Kuriacose Reena, Olive Kenneth E
From the Department of Primary Care Mountain Home VA Medical Center, Mountain Home, and Quillen College of Medicine, Johnson City, Tennessee.
South Med J. 2014 Feb;107(2):66-70. doi: 10.1097/SMJ.0000000000000051.
In recent years, vitamin D deficiency has been recognized increasingly often in patients, and different supplement regimens have been prescribed to treat it. There has been no consensus on treatment regimens. This study was conducted to determine the management of vitamin D deficiency/insufficiency in outpatient adults in northeast Tennessee.
A retrospective record review was conducted in an internal medicine teaching clinic for patients seen from July 2007-July 2008 in Johnson City, Tennessee. A total of 626 nonelectronic charts listed with vitamin D measurements were used in the analysis. Data regarding the level of vitamin D, whether treatment was prescribed, dose and duration of treatment prescribed, and repeat levels of vitamin D, if any were ordered, were collected. Vitamin D deficiency was defined as levels <20 ng/mL; vitamin D insufficiency was defined as levels ranging from 20 to 29.9 ng/mL.
Of the 626 patients, 325 (52%) were vitamin D deficient or insufficient. Of these 325 patients, 184 were given a low-dose supplement and 54 received a high-dose supplement. Eighty-seven were either not prescribed any replacement or the dose was unknown (not documented in the chart). The mean change in serum vitamin D levels was significantly different for the high dose compared with the low dose prescribed. There was no significant sex difference in response to the dose given. On average, those who were vitamin D deficient experienced a greater change than those who were insufficient and a greater change, on average, was observed in those who received a higher dose.
Vitamin D deficiency and insufficiency are highly prevalent. Clinicians tended to prescribe a high dose of treatment for lower levels of serum vitamin D. The response is higher in high-dose treatment. Documentation regarding whether vitamin D supplements were given or the dose of supplements was given and followed up with repeat levels of vitamin D after treatment was poor.
近年来，患者中维生素D缺乏的情况越来越常见，人们采用了不同的补充方案来治疗。但治疗方案尚未达成共识。本研究旨在确定田纳西州东北部门诊成年患者维生素D缺乏/不足的管理方法。
对田纳西州约翰逊市内科教学诊所2007年7月至2008年7月期间就诊的患者进行回顾性病历审查。分析中使用了总共626份列出维生素D测量值的非电子病历。收集了有关维生素D水平、是否开了治疗处方、所开治疗的剂量和持续时间以及维生素D重复检测水平（如果有检测）的数据。维生素D缺乏定义为水平<20 ng/mL；维生素D不足定义为水平在20至29.9 ng/mL之间。
626名患者中，325名（52%）维生素D缺乏或不足。在这325名患者中，184名给予低剂量补充剂，54名接受高剂量补充剂。87名患者要么未开任何替代治疗，要么剂量未知（病历中未记录）。与低剂量相比，高剂量处方的血清维生素D水平平均变化有显著差异。对所给剂量的反应在性别上无显著差异。平均而言，维生素D缺乏者的变化大于不足者，接受高剂量治疗者的变化平均更大。
维生素D缺乏和不足非常普遍。临床医生倾向于对较低的血清维生素D水平开高剂量治疗。高剂量治疗的反应更高。关于是否给予维生素D补充剂或补充剂剂量以及治疗后是否进行维生素D重复检测的记录很差。
