Serum 25-hydroxy Vitamin D Level In Diabetic Patients And Its Effect On Blood Glucose And Bone Mass

ObjectiveTo observe serum 25-hydroxy vitamin D levels in diabetic patients and analyze parameters concerning metabolic syndrome,glucose metabolism and renal function, we detect bone mineral density using dual energy X ray absor-ptiometry in the lumbar spine and femoral neck bone in DM patients with qu-antitative measurements and analyze relationship between serum 25-hydroxy vitamin D levels of diabetic patients and metabolic syndrome, glucose metabo-lism, kidney function and bone mineral density to provide a new basis for the prevention and treatment of osteoporosis and low vitamin D in diabetic patients. We try to reveal different daily dietary calcium intake between diabetic patients and healthy group in our study in same matched gender and age group and provide new clinical evidence for calcium deficiency treatment.Materials and MethodsThis study collected 775 DM patients admitted to Endocrine division of Zh-ongshan hospital affiliated to Fudan university from 2009.10～2011.3. Excludi-ng 94 patients whose serum 25(OH)D had not been detected, the residual 681 patients are analyzed.100 healthy adults from Zhongshan Hospital Medical Examination Center are recruited randomly as controls. Data collecting time expired in March 2011.1. We observed and analyzed serum levels of 25(OH)D and its sex distrib-ution. Further investigation involves analyzing relativity between levels of 25(OH)D3 and gender, age, waist circumstance, BMI, hypertension, hyperlipide-mia, Diabetes, renal function and bone metabolism.2. With analysis of odds ratio of metabolic syndrome in patients with diabe-tes between vitamin D deficiency group and vitamin D normal group, we try to make known the effect of serum 25(OH)D on metabolic syndrome.3.By analyzing the difference of FPG, HbA1C, FINS, HOMA-IR and HOMA-B in vitamin D deficiency group and vitamin D normal group, we conc-lude the influence of serum levels of 25(OH)D on glucose metabolism. 4. By analyzing the difference of SCr, BUN,24h microalbuminuria and eGFR between groups, we observed the effect of serum levels of 25(OH)D on renal function.5. By analyzing the difference of PTH, calcium-phosphorus product, ALP, total lumbar BMD value and femoral neck BMD value, total femoral neck BMD value, we observe the effect of serum levels of 25(OH)D on bone metabolism.6. By analyzing daily calcium intake (diet and oral elemental calcium cal-cium) in diabetic group and the healthy control group, we study calcium intake situation of patients with diabetes.Results1.681 patients with diabetes have average age of (58.60±14.20) years old, an overall average serum 25(OH)D3 level of (38.14±17.37) nmol/L.Vitamin D shortage patients account for 76.51%,25(OH)D level in males'group is (40.94±17.37) nmol/L, females'group (34.58±16.73) nmol/L. There is significant diff-erences between the two groups. There is weak negative correlation between ov-erall diabetes serum 25(OH)D levels and gender (r=—0.182), TG (r=—0.147), HDL (r=—0.088), eGFR (r=—0.104), PTH (r=—0.143), calcium and phosph-orus product (r=—0.081). while there is weak positive correlation between 25(OH)D3 level and waist circumference (r= 0.088), Lg(SCr) (r= 0.160), BUN (r= 0.082), lumbar spine and femoral neck bone mineral density (total lumbar spi ne r= 0.096, femoral neck r= 0.085, total femoral neck r=—0.123); P values all are<0.05.Serum 25(OH)D has no linear relationship with age, BMI, TC, LDL, FBG, HbA1C, Lg(FINS), Lg(HOMA-IR), Lg(HOMA-B), Lg(24h urine albumin), ALP and other indicators.2. Lack of vitamin D in patients with diabetes has obesity OR of 0.852 than those with normal vitamin D, hypertension OR=1.147, high TG OR=1.325, OR of low HDL=1.173, metabolic syndrome OR=1.138, but P values are all not significantly different.3. There is statistical difference of Lg(FFNS) (1.02±0.40 VS 0.94±0.38), Lg(HOMA-IR) (0.63±0.46 VS 0.48±0.41) in vitamin D deficiency group than vitam- in D normal group, P values are all< 0.05; FBS, HbA1C and Lg(HOMA-B) are not found significant different between the two groups. 4.The level of SCr, BUN,24h urinary albumin, eGFR in vitamin D deficient group and vitamin D normal group have no significant difference (adjusted P' are all> 0.05).5. PTH values (36.52±17.51pg/mL VS 32.46±13.91pg/mL), total lumbar BMD values (0.937±0.132g/cm2 VS 0.978±0.157g/cm2),femoral neck BMD values (0.746±0.119g/cm2 VS 0.783±0.112 g/cm2), total femoral neck BMD values (0.873±0.123 g/cm2 VS 0.916±0.136 g/cm2) are siginificantly different between vitamin D deficiency group and the Vitamin D normal group; P and P 'are< 0.05. Product of calcium and phosphorus, ALP are not statistically different between the two groups.6. The average daily dietary calcium intake both in patients with diabetes (727.64±373.20) mg/d and the control group (673.64±276.24) mg/d is lower than the level recommended by the National Nutrition Institute (800mg/d). Difference between two groups is not significant (P>0.05).Conclusion1. Diabetic patients have high morbidity of Vitamin D deficiency; women are more seriously suffered from vitamin D deficiency than men. Dietary calcium intake in both diabetic group and healthy controls is lower than the level recom-mended by the National Nutrition Institute. There is no significant difference between the two groups, the diabetic population and the health population in level of calcium intake.2. Serum 25(OH)D in diabetic patients has a negative correlation with gender, TG, HDL, eGFR, PTH, calcium and phosphorus product and a positive correlation with waist circumference, SCr, BUN, lumbar spine and femoral neck bone density.3. Vitamin D deficient patients have increased Lg(FINS), Lg(HOMA-IR) and PTH compared with the normal group; in the meantime decreased bone min-eral density in lumbar spine and femoral neck.