Poolsup N, Suksomboon N, Plordplong N
Department of Pharmacy, Faculty of Pharmacy, Silpakorn University, Nakhon-Pathom, Thailand.
Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
Diabet Med. 2016 Mar;33(3):290-9. doi: 10.1111/dme.12893. Epub 2015 Oct 6.
To evaluate the effect of vitamin D on insulin resistance and glycaemic control in prediabetes.
A literature search was conducted of MEDLINE, the Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and www.clinicaltrials.gov, together with a historical search through the reference lists of relevant articles until end of June 2014. Studies were included if they were randomized controlled trials of vitamin D or vitamin D analogues in prediabetes and if they reported homeostatic model assessment of insulin resistance or 2-h plasma glucose after oral glucose tolerance test. Treatment effect was estimated according to mean difference in the changes from baseline of homeostatic model assessment of insulin resistance, 2-h oral glucose tolerance test plasma glucose, fasting plasma glucose and HbA1c between vitamin D and control groups. Meta-analysis of eligible studies was performed.
A total of 10 randomized controlled trials were included. Vitamin D did not significantly improve homeostatic model assessment of insulin resistance and 2-h oral glucose tolerance test plasma glucose: the mean differences were -0.06 (95% CI -0.36 to 0.24) and -0.23 mmol/l (95% CI -0.65 to 0.19), respectively. Subgroup analysis suggested that vitamin D improved homeostatic model assessment of insulin resistance in a subgroup with baseline 25-hydroxyvitamin D ≥ 50 nmol/l [mean difference -0.59 (95% CI -1.14 to -0.04); P = 0.03] and improved 2-h oral glucose tolerance test plasma glucose in the subgroup with baseline 25-hydroxyvitamin D < 50 nmol/l [mean difference -0.68 mmol/l (95% CI -1.35 to -0.01); P = 0.05]. Vitamin D significantly reduced fasting plasma glucose and HbA1c levels. The mean differences were -0.10 mmol/l (95% CI -0.18 to -0.03), P = 0.006 and -1 mmol/mol (95% CI -2 to 0), P = 0.008, respectively.
No beneficial effect of vitamin D in improving insulin resistance was identified.
评估维生素D对糖尿病前期胰岛素抵抗及血糖控制的影响。
检索MEDLINE、Cochrane图书馆、护理学与健康相关文献累积索引数据库（CINAHL）、Scopus、科学引文索引数据库（Web of Science）及www.clinicaltrials.gov，并通过相关文章的参考文献列表进行历史检索，直至2014年6月底。纳入的研究需为糖尿病前期维生素D或维生素D类似物的随机对照试验，且需报告胰岛素抵抗的稳态模型评估或口服葡萄糖耐量试验后2小时血浆葡萄糖水平。根据维生素D组与对照组胰岛素抵抗稳态模型评估、2小时口服葡萄糖耐量试验血浆葡萄糖、空腹血浆葡萄糖及糖化血红蛋白（HbA1c）自基线变化的平均差异来估计治疗效果。对符合条件的研究进行荟萃分析。
共纳入10项随机对照试验。维生素D未显著改善胰岛素抵抗的稳态模型评估及2小时口服葡萄糖耐量试验血浆葡萄糖水平：平均差异分别为-0.06（95%可信区间-0.36至0.24）及-0.23 mmol/L（95%可信区间-0.65至0.19）。亚组分析表明，维生素D可改善基线25-羟维生素D≥50 nmol/L亚组的胰岛素抵抗稳态模型评估[平均差异-0.59（95%可信区间-1.14至-0.04）；P = 0.03]，并改善基线25-羟维生素D<50 nmol/L亚组的2小时口服葡萄糖耐量试验血浆葡萄糖水平[平均差异-0.68 mmol/L（95%可信区间-1.35至-0.01）；P = 0.05]。维生素D显著降低空腹血浆葡萄糖及HbA1c水平。平均差异分别为-0.
