Division of Endocrinology, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States.
Division of Pediatric Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States.
Front Endocrinol (Lausanne). 2022 Aug 18;13:974196. doi: 10.3389/fendo.2022.974196. eCollection 2022.
The publication of our recent randomized controlled trial (RCT) showing that vitamin D could protect the β-cells during the honeymoon phase of type 1 diabetes (T1D) has led to calls for guidance for vitamin D supplementation during the critical phase of type 1 diabetes. Prolonging the partial clinical remission (PR) phase of TID improves glycemic control and reduces long-term complications of T1D. This RCT randomized 36 children and adolescents to either receive vitamin D (ergocalciferol, given as 50,000 international units per week for 2 months and then every other week for 10 months) or a placebo. The results showed that vitamin D significantly decreased the temporal rise in both hemoglobin A1c at a mean rate of changes of 0.14% every 3 months versus 0.46% every 3 months for the placebo group (p=0.044); and in the functional marker of PR, the insulin-dose adjusted A1c at a mean rate of change of 0.30% every 3 months versus 0.77% every 3 months for the placebo group, (p=0.015). We recommend a baseline estimation of 25(OH)D concentration at the time of diagnosis of T1D, and to begin vitamin D supplementation if serum 25(OH)D concentration is <30 ng/mL, to maintain serum 25(OH)D concentrations between 30-60 ng/mL. If serum 25(OH)D concentration is >30 ng/mL, monitor vitamin D status with serial 25(OH)D estimations; and initiate vitamin D supplementation if serum 25(OH)D concentrations drop to <30 ng/mL. Continue vitamin D supplementation for at least one year to ensure optimal benefit from vitamin D supplementation during the partial clinical remission phase of type 1 diabetes.
我们最近发表的一项随机对照试验（RCT）表明，维生素 D 可在 1 型糖尿病（T1D）蜜月期保护β细胞，这引发了人们对 T1D 关键期补充维生素 D 的指导建议的呼吁。延长 TID 的部分临床缓解（PR）阶段可改善血糖控制并减少 T1D 的长期并发症。该 RCT 将 36 名儿童和青少年随机分为接受维生素 D（麦角钙化醇，每周给予 50,000 国际单位，持续 2 个月，然后每两周给予 10 个月）或安慰剂。结果表明，维生素 D 可显著降低血红蛋白 A1c 的时间上升，平均每 3 个月变化率为 0.14%，而安慰剂组为 0.46%（p=0.044）；在 PR 的功能性标志物方面，胰岛素剂量调整的 A1c 平均每 3 个月变化率为 0.30%，而安慰剂组为 0.77%（p=0.015）。我们建议在诊断 T1D 时评估 25(OH)D 浓度，如果血清 25(OH)D 浓度<30ng/mL，则开始补充维生素 D，以维持血清 25(OH)D 浓度在 30-60ng/mL 之间。如果血清 25(OH)D 浓度>30ng/mL，则通过连续 25(OH)D 测定来监测维生素 D 状态；如果血清 25(OH)D 浓度降至<30ng/mL，则开始补充维生素 D。在 T1D 的部分临床缓解阶段至少补充一年维生素 D，以确保从维生素 D 补充中获得最佳益处。
