):163-9. doi: 10.2298/vsp110713035k.
BACKGROUND/AIM: Vitamin D deficiency is a well-established risk factor for bone disease, but emerging data suggest that altered vitamin D homeostasis may play a role in the development of type 2 diabetes mellitus (T2DM), dyslipidemia hypertension, and other cardiovascular diseases (CVD). The aim of this study was to investigate the prevalence of vitamin D deficiency in patients with T2DM with/without CVD, to correlate it with anthropometric and metabolic parameters and to determine the predictors of vitamin D deficiency.
A total of 88 patients with T2DM (49 male/39 female, aged 61.0 +/- 0.9 yrs, body mass index (BMI) 29.9 +/- 0.4 kg/m2) and 67 patients (44 male/23 female, aged 63.6 +/- 1.0 yrs, BMI 29.2 +/- 0.5 kg/m2) with T2DM and CVD (myocardial infarction in 57 patients and angina pectoris in 10 patients) were included in this study. These patients were compared with 87 healthy subjects (35 male/52 female, aged 52.8 +/- 1.4 yrs, BMI 27.2 +/- 0.5 kg/m2). Weight, height, waist circumference and BMI were recorded in all patients. Also, total cholesterol, triglycerides, hemoglobin A1c (HbA1c) and 25-hydroxy-vitamin D [25(OH)D] levels were measured in all. According to 25(OH)D level, all subjects were divided into three categories: severe vitamin D deficiency (< or = 15 ng/mL), vitamin D insufficiency (15-20 ng/mL) and vitamin D sufficiency (?20 ng/mL). We correlated vitamin D levels with anthropometric and metabolic status and determined the predictors of vitamin D deficiency.
Severe vitamin D deficiency was registered in 16.1% healthy subjects, in 21.6% patients with T2DM and in 26.9% patients with T2DM and CVD. Patients with T2DM who were vitamin D deficient had increased weight, waist circumference, cholesterol and triglyceride levels when compared with patients with T2DM who had sufficient vitamin D level. 25(OH)D levels correlated with BMI and waist circumference in all subjects, but did not correlate with metabolic parameters (lipids, HbA1c). The best predictors of vitamin D level in all subjects were weight, waist circumference and BMI.
The high prevalence of vitamin D deficiency in patients with T2DM and particularly in patients with T2DM and CVD suggests that supplementation with vitamin D may be beneficial although there is still not sufficient evidence for recommending prescribing vitamin D.
背景/目的：维生素D缺乏是公认的骨病危险因素，但新出现的数据表明，维生素D内稳态的改变可能在2型糖尿病（T2DM）、血脂异常、高血压及其他心血管疾病（CVD）的发生发展中起作用。本研究旨在调查伴或不伴CVD的T2DM患者中维生素D缺乏的患病率，将其与人体测量学和代谢参数相关联，并确定维生素D缺乏的预测因素。
本研究纳入了88例T2DM患者（49例男性/39例女性，年龄61.0±0.9岁，体重指数（BMI）29.9±0.4kg/m²）和67例T2DM合并CVD患者（44例男性/23例女性，年龄63.6±1.0岁，BMI 29.2±0.5kg/m²，其中57例为心肌梗死，10例为心绞痛）。这些患者与87例健康受试者（35例男性/52例女性，年龄52.8±1.4岁，BMI 27.2±0.5kg/m²）进行比较。记录所有患者的体重、身高、腰围和BMI。此外，还测量了所有人的总胆固醇、甘油三酯、糖化血红蛋白（HbA1c）和25-羟基维生素D[25(OH)D]水平。根据25(OH)D水平，将所有受试者分为三类：严重维生素D缺乏（≤15ng/mL）、维生素D不足（15 - 20ng/mL）和维生素D充足（≥20ng/mL）。我们将维生素D水平与人体测量学和代谢状况相关联，并确定维生素D缺乏的预测因素。
16.1%的健康受试者、21.6%的T2DM患者和26.9%的T2DM合并CVD患者存在严重维生素D缺乏。与维生素D水平充足的T2DM患者相比，维生素D缺乏的T2DM患者体重、腰围、胆固醇和甘油三酯水平升高。在所有受试者中，25(OH)D水平与BMI和腰围相关，但与代谢参数（血脂、HbA1c）无关。所有受试者中维生素D水平的最佳预测因素是体重、腰围和BMI。
T2DM患者，尤其是T2DM合并CVD患者中维生素D缺乏的高患病率表明，补充维生素D可能有益，尽管目前仍没有足够的证据推荐常规补充维生素D。
