Department of Endocrine Metabolism, Huishan District Third People's Hospital, Wuxi, Jiangsu, China.
Front Endocrinol (Lausanne). 2024 Jul 15;15:1412228. doi: 10.3389/fendo.2024.1412228. eCollection 2024.
Insulin resistance and/or insulin secretion dysfunction are crucial causes of type 2 diabetes mellitus (T2DM). Although some studies have suggested potential roles for vitamins D and K in glucose metabolism and insulin sensitivity, there is limited and inconclusive research on their levels in T2DM patients and their relationship with blood glucose levels and insulin resistance. Additionally, there is a lack of large-scale clinical trials and comprehensive studies investigating the combined effects of vitamins D and K on T2DM.
A total of 195 participants with newly diagnosed T2DM were included in the research group, while 180 volunteers undergoing physical examinations in our hospital served as the control group. Fasting plasma glucose (FPG) was estimated using the glucose-oxidase technique, and fasting serum insulin (FINS) was evaluated by radioimmunoassay. FPG and FINS were used to calculate the homeostasis model assessment-insulin resistance (HOMA-IR). Serum vitamin D levels were measured using 25-hydroxyvitamin D, and vitamin K levels were evaluated using phylloquinone (VK1) and menaquinone (VK2) via ultra-high performance liquid chromatography and tandem mass spectrometry. Receiver operating characteristic (ROC) analysis was performed to assess the predictive value of these vitamins for T2DM.
Circulating levels of 25-hydroxyvitamin D (25.95 ± 10.42 ng/mL), VK1 (1.24 ± 0.89 ng/mL), and VK2 (0.2 ± 0.21 ng/mL) in T2DM patients were significantly lower than in the control group (37.46 ± 13.95 ng/mL for 25-hydroxyvitamin D, 1.99 ± 1.39 ng/mL for VK1, and 0.33 ± 0.22 ng/mL for VK2; p<0.001 for all comparisons). ROC analysis indicated that 25-hydroxyvitamin D, VK1, and VK2 could predict the occurrence of T2DM, with AUC values of 0.75, 0.69, and 0.71, respectively. In T2DM patients, 25-hydroxyvitamin D levels were positively correlated with VK1 (r=0.43, p<0.001) and VK2 (r=0.40, p<0.001) levels. FPG and HOMA-IR in T2DM patients were negatively correlated with circulating levels of 25-hydroxyvitamin D (r=-0.57, p<0.001), VK1 (r=-0.44, p<0.001), and VK2 (r=-0.36, p<0.001).
Circulating levels of vitamins D and K are lower in T2DM patients and show significant correlations with blood glucose levels and insulin resistance. These findings suggest that measurements of 25-hydroxyvitamin D, VK1, and VK2 could have predictive value for T2DM, highlighting the potential roles of these vitamins in T2DM management.
胰岛素抵抗和/或胰岛素分泌功能障碍是 2 型糖尿病（T2DM）的重要病因。虽然一些研究表明维生素 D 和 K 对葡萄糖代谢和胰岛素敏感性有潜在作用，但关于 T2DM 患者的维生素水平及其与血糖和胰岛素抵抗的关系的研究有限且尚无定论。此外，缺乏关于维生素 D 和 K 联合作用于 T2DM 的大型临床试验和综合研究。
共纳入 195 例新诊断为 T2DM 的患者作为研究组，同期在我院体检的 180 例志愿者作为对照组。采用葡萄糖氧化酶法测定空腹血浆葡萄糖（FPG），放射免疫法测定空腹血清胰岛素（FINS）。用稳态模型评估胰岛素抵抗（HOMA-IR）计算 FPG 和 FINS。采用 25-羟维生素 D 测定血清维生素 D 水平，采用超高效液相色谱串联质谱法测定叶绿醌（VK1）和甲萘醌（VK2）。采用受试者工作特征（ROC）分析评估这些维生素对 T2DM 的预测价值。
T2DM 患者的循环 25-羟维生素 D（25.95±10.42ng/mL）、VK1（1.24±0.89ng/mL）和 VK2（0.2±0.21ng/mL）水平明显低于对照组（25-羟维生素 D 为 37.46±13.95ng/mL，VK1 为 1.99±1.39ng/mL，VK2 为 0.33±0.22ng/mL；所有比较均 p<0.001）。ROC 分析表明，25-羟维生素 D、VK1 和 VK2 均可预测 T2DM 的发生，曲线下面积分别为 0.75、0.69 和 0.71。在 T2DM 患者中，25-羟维生素 D 水平与 VK1（r=0.43，p<0.001）和 VK2（r=0.40，p<0.001）水平呈正相关。T2DM 患者的 FPG 和 HOMA-IR 与循环 25-羟维生素 D（r=-0.57，p<0.001）、VK1（r=-0.44，p<0.001）和 VK2（r=-0.36，p<0.001）水平呈负相关。
T2DM 患者的维生素 D 和 K 循环水平较低，与血糖水平和胰岛素抵抗呈显著相关。这些发现表明，25-羟维生素 D、VK1 和 VK2 的测定可能对 T2DM 具有预测价值，提示这些维生素在 T2DM 管理中的潜在作用。
