维生素 D 补充对伊朗糖尿病患者血糖控制指标的影响：系统评价和荟萃分析。
The effects of vitamin D supplementation on indices of glycemic control in Iranian diabetics: A systematic review and meta-analysis.
机构信息
Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Cellular and Molecular Research Center, Basic Health Sciences Institute, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Medical Toxicology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
出版信息
Complement Ther Clin Pract. 2019 Feb;34:294-304. doi: 10.1016/j.ctcp.2018.12.009. Epub 2018 Dec 19.
BACKGROUND AND PURPOSE
This systematic review and meta-analysis aimed to assess the effects of vitamin D supplements on indices of glycemic control [homeostatic model assessment-insulin resistance (HOMA-IR), hemoglobin A1C (HbA1C), fasting blood glucose (FBG), and quantitative insulin-sensitivity check index (QUICKI) and lipid profile in diabetic patients.
METHODS
Eight databases were searched, for randomized controlled trials (RCTs) or cross-sectional and cohort studies that have been published up to December 2017. We used the comprehensive meta-analysis (CMA) software for all statistical analysis and used the I index for assessing heterogeneity. A p value of <0.05 was considered as statistically significant.
RESULTS
We found 621 articles, and after the exclusion of ineligible publications, 82 studies remained to be assessed of which 37 were used for meta-analysis. Vitamin D supplementation was associated with a significant improvement in FBG (p = 0.001 and 95% CI: -0.526 to -0.136) and HbA1C (p = 0.003 and 95% CI: 1.719 to -0.361) in individuals with type 2 diabetes mellitus (T2DM); while in women with gestational diabetes mellitus (GDM) the reduction in FBG (p = 0.071 and 95% CI: -0.873 to -0.035) and HbA1C (p = 0.199 and 95% CI: 3.270 to 0.681) failed to reach statistical significance. Treatment with vitamin D supplements was associated with an improvement in HOMA-IR in pregnant diabetic women (p = 0.028 and 95% CI: 0.924 to -0.053) and for individuals with diabetes mellitus (p = 0.005 and 95% CI: 1.772 to -0.319). The pooled result of the cross-sectional meta-analysis indicated that serum vitamin D concentrations were significantly lower in diabetic patients than in healthy controls (p = 0.018 and 95% CI: 0.587 to -0.054).
CONCLUSION
This meta-analysis suggests that vitamin D supplementation improves indices of glycemic control (FBG, HOMA-IR, and HbA1C) in patients with diabetes mellitus. Hence, vitamin D supplements may be of potential therapeutic value in diabetic patients, as an adjuvant therapy along with other treatments.
背景与目的
本系统评价和荟萃分析旨在评估维生素 D 补充剂对糖尿病患者血糖控制指标（稳态模型评估-胰岛素抵抗（HOMA-IR）、糖化血红蛋白（HbA1C）、空腹血糖（FBG）、定量胰岛素敏感性检查指数（QUICKI）和血脂谱）的影响。
方法
检索了截至 2017 年 12 月发表的 8 个数据库中的随机对照试验（RCT）或横断面和队列研究。我们使用综合荟萃分析（CMA）软件进行所有统计分析，并使用 I 指数评估异质性。p 值<0.05 被认为具有统计学意义。
结果
我们发现了 621 篇文章，排除不符合条件的出版物后，有 82 项研究仍需评估，其中 37 项用于荟萃分析。维生素 D 补充与 2 型糖尿病患者 FBG（p=0.001，95%CI：-0.526 至-0.136）和 HbA1C（p=0.003，95%CI：1.719 至-0.361）的显著改善相关；而对于妊娠糖尿病患者，FBG（p=0.071，95%CI：-0.873 至-0.035）和 HbA1C（p=0.199，95%CI：3.270 至 0.681）的降低未达到统计学意义。维生素 D 补充剂治疗与妊娠糖尿病妇女 HOMA-IR 的改善相关（p=0.028，95%CI：0.924 至-0.053）和糖尿病患者的 HOMA-IR 改善相关（p=0.005，95%CI：1.772 至-0.319）。横断面荟萃分析的汇总结果表明，糖尿病患者的血清维生素 D 浓度明显低于健康对照组（p=0.018，95%CI：0.587 至-0.054）。
结论
本荟萃分析表明，维生素 D 补充可改善糖尿病患者的血糖控制指标（FBG、HOMA-IR 和 HbA1C）。因此，维生素 D 补充剂可能对糖尿病患者具有潜在的治疗价值，可作为其他治疗的辅助治疗。
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