25(oh) d levels, fetuin final
- 1. Presented by – Dr. Rishika Gaur Jr2 Internal medicine , KGMU
- 2. Principal Guide • Dr. Madhukar Mittal Co-Guides • Prof Ravi Misra • Prof Arvind Mishra • Dr. Vivek Kumar • Prof A.A.Mahdi
- 3. Known since years: The adverse association between low serum vitamin D levels and bone and calcium metabolism Recently researched: Inverse relation between serum vitamin D levels and metabolic syndrome, diabetes mellitus , hypertension and cardiovascular disease
- 4. Insulin secretion Research shows that severe vitamin D deficiency may inhibit insulin secretion Insulin Resistance Vitamin D deficiency also associated with insulin resistance in humans Vitamin D supplementation Conflicting data on whether supplementation improves glycemic control in T2D Inconsistent results regarding supplementation and prevention of progression of prediabetes to diabetes
- 5. IL-6 levels correlate negatively with insulin sensitivity TNF α levels increase with insulin resistance hsCRP-directly associated with insulin resistance Fetuin A Fetuin A Peptide molecule Secreted from hepatocytes Binds to Insulin receptor present on adipose cells and muscles Higher serum Fetuin A levels are associated with insulin resistance
- 6. Comparison of 25(OH)D and Fetuin A levels • Impaired Fasting Glucose/Impaired Glucose Tolerance(IFG/IGT) • Type 2 Diabetes mellitus(T2D), No CAD • Type2 Diabetes Mellitus with Coronary artery disease Effect of Vitamin D supplementation on glycemic parameters
- 7. Study Design- • Observational Cross sectional study • Prospective open label study Duration of study-one year Study population- 3 groups • IFG/IGT • T2D, No CAD • T2D with CAD
- 8. Age : >18 and <70 years Blood sugar CAD: Coronary artery disease- previous h/o myocardial infarction, cardiomyopathy, stable angina, unstable angina IFG: FBS -100-125 IGT: PPBS-140-199 T2D 1.FBS: ≥ 126 2.PPBS: ≥200 3.RBS: ≥200 with symptoms
- 9. Holick’s Classification Lip’s Classification 1.Sufficiency :≥ 30 ng/ml 2.Insufficiency: 20-29 ng/ml 3.Deficiency :<20 ng/ml 1. Mild- 25-50 ng/ml 2. Moderate- 12.5-25 ng/ml 3. Severe- <12.5ng/ml
- 10. • Chronic kidney disease • Vitamin D Supplementation in last 3 month • Vitamin D Fortified food • Malabsorption • Primary hyperparathyroidism • Pregnancy • Breast feeding • Antiepileptics, Steroids, Antifungal, ATT, ART
- 11. • Complete Blood Count • Liver function test • Kidney function test • HbA1c • 25(OH) D : Chemiluminescence (CLIA) • Fetuin A: Human Fetuin A ELISA kit(Booster Immunoleader) • ECG and USG
- 12. Sno. Publication Study design Interventi on Effect Remarks 1. Mittal M et al. (Journal of diabetes &metabolic disorder) Systematic review - - No improvement with vitamin D supplementation on glycemic parameters 2. George PS, Pearson ER,Witham Md et al(2012) Systematic review and meta analysis - - Further studies need to establish relation between 25(OH) D and T2D
- 13. S No. Publication Study design Intervention Change in glycemic parameters REMARKS 1. Jehle et al, 2014, Switzerland RCT, N=55 300,000 IU IM once in 3 month x 6mo HOMA-IR - ↓ by 12.8% ± 5.6% in the D3 group and ↑ by 10% ± 5.4% in placebo group (p = 0.032) 0 Improved HOMA-IR 2. Al-Daghri et al, 2012, Saudi Prospective longitudinal, N=92 Vitamin D3 oral 2000 IU daily for 18 months HOMA-B: 52 ± 9 vs. 97 ± 15 (p=0.002)
- 14. S No. Publication Study design Intervention Change in glycemic parameters Remarks 3. Talaei et al, 2013, Iran Longitudinal study, N=100 50,000 U vitamin D3 orally/weekly for 8 weeks HOMA-IR: 3.57±3.18 and 2.89±3.28 (P=0.008) 4. Nikooyeh et al , 2011, Iran RCT,N = 90 500 IU vitamin D+ calcium twice daily for12 weeks HbA1c(8.7± 1.4 v/s 7.3±1.3(p<0. 001) and HOMA-IR (5.5±3.7 v/s 3.0±1.5)(p< 0.001) Significant improvemen t in HbA1c and HOMA-IR
- 15. S No. Publication Study design Intervention Change in glycemic parameters Remarks 5. Tabesh et al , 2014, Iran RCT, N = 70 Cholecalcifero l for 8 weeks changes from baseline, HbA1c (-0.70 ± 0.19%, (p = 0.02), HOMA-IR (- 0.46 ± 0.20, p = 0.001) QUICKI (0.025 ± 0.01,( p = 0.004) improved HbA1c, HOMA-IR 6. Shab-bidar et al, 2011, Iran RCT, N = 100 1,000 IU vitamin D3 orally daily for12 weeks QUICKI- 0.27±0.02 V/S 0.30±0.02,HBA1c- 8.7±1.8 v/s 7.8±1.3(p=0.015) QUICKI only showed improvement, rest no significant change.
- 16. S No. Publication Study design Interventio n Change in glycemic parameters Remarks 7. Chan et al , 2013, Hong Kong RCT, N = 100 5000 IU Vitamin D3 daily for 12 weeks HbA1c -7.35 vs. 7.20, p = 0.08 No change in HBA1C and other glycemic parameters 8. Hassan et al, 2011, Iran RCT, N = 70 Calcitriol 0.25 μg daily orally for 12 weeks HbA1c -7.1 ± 1.6 vs. 7.9 ± 2.1, p=0.004,QUICKI- 0.33±0.03 v/s0.31±0.02 (p=0.002) Attenuated the increase in glycemic, and QUICKI
- 17. 1. N, % 14 (87.5) 2.BMI 27.21±4.37 27.57(23.84-30.36) 3.25(OH)D, ng/ml 15.29±14.69 9.03(4.45-24.44) 4.HBA1c, % 6.31±0.86 6.30(5.62-6.87) 5.Fasting insulin, mU/L 11.04±7.43 9.92(5.79-13.20) 6.HOMAIR 2.893±1.914 2.642(1.68-3.29) 7.QUICKI 0.341±0.040 0.330(0.320-0.352) Values are means ± SD or median (inter-quartile range)
- 18. 1. N,% 43(63.2) 2.BMI 27.24±6.50 25.77(22.56-31.00) 3.25(OH)D, ng/ml 14.62±9.67 12.67(7.277-19.91) 4.HBA1c,% 9.16±2.63 8.65(6.70-11.28) 5.Fasting insulin, mU/L 13.12±18.65 8.17(4.60-14.70) 6.HOMAIR 4.201±6.561 2.57(1.28-4.00) 7.QUICKI 0.339±0.0488 0.331(0.311-0.368) Values are means ± SD or median (inter-quartile range)
- 19. 1. N,% 5(31.2) 2.BMI 27.55±7.27 25.96(25.00-27.63) 3.25(OH)D, ng/ml 16.12±13.25 12.56(5.89-24.47) 4.HBA1c,% 9.54±2.25 9.50(8.80-10.60) 5.Fasting insulin, mU/L 7.16±4.17 5.46(4.60-10.76) 6.HOMAIR 2.297±1.566 1.600(1.30-3.68) 7.QUICKI 0.354±0.047 0.355(0.315-0.368) Values are means ± SD or median (inter-quartile range)
- 20. Characteristic Deficient (N=92) Non deficient (N=8) P value 1. N,% 57(91.93) 5(8.06) 0.976 2.BMI 27.48±6.42 25.96(23.68- 30.08) 25.20±4.65 25.61(21.22- 27.18) 0.332 3.25(OH)D, ng/ml 12.57±7.30 10.97(5.8- 18.77) 42.55±10.01 40.91 0.00 4.HBA1c,% 8.89±2.64 8.60(6.6- 10.7) 7.30±1.60 6.70(6.07-8.35) 0.097 5.Fasting insulin, mU/L 10.933±9.425 8.38(4.81- 13.5) 22.422±47.21 3 5.56(4.18-10.75) 0.049 6.HOMAIR 3.262±2.933 2.57(1.38- 3.80) 6.822±15.016 1.60(0.94-2.77) 0.074 7.QUICKI 0.340±0.043 0.331(0.313- 0.36) 0.359±0.074 0.355(0.328- 0.387) 0.272 Values are means ± S D or median (inter-quartile range)
- 21. Characteristic Female (N=62) Male (N=38) P value 1. N, % 62(100) 8(0) 2.BMI 28.54±6.89 26.66(18.00- 27.00) 25.22±4.59 25.39(21.98- 27.38) 0.012 3.25(OH)D, ng/ml 15.38±11.58 12.76(5.48- 21.52) 14.28±10.34 11.68(6.96- 19.03) 0.631 4.HBA1c,% 8.72±2.44 8.45(6.47- 10.72) 8.83±2.88 8.60(6.50- 10.45) 0.844 5.Fasting insulin, mU/L 13.49±19.36 8.80(4.66- 15.05) 9.18±6.55 6.94(4.43- 12.79) 0.194 6.HOMAIR 4.299±6.522 2.72(1.368- 4.454) 2.44±1.83 1.925(1027- 3.334) 0.134 7.QUICKI 0.336±0.045 0.328(0.307- 0.364) 0.352±0.048 0.346(0.319- 0.368) 0.123 Values are means ± SD or median (inter-quartile range)
- 22. Characteristic IFG (N=16) T2D (N=84) pvalue 1. N , % 14(87.5) 48(57.14) 0.025 2.BMI 27.21±4.37 27.57(23.84- 30.36) 27.30±6.60 25.77( 22.91- 29.47) 0.961 3.25(OH)D, ng/ml 15.29±14.69 9.03(4.45- 24.44) 14.90±10.37 12.76(6.44- 19.91) 0.899 4.HBA1c,% 6.31±0.86 6.30(5.62-6.87) 9.23±2.56 8.90(6.70- 11.24) 0.00 5.Fasting insulin, mU/L 11.04±7.43 9.92(5.79- 13.20) 12.03±17.08 7.42,(4.51- 13.46) 0.822 6.HOMAIR 2.893±1.914 2.642(1.68- 3.29) 3.791±5.895 2.233(1.32- 3.80) 0.551 7.QUICKI 0.341±0.0404 0.330(0.320- 0.352) 0.3427±0.0485 0.338(0.3138- 0.3665) 0.895 Values are means ± SD or median (inter-quartile range)
- 24. Sno. Publication Study design Fetuin A levels REMARKS 1. Liang Yin et al, China ,2015 Cross Sectional Study T2D v/s NGT (368.5±15.6 vs. 152.7±7.1 mg/l (P<0.01) 2. Aiyun Song et al,China,2011 Cross Sectional Study NGT v/s IFG/IGT v/s T2D 285.3 v/s291.0 v/s 307.7 (p value= 0.0008) Significant difference among three group.