Tuesday 25 January 2022

What do studies say about the link between diabetes and vitamin D levels?

 Proposing that vitamin D is a panacea that could prevent, or even cure, a range of diseases is a sure way to start a fight in some circles. The role of vitamin D in diabetes has been investigated for years without yielding clear conclusions. So what do the studies actually say?

Diabetes, both types 1 and 2, are potentially life threatening and certainly life changing conditions that affect people worldwide. Case numbers increased nearly fourfold between 1980 and 2014 according to the World Health Organization (WHO)Trusted Source, with associated increases in mortality and disability caused by the disease.

The majority of those cases are type 2 diabetes, caused by excess visceral fat, though the interactionTrusted Source between genetic susceptibility, environment, obesity, and sedentary lifestyle is complex. It is not uncommonTrusted Source for people to have a moderate body mass index (BMI) and type 2 diabetes, though they still respond to weight loss.

Case numbers of type 1 diabetes are also growing. The reasons for this are not well understood, but some have compared the increase in type 1 diabetes cases to those of other autoimmune diseases such as multiple sclerosis. Both are more common in the northern hemisphere, as is vitamin D deficiency.

In fact, estimates suggest that as many as 40% of Europeans are vitamin D deficient, and 13% may be severely so — and the situation is worse still for individuals with dark skin. It is also difficult to ascertain how many people are deficient, as debate rages over the definition of deficiency.

Dr. Victoria Salem, a consultant endocrinologist and clinical scientist based at Imperial College London, told Medical News Today in an interview: “We know that type 1 diabetes is much more prevalent in the northern hemisphere and that’s usually put down to the fact that we get less sunlight and therefore have less vitamin D levels. That’s true also for multiple sclerosis. But it’s essential that that’s an association.”

While it is just an association, the links do not stop there. “[There is] quite good data showing that vitamin D deficiency, frank deficiencies — so children who’ve got rickets — are much more likely later in life to develop type 1 diabetes. But equally, people who are given a high dose of vitamin D […] are also less likely to get type 1 later on,” she explained.

Of course, suggesting vitamin D, or lack of it, is responsible for disease or susceptibility to it, is rife with controversy. Particularly with the heavily racialised discussion over the role of vitamin D deficiency in susceptibility to COVID-19.

The controversy over the role of vitamin D in diabetes is most likely due to poorly designed trials that have failed to adequately measure the impact of vitamin D supplementation on groups that can be generalized, a recent update in the European Journal of Clinical NutritionTrusted Source argued.

Type 2 diabetes is typically diagnosed when high blood glucose levels are detected. This is ultimately caused by low insulin sensitivity in the tissues which makes it hard for the body to take glucose out of the blood.

To compensate for this lack of sensitivity, the body creates a larger amount of insulin until eventually the beta cells in the pancreas give up, and the affected individual cannot produce enough insulin to transport glucose into their cells, resulting in high blood sugar. It is often at this point that people receive the diagnosis of type 2 diabetes.

Dr. James Brown from Aston Research Centre for Healthy Ageing, Aston University in Birmingham, United Kingdom, studies type 2 diabetes and metabolism and explained the theory to MNT in an interview:

This theory has led to studies that hoped to determine if vitamin D could prevent or even treat type 2 diabetes. The largest of those studies in recent years was the D2D studyTrusted Source. This National Institutes of Health-funded study was the first large-scale randomized control trial of its kind and sought to determine if vitamin D supplementation would help reduce the risk of type 2 diabetes among people with prediabetes, a condition where blood glucose is already slightly elevated.

Researchers followed 2,423 participants for 2.5 years, with half assigned to take 4,000 IU — 100 micrograms (mcg) — of vitamin D supplementation a day, while half took no supplement.

At the end of the trial, results in the New England Journal of Medicine showed that those who had taken vitamin D supplementation had a higher level of vitamin D in their blood. Though they were 12% less likely to develop type 2 diabetes during the study, this was not found to be significantly different to the group who received no supplementation.

Source: Medical News Today

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