Primary Health Care Center, University of Montenegro, Faculty of Medicine, Podgorica, Montenegro.
Clinic for Endocrinology, Faculty of Medicine, University of Nis, Nis, Serbia.
Oxid Med Cell Longev. 2021 Jun 21;2021:7942716. doi: 10.1155/2021/7942716. eCollection 2021.
Recent advances in vitamin D research indicate that patients with type 2 diabetes mellitus (T2DM) are suffering from vitamin D deficiency and increased oxidative stress to a variable extent, which could produce different health impacts for each individual. The novel multivariate statistical method applied in the present study allows metabolic phenotyping of T2DM individuals based on vitamin D status, metabolic control, and oxidative stress status in order to identify effectively different subtypes in our type 2 DM study population. Data-driven statistical cluster analysis was performed with 95 patients with T2DM, treated with metformin. Clusters were based on 12 variables-age, disease duration, vitamin D level, insulin, fasting glycemia (FG), glycated hemoglobin (HbA1c), high-density and low-density lipoprotein, total cholesterol (TC), triglycerides (TG), body mass index (BMI), and triglycerides/glucose index (TYG). The analysis revealed four unique clusters which differed significantly in terms of vitamin D status, with a mean 25 (OH) D level in cluster 1 (57.84 ± 11.46 nmol/L) and cluster 4 (53.78 ± 22.36 nmol/L), falling within the insufficiency range. Cluster 2 had the highest mean level of 25 (OH) D (84.55 ± 22.66 nmol/L), indicative of vitamin D sufficiency. Cluster 3 had a mean vitamin D level below 50 nmol/L (49.27 ± 16.95), which is considered deficient. Patients in the vitamin D sufficient cluster had a significantly better glycemic and metabolic control as well as a lower level of lipid peroxidation compared to other clusters. The patients from the vitamin D sufficient cluster also had a significantly higher level of vitamin D/MPO, vitamin D/XO, vitamin D/MDA, vitamin D/CAT, and vitamin D/TRC than that in the vitamin deficient and insufficient clusters. The vitamin D deficient cluster included significantly younger patients and had a significantly lower level of AOPP/TRC and albumin/TRC than the vitamin D sufficient cluster. The evidence from our cluster analysis in the context of separated T2DM demonstrates beneficial effects of optimal vitamin D status on metabolic control and oxidative stress in T2DM patients. Older T2DM patients require higher vitamin D levels in order to achieve good metabolic control and favorable antioxidant protection. Since protein damage is more pronounced in these patients, adding water-soluble antioxidant in addition to higher doses of vitamin D should be considered.
最近的维生素 D 研究进展表明，2 型糖尿病（T2DM）患者存在不同程度的维生素 D 缺乏和氧化应激增加，这可能对每个人的健康产生不同的影响。本研究应用的新型多变量统计方法允许根据维生素 D 状态、代谢控制和氧化应激状态对 T2DM 个体进行代谢表型分析，以便有效地识别我们的 2 型 DM 研究人群中的不同亚型。对 95 名接受二甲双胍治疗的 T2DM 患者进行数据驱动的统计聚类分析。聚类基于 12 个变量-年龄、疾病持续时间、维生素 D 水平、胰岛素、空腹血糖（FG）、糖化血红蛋白（HbA1c）、高密度和低密度脂蛋白、总胆固醇（TC）、甘油三酯（TG）、体重指数（BMI）和甘油三酯/葡萄糖指数（TYG）。分析显示，四个独特的聚类在维生素 D 状态方面存在显著差异，第 1 组（57.84 ± 11.46nmol/L）和第 4 组（53.78 ± 22.36nmol/L）的 25（OH）D 水平平均值均处于不足范围内。第 2 组的 25（OH）D 水平最高（84.55 ± 22.66nmol/L），表明维生素 D 充足。第 3 组的维生素 D 水平低于 50nmol/L（49.27 ± 16.95），被认为是不足的。与其他聚类相比，维生素 D 充足聚类的患者血糖和代谢控制更好，脂质过氧化水平更低。与维生素 D 缺乏和不足聚类相比，维生素 D 充足聚类的患者维生素 D/MPO、维生素 D/XO、维生素 D/MDA、维生素 D/CAT 和维生素 D/TRC 水平显著更高。维生素 D 缺乏聚类包括年龄明显较小的患者，维生素 D 充足聚类的 AOPP/TRC 和白蛋白/TRC 水平明显低于维生素 D 缺乏聚类。我们在单独的 T2DM 背景下进行的聚类分析的证据表明，最佳维生素 D 状态对 T2DM 患者的代谢控制和氧化应激具有有益影响。年龄较大的 T2DM 患者需要更高的维生素 D 水平才能实现良好的代谢控制和有利的抗氧化保护。由于这些患者的蛋白质损伤更为明显，除了更高剂量的维生素 D 外，还应考虑添加水溶性抗氧化剂。
