Effects of vitamin D therapy on glucose metabolism in patients with prediabetes

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Abstract

There have been an increasing number of investigations on the role of vitamin D in glucose metabolism and the possibility of type 2 diabetes prevention with cholecalciferol but the optimal doses have not been determined yet. Aim. To assess the effect of cholecalciferol therapy at various doses on glucose metabolism in patients with prediabetes. Materials and methods. The study included 70 women aged 40 to 62 years (mean age 53.5±6.4 years) with prediabetes not taking vitamin D and without diseases affecting its metabolism. Patients were randomized into two groups: group 1 (n=32) received cholecalciferol 500 IU/day, group 2 (n=38) - 4000 IU/day for three months. Anthropometric data, comorbidities, and concomitant medications were assessed. Before and after three months of cholecalciferol therapy all patients underwent a standard oral glucose tolerance test with venous blood sampling at points 0’, 60’, and 120’. Plasma glucose was evaluated by the glucose oxidase method, insulin and glucagon-like peptide 1 (GLP-1) - by enzyme-linked immunosorbent assay. The indices of insulin resistance (HOMA-IR), insulin sensitivity (ISI-0,120) and functional activity of р-cells (HOMA-B) were calculated. Glycated hemoglobin (HbA1c) was determined by ion exchange chromatography. Serum 25-hydroxycalciferol [25(OH)D] and parathyroid hormone (PTH) were evaluated by the chemiluminescent immunoassay. Results. Fifty-eight patients completed the study. Initially most women (87.9%) had vitamin D deficiency or insufficiency. After three months of cholecalciferol therapy, an increase in 25(OH)D and decrease in PTH concentration were found in both groups (p=0.01). Normal values of serum 25(OH)D were reached by 9 patients (28.1%) from group 1 (500 IU/day) and 22 patients (73.3%) from group 2 (4000 IU/day). Reduction in HbA1c (p=0.001) and plasma glucose at points 60' (p=0.04) and 120' (p=0.04), increase in insulin level at point 120' (p=0.03) and gain in HOMA-B index (25.3%) at the end of the study were observed only in patients taking 4000 IU of cholecalciferol daily. After three months of therapy in 19 women (50%) from group 2 glucose and HbA,c levels corresponded to normal values while only 2 patients (7.1%) from group 1 had these parameters within normal ranges (p=0.001). Conclusions. Treatment with 4000 IU of cholecalciferol per day for three months is associated with increase in vitamin D level and glucose metabolism improvement in women with prediabetes. Key words: prediabetes, vitamin D, glucose, insulin, 25(OH)D, cholecalciferol. For citation: Andreeva A.T., Gavrilova V.I., Ustyuzhanina A.O. et al. Effects of vitamin D therapy on glucose metabolism in patients with prediabetes. Consilium Medicum. 2020; 22 (4): 47-54. DOI: 10.26442/20751753.2020.4.200115

About the authors

Alena T. Andreeva

Almazov National Medical Research Centre

Email: arabicaa@gmail.com
Saint Petersburg, Russia

Valeriya I. Gavrilova

Almazov National Medical Research Centre

Saint Petersburg, Russia

Anna O. Ustyuzhanina

Pavlov First Saint Petersburg State Medical University

Saint Petersburg, Russia

Anna A. Bystrova

Almazov National Medical Research Centre; Pavlov First Saint Petersburg State Medical University

Saint Petersburg, Russia

Maria A. Kokina

Almazov National Medical Research Centre

Saint Petersburg, Russia

Tatiana L. Karonova

Almazov National Medical Research Centre; Pavlov First Saint Petersburg State Medical University

Saint Petersburg, Russia

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