Effect of Vitamin D3 Supplementation on the Level of 25(OH)D3, Osteocalcin, and HbA1c in Children with Type 1 Diabetes Mellitus: Vitamin D3 and Type 1 DM

Hajeng Wulandari; Harjoedi Adji Tjahjono; Edi Widjajanto

doi:10.11594/jtls.12.02.14

Authors

Hajeng Wulandari Department of Pediatrics, Faculty of Medicine, University of Brawijaya, Malang, Indonesia
Harjoedi Adji Tjahjono Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, University of Brawijaya, Malang, Indonesia
Edi Widjajanto Department of Clinical Pathology, Faculty of Medicine, University of Brawijaya, Malang, Indonesia

DOI:

https://doi.org/10.11594/jtls.12.02.14

Keywords:

HbA1c, osteocalcin, T1DM, vitamin D

Abstract

Type 1 diabetes mellitus (T1DM) is a chronic disease caused by insulin deficiency
resulting from autoimmune destruction of pancreatic beta cells. Increased risk of fractures and osteoporosis in T1DM is associated with reducing osteoblast proliferation,
survival, and activity. Osteocalcin (OC) is a marker of late-stage osteoblast differentiation. It might be positively modulated by vitamin D. This study was aimed to investigate the effect of vitamin D3 supplementation on the level of 25(OH)D3, HbA1c,
and OC in children with T1DM. A randomized clinical trial was conducted to
measures the levels of 25(OH)D3, HbA1c, and OC in children with T1DM supplemented with vitamin D3. Many 26 children with T1DM were equally assigned into
two groups: control (standardized insulin treatment) and treatment group (standardized insulin treatment + vitamin D3 2000 IU/day). Subject characteristics showed that
the subjects were predominantly female (15/26), well-nourished (19/26), the average
age is 12,31 ± 3,069 year, and the dose of insulin average is 1,17 ± 0,233 IU/kg
BW/day. Our data demonstrated that vitamin D3 treatment significantly increased the
level of 25(OH)D3 and improved glycemic control, represented by a low HbA1c level.
However, there was no significant difference in OC level in both groups (independent
t-test, p > 0.05). Further analysis showed no significant relationship between the level
of 25(OH)D3, HbA1c, and OC. We concluded that vitamin D3 supplementation improves children's glycemic control with T1DM, but no significant alteration on OC
levels.
Keywords: HbA1c, Osteocalcin, T1DM, Vitamin D

References

Batubara JRL, Tridjaya B, Pulungan AB (2010) Diabetes mellitus. In: Batubara JRL, Tridjaya B, Pulungan AB, First Edition. Buku ajar endokrin anak. Jakarta, IDAI. 125-194.

Craig ME, Hattersley A, Donaghue KC (2009) Definition, epidemiology and classification of diabetes in children and adolescents. Pediatric Diabetes 10(Suppl 12): 3-12. doi: 10.1111/j.1399-5448.2009.00568.x.

Batubara JRL, Tridjaja B, Pulungan AB, Himawan IW (2012) Komplikasi jangka panjang dan jangka pendek diabetes melitus tipe 1. Sari Pediatri 10(6): 367-372. doi: 10.14238/sp10.6.2009.

Steck AK, Barriga KJ, Emery LM, Fiallo-Scharer RV, Gottlieb PA, Rewer MJ (2005) Secondary attack rate of type 1 diabetes in Colorado families. Diabetes Care 28(2): 296-300. doi: 10.2337/diacare.28.2.296.

Maddaloni E, D'Onofrio L, Lauria A, Maurizi AR, Strollo R, Palermo A, et al (2014) Osteocalcin levels are inversely associated with HbA1c and BMI in adult subjects with long-standing type 1 diabetes. Journal Endocrinol Investigation 37(7): 661-666. doi: 10.1007/s40618-014-0092-7.

Cahyono HA (2013) Gambaran klinis dan laboratoris diabetes melitus tipe-1 pada anak. Jurnal Kedokteran Brawijaya 26(4): 195-198. doi: 10.21776/ub.jkb.2011.026.04.2.

Erlich H, Valdes AM, Noble J, Carlson JA, Varney M, Concannon P, et al (2008) HLA DR-DQ haplotypes and genotypes and type 1 diabetes risk: analysis of the type 1 diabetes genetics consortium families. Diabetes 57(4): 1084-1092. doi: 10.2337/db07-1331.

Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, et al (2010) Maternal age at birth and childhood type 1 diabetes: a pooled analysis of 30 observational studies. Diabetes 59(2): 486-494. doi: 10.2337/db09-1166.

American Diabetes Association (2016) Classification and diagnosis of diabetes. Diabetes Care 39(1): S13â€“S22.

De Luca HF (2004) Overview of general physiologic features and functions of Vitamin D. American Journal of Clinical Nutrition 80(6 Suppl): 1689S-1696S. doi: 10.1093/ajcn/80.6.1689S.

Savastio S, Cadario F, Beux S, Giorgis A, Genoni G, Bagnati M, et al (2018) Vitamin D and type I diabetes. The Open Rheumatology Journal 12(Suppl-1): 289-299. doi: 10.2174/1874312901812010289

Endyarni B, Batubara JRL, Boediman I (2006) Effects of a structured educational intervention on metabolic control of type-1 diabetes mellitus patients. Paediatric Indonesia 46(11-12): 260-265. doi: 10.14238/pi46.6.2006.260-5.

Dejkhamron P, Menon RK, Sperling M (2007) Childhood diabetes mellitus: recent advances and future prospects. Indian Journal Medical Research 125(3): 231â€“250. PMID: 17496353.

Hassanein MA, Sultan I (2014) Evaluation of nutrition and health status among children with diabetes. Life Science Journal 11(2): 327-334.

Pulungan AB (2010) Pubertas dan gangguannya. In: Batubara JRL, Tridjaya B, Pulungan AB, First Edition. Buku ajar endokrin anak. Jakarta, IDAI. 85-120.

Tfayli H, Arslanian S (2007) The challenge of adolescence: hormonal changes and sensitivity to insulin. Diabetes Voice 52: 28-30.

Janner M, Ballinari P, Mullis PE, Flick CE (2010) High prevalence of vitamin D deficiency in children and adolescent with type 1 diabetes. Swiss Medical Weekly 140(7): 1-6. doi: 10.4414/smw.2010.13091.

Al-Agha AE, Ahmad IA (2015) Association among vitamin D deficiency, type 1 diabetes mellitus and glycemic control. Journal of Diabetes and Metabolism (6): 594. doi: 10.4172/2155-6156.1000594.

Borkar V, Devidayal V, Verma S, Bhalla AK (2010) Low levels of vitamin D in North Indian children with newly diagnosed type 1 diabetes. Pediatric Diabetes 11(5): 345â€“350. doi: 10.1111/j.1399-5448.2009.00589.x.

Greer S, Portelli L, Hung BS, Cleghorn GJ, McMahon SK, Batch JA, Conwell LS (2013) Serum vitamin D levels are lower in Australian children and adolescents with type 1 diabetes than in children without diabetes. Pediatric Diabetes 14(1): 31â€“41. doi: 10.1111/j.1399-5448.2012.00890.x.

Svoren BM, Volkening LK, Wood JR, Laffel LMB (2009) Significant vitamin D deficiency in youth with type 1 diabetes mellitus. Journal of Paediatrics 154(1): 132-134. doi: 10.1016/j.jpeds.2008.07.015.

Holick MF, Chen TC (2008) Vitamin D deficiency: a worldwide problem with health consequences. American of Journal Clinical Nutrition 87(4): 1080Sâ€“1086S. doi: 10.1093/ajcn/87.4.1080S.

Mohammadian S, Fatahi N, Zaeri H, Vakili M (2015) Effect of vitamin D3 supplement in glycemic control of pediatrics with type 1 diabetes mellitus and vitamin D deficiency. Journal of Clinical and Diagnostic Research 9(3): sc05-sc07. doi: 10.7860/JCDR/2015/10053.5683.

Thnc O, Cetinkaya S, Kizilgun M, Aycan Z (2011) Vitamin D status and insulin requirements in children and adolescent with type 1 diabetes. Journal of Pediatrics Endocrionology and Metabolism 24: 1037â€“1041. PMID: 22308861.

Magee L, Mughal Z, Ehtisham S, Marshall M, Campbell J, Ainsworth S, et al (2012) The relationship between vitamin D and HbA1C in a type 1 diabetic paediatric population. Endocrinology Abstract [Abstract] 28: 38â€“42.

Seydewitz H, Henschen M, Kuhnel W, Brandis M (2001) Pediatric references ranges for osteocalcin measured by the immulite analyser. Clinical Chemistry and Laboratory Medicine 39(10): 980-982. doi: 10.1515/CCLM.2001.159.

Napoli N, Strollo R, Pitocco D, Bizzarri C, Maddaloni E, Maggi D, et al (2013) Effect of calcitriol on bone turnover and osteocalcin in recent-onset type 1 diabetes. PLoS One 8(2): e56488. doi: 10.1371/journal.pone.0056488.

Mutlu A, Mutlu GY, Ozsu E, Cizmecioglu FM, Hatun S (2011) Vitamin D deficiency in children and adolescents with type 1 diabetes. Journal of Clinical Research Pediatric Endocrinology 3(4): 179-183. doi: 10.4274/jcrpe.430.

Pietschmann P, Schernthaner G, Woloszczuk W (1988) Serum osteocalcin levels in diabetes mellitus: analysis of the type of diabetes and microvascular complications. Diabetologia 31: 892-895. doi: 10.1007/BF00265373.

Prats-Pruig A, Mas-Parareda M, Riera-Perez E, Gonzalez-Forcadell D, Mier C, Mallol-Guisset M, et al (2010) Carboxylation of osteocalcin effects its association with metabolic parameters in healthy. Diabetes Care 33(3): 661-663. doi: 10.2337/dc09-1837.