To evaluate vitamin D as a predictor of all-cause and cardiovascular mortality and risk of progression to micro- or macroalbuminuria in type 2 diabetic patients

A. Schmedes

Agarwal

C. Joergensen

de Boer

Dobnig

Gall

H.-H. Parving

Haffner

Holick

Hollis

Kalantar-Zadeh

Kull

L. Tarnow

Lambers Heerspink

M.-A. Gall

Melamed

Mortensen

P. Rossing

Pfeffer

Ravani

Rose

Schwarz

Teng

Wolf

Zehnder

English

PubMed

Joergensen, Christel

Gall, Mari-Anne

Schmedes, Anne

Tarnow, Lise

Parving, Hans-Henrik

Rossing, Peter

Syddansk Universitets Forskerportal

Vitamin D levels and mortality in type 2 diabetes

Copenhagen University Research Information System


                  OBJECTIVE
                  To evaluate vitamin D as a predictor of all-cause and cardiovascular mortality and risk of progression to micro- or macroalbuminuria in type 2 diabetic patients.
               
               
                  RESEARCH DESIGN AND METHODS
                  In a longitudinal observational follow-up study, 289 type 2 diabetic patients with normoalbuminuria (n = 172), microalbuminuria (n = 73), and macroalbuminuria (n = 44) at baseline were followed for a median (range) of 15.0 (0.2–23) years. Mean ± SD age was 54 ± 9 years. Plasma 25-hydroxyvitamin D3 levels were determined by high-performance liquid chromatography/tandem mass spectrometry on baseline samples. Severe vitamin D deficiency was defined as the lower 10th percentile (&amp;lt;13.9 nmol/l).
               
               
                  RESULTS
                  Median (range) vitamin D level was 35.7 (5–136.7) nmol/l. Vitamin D levels were not associated with age, sex, estimated glomerular filtration rate, urinary albumin excretion rate (UAER), or A1C at baseline, but low levels were weakly associated with elevated systolic blood pressure (R = 0.13, P = 0.03). During follow-up, 196 (68%) patients died. All-cause mortality was increased in patients with severe vitamin D deficiency (hazard ratio 1.96 [95% CI 1.29–2.98]). The association persisted after adjustment for UAER, A1C, diabetes duration, and conventional cardiovascular risk factors (2.03 [1.31–3.13]). Severe vitamin D deficiency was associated with increased cardiovascular mortality (1.95 [1.11–3.44]), and the association persisted after adjustment (1.90 [1.15–3.10]). Severe vitamin D deficiency at baseline did not predict progression to micro- or macroalbuminuria.
               
               
                  CONCLUSIONS
                  In type 2 diabetic patients, severe vitamin D deficiency predicts increased risk of all-cause and cardiovascular mortality, independent of UAER and conventional cardiovascular risk factors. Whether vitamin D substitution improves prognosis remains to be investigated.
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Christel Joergensen

Mari-Anne Gall

Anne Schmedes

Lise Tarnow

Hans-Henrik Parving

Peter Rossing

Crossref

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Vitamin D Levels and Mortality in Type 2 Diabetes

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Syddansk Universitets Forskerportal

Copenhagen University Research Information System

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Syddansk Universitets Forskerportal

Syddansk Universitets Forskerportal