Diabetes, whether it is type 1 or type 2, is a potentially life-threatening disease that is certainly life-changing for people around the world. The number of cases nearly quadrupled between 1980 and 2014 according to the World Health Organization (WHO), with associated increases in mortality and disability caused by the disease.
The majority of these cases are type 2 diabetes, caused by excess visceral fat, although the interaction between genetic susceptibility, environment, obesity and physical inactivity is complex. It is not uncommon for people to have a moderate body mass index (BMI) and type 2 diabetes, even though they are responding to weight loss.
The number of cases of type 1 diabetes is also on the rise. The reasons for this are not well understood, but some have compared the increase in type 1 diabetes to that of other autoimmune diseases like multiple sclerosis. Both are more common in the northern hemisphere, as is vitamin D deficiency.
In fact, it is estimated that up to 40% of Europeans are vitamin D deficient, and 13% of them could be seriously affected. And the situation is even worse for people with dark skin. It is also difficult to determine how many people are deficient, as the debate rages over the definition of deficiency.
Type 1 diabetes is much more prevalent in the northern hemisphere and this is usually blamed on the fact that we get less sunlight and therefore have lower vitamin D levels. This is also true for multiple sclerosis. If it is only an association, the links do not stop there. There is pretty good data showing that vitamin D deficiency, frank deficiency (so children who have rickets) are much more likely, later in life, to develop type 1 diabetes. But similarly way, people who get a high dose of vitamin D are also less likely to develop type 1 diabetes later on.
Of course, to suggest that vitamin D, or lack thereof, is responsible for disease or susceptibility to it, is controversial.
The controversy over the role of vitamin D in diabetes is most likely due to poorly designed trials that failed to properly measure the impact of vitamin D supplementation on groups that can be generalized, according to an update. recent update from the European Journal of Clinical Nutrition.
Vitamin D and the pancreas
Type 2 diabetes is usually diagnosed when high glucose levels are detected in the blood. This phenomenon is ultimately due to low insulin sensitivity in the tissues, which makes it difficult for the body to remove glucose from the blood. To compensate for this lack of sensitivity, the body creates more insulin until the beta cells in the pancreas eventually let go and the affected person can no longer produce enough insulin to transport glucose into its cells, resulting in high blood sugar. It is often at this stage that people are diagnosed with type 2 diabetes.
There is evidence that vitamin D improves what we call insulin sensitivity, which is a key component of type 2 diabetes. And there is also evidence that vitamin D increases insulin secretion, and both of these things are what actually go wrong in type 2 diabetes because you become insulin resistant and the insulin doesn’t work as well. So, there does seem to be a theoretical basis for these ongoing studies.
Early intervention could be the key
This theory led to studies that hoped to determine if vitamin D could prevent or even treat type 2 diabetes. The most prominent of these studies in recent years has been the D2D study. This National Institutes of Health-funded study was the first large-scale randomized controlled trial of its kind and aimed to determine whether vitamin D supplementation would help reduce the risk of type 2 diabetes in people with prediabetes, a condition where blood sugar is already slightly elevated.
The researchers followed 2,423 participants for 2.5 years, with half of them assigned to take 4,000 IU (100 micrograms (mcg)) of vitamin D daily, while the other half took no no supplement.
At the end of the trial, results published in the New England Journal of Medicine showed that those who took vitamin D supplements had higher levels of vitamin D in their blood. Although they were 12% less likely to develop type 2 diabetes during the study, these results were not found to be significantly different from the group that did not receive supplementation.
A few months later, the results of a smaller randomized placebo-controlled trial were published in the European Journal of Endocrinology, showing the impact of a 5,000 IU (125 mcg) vitamin D supplement on 48 patients with risk of type 2 diabetes, compared to a group of 48 patients who took a placebo.
The researchers looked at insulin sensitivity and secretion and found that vitamin D supplementation improved both sensitivity and beta cell function.
Identify at-risk children early on
Whether vitamin D could be used to prevent or delay the onset of type 1 diabetes is yet another question. This is one of the questions underlying the TEDDY study, a global longitudinal study of the environmental causes of type 1 diabetes.
Type 1 diabetes differs from type 2 diabetes in that it is an autoimmune disease. Beta cells in the pancreas are destroyed, which means that insulin is not produced and must be replaced by insulin injections. This disease is usually diagnosed in children between the ages of 4 and 14.
A paper from the TEDDY study was published in the journal Diabetes in 2018. It describes the research undertaken as part of the study, which involved 8,676 children born with genetic risk factors for type 1 diabetes. 1.
The authors undertook a nested case-control study within this cohort, meaning they specifically sought out children who had persistent signs of islet autoimmunityTrusted Source (376 cases) and compared them to 1,041 controls from the same cohort who showed no evidence of islet autoimmunity.
In children with islet autoimmunity, the body reacts against specific antigens, including insulin.
The observational study looked at blood vitamin D levels from infancy through childhood. It showed that having sufficiently high vitamin D levels in early childhood was associated with a risk of autoimmunity from islets of Langerhans, a sign of type 1 diabetes, 41% lower than that of adults. people whose levels were insufficient.
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