Diabetes Type 2 and Vitamin D for Adult
Adil Omar Bahathiq*
Department of Physiology, Um-Alqura University, Saudi Arabia
Submission: November 26, 2018; Published: February 12, 2019
*Corresponding author: Adil Omar Bahathiq, Department of Physiology, Associate professor of Reproductive Endocrinology, Faculty of Medicine, Um-Alqura University, Saudi Arabia
How to cite this article: Adil Omar Bahathiq. Diabetes Type 2 and Vitamin D for Adult. Curre Res Diabetes & Obes J. 2019; 9(5): 555773. DOI: 10.19080/CRDOJ.2019.09.555773
Abstract
Renewed interest in vitamin D, the so-called “sunshine vitamin,” has occurred currently because it has been linked to the entirety from cancer and heart disease to diabetes [1]. Research studiescontinue to pour into the literature mentioning that vitamin D is a celeb when it comes to health. However, most of the research is based on observational, epidemiological studies, which are important for producing hypotheses however do no longer show causality. The challenge for health care providers and nutrition researchers is to decide whether vitamin D deficiency certainly causes or increases the incidence of certain diseases or whether, instead, low degrees of vitamin D are certainly coincidental given that the majority of the widely wide-spread population, regardless of disease, is likely to have insufficient levels of vitamin D. In other words, do people who develop disorder states just happen to be deficient in vitamin D, or do low levels of vitamin D cause the disease? Will supplementation with vitamin D prevent diseases, and can it be used to treat diseases such as diabetes?
Keywords:Vitamin D; Sunshine vitamin; Epidemiological studies; Diabetes; Hypovitaminosis; Nutrition; Glucose metabolism; Hydroxylase deficiency; Metabolic diseases; Insulin receptor
Abbreviations: MetS: Metabolic Syndrome; IR: Insulin Resistance; T2D: Type 2 Diabetes; NHANES: The National Health and Nutrition Examination Survey; VDRs: Vitamin D Receptors
Introduction
Vitamin D and diabetes
Vitamin D deficiency and diabetes have one major trait in common: both are pandemic. The International Diabetes Federation estimates the range of people with diabetes worldwide to be nearly 285 million, or 7% of the world’s population [2]. Persons with type 2 diabetes, it has been said that girls with type 2 diabetes have a high prevalence of (hypovitaminosis D)
Vitamin D and type 2 diabetes
After conducting a meta-analysis and review of the impact of nutrition D and calcium on glycemic manipulate in sufferers with type 2 diabetes, Pittas et al. [3] concluded that inadequate vitamin D and calcium seems to avoid glycemic manipulate and that supplementing each nutrient may also be necessary to optimize glucose metabolism.
An observational study from the Nurses Health Study [4] that included 83,779 women > 20 years of age discovered an increased hazard of type 2 diabetes in these with low vitamin D status. A mixed daily intake of > 800 IU of vitamin D and 1,000 mg of calcium reduced the risk of type 2 diabetes via 33%. The National Health and Nutrition Examination Survey (NHANES) III study between 1988 and 199452 established that there is a sturdy inverse affiliation between low degrees of 25(OH)D and diabetes prevalence. Low vitamin D levels have also been proven to be predictive of the future improvement of type 2 diabetes [5].
Increasing vitamin D serum levels to normal led to a 55% relative reduction in the risk of developing type 2 diabetes. As with most sickness states and vitamin D, prospective studies associated to vitamin D supplementation and diabetes are uncommon and limited. Prospective trials of vitamin D and diabetes to date have been both too small or used insufficient amounts of vitamin D [6].
Vitamin D and complications of diabetes
Diabetes is associated with issues such as cardiovascular disease, renal impairment, and peripheral neuropathies. Studies have explored the relationship of vitamin D concentrations to these complications [7].
Vitamin D and metabolic outcomes
Vitamin D popularity may additionally have an impact on the danger of creating metabolic illnesses such as Type 2 diabetes (T2D), metabolic syndrome (MetS) and insulin resistance (IR). Several studies have assessed vitamin D in relationship with metabolic outcomes; however, and vitamin D popularity at baseline in apparently healthful adults is inversely related with future dangers of T2D and MetS. Interventions aimed at maintaining adequate levels of vitamin D in addition to preventing deficiency may also be a useful preventive measure for metabolic diseases [8].
Mechanisms of Action
There is developing evidence that vitamin D deficiency could be a contributing factor in the development of both type 1 and type 2 diabetes. First, the β-cell in the pancreas that secretes insulin has been shown to comprise VDRs as nicely as the 1 alpha hydroxylase enzyme [9]. Evidence suggests that vitamin D cure improves glucose tolerance and insulin resistance [10,11]. Vitamin D deficiency leads to reduced insulin secretion. Supplementation with vitamin D has been shown to repair insulin secretion in animals [12]. Researchers have also found an oblique effect on insulin secretion, potentially via a calcium effect on insulin secretion. Vitamin D contributes to normalization of extracellular calcium, ensuring ordinary calcium flux through mobile membranes; therefore, low vitamin D may scale down calcium’s capacity to have an effect on insulin secretion [13]. Other conceivable mechanisms related with vitamin D and diabetes include improving insulin action through stimulating expression of the insulin receptor, enhancing insulin responsiveness for glucose transport, having an indirect impact on insulin action doubtlessly by way of a calcium effect on insulin secretion, and enhancing systemic infection with the aid of a direct effect on cytokines [13].
Assessment of Vitamin D Status
Elucidation of the cell-biologic mechanism of vitamin D action, and numerous clinical trials and observational studies concerning vitamin D reputation to health and disease. The distinction between deficiency and insufficiency is not useful or necessary. Serum 25(OH)D values below 120 nmol/l (48ng/ ml) associated with preventable disease and are consequently indicative of deficiency. The upper limit of the normal range can be set at 225 nmol/l (90 ng/ml), although toxicity is uncommon below 500 nmol/l (200 ng/ml) [14]
There are two main forms of vitamin D: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D2 is synthesized by using plants (mainly mushrooms and yeast), whereas vitamin D3 is synthesized in skin when it is exposed to ultraviolet B rays from sunlight. Vitamin D3 is also found in a few foods such as fatty fish [15].
Unfortunately, it is very difficult to get enough vitamin D from food sources alone. Both vitamin D2 and vitamin D3 can be made synthetically and are used to enhance foods such as milk products, margarine, and soy milk and to make dietary supplements. The synthetic form of vitamin D3 is derived from animal sources and is currently the most common form of vitamin D used in dietary supplements and fortified foods [16].
The dietary types of vitamin D are absorbed in the small intestine with dietary fat and other fat-soluble vitamins, whereas vitamin D3 enters circulation after it is synthesized nonenzymatically in the skin throughout exposure to the ultraviolet rays in sunlight. Neither vitamin D2 or vitamin D3 have any biological functions in the body until they go via a two-step process of metabolism. The metabolism of the various forms of vitamin D requires conversion in the liver and kidney, and the active form, 1,25-dihydroxyvitamin D (calcitriol), needs to bind to vitamin D receptors (VDRs) before biological actions occur [17,18]. Thus, diabetic patients with liver or kidney issues are at high risk of deficiency, as are patients with gastrointestinal issues such as celiac disease, pancreatitis, low bile levels, or sprue [19].
In the past, the major source of vitamin D for humans was exposure to sunlight. One possible cause of the current widespread vitamin D deficiency is the lack of sunlight exposure. Another possible cause is a lack of dietary sources of vitamin D [17].
Since the industrial revolution, very few people get much sun exposure while working. Other barriers to sunshine exposure include fear of skin cancer, which has led to an increased use of sunscreen, hats, and other sun barriers. For some people, religious beliefs require that their skin be covered. Environmental factors such as pollution and fewer hours of sun exposure during the winter (especially in latitudes north of ∼ 37°) also decrease vitamin D synthesis from sunlight exposure [20]. Additionally, aging skin and skin of darker color require longer exposure to sunlight to initiate vitamin D synthesis [17].
It has been suggested that ∼ 5–30 minutes of sun exposure between 10:00 a.m. and 3:00 p.m. at least twice per week on the skin of the face, arms, back, or legs (without sunscreen) is usually adequate for vitamin D synthesis [21]. Skin exposed to sunshine indoors, as through a glass window, will not produce vitamin D [22,23].
Mutations in the CYP27B1 Gene as the Molecular Basis for 1α-Hydroxylase Deficiency
Heterogeneous mutations in the CYP27B1 gene that abolish or reduce 1α-hydroxylase enzymatic activity, which cannot Control the blood sugar. A recent review by the Miller and Portale group catalogs the multiple different mutations in the CYP27B1 gene that have been described including missense mutations, deletions, duplications, and splice site changes [23,24]. To date, 48 patients have been described with mutations in CYP27B1 gene including both genders from multiple ethnic backgrounds often in the setting of consanguinity.
Summary and Conclusion
Although the role of vitamin D in helping to regulate blood glucose remains poorly understood, vitamin D status appears to play a role in the development and treatment of diabetes. It is possible that optimal levels of serum vitamin D may be different for people at risk for developing diabetes, those with diabetes, and those without diabetes. According to Danescu et al. [23], “both animal and humanstudies support the notion that adequatevitamin D supplementation may decrease the incidence of type 1 and possibly also of type 2 diabetes mellitus and may improve the metabolic control in the diabetes state. However, the exact mechanisms are not clear and need further investigation.”
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