Vitamin D Status in Saudi Patients with Type 1 Diabetes Mellitus

Khalid Salim Aljabri, S. A. Bokhari, K. A. Alqurashi

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Department of Endocrinology, King Fahad Armed Forces Hospital, Jeddah, KSA.

DOI: 10.4236/ojemd.2013.32021                

Abstract

Aims/Introduction: There are studies in different countries regarding the prevalence of vitamin D deficiency in non diabetic population. Few studies were done in adults with type 1 diabetes mellitus. This study was conducted to determine Vitamin D Status among Saudi patients with type 1 diabetes and to correlate the associated environmental risk factors. Materials and Methods: A cross-sectional single centre study was conducted in 221 Saudi patients with type 1 diabetes mellitus. These patients were recruited through the Diabetes Centre at King Fahad Armed Forces Hospital between January 2008 and June 2009. 25-hydroxy-vitamin D, Parathyroid hormone, calcium, phosphate and alkaline phosphatase were measured. Results: There were 221 patients with type 1 diabetes mellitus, 92 males (42%) and 129 females (58%). The mean age was 21.3 ± 7.2 and the mean diabetes duration was 7.5 ± 5.7. The frequency of 25-hydroxyvitamin D < 50 nmol/l and <25 nmol/l were 97% and 60% respectively. The frequency of 25-hydroxyvitamin D < 25 nmol/l was significantly more frequent in female. 67% were either only exposed face or totally covered. Duration of sun exposure in 64% was less than 30 minutes per day. The area of skin exposed and duration of sunlight exposure associated significantly with Vitamin D levels (p < 0.0001 and p < 0.0001 respectively). Age was associated with more vitamin D < 25 nmol/l (the odds ratio (95% confidence interval); 4.8 (4.6,14.5), p = 0.005; 5.3 (1.8,15.5), p = 0.003; 3.9 (1.5,10.5), p = 0.007 for age groups 12 - 15, 16 - 19 and 20 - 24 years old consequently. Male gender and exposing face, arms and legs to sun were associated with vitamin D ≥ 25 nmol/l; the odds ratio (95% confidence interval); 0.27 (0.11,0.6), p = 0.001; 0.26 (0.09,0.75), p = 0.01 consequently. Conclusions: Pr

Keywords

Type 1 Diabetes Mellitus; Vitamin D Deficiency; Frequency

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	American Diabetes Association, “Diagnosis and Classification of Diabetes Mellitus,” Diabetes Care, Vol. 33, Suppl. 1, 2011, pp. S62-S69.
[2]	G. S. Eisenbarth, “Update in Type 1 Diabetes,” Journal of Clinical Endocrinology & Metabolism, Vol. 92, No. 7, 2007, pp. 2403-2407. doi:10.1210/jc.2007-0339
[3]	M. F. Holick, “High Prevalence of Vitamin D Inadequacy and Implications for Health,” Mayo Clinic Proceedings, Vol. 81, No. 3, 2006, pp. 353-373. doi:10.4065/81.3.353
[4]	C. Mathieu and K. Badenhoop, “Vitamin D and Type 1 Diabetes Mellitus: State of the Art,” Trends in Endocrinology & Metabolism, Vol. 16, No. 6, 2005, pp. 261-267. doi:10.1016/j.tem.2005.06.004
[5]	K. Luong, L. T. Nguyen and D. N. Nguyen, “The Role of Vitamin D in Protecting Type 1 Diabetes Mellitus,” Diabetes/Metabolism Research and Reviews, Vol. 21, No. 4, 2005, pp. 338-346. doi:10.1002/dmrr.557
[6]	C. Mathieu, C. Gysemans, A. Giulietti and R. Bouillon, “Vitamin D and Diabetes,” Diabetologia, Vol. 48, No. 7, 2005, pp. 1247-1257. doi:10.1007/s00125-005-1802-7
[7]	R. M. Greer, M. A. Rogers, F. G. Bowling, H. M. Buntain, M. Harris, G. M. Leong and A. M. Cotterill, “Australian Children and Adolescents with Type 1 Diabetes Have Low Vitamin D Levels,” Medical Journal of Australia, Vol. 187, No. 1, 2007, pp. 59-60.
[8]	B. M. Svoren, L. K. Volkening, J. R. Wood and L. M. Laffel, “Significant Vitamin D Deficiency in Youth with Type 1 Diabetes Mellitus,” Journal of Pediatrics, Vol. 154, No. 1, 2009, pp. 132-134. doi:10.1016/j.jpeds.2008.07.015
[9]	A. Bener, A. Alsaied, M. Al-Ali, A. Al-Kubaisi, B. Basha, A. Abraham, G. Guiter and M. Mian, “High Prevalence of Vitamin D Deficiency in Type 1 Diabetes Mellitus and Healthy Children,” Acta Diabetologica, Vol. 46, No. 3, 2008, pp. 183-189.
[10]	P. Pozzilli, “Low Levels of 25-Hydroxyvitamin D3 and 1,25 Dihydroxy Vitamin D3 in Patients with Newly Diagnosed Type 1 DM,” Hormone and Metabolic Research, Vol. 37, No. 11, 2005, pp. 680-683. doi:10.1055/s-2005-870578
[11]	B. Littorin, P. Blom, A. Scholin, H. J. Arnqvist, G. Blohmé, J. Bolinder, A. Ekbom-Schnell, J. W. Eriksson, S. Gudbjornsdottir, L. Nystrom, J. Ostman and G. Sundkvist, “Lower Levels of Plasma 25-Hydroxy D among Young Adults at Diagnosis of Autoimmune Type 1 Diabetes Compared with Control Subjects: Results from the Nationwide Diabetes Incidence study in Sweden (DISS),” Diabetologia, Vol. 49, No. 12, 2006, pp. 2847-2852. doi:10.1007/s00125-006-0426-x
[12]	S. H. Sedrani, “Vitamin D Status of Saudis III. Prevalence of Inadequate Plasma 25-Hydroxyvitamine D Concentrations,” Saudi Medical Journal, Vol. 13, 1992, pp. 214-219.
[13]	A. M. Siddiqui and H. Z. Kamfar, “Prevalence of Vitamin D Deficiency Rickets in Adolescent School Girls in Western Region,” Saudi Medical Journal, Vol. 28, No. 3, 2007, pp. 441-444.
[14]	S. Hashemipour, B. Larijani, H. Adibi, E. Javadi, M. Sedaghat and M. Pajouhi, “Vitamin D Deficiency and Causative Factors in the Population of Tehran,” BMC Public Health, Vol. 4, No.1, 2004, p. 38.
[15]	X. Du, H. Greenfield and D. R. Fraser, “Vitamin D Deficiency and Associated Factors in Adolescent Girl in Beijing,” American Journal of Clinical Nutrition, Vol. 74, 2001, pp. 494-500.
[16]	F. Alagol, Y. Shihadeh and H. Boztepe, “Sunlight Exposure and Vitamin D in Turkish Women,” Journal of Endocrinological Investigation, Vol. 23, 2000, pp. 173-177.
[17]	R. Goswami, N. Gupta, D. Goswami, R. K. Marwaha, N. Tandon and N. Kochupillai, “Prevalence and Significance of Low 25-Hydroxy Vitamin D Concentrations in Healthy Subjects in Dehli,” American Journal of Clinical Nutrition, Vol. 72, 2000, pp. 422-475.
[18]	A. Sachan, R. Gupta and V. Das, “High Prevalence of Vitamin D Deficiency among Pregnant Women and Their Newborns in Northern India,” American Journal of Clinical Nutrition, Vol. 81, 2005, pp. 1060-1064.
[19]	M. H. Gannage-Yared, R. Chemali, N. Yaacoub and G. Halaby, “Hypovitaminosis D in a Sunny Country: Relation to Lifestyle and Bone Markers,” Journal of Bone and Mineral Metabolism, Vol. 15, No. 9, 2000, pp. 1856-1862. doi:10.1359/jbmr.2000.15.9.1856
[20]	A. A. Mishal, “Effects of Different Dress Styles on Vitamin D Levels in Healthy Young JORDANIAN Women,” Osteoporosis International, Vol. 12, No. 11, 2001, pp. 931-935. doi:10.1007/s001980170021
[21]	S. Al Faraj and K. Al Mutairi, “Vitamin D Deficiency and Chronic Low Back Pain in Saudi Arabia,” Spine, Vol. 28, No. 2, 2003, pp. 177-179. doi:10.1097/00007632-200301150-00015
[22]	M. Moussavi, R. Heidarpur and A. Aminorroaya, “Prevalence of Vitamin D Deficiency in Isfahani High School Students in 2004,” Hormone Research, Vol. 64, 2005, 144-148. doi:10.1159/000088588
[23]	N. Meddeb, H. Sahli and M. Chahed, “Vitamin D Deficiency in Tunisia,” Osteoporosis International, Vol. 16, No. 2, 2005, pp. 180-183. doi:10.1007/s00198-004-1658-6
[24]	B. M. Svoren, L. K. Volkening, J. R. Wood and L. M. Laffel, “Significant Vitamin D Deficiency in Youth with Type 1 Diabetes Mellitus,” Journal of Pediatrics, Vol. 154, No. 1, 2009, pp. 132-134. doi:10.1016/j.jpeds.2008.07.015
[25]	M. Janner, P. Ballinari, P. Mullis and C. Flück, “High Prevalence of Vitamin D Deficiency in Children and Adolescents with Type 1 Diabetes,” Swiss Medical Weekly, Vol. 140, 2010, Article ID: w13091.
[26]	G. L. Saraiva, M. S. Cendoroglo and L. R. Ramos, “Influence of Ultraviolet Radiation on the Production of 25 Hydroxyvitamin D in the Elderly Population in the City of Sao Paulo (23 Degrees 342 S), Brazil,” Osteoporosis International, Vol. 16, No. 12, 2005, pp. 1649-1654. doi:10.1007/s00198-005-1895-3
[27]	R. Bouillon, “Vitamin D. Photosynthesis, Metabolism, and Action to Clinical Applications,” In: L. De Groot, J. L. Jameson and H. G. Burger, Eds., Endocrinology, 3rd Edition, Saunders, Philadelphia, 2001, pp. 1009-1028.
[28]	M. Z. Islam, M. Akhtaruzzaman and C. Lamberg-Allardt, “Hypovitaminosis D Is Common in both Veiled and Nonveiled Bangladeshi Women,” Asia Pacific Journal of Clinical Nutrition, Vol. 15, 2006, pp. 81-87.
[29]	J. Wortsman, L. Y. Matsuoka, T. C. Chen, Z. Lu and M. F. Holick, “Decreased Bioavailability of Vitamin D in Obesity,” American Journal of Clinical Nutrition, Vol. 72, 2000, pp. 690-693.
[30]	M. B. Snijder, R. M. van Dam, M. Visser, et al., “Adiposity in Relation to Vitamin D Status and Parathyroid Hormone Levels: A Population-Based Study in Older Men and Women,” Journal of Clinical Endocrinology & Metabolism, Vol. 90, No. 7, 2005, pp. 4119-4123. doi:10.1210/jc.2005-0216
[31]	S. Arunabh, S. Pollack, J. Yeh and J. F. Aloia, “Body Fat Content and 25-Hydroxyvitamin D Levels in Healthy Women,” Journal of Clinical Endocrinology & Metabolism, Vol. 88, No. 1, 2003, pp. 157-161. doi:10.1210/jc.2002-020978
[32]	N. H. Bell, S. Epstein, A. Greene, J. Shary, M. J. Oexmann and S. Shaw, “Evidence for Alteration of the Vitamin D-Endocrine System in Obese Subjects,” Journal of Clinical Investigation, Vol. 76, No. 1, 1985, pp. 370-373. doi:10.1172/JCI111971
[33]	A. M. Parfitt, J. C. Gallagher, R. P. Heaney, C. C. Johnston, R. Neer and G. D. Whedon, “Vitamin D and Bone Health in the Elderly,” American Journal of Clinical Nutrition, Vol. 36, Suppl. 5, 1982, pp. 1014-1031.
[34]	M. Peacoak, “Effect of Calcium and Vitamin D Insufficiency on the Skeleton,” Osteoporosis International, Vol. 8, No. 2, 1998, pp. S45-S51. doi:10.1007/PL00022733
[35]	M. K. Thomas, D. M. Lloyd-Jones, R. I. Thadhani, A. C. Shaw, D. J. Deraska, B. T. Kitch, et al., “Hypovitaminosis D in Medical Inpatients,” New England Journal of Medicine, Vol. 338, 1998, pp. 777-783. doi:10.1056/NEJM199803193381201
[36]	N. Fogh-Andersen, P. McNair, J. Moller-Petersen and S. Madsbad, “Lowered Serum Ionized Calcium in Insulin Treated Diabetic Subjects,” Scandinavian Journal of Clinical & Laboratory Investigation, Vol. 165, 1983, pp. 93-97.
[37]	P. Schwarz, H. A. Sorensen, G. Momsen, T. Friis, I. Transbol and P. McNair, “Hypocalcemia and Parathyroid Hormone Responsiveness in Diabetes Mellitus: A Tri-Sodium-Citrate Clamp Study,” Acta Endocrinologica (Copenhagen), Vol. 126, 1992, pp. 260-263.
[38]	G. Saggese, G. Federico, S. Bertelloni, G. I. Baroncelli and L. Calisti, “Hypomagnesemia and the Parathyroid Hormone-Vitamin D Endocrine System in Children with Insulin-Dependent Diabetes Mellitus: Effects of Magnesium Administration,” Journal of Pediatrics, Vol. 118, No. 2, 1991, pp. 220-225. doi:10.1016/S0022-3476(05)80486-X