Vitamin D Deficiency and Glycemic Status in Children and Adolescents with Type 1 Diabetes Mellitus.
BACKGROUND
Vitamin D (25OHD) effects on glycemic control are unclear in children and adolescents with type 1 diabetes. Aims of this study were to investigate 25OHD status among children with T1DM and its relationship with insulin sensitivity and glycemic status.


METHODS
A cross sectional study was carried out between 2008-2014. A total of 141 patients had a T1DM >12 months diagnosis and were enrolled in the present study. Of these 35 (24.8%) were migrants and 106 (75.2%) Italians (T2). We retrospectively analyzed data at the onset of the disease (T0)(64 subjects) and 12-24 months before the last visit (T1,124 subjects). Fasting glucose, glycated hemoglobin (HbA1c), 25OHD levels and daily insulin requirement were evaluated and Cholecalciferol 1000 IU/day supplementation for the management of vitamin D insufficiency (<75 nmol/L) was systematically added.


RESULTS
A generalized 25OHD insufficiency was found at each study time, particularly in migrants. At T0, the 25OHD levels were inversely related to diabetic keto-acidosis (DKA) severity (p<0.05). At T1 and T2, subjects with 25OHD ≤25nmol/L (10 ng/mL) showed higher daily insulin requirement (p<0.05) and HbA1c values (p<0.01) than others vitamin D status. The 25OHD levels were negatively related with HbA1c (p<0.001) and daily insulin dose (p<0.05) during follow up. There was a significant difference in 25OHD (p<0.01) between subjects with different metabolic control (HbA1c <7.5%,7.5-8%,>8%), both at T1 and T2. In supplemented subjects, we found a significant increase in 25OHD levels (p<0.0001) and decrease of HbA1c (p<0.001) between T1 and T2, but this was not significant in the migrants subgroup. Multivariate regression analysis showed a link between HbA1c and 25OHD levels (p<0.001).


CONCLUSIONS
Children with T1DM show a generalized 25OHD deficiency that impact on metabolic status and glycemic homeostasis. Vitamin D supplementation improves glycemic control and should be considered as an additional therapy.
Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Silvia
S
Savastio
Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.|IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Novara, Italy.
Francesco
F
Cadario
Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Giulia
G
Genoni
Central Laboratory of Maggiore della Carità Hospital, University of Piemonte Orientale, Novara, Italy.
Giorgio
G
Bellomo
Central Laboratory of Maggiore della Carità Hospital, University of Piemonte Orientale, Novara, Italy.
Marco
M
Bagnati
Division of Cardiology, Ospedale Santi Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
Gioel
G
Secco
Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Raffaella
R
Picchi
Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Enza
E
Giglione
Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy.
Gianni
G
Bona
D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D019587:Dietary Supplements; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications*; D007328:Insulin / Q000627:therapeutic use; D007558:Italy; D014171:Transients and Migrants; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications*
D006442:Glycated Hemoglobin; D007328:Insulin; D014807:Vitamin D; C104450:25-hydroxyvitamin D