Association among vitamin d and HbA1c in type-2 diabetes mellitus patients in the north coastal Andhra Pradesh

 

Abstract               Aim and Objective: The purpose of the study was to find out how vitamin D deficiency associated with glycated haemoglobin in type-2 diabetics patients. Methods: This retrospective cohort study used data from 410 known type-2 diabetic patients enrolled at Department of Biochemistry, Pinnacle Hospital Visakhapatnam. The search criteria was used to include all patients who had their level of 25(OH) D level obtained by electrochemiluminescence (ECLIA) method and HbA1C levels obtained by Ion-exchange high performance liquid chromatography (HPLC). Conclusion: The most important finding of this study is that vitamin D negatively correlates with HbA1c.The significant outcome we find from this study is a major decrease in HbA1c as vitamin D levels increased. The proportion of vitamin D deficiency in the population and the growth of diabetes in the population suggest that repletion can improve overall health. We suggest advising patients with higher HbA1c to get tested for lower vitamin D values and correct any insufficiency if establish may result in improved blood glucose control and assistance the patient’s in general wellbeing.

Key words: Haemoglobin, Diabetes, vitamin D, HBA

 

 

INTRODUCTION

Diabetes mellitus is the mainly widespread never-ending metabolic endocrine disorder almost in all countries, the trouble of continue to increase in numbers and consequence, putting a important strain on healthcare resources that will impact most on developing region of the world.1 Circulating 25-hydroxyvitamin D (25(OH)D) concentrations are measured as a sign of vitamin D status2. Compared to healthy controls, subjects with T2DM have been experiential to have considerably lower circulating 25(OH) D concentrations 3. Possibly not coincidently, both vitamin D insufficiency and T2DM contribute to the similar risk factors, counting African-American, Asian, or Hispanic ethnicity, improved adiposity, age, and physical inactivity (which may explain to reduced time spent outdoors or reduced sun exposure) 4. T2DM is measured a condition of insulin resistance (beta cell compensation) and insulinopenia (beta cell decompensation) and is characterized by progressive decline in beta cell function and ultimately loss of beta cell mass 5. The mechanism by which vitamin D deficiency and T2DM are related is not well known. Although the fact that insulin secretion and action being the cause of diabetes, in routine clinical care, insulin is infrequently considered, even although it can be considered simply on automated equipment in laboratories. Blood glucose control in diabetic patients is regularly monitored by resolve of HbA1C (glycated haemoglobin) which is currently the gold standard, and gives the amount of glucose in the blood over the preceding two to three months.5 Lowering the blood glucose levels will lead to lower HbA1C, and failure to control high blood glucose will lead to high HbA1C. As HbA1C is known to associate positively with blood glucose the present study aim to find out the association of HbA1C and hypovitaminosis D in type-2 diabetes mellitus subjects

 

METHODS

This retrospective cohort study used data from 410 known type-2 diabetic patients enrolled at Department of Biochemistry, Pinnacle Hospital Visakhapatnam. The investigation criteria was used to include all patients who had their level of 25(OH)D level obtained by electro chemiluminescence (ECLIA) method and HbA1C levels obtained by Ion-exchange high performance liquid chromatography (HPLC). And the data obtained was statistically analyzed using M.S Excel 2010 to determine the mean, standard deviation and Carl Pearson correlation co-efficient.

 RESULTS

Table 1: Shows the difference of HbA1C with improvement in vitamin D status

	Age		HbA1C
Vitamin D	Mean	SD	Mean	SD
Deficiency	55	11.7	8.1	1.8
Insufficencey	53	10.1	6.9	1.5
Sufficiency	59	11.1	7.6	1.4

Table 2: Shows the Carl Pearson Correlation co-efficient between vitamin D status and HbA1C

 

DISCUSSION

Vitamin D the sunlight hormone, has been related with a function in insulin secretion and insulin action, still though the natural mechanism are inadequately understood, the involvement between hypovitaminosis D and type 2 diabetes mellitus may be recognized to the outcome of vitamin D on the glucose homeostasis and in particular the through effect of vitamin D on the β-cells function and thus insulin secretion 6 the use of HbA1c for the monitoring of blood glucose which has also been extended to analyze and monitor for diabetes mellitus as support by the world health organization. The initiation of automation for precise and specific quantity of blood glucose has shifted the criteria of monitoring blood glucose from mainly fasting plasma glucose to HbA1c which is now the gold standard.7 Mainly remarkable element of the result of the current study is that there is drop off in the level of glycated haemoglobin (HbA1c) as the vitamin D status get better from deficiency from first to last insufficiency to sufficiency, this shows that enhancement in vitamin D status play an vital role in glucose homeostasis (Table 1) This result outcome also carry the conclusion and implication of many investigators like Bourlon PM et al in 1996, who suggested that hypovitaminosis D reserved insulin secretion and by addition get better vitamin D status lead to advance insulin secretion and insulin action and as a result concern the glucose homeostasis an additional significant finding of this outcome (Table 2: shows the Correlation between Vitamin D and HbA1c ) is that vitamin D status is negatively correlated (-0.110) with HbA1c , significance that as vitamin D level increases the level of HbA1C decreases, likewise the as the level of HbA1c increases the level of vitamin D decreases.8 To make clear this, even though the glycation of haemoglobin is not catalyzed by the enzyme, rather it occurs during a reaction that depends on the quantity of glucose that is circulating in the blood and the length and duration of exposure. The main element of in the structure of glycated haemoglobin, HbA1c is formed by the add-on of glucose of glucose molecule to the N-terminal of the β-globin chain, valine. Primarily the labile translation of the HbA1c is produced which is later transformed to a more stable form through rearrangement process known as Amadori rearrangement.8,9 The association between vitamin D and HbA1c may be due to the role of vitamin D mainly on the β-cell of the pancrease islet of langerhans which result in enhanced insulin secretion and insulin action, and as a result, enhanced glucose homeostasis, or it may be that vitamin D plays a vital role in the modification of haemoglobin empathy to glucose, need further research and confirmation.

 

CONCLUSION

The most important finding of this study is that vitamin D negatively correlates with HbA1c.The significant outcome we find from this study is a major decrease in HbA1c as vitamin D levels increased. The proportion of vitamin D deficiency in the population and the growth of diabetes in the population suggest that repletion can improve overall health. We suggest advising patients with higher HbA1c to get tested for lower vitamin D values and correct any insufficiency if establish may result in improved blood glucose control and assistance the patient’s in general wellbeing.

 

REFERENCES