Mourelatou Niki G, Kounatidis Dimitris, Jude Edward B, Rebelos Eleni
Second Department of Internal Medicine, NIMTS Hospital, 11521 Athens, Greece.
Diabetes Center, First Department of Propaedeutic and Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece.
Nutrients. 2024 Nov 27;16(23):4072. doi: 10.3390/nu16234072.
Latent autoimmune diabetes of adults (LADA) is the most prevalent form of autoimmune diabetes (AI-D) in adulthood; however, its accurate diagnosis and optimal treatment remain challenging. Vitamin D deficiency (VDD) is commonly observed in LADA patients, while increased vitamin D exposure through supplementation and dietary intake is associated with a reduced incidence of LADA. Although limited, case reports, case-control studies, and randomized clinical trials have examined the effects of vitamin D supplementation-alone or combined with dipeptidyl peptidase-4 inhibitors (DPP4-is)-on glucose regulation, residual β-cell function, and glutamic acid decarboxylase antibody (GADA65) levels. Findings, while preliminary, indicate that vitamin D supplementation may enhance glycemic control, preserve β-cell function, and reduce autoimmune activity. Given its accessibility, affordability, and relative safety, vitamin D supplementation presents an attractive adjunct treatment option for LADA patients. This narrative review discusses current evidence on the potential therapeutic benefits of vitamin D supplementation in patients with AI-D, including LADA, who are also vitamin D deficient. Beginning with an exploration of the epidemiological patterns, clinical presentation, and diagnostic framework essential for understanding and identifying LADA, this review then examines the proposed mechanisms through which vitamin D may influence autoimmune modulation of pancreatic β-cells, integrating recent data pertinent to LADA pathology. By distilling and consolidating existing research, we aim to provide a platform for advancing targeted investigations within this distinct patient population.
成人隐匿性自身免疫性糖尿病（LADA）是成年期最常见的自身免疫性糖尿病（AI-D）形式；然而，其准确诊断和最佳治疗仍然具有挑战性。LADA患者中普遍存在维生素D缺乏（VDD），而通过补充剂和饮食摄入增加维生素D暴露与LADA发病率降低相关。尽管病例报告、病例对照研究和随机临床试验数量有限，但已经研究了单独补充维生素D或与二肽基肽酶-4抑制剂（DPP4-i）联合使用对血糖调节、残余β细胞功能和谷氨酸脱羧酶抗体（GADA65）水平的影响。研究结果虽然初步，但表明补充维生素D可能会增强血糖控制、保留β细胞功能并降低自身免疫活性。鉴于其可及性、可承受性和相对安全性，补充维生素D为LADA患者提供了一种有吸引力的辅助治疗选择。这篇叙述性综述讨论了关于补充维生素D对包括LADA在内的维生素D缺乏的AI-D患者潜在治疗益处的现有证据。本综述首先探讨了理解和识别LADA所必需的流行病学模式、临床表现和诊断框架，然后研究了维生素D可能影响胰腺β细胞自身免疫调节的拟议机制，并整合了与LADA病理学相关的最新数据。通过提炼和整合现有研究，我们旨在为在这一独特患者群体中推进针对性研究提供一个平台。
