维生素D补充剂对2型糖尿病患者胰岛素抵抗的影响

[Effects of vitamin D supplementation on insulin resistance in patients with type 2 diabetes mellitus].

作者信息

Zhou Jie, Chen Haiyan, Wang Zhe, Li Yinyin, Li Minlong, Xiang Hongding

机构信息

Department of Healthcare Endocrinology, Affiliated Shandong Provincial Hospital, Shandong University, Jinan 250021, China.

Email:

出版信息

Zhonghua Yi Xue Za Zhi. 2014 Nov 25;94(43):3407-10.

PMID:25622671

Abstract

OBJECTIVE

To explore the effects of oral vitamin D supplementation on anthropometric parameters and insulin resistance (IR) in type 2 diabetes mellitus (T2DM).

METHODS

A total of 164 subjects with T2DM, aged 30-75 years, were randomly divided into two groups of intervention and control. The intervention group received a daily dose of 0.50 µg calcitriol while the control group maintained the original treatment regimen. At the beginning and end of 12-week supplementation trial, the demographic and anthropometric data were recorded and the serum levels of glucose, insulin, HbA1C and 25(OH)D measured. IR was assessed by the homeostasis model approximation index.

RESULTS

There was no significant inter-group difference at baseline. Compared with the baseline level, body mass index (BMI) ((-0.7 ± 1.7) vs (-0.4 ± 1.4) kg/m(2)) (P < 0.05), waist circumference (WC) ((-1.3 ± 1.3) vs ( -0.2 ± 1.1) cm) (P < 0.05) , fasting plasma glucose (FPG) ((-1.2 ± 2.3) vs (-0.6 ± 2.8) mmol/L) , fasting plasma insulin (FPI) ((-1.6 ± 2.2) vs (-0.32 ± 1.49) µU/ml) (P < 0.05), HbA1C ((-0.1 ± 0.6) vs (-0.03 ± 0.94))(P < 0.05), HOMA-IR ((-0.91 ± 2.63) % vs (-0.15 ± 1.78) %)(P < 0.05) and 25(OH)D ((20 ± 17) vs (1.0 ± 3.3) ng/ml) (P < 0.05) decreased obviously in the intervention group at the end of study. After stratifying by different baseline serum levels of 25(OH)D, HOMA-IR significantly decreased after supplementation in < 20 ng/ml group ((6 ± 3) vs (5 ± 3) ) (P < 0.05) , 20-30 ng/ml group ((6 ± 3) vs (5 ± 3)) (P < 0.05) and >30 ng/ml group ((5 ± 3) vs (4 ± 3)) (P < 0.05) . And BMI ((26 ± 6) vs (26 ± 4) kg/m(2)) (P < 0.05) , WC ((84 ± 11) vs (82 ± 12) cm) (P < 0.05) , FPG ((8 ± 4) vs (6 ± 4) mmol/L) (P < 0.05), FPI ((17 ± 4) vs (16 ± 4) µU/ml) (P < 0.05) and HbA1C((7.4 ± 0.9) % vs (7.0 ± 1.2) %) (P < 0.05) decreased statistically significant only in 15-20 ng/ml group. Multivariate regression analysis showed that HOMA-IR was a significant independent risk factor for 25 (OH) D (OR = 13, 95%CI = 4-39, P < 0.05).

CONCLUSION

There are significant improvements in BMI, WC, FPG, FPI, HbA1C and HOMA-IR after supplementation. Thus vitamin D supplementation may reduce insulin resistance in T2DM.

摘要

目的

探讨口服补充维生素D对2型糖尿病（T2DM）患者人体测量学参数及胰岛素抵抗（IR）的影响。

方法

将164例年龄在30 - 75岁的T2DM患者随机分为干预组和对照组。干预组每日服用0.50μg骨化三醇，对照组维持原治疗方案。在为期12周的补充试验开始和结束时，记录人口统计学和人体测量学数据，并检测血清葡萄糖、胰岛素、糖化血红蛋白（HbA1C）和25（OH）D水平。采用稳态模型评估指数评估IR。

结果

基线时两组间无显著差异。与基线水平相比，研究结束时干预组的体重指数（BMI）（（-0.7±1.7） vs （-0.4±1.4）kg/m²）（P<0.05）、腰围（WC）（（-1.3±1.3） vs （-0.2±1.1）cm）（P<0.05）、空腹血糖（FPG）（（-1.2±2.3） vs （-0.6±2.8）mmol/L）、空腹血浆胰岛素（FPI）（（-1.6±2.2） vs （-0.32±1.49）μU/ml）（P<0.05）、HbA1C（（-0.1±0.6） vs （-0.03±0.94））（P<0.05）、稳态模型评估胰岛素抵抗指数（HOMA-IR）（（-0.91±2.63）% vs （-0.15±1.78）%）（P<0.05）和25（OH）D（（20±17） vs （1.0±3.3）ng/ml）（P<0.05）均明显下降。按不同基线血清25（OH）D水平分层后，<20 ng/ml组（（6±3） vs （5±3））（P<0.05）、20 - 30 ng/ml组（（6±3） vs （5±3））（P<0.05）和>30 ng/ml组（（5±3） vs （4±3））（P<0.05）补充后HOMA-IR均显著下降。且仅在15 - 20 ng/ml组中，BMI（（26±6） vs （26±4）kg/m²）（P<0.05）、WC（（84±11） vs （82±12）cm）（P<0.05）、FPG（（8±4） vs （6±4）mmol/L）（P<0.05）、FPI（（17±4） vs （16±4）μU/ml）（P<0.05）和HbA1C（（7.4±0.9）% vs （7.0±1.2）%）（P<0.05）有统计学意义的下降。多因素回归分析显示，HOMA-IR是25（OH）D的显著独立危险因素（OR = 13，95%CI = 4 - 39，P<0.05）。