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      Seasonal variation of vitamin D and HbA 1c levels in patients with type 1 diabetes mellitus in the Middle East

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          Abstract

          Introduction

          The discovery that many tissues express the vitamin D receptor and are able to transform the 25-hydroxyvitamin D into 1,25-dihydroxyvitamin D (active metabolite) has led to the hypothesis that vitamin D could have a role in the pathogenesis and prevention of diabetes mellitus. Accumulating evidence has linked vitamin D deficiency with immunological disturbance in type 1 diabetes mellitus. Several epidemiological studies have shown lower serum 25-hydroxyvitamin D concentrations in diabetic individuals compared to nondiabetic individuals.

          Patients and methods

          A total of 105 Lebanese patients with type 1 diabetes mellitus were recruited. Levels of HbA 1c and vitamin D were recorded during two phases with phase 1 being the period from June–September 2009 and phase 2 from January–April 2009.

          Results

          Vitamin D levels at the end of sunny season (phase 2), reflecting the previous sunny months, were found to be higher than in the early summer season (phase 1) reflecting the previous cloudy months season, with a mean change of 0.70 ± 6.87 ng/mL ( P = 0.029). HbA 1c levels were higher in phase 2 than in phase 1 with an increase of 0.175% ± 1.46% ( P = 0.113).

          Conclusion

          Vitamin D levels were higher at the end of the sunny season than at the end of cloudy season. HbA 1c was also lower (but not significantly so) in the early summer season (cloudy months). There was a weak correlation between seasonal changes of vitamin D levels and the control of blood glucose as monitored by HbA 1c in a cohort of Lebanese patients with type 1 diabetes mellitus.

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          Most cited references17

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          Resurrection of vitamin D deficiency and rickets.

          The epidemic scourge of rickets in the 19th century was caused by vitamin D deficiency due to inadequate sun exposure and resulted in growth retardation, muscle weakness, skeletal deformities, hypocalcemia, tetany, and seizures. The encouragement of sensible sun exposure and the fortification of milk with vitamin D resulted in almost complete eradication of the disease. Vitamin D (where D represents D2 or D3) is biologically inert and metabolized in the liver to 25-hydroxyvitamin D [25(OH)D], the major circulating form of vitamin D that is used to determine vitamin D status. 25(OH)D is activated in the kidneys to 1,25-dihydroxyvitamin D [1,25(OH)2D], which regulates calcium, phosphorus, and bone metabolism. Vitamin D deficiency has again become an epidemic in children, and rickets has become a global health issue. In addition to vitamin D deficiency, calcium deficiency and acquired and inherited disorders of vitamin D, calcium, and phosphorus metabolism cause rickets. This review summarizes the role of vitamin D in the prevention of rickets and its importance in the overall health and welfare of infants and children.
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            Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis.

            To assess whether vitamin D supplementation in infancy reduces the risk of type 1 diabetes in later life. This was a systematic review and meta-analysis using Medline, Embase, Cinahl, Cochrane Central Register of Controlled Trials and reference lists of retrieved articles. The main outcome measure was development of type 1 diabetes. Controlled trials and observational studies that had assessed the effect of vitamin D supplementation on risk of developing type 1 diabetes were included in the analysis. Five observational studies (four case-control studies and one cohort study) met the inclusion criteria; no randomised controlled trials were found. Meta-analysis of data from the case-control studies showed that the risk of type 1 diabetes was significantly reduced in infants who were supplemented with vitamin D compared to those who were not supplemented (pooled odds ratio 0.71, 95% CI 0.60 to 0.84). The result of the cohort study was in agreement with that of the meta-analysis. There was also some evidence of a dose-response effect, with those using higher amounts of vitamin D being at lower risk of developing type 1 diabetes. Finally, there was a suggestion that the timing of supplementation might also be important for the subsequent development of type 1 diabetes. Vitamin D supplementation in early childhood may offer protection against the development of type 1 diabetes. The evidence for this is based on observational studies. Adequately powered, randomised controlled trials with long periods of follow-up are needed to establish causality and the best formulation, dose, duration and period of supplementation.
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              Vitamin D and diabetes.

              Vitamin D deficiency predisposes individuals to type 1 and type 2 diabetes, and receptors for its activated form-1alpha,25-dihydroxyvitamin D3-have been identified in both beta cells and immune cells. Vitamin D deficiency has been shown to impair insulin synthesis and secretion in humans and in animal models of diabetes, suggesting a role in the development of type 2 diabetes. Furthermore, epidemiological studies suggest a link between vitamin D deficiency in early life and the later onset of type 1 diabetes. In some populations, type 1 diabetes is associated with certain polymorphisms within the vitamin D receptor gene. In studies in nonobese diabetic mice, pharmacological doses of 1alpha,25-dihydroxyvitamin D3, or its structural analogues, have been shown to delay the onset of diabetes, mainly through immune modulation. Vitamin D deficiency may, therefore, be involved in the pathogenesis of both forms of diabetes, and a better understanding of the mechanisms involved could lead to the development of preventive strategies.
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                Author and article information

                Journal
                Int J Gen Med
                International Journal of General Medicine
                Dove Medical Press
                1178-7074
                2011
                06 September 2011
                : 4
                : 635-638
                Affiliations
                Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
                Author notes
                Correspondence: Sami T Azar, Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, 3 Dag Hammarskjold Plaza, 8th floor, New York, NY 10017, USA, Tel + 961 3 234 250, Fax +961 1 365 189, Email sazar@ 123456aub.edu.lb
                Article
                ijgm-4-635
                10.2147/IJGM.S23548
                3177588
                21941448
                6362c71b-e566-4c0d-a89b-fc43434a4ad8
                © 2011 El Baba et al, publisher and licensee Dove Medical Press Ltd.

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

                History
                Categories
                Rapid Communication

                Medicine
                type 1 diabetes,vitamin d,hba1c,seasonal variation
                Medicine
                type 1 diabetes, vitamin d, hba1c, seasonal variation

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