Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and the Central Manchester University Hospitals Foundation Trust, Manchester, UK.
Barts and The London SMD, London, UK.
J Diabetes Complications. 2014 Jan-Feb;28(1):66-70. doi: 10.1016/j.jdiacomp.2013.09.003. Epub 2013 Oct 16.
The optimal treatment regimen for correcting vitamin D insufficiency in diabetic patients has not been established.
Two hundred and forty four adult diabetic patients with vitamin D insufficiency were enrolled to receive: Ergocalciferol (D2) 50,000 IU daily over 10 days (500,000 IU) followed by Calcichew D3 (calcium carbonate/Cholecalciferol) BID (24,000 IU cholecalciferol/month) (ECC) (n=53); Cholecalciferol (D3) 40,000 IU daily over 10 days (400,000 IU) followed by Calcichew D3 BID (24,000 IU cholecalciferol/month) (CCC) (n=94) or Cholecalciferol 40,000 IU daily over 10 days (400,000 IU) followed by Cholecalciferol 40,000 IU monthly (CC) (n=97). The 25(OH)D, HbA1c, lipids, blood pressure and eGFR were assessed at baseline and after a mean follow up of 8.0±4.0 months.
Treatment increased 25(OH)D concentrations significantly in ECC (17.4±13.8 vs 29.9±9.6 ng/ml, P<0.0001), CCC (14.2±6.6 vs 30.9±13.1 ng/ml, p<0.0001) and CC (13.5±8.4 vs 33.9±14.4 ng/ml, P<0.0001). The relative increase in 25(OH)D was significantly lower with ECC compared to CC (+14.6±12.2 vs +20.6±15.0, P=0.01) and the majority of subjects in the ECC group (63%) remained vitamin D deficient (25(OH)D <30 ng/ml) compared to CCC (46%) and CC (36%) (P=0.0005).
This study demonstrates that relatively aggressive treatment regimens of both vitamin D2 and D3 increase 25(OH)D concentrations in diabetic patients, but the ability to raise 25(OH)D status to 'sufficient' levels is inadequate in a large proportion of individuals.
对于纠正糖尿病患者维生素 D 不足，尚未确立最佳的治疗方案。
纳入 244 例维生素 D 不足的成年糖尿病患者，接受以下治疗：依降钙素（D2）50000IU 每日，共 10 天（50 万 IU），随后每日服用 Calcichew D3（碳酸钙/胆钙化醇）2 次（约 24000IU 胆钙化醇/月）（ECC）（n=53）；胆钙化醇（D3）40000IU 每日，共 10 天（40 万 IU），随后每日服用 Calcichew D3 2 次（约 24000IU 胆钙化醇/月）（CCC）（n=94）或胆钙化醇 40000IU 每日，共 10 天（40 万 IU），随后每月服用胆钙化醇 40000IU（CC）（n=97）。在基线和平均 8.0±4.0 个月后评估 25（OH）D、HbA1c、血脂、血压和 eGFR。
ECC（17.4±13.8 比 29.9±9.6ng/ml，P<0.0001）、CCC（14.2±6.6 比 30.9±13.1ng/ml，p<0.0001）和 CC（13.5±8.4 比 33.9±14.4ng/ml，p<0.0001）治疗后 25（OH）D 浓度显著升高。与 CC 相比，ECC 组 25（OH）D 的相对增加幅度较低（+14.6±12.2 比+20.6±15.0，P=0.01），ECC 组中 63%的患者（25（OH）D<30ng/ml）仍存在维生素 D 缺乏，而 CCC 组为 46%，CC 组为 36%（P=0.0005）。
本研究表明，维生素 D2 和 D3 的相对强化治疗方案均可增加糖尿病患者 25（OH）D 浓度，但大多数个体将 25（OH）D 状态提高到“充足”水平的能力不足。
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