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BACKGROUND: Chronic low-grade inflammation is common in obesity and related chronic conditions, including type 2 diabetes. Vitamin D has been proposed to have anti-inflammatory properties; however the effect of vitamin D supplementation on inflammation in type 2 diabetes has not been established. AIM: We conducted a systematic review and meta-analysis to examine the effect of vitamin D supplementation on inflammatory markers compared to placebo or usual care in patients with type 2 diabetes, and to identify relevant knowledge gaps. METHODS: Medline, CINAHL, EMBASE and All EBM were systematically searched (from inception to 25 January 2017) for randomized controlled trials (RCTs) investigating the effects of vitamin D supplementation on inflammatory markers in type 2 diabetes patients. Two independent reviewers screened all full text articles (no date or language limits) for RCTs of vitamin D supplementation (any form, route, duration, and co-supplementation) compared to placebo or usual care on all inflammatory marker outcomes in patients with type 2 diabetes (on any treatment regimen and with or without comorbidities). Meta-analyses and meta-regression were conducted using random-effects models to calculate standardized mean differences (SMD) and 95%CIs. Two independent reviewers extracted data and assessed risk of bias and quality using the grading of recommendations, assessment, development and evaluation (GRADE) approach.RESULTS: Twenty-nine RCTs (n=1,780) met the inclusion criteria, 20 of which had available data for pooling. In meta-analyses of 20 RCTs (n=1,270), vitamin D-supplemented groups had lower follow-up levels of C-reactive protein (SMD: -0.23 mg/L (-0.37,-0.09); p=0.002), tumor necrosis factor-alpha (SMD: -0.49 pg/ml (-0.84,-0.15); p=0.005), and erythrocyte sedimentation rate (SMD: -0.47 mm/hr (-0.89,-0.05); p=0.03), and higher levels of leptin (SMD: 0.42 u00b5g/L (0.04, 0.81); p=0.03), compared to placebo. No differences were observed for adiponectin, interleukin-6, or E-selectin (all p>0.05). In meta-regression and subgroup analyses, age, sex, BMI, diabetes duration, baseline vitamin D status, and supplementation dose and duration did not alter the results. There was no evidence of heterogeneity (p>0.1) or publication bias (p>0.1) and most studies were low to moderate risk of bias. CONCLUSIONS: Our meta-analysis provides level one evidence that vitamin D supplementation may improve chronic low-grade inflammation in patients with type 2 diabetes. Further studies are needed to establish whether improved inflammation following vitamin D supplementation would translate into improved health outcomes for patients with type 2 diabetes. PROSPERO registration number: CRD42016047755.
This dissertation, "Systematic Review of the Effectiveness of Vitamin D Supplement for Type 2 Diabetes Mellitus Patients" by Jing, Xu, 许静, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Background Worldwide, as of 2010, about 285 million people suffered diabetes mellitus (DM), with type 2 constituting about 90% of the cases. DM is more common, in particular, type 2 diabetes mellitus (T2DM) in developed countries. The greatest increase in prevalence appears in Asia and Africa. More important, it associated with complications including uremia, heart disease and diabetic retinopathy. Recent research has investigated whether there would have effect of vitamin D (VD) supplementation in addition to other treatment or/and relevant interventions that would improve health outcomes of patients diagnosed with T2DM. Furthermore, the costs of using VD supplements are relatively low. Methods A systematic review was conducted by searching for relevant studies published from the year of 2004 to 2014 (all the studies were randomized controlled trials) from database of PubMed with specified keywords. All studies were conducted in Asia and all subjects were T2DM patients. Studies were included when they were in relation to the association between VD supplementation and T2DM patients. After filtering, ten trials were identified to be relevant and adopted in this systematic review. The effects of calcium intake were also explored whenever applicable. Results Ten studies were included, with all of them conducted in Asia. In seven trials, VD supplementation indicated insignificantly differences of VD effects on T2DM through impact of metabolic parameters such as glycated hemoglobin (HbA1c), Fasting plasma glucose (FPG), insulin, insulin resistance (IR).etc. However, three trials revealed significant differences in HbA1c, FPG, insulin, IR and insulin sensitivity (IS) with VD supplementation. Conclusions There were insufficient evidences concerning the effectiveness of VD supplementary for T2DM patients in Asian populations, in terms of improving their health outcomes. It could be likely to be useful for our Hong Kong Chinese population. Because some included trials were subject to small sample sizes, incompletely follow up, and/or low methodological quality, these might influence the validity of the findings. Future studies on the effectiveness of VD for T2DM would be warranted for Chinese population. Subjects: Non-insulin-dependent diabetes Vitamin D - Therapeutic use
This dissertation, "Vitamin D Deficiency in Patients With Type 2 Diabetes in a Shanghai Hospital: the Impact on Glycemic Control" by Xiaoming, Zhuang, 庄小鸣, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Objective：Low vitamin D has been implicated in the development of type 2 diabetes. However, whether vitamin D continues to have a clinically significant effect in existing diabetes is unclear. The objective of this study was to examine the association of serum vitamin D with glycemic control in established type 2 diabetes. Methods: This was a retrospective analysis of medical records. Characteristics of 487 patients with type 2 diabetes were stratified by vitamin D status and serum glycosylated hemoglobin (HbA1c). Vitamin D deficiency among the subjects was studied. The relationship between vitamin D and glycemic control was explored by multiple linear regression, multivariate analysis of variance (MANOVA) and chi-square test. Patients were stratified into overweight and non-overweight group based on body mass index (BMI), and the association of serum vitamin D concentration with glycemic control was evaluated in each group. Insulin resistance and C-peptide as mediators between vitamin D and HbA1c was tested. The impact of vitamin D on cholesterol metabolism was also assessed. Results: (1) Vitamin D deficiency was highly prevalent, accounting for 88.3% of the study sample. (2) Serum vitamin D levels were significantly inversely associated with serum HbA1c. This correlation was stronger in overweight group than in non-overweight group. There was no significant relationship between serum vitamin D levels and fasting plasma glucose (FPG). HbA1c was significantly lower in vitamin D insufficiency group than in vitamin D severe deficiency group. (3) Insulin resistance partially mediated the association between vitamin D and HbA1c. (4) No significant association of Vitamin D with low density lipoprotein (LDL) or high density lipoprotein (HDL) was found in this study. Conclusions: There was an inverse association between serum vitamin D levels and HbA1c. The inverse correlation of serum vitamin D level and HbA1c was stronger in overweight group than in non-overweight group, which indicates patients with obesity might benefit more from vitamin D supplementation. DOI: 10.5353/th_b5099026 Subjects: Vitamin D deficiency Non-insulin-dependent diabetes
This dissertation, "Effects of Vitamin D Deficiency and Supplementation on Vascular Function in Patients With Type II Diabetes" by Yuen-fung, Yiu, 饒元豐, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Despite the medical advances in recent decades, cardiovascular disease (CVD) remains one of the leading causes of mortality in most developing countries. Ongoing efforts have been focused on evaluating new strategies targeting on novel risk factors. Vitamin D deficiency, a previously neglected condition, has recently attracted much attention from the scientific community with its potential extra-skeletal effects. There is accumulating evidence from epidemiological studies that a suboptimal 25-hydroxyvitamin D [25(OH)D] level is associated with all-cause and cardiovascular mortality, increased risk of coronary heart disease, stroke and peripheral vascular disease, and various traditional CVD risk factors including hypertension, diabetes mellitus (DM) and metabolic syndrome. Several theories have been proposed to explain these relationships but none receive universal recognition. There is recent laboratory evidence that vitamin D may exert specific effects in patients with DM. However, relationships between vitamin D deficiency and supplementation on vascular function in this group of patients are unclear. In this dissertation, I sought to explore the effects of vitamin D deficiency on vascular function in patients with type II DM in a cross-sectional study. In the later part, the results of a randomized controlled trial investigating the effects of daily vitamin D supplementation in type II DM patients are presented and discussed. The cross-sectional study (Chapter 3) investigated the association of vitamin D status with endothelial function as measured by brachial flow-mediated dilation (FMD) and circulating endothelial progenitor cell (EPC) numbers in 280 patients with type II DM. The results showed that suboptimal vitamin D status was more common among patients with DM. Furthermore, patients with vitamin D deficiency had significantly lower brachial FMD (mean difference = -1.43%, 95% CI: -2.31 to -0.55, P = 0.001) and CD133/KDR+ EPC counts (mean difference = -0.12%, 95% CI: -0.21 to -0.02, P = 0.022) than those with sufficient vitamin D after adjustment for age, sex and cardiovascular risk factors, including HbA1c levels. Based on these positive results, the objectives of the randomized controlled trial (Chapter 4) were to study and confirm the effects of daily oral vitamin D supplementation on the vascular function in this group of patients. Over a 12-week period, 100 DM patients with suboptimal vitamin D status were randomized to receive 5,000 IU/day vitamin D or placebo. There were no reported adverse events including hypercalcemia, although a slight increase in serum ionized calcium (treatment effect 0.037 mmol/L, P = 0.018) was recorded in the vitamin D group. Despite a significant improvement in serum 25(OH)D in the treatment group, supplementation of vitamin D did not result in any significant improvement in vascular function as determined by FMD, circulating EPC count or arterial stiffness (all P > 0.05). Furthermore, the serum level of high-sensitivity C-reactive protein, oxidative stress markers, low- and high-density lipoprotein and glycated haemoglobin were also similar between two groups (all P > 0.05). The results of this study did not support a therapeutic role of supplementation with vitamin D for cardiovascular benefits. In conclusion, the results of these studies demonstrated that deficiency of vit
Vitamin D: Volume 2: Health, Disease and Therapeutics, Fourth Edition, authoritatively covers the evidence for new roles for vitamin D, ranging from cardiovascular disease, to cancer, diabetes, inflammatory bowel disease, multiple sclerosis and renal disease. This collection represents a who’s who of vitamin D research and the coverage is appropriately broad, drawing in internal medicine, orthopedics, oncology and immunology. Clinical researchers will gain a strong understanding of the molecular basis for a particular area of focus. Offers a comprehensive reference, ranging from basic bone biology, to biochemistry, to the clinical diagnostic and management implications of vitamin D Saves researchers and clinicians time in quickly accessing the very latest details on the diverse scientific and clinical aspects of Vitamin D, as opposed to searching through thousands of journal articles Chapter authors include the most prominent and well-published names in the field Targets chemistry, metabolism and circulation, mechanisms of action, mineral and bone homeostasis and vitamin D deficiency Presents a clinical focus on disorders, analogs, cancer, immunity, inflammation, disease and therapeutic applications
This issue of Endocrinology and Metabolism Clinics, guest edited by Drs. J. Chris Gallagher and Daniel Bikle, is devoted to Vitamin D. Articles in this issue include: The Molecular and Cellular Mechanisms of Action of Vitamin D, Worldwide Review of Serum 25OHD Status; RDA Update (7 Years Post IOM); The Use of Vitamin D Metabolites and Analogs in the Treatment of Chronic Kidney Disease; Effect of Vitamin D on Falls and Physical Performance; Vitamin D Effect on BMD and Fractures; Bariatric Surgery and Vitamin D Metabolism, Role of Vitamin D in the Prevention and Treatment of Cancer; Role of Vitamin D in Cardiovascular Disease; Regulation of Immune Function by Vitamin D and its Use in Diseases of Immunity; Genetic Diseases of Vitamin D Metabolizing Enzymes; Measurement of Vitamin D Metabolites: Clinical Issues; The Free 25OHD Hypothesis, and Ethnic/Racial Differences in Vitamin D Levels: Physiologic or Pathologic.
Vitamin D deficiency is a worldwide problem linked to numerous diseases affecting men, women, and children of all ages. Enormous progress in the study of vitamin D has been made since the first edition of this highly-acclaimed book was published nearly 20 years ago, and current research continues to draw headlines. Feldman and Pike’s Vitamin D, Fifth Edition continues to build on the successful formula from previous editions, taking the reader from the basic elements of fundamental research to the most sophisticated concepts in therapeutics. The two comprehensive volumes provide investigators, clinicians, and students with a comprehensive, definitive, and up-to-date compendium of the diverse scientific and clinical aspects of vitamin D, where each area is covered by both basic and clinical experts in the field. In Volume I: Biochemistry, Physiology and Diagnostics, international experts in endocrinology, bone biology, and human physiology take readers through the basic research of vitamin D. This impressive reference presents a comprehensive review of the multi-faceted actions of vitamin D relating both to skeletal and extra-skeletal action. Researchers from all areas of vitamin D will gain insight into how clinical observations and practices can feed back into the research cycle and will, therefore, be able to develop more targeted genomic and proteomic insights into the mechanisms of disease. Volume II: Health, Disease and Therapy authoritatively covers the evidence for new roles of vitamin D, ranging from organ transplantation to cancer, diabetes, inflammatory bowel disease, multiple sclerosis, and renal disease. The coverage is appropriately broad, drawing on aspects of internal medicine, pediatrics, nutrition, orthopedics, oncology, neurology, obstetrics and gynecology, and immunology, as well as, new areas for vitamin D including sports medicine, opthalmology, veterinary medicine and ICU care – including COVID-19. Clinical researchers will gain a strong understanding of the molecular basis for a particular disease and better understand future directions for research in this still-growing field. A comprehensive reference ranging from basic biochemistry, cell biology, and physiology principles to the clinical diagnostic and management implications of vitamin D Saves researchers and clinicians time in quickly accessing the very latest details on the diverse scientific and clinical aspects of vitamin D, as opposed to searching through thousands of journal articles Chapters written by the most prominent and well-published names in the field
The International Textbook of Diabetes Mellitus has been a successful, well-respected medical textbook for almost 20 years, over 3 editions. Encyclopaedic and international in scope, the textbook covers all aspects of diabetes ensuring a truly multidisciplinary and global approach. Sections covered include epidemiology, diagnosis, pathogenesis, management and complications of diabetes and public health issues worldwide. It incorporates a vast amount of new data regarding the scientific understanding and clinical management of this disease, with each new edition always reflecting the substantial advances in the field. Whereas other diabetes textbooks are primarily clinical with less focus on the basic science behind diabetes, ITDM's primary philosophy has always been to comprehensively cover the basic science of metabolism, linking this closely to the pathophysiology and clinical aspects of the disease. Edited by four world-famous diabetes specialists, the book is divided into 13 sections, each section edited by a section editor of major international prominence. As well as covering all aspects of diabetes, from epidemiology and pathophysiology to the management of the condition and the complications that arise, this fourth edition also includes two new sections on NAFLD, NASH and non-traditional associations with diabetes, and clinical trial evidence in diabetes. This fourth edition of an internationally recognised textbook will once again provide all those involved in diabetes research and development, as well as diabetes specialists with the most comprehensive scientific reference book on diabetes available.