Effect Of Vitamin D Intervention On The Outcome Of Glucose Metabolism In Patients With Impaired Glucose Regulation

Objective:Recently,growing evidences have suggested that vitamin D receptors exist in several kinds of tissues and cells,including pancreas,gastrointestinal tract,skin and immune cells.The purpose of this study is to explore the intervention effect of VitD on impaired glucose regulation population,and the relationship between VitD and insulin resistance and islet?-cell function.To provide a rationalization strategy for early screening and VitD supplementation for high risk population of diabetes.Methods:1.Subjects196 patients who received treatment in the third hospital of hebei medical university were included in the analysis and research data.The case was selected from January 2015 to May 2016,including 96 males,whose average age was 54.32±11.55 years.In addition,100 women,with an average age of52.47±13.19 years,received oral glucose tolerance test?OGTT?in 196patients,and all patients and their family members signed the informed consent voluntarily.By understanding the patient's medical history and combining their clinical medical records,the following patients were excluded:1)patients diagnosed with type 1 diabetes,type 2 diabetes and special type diabetes;2)patients with tumors,patients with autoimmune diseases,and patients with connective tissue diseases;3)patients with severe heart,kidney,liver and other related functional insufficiency;?4?patients with thyroid insufficiency and patients with parathyroid insufficiency;5)patients who were treated with vitamin D,vitamin D derivative and calcium in the last3 months of this study;6)patients receiving drugs that may have an effect on vitamin D?e.g.,antiepileptic drugs,glucocorticoid drugs?;7)patients with osteoporosis,patients with metabolic bone disease,and patients with fracture;8)patients with a history of sun exposure within 7 days of inclusion in this study;?9?patients with acute infection and patients with stress;?10?patients who like to drink strong tea and coffee.This study was applied to the ethics committee of the third hospital of hebei medical university and approved by the corresponding staff.According to the diabetes-related diagnosis and classification standard proposed by the World health organization?WHO?in1999,196 patients were divided according to the normal glucose tolerance:including impaired glucose regulation?IGR?group?n=129?,normal glucose tolerance?NGT?group?n=67?.The IGR group was divided into non-intervention group?n=65?and intervention group?n=64?according to whether the vitamin D intervention?400U/d,for 1 year?was performed.This study was approved by the institutional review board of Hebei Medical University.Written informed consent was obtained from all subjects.2.Methods1)Measure and record the patient's height,weight,waist size,etc.,arrange the same person to take measurement,and calculate and count the patient's body mass index.2)Of patients serum 25?OH?D₃ value and related biochemical indicators to determine:keep patients was collected on an empty stomach 5 ml venous blood,half an hour to centrifugal under 4?,the serum of patients to pay,in-20?to storage,measurements shall be focusing on.The value of25?OH?D₃ was determined by electrochemil-uminescence method,and the reagent was used by roche 601.The triglyceride?TG?value,cholesterol?TC?value and low-density lipoprotein cholesterol?ldl-c?value of the patients were detected by the automatic biochemical analysis system and enzyme method.Glucose oxidase was used to measure the blood glucose of the patients.The insulin value of the patient was detected by electrochemical luminescence method,and the insulin resistance index?mmol/L?was calculated and calculated,that is,FPG?unit:mmol/L?was multiplied by FINS?unit:mIU/L?divided by 22.5,the islet cytoskeleton function index?mmol/L?was measured,that is,20 times FINS?unit:mIU/L?divided by[FPG?unit:mmol/L?minus3.5].Relevant operations are carried out according to the instrument and kit instructions,ensuring that the difference value between batches is within 9%and that between batches is within 15%.3)Satistical analysis:Into SPSS21.0 calculation analysis software in this paper,involving the clinical data of 196 patients,non-normal distribution clinical numerical description for the distance between the median and interquartile[in the median quartile?quartile 1,3?in the form of expression],clinical value of normal distribution described as mean+/-standard deviation in the form of?x±s?expression.Clinical numerical comparison between groups:when the quantitative clinical data and normal distribution are consistent and the variance is homogeneous,the single-factor ANOVA method is adopted,while the lsd-t method with the least significant difference is adopted for the comparison between two groups.Qualitative clinical data were examined by chi-square test.The correlation between 25?OH?D₃ and normal distribution data was analyzed by Pearson correlation method,while the correlation between 25?OH?D₃ and non-normal distribution data was analyzed by Spearman rank correlation method.When the quantitative clinical data did not conform to the normal group,the k-w rank sum test?kruskal-wallis test?and Wilcoxon rank sum test?Wilcoxon rank sum test?were used.P<0.05,statistical data calculation and analysis significance exist.Results:1.The level of serum 25?OH?D₃ was significantly lower in the impaired glucose regulation group[22.02?20.31,24.13?ng/ml]than that of normal control group[30.20?26.68,35.51?ng/ml]?P<0.05?.After Vitamin D intervention,serum 25?OH?D₃ was significantly increased in Vitamin D intervention group[28.56?25.08,31.65?ng/ml]than that of non-intervention group[22.81?20.47,26.24?ng/ml]?P=0.000?.2.TG?TC?LDL-c?FINS and HOMA-IR were significantly increased in the impaired glucose regulation group,whereas HOMA-?was significantly decreased when compared with normal control group?P<0.05?.Compared with normal control group,Vitamin D intervention could decreae TG[0.74?0.68,0.87?mmol/L VS 1.08?0.84,1.81?mmol/L]?FPG[?5.84±1.17?mmol/L VS?6.67±0.96 mmol/L?]?FINS[?15.24±1.59?mIU/L VS?17.16±1.71?mIU/L],improve insulin sensitivity[140.93?99.44,192.99?VS120.75?90.62,150.04?],and ameliorate insulin resistance[?3.98±0.98?VS?5.26±0.8?].3.Diabetes developed less frequently in the VitD group?25 of 64[39.1%]?compared with non-intervention group?30 of 65[46.2%]?.But there was no significant different between the two group.4.The level of serum 25?OH?D₃ was positive correlated with HOMA-??r=0.231,P<0.05?,there was a negative correlation with age,TG,TC,ldl-c,FPG,2hPG,FINS,and homa-ir?r=-0.215,-0.227,-0.129,-0.275,-0.326,-0.173,-0.269,-0.331,P<0.05?.5.Serum 25?OH?D₃ was 27.25?25.39,35.41?ng/ml in male and30.62?27.80,35.51?ng/ml in female in NGT group,which was 22.16?20.74,24.24?ng/ml in male and 21.99?20.23,23.76?ng/ml in female in IGR group.Serum 25?OH?D₃ was not significantly different between men and women in the normal glucose tolerance group and the impaired glucose regulation group?all P>0.05?.The serum 25?OH?D₃ test values were28.53?21.66,33.39?ng/ml and 26.20?21.70,31.92?ng/ml in the youth group?younger than 45 years old?and the middle aged group?older than 45 years old?,respectively.The serum 25?OH?D₃ test values in the youth group were slightly higher than those in the middle aged group,showing no significant statistical difference?P>0.05?.The results indicated that the age and gender of normal and prediabetic populations were not the main influencing factors of serum 25?OH?D₃.nd stmenopausal osteoporosis.Conclusions:1.Serum VitD and insulin sensitivity are decreased in patients with impaired glucose regulation,furthermore,they also have insulin resistance and lipid dysfunction.VitD intervention could improve insulin sensitivity,reduce TG?FPG?FINS and ameliorate insulin resistance.2.VitD intervention could reduce the incidence of type 2 diabetes in subjects with impaired glucose regulation.3.Serum 25?OH?D₃ can be used as an independent predictor of prediabetes.Age and sex were not the main influencing factors of 25?OH?D₃.