Endocrinology Division, University Hospital João de Barros Barreto, Federal University of Pará, Belém, Brazil.
Front Endocrinol (Lausanne). 2021 Oct 7;12:723502. doi: 10.3389/fendo.2021.723502. eCollection 2021.
The effect of glycemic control on diabetic kidney disease (DKD) is well known. Recent evidence has suggested that Vitamin D (VD) may have a nephroprotective effect in diabetes, but the relationship between VD, glycemic control, and albuminuria has yet to be clarified.
Evaluate the relationship between 25-hydroxy-vitamin D [25(OH)D], HbA1c, and albuminuria in Diabetes Mellitus (DM).
Cross-sectional study with 1576 individuals with DM who had 25(OH)D, HbA1c, and albuminuria levels measured. Patients with abnormal creatinine levels were excluded, in order to avoid interference on VD levels by impaired kidney function.
Patients with HbA1c ≥7% had lower 25(OH)D when compared to patients with HbA1c <7% (29.7 ± 10.2 28.1 ± 9.9 ng/ml, p = 0.003) and 25(OH)D levels seems to predict 1.5% of HbA1c behavior. The 25(OH)D concentrations in patients with normoalbuminuria were higher than the levels observed in those with micro or macroalbuminuria (29.8 ± 9.0 26.8 ± 8.6 and 25.1 ± 7.6, respectively, p = 0.001), patients who had 25(OH)D <20 ng/ml and 25(OH)D <30 ng/ml were at a higher risk of presenting albuminuria [OR = 2.8 (95% CI = 1.6 - 4.9), p<0.001, and OR = 2.1 (95% CI = 1.3 - 4.6), p<0.001, respectively]. In our regression model, albuminuria was influenced by HbA1c (r² = 0.076, p<0.00001) and 25(OH)D (r² = 0.018, p = 0.002) independently.
Our study found an association between vitamin D levels, HbA1c and DKD. Additionally, our data suggest that the association between urinary albumin excretion and vitamin D levels is independent of glycemic control in patients with diabetes. Even though our patients presented normal creatinine levels, it is necessary further prospective studies to confirm if this association precedes or not the loss of renal function.
血糖控制对糖尿病肾病（DKD）的影响是众所周知的。最近的证据表明，维生素 D（VD）在糖尿病中可能具有肾脏保护作用，但 VD、血糖控制和蛋白尿之间的关系尚未阐明。
评估 25-羟维生素 D [25(OH)D]、HbA1c 和白蛋白尿在糖尿病中的关系。
这是一项横断面研究，共纳入 1576 名患有 DM 的个体，他们的 25(OH)D、HbA1c 和白蛋白尿水平均有测量。排除了肌酐水平异常的患者，以避免肾功能受损对 VD 水平的干扰。
与 HbA1c<7%的患者相比，HbA1c≥7%的患者 25(OH)D 水平更低（29.7±10.2 vs 28.1±9.9ng/ml，p=0.003），且 25(OH)D 水平似乎可以预测 1.5%的 HbA1c 变化。正常白蛋白尿患者的 25(OH)D 浓度高于微量白蛋白尿和大量白蛋白尿患者（分别为 29.8±9.0、26.8±8.6 和 25.1±7.6，p=0.001），25(OH)D<20ng/ml 和 25(OH)D<30ng/ml 的患者发生白蛋白尿的风险更高[OR=2.8（95%CI=1.6-4.9），p<0.001，和 OR=2.1（95%CI=1.3-4.6），p<0.001]。在我们的回归模型中，白蛋白尿受 HbA1c（r²=0.076，p<0.00001）和 25(OH)D（r²=0.018，p=0.002）的独立影响。
我们的研究发现维生素 D 水平、HbA1c 和 DKD 之间存在关联。此外，我们的数据表明，糖尿病患者中尿白蛋白排泄与维生素 D 水平之间的关联独立于血糖控制。尽管我们的患者肌酐水平正常，但需要进一步的前瞻性研究来确认这种关联是否先于肾功能丧失。
