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DOI: 10.9734/BJMMR/2015/14374
Editor(s):
(1) Kate S Collison, Department of Cell Biology, King Faisal Specialist Hospital & Research Centre, Saudi Arabia.
(2) Chan Shen, Department of Biostatistics, MD Anderson Cancer Center, University of Texas, USA.
Reviewers:
(1) Anonymous, Saudi Arabia.
(2) Anonymous, Egypt.
(3) Anonymous, Slovakia.
(4) Anonymous, Mexico.
Complete Peer review History: http://www.sciencedomain.org/review-history.php?iid=723&id=12&aid=7486
th
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*Corresponding author: Email: sbahijri@gmail.com;
ABSTRACT
Background: Type 2 diabetes (T2D) is one of the fastest growing public health problems
worldwide. Evidence linking vitamin D (VTD) status and T2D was reported. However, its role, and
whether it acts directly or through stimulating synthesis of osteocalcin is still unclear. Vitamin D
deficiency is common amongst Saudi adults. However, vitamin D supplement is not part of usual
management regimen for diabetic patients.
Objectives: To study: 1-The effect of self- administered minimum dose of vitamin D supplements
on glycemic control, insulin sensitivity, and lipids profile in T2DM females, 2-The relationship
between serum levels of VTD and different forms of osteocalcin (OC), and the active circulating
form of adiponectin.
Subjects and Methods: Sixty T2DM females were recruited to form two groups matched in age
and body mass index (BMI). Group A (GA) was the vitamin supplemented group, with a minimum
of 3 months intake of cholecalciferol (400IU/day), while Group B (GB) was the control group
receiving no supplements. Fasting blood samples were drawn for the measurements of glucose,
lipids profile, insulin, glycated hemoglobin (HbA1c), 25(OH) vitamin D, total OC, carboxylated OC
(cOC), uncarboxylated OC (ucOC), and High molecular weight adiponectin (HMWApn).
Results: Means of 25(OH) vitamin D, triglycerides, total OC, cOC and HMWApn were all
significantly higher in Group A compared to corresponding means in Group B, while mean HbA1c
was significantly lower (P< 0.05 in all cases). VTD correlated positively with total and cOC in both
groups. However, it correlated positively with HMWApn, and negatively with HbA1c in Group A
only. No correlation between VTD and ucOC was found. cOC correlated highly positively with
HMWApn, and negatively with HbA1c in both groups.
Conclusion: VTD supplemented subjects showed better glycemic control, possibly indirectly by
stimulating the synthesis of osteocalcin, and hence adiponectin. Caboxylated OC is most likely the
active form. Therefore, vitamin K status must be monitored.
Keywords: Vitamin D; glycemic control; osteocalcin; carboxylated osteocalcin; adiponectin.
1. INTRODUCTION
Type 2 diabetes (T2D) is one of the fastest
growing public health problems in both
developed and developing countries imposing a
high financial burden on health care costs [1,2].
Reports indicate that Saudi Arabia has one of the
highest prevalence rates of T2D in the world
[2-4]. The hyperglycaemia in T2D has long been
known to be associated with reductions in both
insulin sensitivity and beta cell function [5], with
genetic, environmental, dietary and lifestyle
factors playing major roles in its development
[6-8]. Once established, T2D is difficult to treat,
and despite pharmacologic treatment blood
glucose levels tend to increase over time leading
to serious health complications [9,10]. This
rapidly increasing incidence and prevalence
emphasizes the importance of innovative
approaches for the management and prevention
of the disease. Indeed, various efforts were
made to study its pathogenesis and etiology, in
order to prevent its development, or; at least; to
control associated complications.
More than fifty years ago, animal studies
indicated that calcium is needed for insulin
405
406
3. RESULTS
Age of recruited subjects ranged between 40- 62
years, with no significant difference between the
means of the experimental and control groups
(P= 0.221), and mean SEM being 53.20 1.22
25 (OH) D3
(ng/ml)
Fasting Glucose
(mmol/L)
HbA1c (%)
Fasting Insulin (mU/L)
HOMA-IR
Total Cholesterol
(mmol/L)
HDL
(mmol/L)
LDL
(mmol/L)
TG
(mmol/L)
Total Osteocalcin
(ng/ml)
Uncarboxylated Osteocalcin
(ng/ml)
Carboxylated Osteocalcin
(ng/ml)
HMW Adiponectin
(ng/ml)
Group A
Range
(Mean SEM)
10.00 70.71
(30.27 3.36)
3.5 20.7
(7.8 0.6)
6.1 12.7
(7.97 0.27)
5.10 35.63
(14.50 1.34)
1.54 13.74
(4.94 0.56)
3.28 5.96
(4.50 0.14)
0.92 1.94
(1.35 0.06)
1.90 4.66
(2.79 0.12)
0.66 - 3.35
(1.67 0.13)
2.0 16.1
(8.02 0.77)
1.0 4.4
(2.21 0.20)
0.7 14.6
(5.81 0.76)
1.1 6.3
(4.18 0.24)
407
Group B
Range
(Mean SEM)
10.00 43.00
(18.57 1.74)
5.2 21.8
(9.0 0.6)
5.6 15.1
(9.05 0.43)
4.91 30.70
(13.68 1.28)
1.40 17.19
(5.47 0.66)
1.88 6.97
(4.80 0.22)
0.81 1.83
(1.32 0.06)
1.13 4.76
(3.17 0.18)
0.57 2.52
(1.34 0.08)
1.9 11.2
(5.84 0.43)
0.9 6.3
(2.46 0.22)
0.9 8.3
(3.38 0.33)
0.8 6.5
(3.07 0.29)
P-Value
0.003
0.191
0.036
0.659
0.542
0.252
0.787
0.082
0.033
0.016
0.406
0.005
0.005
Fig. 1. Correlation between 25(OH) vitamin D and HbA1c in Group A (a) and Group B (b
408
Fig. 2. Correlation between 25(OH) vitamin D and carboxylated osteocalcin (cOC) in Group A
(a) and Group B (b)
Fig. 3. Correlation between carboxylated osteocalcin (cOC) and HbA1c in Group A (a) and
Group B (b)
Fig. 4. Correlation between carboxylated osteocalcin (cOC) and high molecular weight
adiponectin (HMWApn) in Group A (a) and Group B (b)
4. DISCUSSION
As reported by studies in our region [31,32] a
high percentage of the studied groups had below
optimal vitamin D status, reflected on low 25(OH)
vitamin D serum concentration. Ingestion of 400
409
410
5. CONCLUSION
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CONSENT
All authors declare that written informed consent
was obtained from all involved patients for
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ETHICAL APPROVAL
All authors hereby declare that all experiments
have been examined and approved by the
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ACKNOWLEDGMENTS
The authors would like to thank King Abdulaziz
City for Science and Technology, and The
Deanship of Scientific Research - King Abdulaziz
University- Jeddah- Saudi Arabia for their
financial support of this work (Project no. 210-10
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2015 Bahijri et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
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