Introduction: Vitamin D deficiency is involved in the pathogenesis of insulin resistance, which is the main factor in the development of type 2 diabetes. In Poland, a high percentage of people with vitamin D deficiency is observed, as well as incidences of type 2 diabetes. In 2013, recommendations regarding vitamin D supplementation for Central Europe inhabitants were published, which recommend the use of vitamin D preparations for obese people with a dose of 600-4000 IU / per Day
Purpose of the work: Evaluation of the prevalence of vitamin D deficiency in obese patients with chronically decompensated type 2 diabetes mellitus and appropriate supplementation in accordance with given recommendations.
Material and metod: Evaluation of laboratory tests and applied pharmacotherapy in 40 patients with chronically decompensated type 2 diabetes, aged from 38 to 89 years old.
Results: In the experimental group the average concentration of 25 (OH) D3 was 20.3 ng / ml ± 11.7. Supplementation of vitamin D preparations was used by 15% of patients. Only 22.5% of patients had correct concentrations of 25 (OH) D3, but only one person used vitamin D supplements in this group.
Conclusions:  One in five obese patients with type 2 diabetes have normal levels of vitamin D. Among obese diabetics nearly 90% of patients do not apply the recommendations for vitamin D supplementation. Knowledge about the benefits of vitamin D supplementation should be widely propagated among diabetologists and general practitioners

Matyjaszek-Matuszek, Beata

Porada, Dominik

Szafraniec, Aneta

Journal of Education Health and Sport

English

Introduction: Vitamin D deficiency is involved in the pathogenesis of insulin resistance, which is the main factor in the development of type 2 diabetes. In Poland, a high percentage of people with vitamin D deficiency is observed, as well as incidences of type 2 diabetes. In 2013, recommendations regarding vitamin D supplementation for Central Europe inhabitants were published, which recommend the use of vitamin D preparations for obese people with a dose of 600-4000 IU / per Day

Purpose of the work: Evaluation of the prevalence of vitamin D deficiency in obese patients with chronically decompensated type 2 diabetes mellitus and appropriate supplementation in accordance with given recommendations.

Material and metod: Evaluation of laboratory tests and applied pharmacotherapy in 40 patients with chronically decompensated type 2 diabetes, aged from 38 to 89 years old.

Results: In the experimental group the average concentration of 25 (OH) D3 was 20.3 ng / ml ± 11.7. Supplementation of vitamin D preparations was used by 15% of patients. Only 22.5% of patients had correct concentrations of 25 (OH) D3, but only one person used vitamin D supplements in this group.

Conclusions:  One in five obese patients with type 2 diabetes have normal levels of vitamin D. Among obese diabetics nearly 90% of patients do not apply the recommendations for vitamin D supplementation. Knowledge about the benefits of vitamin D supplementation should be widely propagated among diabetologists and general practitioners

Aneta Szafraniec

Dominik Porada

Beata Matyjaszek-Matuszek

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1548  Szafraniec Aneta, Porada Dominik, Matyjaszek Matuszek Beata. Vitamin D deficiency in obese patients with Type 2 diabetes. Journal of Education, Health and Sport. 2018;8(9):1548-1554 eISNN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.1436416 http://ojs.ukw.edu.pl/index.php/johs/article/view/6108      The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part b item 1223 (26/01/2017). 1223 Journal of Education, Health and Sport eissn 2391-8306 7  © The Authors 2018; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited.  The authors declare that there is no conflict of interests regarding the publication of this paper.  Received: 02.08.2018. Revised: 18.08.2018. Accepted: 15.09.2018.     Vitamin D deficiency in obese patients with Type 2 diabetes  Aneta Szafraniec, Dominik Porada, Beata Matyjaszek-Matuszek  Chair and Department of Endocrinology, Medical University of Lublin   ABSTRACT Introduction: Vitamin D deficiency is involved in the pathogenesis of insulin resistance, which is the main factor in the development of type 2 diabetes. In Poland, a high percentage of people with vitamin D deficiency is observed, as well as incidences of type 2 diabetes. In 2013, recommendations regarding vitamin D supplementation for Central Europe inhabitants were published, which recommend the use of vitamin D preparations for obese people with a dose of 600-4000 IU / per Day. Purpose of the work: Evaluation of the prevalence of vitamin D deficiency in obese patients with chronically decompensated type 2 diabetes mellitus and appropriate supplementation in accordance with given recommendations. Material and method: Evaluation of laboratory tests and applied pharmacotherapy in 40 patients with chronically decompensated type 2 diabetes, aged from 38 to 89 years old. Results: In the experimental group the average concentration of 25 (OH) D3 was 20.3 ng / ml ± 11.7. Supplementation of vitamin D preparations was used by 15% of patients. Only 22.5% of patients had correct concentrations of 25 (OH) D3, but only one person used vitamin D supplements in this group. Conclusions: One in five obese patients with type 2 diabetes have normal levels of vitamin D. Among obese diabetics nearly 90% of patients do not apply the recommendations for 1549  vitamin D supplementation. Knowledge about the benefits of vitamin D supplementation should be widely propagated among diabetologists and general practitioners.  Keywords: vitamin D, type 2 diabetes mellitus, insulin resistance, carbohydrate management    Introduction In recent years, the role of vitamin D has increased in clinical significance as one of the factors that may elevate the risk of many diseases and pathological conditions. It is now believed that vitamin D, through its pleiotropic effects in the human body, may play a key role not only in calcium-phosphate management, but also in the development of cardiovascular, neoplastic and autoimmune diseases [1-5]. It has been proven that vitamin D deficiency is involved in the pathogenesis of insulin resistance, which is the main factor in the development of type 2 diabetes. Vitamin D has been shown to increase mRNA synthesis for insulin receptors, thereby improving insulin-dependent glucose transport and, consequently, reducing insulin resistance [4, 6 ]. In Poland, there is a high percentage of people with vitamin D deficiency, but also of obesity and comorbid type 2 diabetes incidences. That is why in 2013 the recommendations for vitamin D supplementation for Central Europe inhabitants were published, which advocate the use of vitamin D for obese people all year round with a dose of 600-4000 IU / day [7].  Purpose of work The aim of the study is to assess the prevalence of vitamin D deficiency in obese patients with chronically decompensated type 2 diabetes mellitus. Additionally, the implementation of the appropriate supplementation in accordance with given recommendations was evaluated.  Material and methods The observations were conducted on  40 patients, aged from 38 to 89 years, including 19 men (47.5%) and 21 women (52.5%) hospitalized in the period from May to July 2017 in the Department of Endocrinology in Lublin, who were diagnosed with type 2 diabetes over 6 months ago. Data regarding the patients was obtained on the basis of a retrospective analysis 1550  of medical records, in particular with regard to anamnesis and subject examination as well as laboratory tests. The state of carbohydrate metabolism was assessed by means of HbA1c concentration, while the supply of vitamin D3 was classified by the concentration of 25 (OH) D3. Pharmacotherapy, including dietary supplements, was also analyzed. The obtained results of the tests were of quantitative variability and are presented using elements of parametric descriptive statistics - mean and standard deviation. Information on qualitative variables was presented in the form of the number and percentage of cases reported.  Results Detailed characteristics of the studied group are presented in Table 1.  Table 1. Characteristics of patients in the study group.  Average age BMI Waist circumference WHR The whole group 61,2± 10,2 y 35,2±5,8 kg/m2 115,6± 14,5 cm 1,0 0±0,08 Women 64,4± 9,8 y 34,7±3,9 kg/m2 111,5±9,8 cm 0,98±0,08 Men 57,8 ± 9,9 y 35,9±7,4 kg/m2 120,2±17,5 cm 1,04±0,06  In all subjects, a chronic lack of compensation of the carbohydrate metabolism (mean HbA1c 9.5% ± 1.9) was demonstrated. As a result of the conducted tests, it was found that the average vitamin D concentration was 20.3 ng / ml ± 11.7, however with normal total calcium in all the patients' venous blood (mean 9.31 ± 0.4 mg / dl N: 8, 7-10.4). Inadequate supply of vitamin D occurred in 77.5% of patients. Hypovitaminosis D (30%) was observed the most frequently, and an extreme deficiency of vitamin D occurred in every fourth patient (25%). The percent distribution of supply in vitamin D is shown in Figure 1. No hypervitaminosis was observed in obese patients with type 2 diabetes. 1551   Figure 1. Compensated serum 25 (OH) D3 in the test group.  Supplementation with vitamin D preparations was used by 15% of patients (6), at a dose of 400-3000j / day. Only 9 patients had a normal concentration of 25 (OH) D3 (above 30 ng / m) l, but in this group only one person used supplementation.   Figure 2. The implementation of supplementation recommendations.  Discussion  In studies carried out in recent years, there is an increase in evidence confirming the important role of vitamin D deficiency in the development of carbohydrate disorders, including type 2 1552  diabetes. Vitamin D receptors (VDR) and specific enzyme 1α - hydroxylase have been shown on pancreatic β cells, which confirms the effect of active metabolites of vitamin D have on carbohydrate metabolism [6, 8]. Calcitriol binding to VDR receptors located on pancreatic β cells stimulates insulin secretion in response to changes in serum glucose. The expression of VDR receptors on pancreatic cells and the presence of VDRE sequences in the insulin gene promoter and its calcitriol-dependent expression indicate the need to maintain normal vitamin D concentrations in order to maintain adequate synthesis of endogenous insulin [9-12]. Additionally, it was found that active metabolites of vitamin D accelerate the conversion of proinsulin to its active form, even in people without known diabetes [9,13]. Co-occurring lack of proper supply of vitamin D also results in the intensification of inflammation, which plays an important role in the pathogenesis of type 2 diabetes and insulin resistance [13, 14]. Vitamin D deficiency also increases the risk of developing insulin resistance and the typical features of metabolic syndrome, such as obesity, hypertension or lipid metabolism disorders, which promotes the development of diabetic complications [15-18]. Low levels of vitamin D should be associated with increased incidences of microvascular and macrovascular complications in patients with diabetes. In particular, patients with nephropathy are at risk of vitamin D deficiency and its level depends on the severity of the disease [18-20]. Based on literature data, it has been shown that compensating vitamin D deficiency after adequate supplementation may lead to a reduction of insulin resistance, which in turn promotes HbA1c normalization and restoration of carbohydrate balance [13, 21-23]. Studies by numerous authors indicate the necessity of screening for vitamin D deficiencies in patients with type 2 diabetes, because diagnosing vitamin D deficiencies and implementing supplementation therapy in this group of patients may significantly affect metabolic control and improve disease control.  Conclusions In the spring and summer season, despite the relatively good sun exposure in Poland, only every fifth obese patient with type 2 diabetes has the correct concentration of vitamin D. Among obese diabetics, the supplementation of vitamin D is not used in almost 90% of patients. Knowledge about the benefits of supplementing Vitamin D should be widely promoted among diabetologists as well as family medicine doctors.   1553  References: 1. Holick MF (2007).. Vitamin D deficiency. N Engl J Med. 357: 266-81. 2. Adams JS, Hewison M. (2010). Update in vitamin D. J Clin Endocrinol Metab 95: 471–478. 3. Rosner CJ. (2011). Vitamin D insufficiency. N Engl J Med 364: 248–254 4. Muscogiuri G. (2018). Vitamin D: past, present and future perspectives in the prevention of chronic diseases. Eur J Clin Nutr. 72(9):1221-1225. 5. Nitsa A, Toutouza M, Machairas N, Mariolis A, Philippou A, Koutsilieris M. (2018). Vitamin D in Cardiovascular Disease. In Vivo. 32(5):977-981 6.  Maestro B, Campión J, Dávila N, Calle C. (200). Stimulation by 1,25-dihydroxyvitamin D3 of insulin receptor expression and insulin responsiveness for glucose transport in U-937 human promonocytic cells. Endocr J.  47(4):383-91. 7. Płudowski P, Karczmarewicz E, Bayer M, et al. (2013). Practical guidelines for the supplementation of vitamin D and the treatment of deficits in Central Europe - recommended vitamin D intakes in the general population and groups at risk of vitamin D deficiency. Endokrynol Pol. 64(4):319-27. 8. Markovic D, Hills CE et al. (2004). Expression of 25-hydroxyvitamin D3-1 alpha-hydroxylase in pancreatic islets. J Steroid Biochem Mol Biol 121: 89–90. 9. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. (2007). The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab; 92: 2017-29. 10. Zeitz U, Weber K, Soegiarto DW. Et al. (2003). Impaired insulin secretory capacity in mice lacking a functional vitamin D receptor. FASEB J 17: 509-11. 11. Bland R, Markovic D, Hills CE. Et al. (2004). Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in pancreatic islets. J Steroid Biochem Mol Biol 89-90: 121-5. 12. Maestro B, Dávila N, Carranza MC et al. (2003). Identification of a vitamin D response element in the human insulin receptor gene promoter. J Steroid Biochem Mol Biol 84: 223-30. 13. Chiu KC, Chu A, Go VL et al. (2004). Hypovitaminosis D is associated with insulin resistance and a cell dysfunction. Am J ClinNutr 79: 820-5. 14. Berridge MJ. (2017). Vitamin D deficiency and diabetes. Biochem J. 24;474(8):1321-1332. 1554  15. Pittas AG, Lau J, Hu FB et al. (2007). The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 92: 2017-29. 16. Mathieu C. (2015). Vitamin D and diabetes: Where do we stand? Diabetes Res Clin Pract. 108(2):201-9. 17. Botella-Carretero JI, Alvarez-Blasco F, Villafruela JJ et al. (2007). Vitamin D deficiency is associated with the metabolic syndrome in morbid obesity. ClinNutr 26: 573-80. 18. Liyanage GC, Lekamwasam S, Weerarathna TP, Liyanage CE. (2017). Effects of high-dose parenteral vitamin D therapy on lipid profile and blood pressure in patients with diabetic nephropathy: A randomized double-blind clinical trial. Diabetes Metab Syndr. 11 Suppl 2:S767-S770. 19. Usluogullari CA, Balkan F, Caner S, Ucler R, Kaya C, Ersoy R, Cakir B.(2015). The relationship between microvascular complications and vitamin D deficiency in type 2 diabetes mellitus. BMC Endocr Disord. 15:33. 20. Herrmann M, Sullivan DR, Veillard AS, McCorquodale T. et al. (2015). Serum 25-hydroxyvitamin D: a predictor of macrovascular and microvascular complications in patients with type 2 diabetes. Diabetes Care 38(3):521-8. 21. Cade C, Norman AW. (1986). Vitamin D3 improves impaired glucose tolerance and insulin secretion in the vitamin D-deficient rat in vivo. Endocrinology 119: 84-90. 22. Clark SA, Stumpf WE, Sar M. (1981). Effect of 1,25-dihydroxyvitamin D3 on insulin secretion. Diabetes 30: 382-6. 23. Jehle S, Lardi A, Felix B, Hulter HN, Stettler C, Krapf R.(2014).  Effect of large doses of parenteral vitamin D on glycaemic control and calcium/phosphate metabolism in patients with stable type 2 diabetes mellitus: a randomised, placebo-controlled, prospective pilot study. Swiss Med Wkly 144:w13942. 

Vitamin D deficiency in obese patients with Type 2 diabetes

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Vitamin D deficiency in obese patients with Type 2 diabetes

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