학술논문
补充维生素D对2型糖尿病患者胰岛素抵抗的影响 / Effects of vitamin D supplementation on insulin resistance in patients with type 2 diabetes mellitus
Document Type
Academic Journal
Author
Source
中华医学杂志 / National Medical Journal of China. 94(43):3407-3410
Subject
Language
Chinese
ISSN
0376-2491
Abstract
目的 观察2型糖尿病患者补充维生素D前后其代谢指标的变化及血维生素D水平和胰岛素抵抗的关系.方法 胰岛素抵抗用胰岛素稳态模型评估(HOMA-IR)表示,选择山东省立医院内分泌科2013年1-6月门诊和病房的164例30 ～ 75岁的2型糖尿病患者,按随机数字法分为2组:试验组和对照组,试验组口服骨化三醇0.5 μg/d,共12周,对照组维持原治疗方案不变,在试验研究开始和结束时分别记录入组者的人体测量学数据,抽空腹血测血糖、胰岛素、糖化血红蛋白(HbA1C)、25(OH)D等水平.结果 两组的基线数据差异无统计学意义;和基线水平相比,服用维生素D 12周后,试验组和对照组的体质指数(BMI)[(-0.7±1.7)kg/m2比(-0.4±1.4)kg/m2](P＜0.05)、腰围(WC)[(-1.3±1.3)cm比(-0.2±1.1)cm] (P ＜0.05)、空腹血糖(FBG)[(-1.2±2.3)mmol/L比(-0.6±2.8)mmol/L](P＜0.05)、空腹胰岛素(FPI)[(-1.6±2.2)μU/ml比(-0.32±1.49)μU/ml] (P＜0.05)、HbA1C[(-0.1±0.6)％比(-0.03±0.94)％](P＜0.05)、HOMA-IR[(-0.91±2.63)比(-0.15±1.78)](P＜0.05)、25(OH)D[(20±17) ng/ml比(1.0±3.3) ng/ml](P＜0.05)的改变差异有统计学意义.根据基线25(OH)D的水平分层,可以发现服用维生素D后,HOMA-IR在维生素D水平＜20 ng/ml组[(6±3)比(5±3)](P＜0.05)、20～30 ng/ml组[(6±3)比(5±3)](P＜0.05)、≥30 ng/ml组[(5±3)比(4±3)](P＜0.05)均明显下降,而BMI[(26±6)kg/m2比(26±4) kg/m2] (P＜0.05)、WC[(84±11) cm比(82±12) cm] (P＜0.05)、FPG[(8±4)mmol/L比(6±4) mmol/L] (P ＜0.05)、FPI[(17±4).μU/ml比(16±4).μU/ml] (P＜0.05)、HbA1C[(7.4±0.9)％比(7.0±1.2)％](P＜0.05)仅在维生素D水平为15—20 ng/ml组的下降差异有统计学意义.多变量回归分析显示:HOMA-IR是25(OH)D的显著独立危险因素(OR=13,95％CI=4 ～39,P＜0.05).结论 补充维生素D后,患者的体质指数、腰围、空腹血糖、空腹胰岛素、HbA1C、HOMA-IR有显著改善,提示2型糖尿病患者补充维生素D可以降低胰岛素抵抗.
Objective To explore the effects of oral vitamin D supplementation on anthropometric parameters and insulin resistance (IR) in type 2 diabetes mellitus (T2DM).Methods A total of 164 subjects with T2DM,aged 30-75 years,were randomly divided into two groups of intervention and control.The intervention group received a daily dose of 0.50 μg calcitriol while the control group maintained the original treatment regimen.At the beginning and end of 12-week supplementation trial,the demographic and anthropometric data were recorded and the serum levels of glucose,insulin,HbA1C and 25 (OH)D measured.IR was assessed by the homeostasis model approximation index.Results There was no significant inter-group difference at baseline.Compared with the baseline level,body mass index (BMI) ((-0.7±1.7) vs (-0.4±1.4) kg/m2)(P＜0.05),waist circumference (WC) ((-1.3±1.3) vs (-0.2±1.1) cm)(P＜0,05),fasting plasma glucose (FPG) ((-1.2±2.3) vs (-0.6±2.8) mmol/L),fasting plasma insulin (FPI) ((-1.6 ±2.2)vs(-0.32 ± 1.49) μU/ml) (P ＜0.05),HbA1C ((-0.1 ± 0.6) vs (-0.03±0.94))(P＜0.05),HOMA-IR ((-0.91 ±2.63)％ vs(-0.15 ±1.78)％)(P＜ 0.05) and 25 (OH)D ((20 ± 17) vs(1.0 ± 3.3)ng/ml) (P ＜ 0.05)decreased obviously in the intervention group at the end of study.After stratifying by different baseline serum levels of 25 (OH) D,HOMA-IR significantly decreased after supplementation in ＜ 20 ng/ml group ((6 ±3) vs(5 ±3)) (P ＜0.05),20-30 ng/ml group ((6±3) vs (5 ±3)) (P＜0.05)and ＞30 ng/ml group ((5 ±3)vs (4 ±3))(P＜0.05).AndBMI ((26±6) vs (26±4) kg/m2)(P＜0.05),WC ((84±11) vs (82±12) cm) (P＜0.05),FPG ((8±4) vs (6±4)mmol/L)(P＜0.05),FPI ((17 ±4) vs (16 ±4)μU/ml)(P＜0.05)and HbA1C ((7.4 ± 0.9) ％ vs (7.0 ± 1.2) ％) (P ＜ 0.05) decreased statistically significant only in 15-20 ng/ml group.Multivariate regression analysis showed that HOMA-IR was a significant independent risk factor for 25 (OH) D (OR =13,95％ CI =4-39,P ＜ 0.05).Conclusion There are significant improvements in BMI,WC,FPG,FPI,HbA1C and HOMA-IR after supplementation.Thus vitamin D supplementation may reduce insulin resistance in T2DM.
Objective To explore the effects of oral vitamin D supplementation on anthropometric parameters and insulin resistance (IR) in type 2 diabetes mellitus (T2DM).Methods A total of 164 subjects with T2DM,aged 30-75 years,were randomly divided into two groups of intervention and control.The intervention group received a daily dose of 0.50 μg calcitriol while the control group maintained the original treatment regimen.At the beginning and end of 12-week supplementation trial,the demographic and anthropometric data were recorded and the serum levels of glucose,insulin,HbA1C and 25 (OH)D measured.IR was assessed by the homeostasis model approximation index.Results There was no significant inter-group difference at baseline.Compared with the baseline level,body mass index (BMI) ((-0.7±1.7) vs (-0.4±1.4) kg/m2)(P＜0.05),waist circumference (WC) ((-1.3±1.3) vs (-0.2±1.1) cm)(P＜0,05),fasting plasma glucose (FPG) ((-1.2±2.3) vs (-0.6±2.8) mmol/L),fasting plasma insulin (FPI) ((-1.6 ±2.2)vs(-0.32 ± 1.49) μU/ml) (P ＜0.05),HbA1C ((-0.1 ± 0.6) vs (-0.03±0.94))(P＜0.05),HOMA-IR ((-0.91 ±2.63)％ vs(-0.15 ±1.78)％)(P＜ 0.05) and 25 (OH)D ((20 ± 17) vs(1.0 ± 3.3)ng/ml) (P ＜ 0.05)decreased obviously in the intervention group at the end of study.After stratifying by different baseline serum levels of 25 (OH) D,HOMA-IR significantly decreased after supplementation in ＜ 20 ng/ml group ((6 ±3) vs(5 ±3)) (P ＜0.05),20-30 ng/ml group ((6±3) vs (5 ±3)) (P＜0.05)and ＞30 ng/ml group ((5 ±3)vs (4 ±3))(P＜0.05).AndBMI ((26±6) vs (26±4) kg/m2)(P＜0.05),WC ((84±11) vs (82±12) cm) (P＜0.05),FPG ((8±4) vs (6±4)mmol/L)(P＜0.05),FPI ((17 ±4) vs (16 ±4)μU/ml)(P＜0.05)and HbA1C ((7.4 ± 0.9) ％ vs (7.0 ± 1.2) ％) (P ＜ 0.05) decreased statistically significant only in 15-20 ng/ml group.Multivariate regression analysis showed that HOMA-IR was a significant independent risk factor for 25 (OH) D (OR =13,95％ CI =4-39,P ＜ 0.05).Conclusion There are significant improvements in BMI,WC,FPG,FPI,HbA1C and HOMA-IR after supplementation.Thus vitamin D supplementation may reduce insulin resistance in T2DM.