Katie Walczuk 1

Vitamin D Consumption and Managing the Onset and Symptoms of Type II Diabetes

The Sage Colleges

Katie Walczuk 2

Introduction

Type II Diabetes (T2DM) is a metabolic disorder in which blood glucose levels are too

high due to insulin resistance, insulin deficiency, and beta-cell failure (Mahan et al., 2017).

T2DM accounts for about 90-95% of all diabetes in the United States and roughly 8.5% of the

U.S. population suffers from this disorder (Mahan et al., 2017). Minority populations and ethnic

groups have the highest rates of T2DM and the incidence of this condition is increasing greatly

among younger generations (Alam et al., 2017). Obesity is common in most people that are

diagnosed with T2DM, however there are many other factors including genetic predisposition,

environmental factors, and disease history (Mahan et al., 2017). Controlling the occurrence and

symptoms of T2DM is important as the population of people with T2DM continues to increase.

The consumption of vitamins and minerals is known to impact a variety of diseases. Specifically,

vitamin D has previously been in the news regarding its potential role in the secretion of

pancreatic insulin (Rosen et al., 2012). The purpose of this review is to explore an increased

consumption of vitamin D impacts the onset of T2DM and the symptoms that come with the

disease.

Incidence of Type II Diabetes

A clinical trial conducted by Gao et al. (2018) focused on the association between

Vitamin D consumption and the incidence of T2DM. The study was conducted using a

population of people from the Chengdu plain in China, which notoriously has the highest

insufficiency of vitamin D among its people due to the constant overcast in the region (Gao et

al., 2018). 490 participants between the ages of 20-74 years old that were enrolled in the China

national Diabetes and Metabolic Disorders Study were followed and analyzed for 4 years (Gao et

al., 2018).
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Fasting blood samples were collected throughout the summer months to assess vitamin D

status and were stored appropriately prior to being assayed (Gao et al., 2018). An oral glucose-

tolerance test, 2-hour plasma glucose test, or a treatment with insulin or oral hypoglycemic agent

was administered to assess the incidence of T2DM (Gao et al., 2018). A standardized

questionnaire assessing demographics, risk factors from lifestyle, family history, medical history,

and other anthropometric factors was given to each participant (Gao et al., 2018).

The diagnostic criteria used for T2DM was determined by the World Health

Organization’s (WHO) definition from 1999 and the homeostasis model assessment of insulin

resistance (HOMA-IR) and insulin sensitive index composite (ISIcomp) were used to assess

insulin sensitivity (Gao et al., 2018). β-cell function was assessed using the ratio of incremental

insulin in response to glucose over the first 30 minutes of the oral glucose tolerance test and was

adjusted for using the results of insulin sensitivity (Gao et al., 2018). The Pearson’s chi-squared

test was used to test differences between variables and an ANOVA was used for analysis (Gao et

al., 2018).

After 4 years of analysis, 15.8% of the participants developed T2DM (Gao et al., 2018).

Low vitamin D levels were associated with an increased risk of T2DM (P=0.004) (Gao et al.,

2018). Low baseline levels of vitamin D were associated with an increase in insulin resistance

and a decrease in insulin sensitivity in the participants that developed T2DM (P<0.05) (Gao et

al., 2018).

From these findings by Gao et al. (2018), the data suggests that low vitamin D levels

predicts the onset of T2DM and that it may be involved in the development of the disease. Over

the four years of examination, vitamin D was independently predictive of hyperglycemia

development in T2DM and the researchers suggest that the higher levels of vitamin D may be
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associated with increasing β-cell function and insulin sensitivity (Gao et al., 2018).

The limitations to this research includes that this study was done on only a Chinese

population. Due to genetic factors, environmental factors, and adaptability, therefore more

studies would need to be done for it to be generalizable. Additionally, the data on how the

participant received their vitamin D—whether from sun exposure, food intake, or

supplementation—were not recorded (Gao et al., 2018). As an observational study, there could

be other confounding variables that the researchers did not remove that could be impacting the

outcomes of this study.

Overall, this study found that a deficiency in vitamin D may increase insulin resistance

and decrease insulin sensitivity in a healthy Chinese population (Gao et al., 2018). Further

studies are needed for this finding to have practical applications and to clarify the role that

vitamin D has on T2DM.

Association with Body Weight

A study conducted by Ceglia et al. (2018) examined the effect of vitamin D consumption

on body weight in people with pre-diabetes that are at risk for developing T2DM. Obesity is a

main factor that contributes to the occurrence of T2DM and several factors regarding vitamin D

and its association with obese individuals led the researchers to be invested in this topic (Ceglia

et al., 2018). The randomized controlled clinical trial examined multi-racial pre-diabetes

participants from the Diabetes Prevention Program cohort at a baseline and over a 2-year period

(Ceglia et al., 2018). 1,998 participants were randomized into a control group and an intensive

lifestyle group and body weight was measured at a baseline, at 6 months, 1 year, and 2 years

(Ceglia et al., 2018). The intensive lifestyle group received weight loss intervention and physical

activity insight (Ceglia et al., 2018). BMI, waist circumference, anthropometric measures,
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visceral and subcutaneous adipose tissue, and total fat was measured (Ceglia et al., 2018).

Vitamin D blood levels were measured at the same time increments as body weight and physical

activity was assessed using the Modifiable Activity Questionnaire (Ceglia et al., 2018). Daily

nutrient intake was measured on a yearly basis starting with the baseline using a food frequency

questionnaire and standardized interviewer questions were used to assess other confounding

variables including smoking, medical history and medications, alcohol use, and supplementation

(Ceglia et al., 2018). Fasting blood was taken and examined for each participant after being

stored properly (Ceglia et al., 2018). Independent sample t-tests, chi-squared tests, and a cross-

sectional analysis were used to identify the difference between the two groups (Ceglia et al.,

2018). Mediation analyses were used to measure total, visceral, and subcutaneous fat (Ceglia et

al., 2018).

Over the two years analysis range, vitamin D concentrations on the blood were inversely

correlated with body weight, BMI, and waist circumference (P<0.001) (Ceglia et al., 2018).

Visceral fat measured at the baseline was found to directly effect 40% of body weight with the

association of vitamin D levels (P=0.04) (Ceglia et al., 2018). These findings suggest that higher

vitamin D concentrations in the blood are correlated with a lower body weight or increased

weight loss in pre-diabetics (Ceglia et al., 2018). No differences were found between the control

and experimental groups. Vitamin D could possibly help prevent the onset of T2DM in pre-

diabetics that are struggling with maintaining their body weight. More studies will need to be

done for this to have practical importance, but there is some theoretical importance behind these

findings.

Improvement of Symptoms

The researches Alam et al. (2017) examined the effect of vitamin D supplementation on
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neuropathy on patients with T2DM. Painful neuropathy is a major symptom in T2DM and

vitamin D deficiency has been associated with diabetic peripheral neuropathy in previous studies

(Alam et al., 2017). An open label clinical trial was performed between June 2012 and April

2013 in patients with severe neuropathy from the Baqai Institute of Diabetology and

Endocrinology in Pakistan (Alam et al., 2017). 143 participants with no comorbidities above the

age of 18 with an HbA1c less than 11 % were sampled (Alam et al., 2017). Participants were

given a single intramuscular injection of a 600,000 IU of vitamin D3 and were assessed for

changes in neuropathy for 4 weeks at 5 different follow-up visits (Alam et al., 2017). The

NeuroQol questionnaire was used to assess physical and emotional problems related to diabetic

neuropathy (Alam et al., 2017). T-tests and chi-squared tests were used to assess the

anthropometric measures of the participants as identified in the survey over each follow-up

(Alam et al., 2017).

Supplementation of vitamin D in the 41.3% of participants that tested positive for vitamin

D deficiency was significantly associated with an improvement in emotional distress (P=0.04)

(Alam et al., 2017). Participants that were vitamin D deficient prior to the injection reported a

significant reduction in foot pain and foot neuropathy after the injection (P<0.0001) (Alam et al.,

2017). Treatment of vitamin D was also associated with a reduction in HbA1c (P=0.02) (Alam et

al., 2017). Based on these results, vitamin D consumption may be effective as a treatment to help

reduce the symptoms of T2DM. Quality of life may be improved in patients with T2DM and pre-

diabetes that suffer from neuropathy as a result of their diabetes.

Discussion

Managing the incidence and symptoms of T2DM is exceedingly important as the

population of people diagnosed with T2DM continues to increase. The consumption of vitamin
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D may decrease the incidence of T2DM and may lessen the symptoms associated with the

disease. Vitamin D deficiencies were correlated with the onset of T2DM in the study led by Gao

et al. (2018), and vitamin D levels could independently determine hyperglycemia in T2DM

participants. Additionally, Ceglia et al. (2018) found that vitamin D levels were inversely

associated wit body weight, BMI, and waist circumference—three factors that are known to

contribute to the incidence of T2DM. In regards to symptoms, an increase in vitamin D in the

blood led to a significant decrease in emotional distress, foot discomfort, and HbA1c among

participants with severe neuropathy (Alam et al., 2018). More studies will need to be done for

these results to have more reliability and more generalizability as solutions to T2DM problems.

Despite this, these findings suggest that increasing the consumption of vitamin D, may lead to

improved symptoms and improved outcomes for T2DM patients.

Medical Nutrition Therapy

The current medical nutrition therapy (MNT) for T2DM includes adopting lifestyle

strategies that improve glycemia, blood pressure, and dyslipidemia, providing nutrition education

and counseling, practicing a lower-energy diet, monitoring blood glucose levels to determine

necessary food or medication changes, and intervening with cardioprotective nutrition (Mahan et

al., 2017, p. 590). Managing T2DM requires a lot of self-evaluation, counseling, and support as

the daily tasks of monitoring all of the entities that effect blood glucose levels can be

overwhelming (Mahan et al., 2017, p. 593). The MNT for T2DM focuses on macronutrients and

Mahan et al. (2017) states that there is no clear evidence that has been established in regards to

micronutrient benefits in T2DM management. Specifically, evidence for vitamin D consumption

in T2DM patients was noted as insufficient (Mahan et al., 2017, p. 597). The new research that

has been examined regarding vitamin D levels and T2DM differs from what is seen in Krause
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and is not indicated in this resource (Mahan et al., 2017).

Practical Applications

Patients with T2DM and those who are at risk for developing the disease will need to

self-evaluate their own symptoms and risks when it comes to increasing their consumption of

vitamin D. Following the nutrition guidance of a Registered Dietitian is by far the most

important treatment and management strategy when it comes to T2DM. T2DM is a highly

individualized disease, so it is up to the patient to discuss with an RD any possible other

treatment that may improve their experience with the condition. There is not much research

behind vitamin D consumption and T2DM, but it is possible that a patient may receive some

benefits from the micronutrient. Ultimately, with the guidance of an RD, patients can come up

with a plan that can help them manage the incidence and symptoms of T2DM.

Conclusion

An increase in vitamin D consumption may decrease the incidence of T2DM in those that

are at risk for developing the disease and may decrease symptoms that are associated with

T2DM. However, vitamin D consumption should not be used in place of standard MNT by an

RD. More research needs to be done to identify if this micronutrient truly does have an impact of

T2DM. The treatment and management strategies for T2DM should be individualized and well

researched for all patients. It is up to the patient to decide if the consumption of vitamin D could

prove to be beneficial for their health and for their T2DM.

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Literature Cited

Alam, U., Fawwad, A., Shaheen, F., Tahir, B., Basit, A., Malik, R. (2017). Improvement in

neuropathy specific quality of life in patients with diabetes after vitamin D

supplementation. Journal of Diabetes Research, 2017. doi: 10.1155/2017/7928083

Ceglia, L., Nelson, J., Ware, J., Alysandratos, K.D., Bray, G., Garganta, C., Nathan, D., Hu, F.,

Dawson-Hughes, B., Pittas, A. (2018). Association between body weight and

composition and plasma 25-hydroxyvitamin D level in the diabetes prevention program.

European Journal of Nutrition, 56: 161-170. doi: 10.1007/s00394-015-1066-z

Gao, Y., Zheng, T., Ran, X., Ren, Y., Chen, T., Zhong, L., Yan, D., Yan, F., Wu, Q., Tian, H.

(2018). Vitamin D and incidence of prediabetes or type 2 diabetes: A four-year follow-up

community-based study. Disease Markers. 2018. doi: 10.1155/2018/1926308

Mahan, L. K. & Raymond, J. L. (2017). Krause’s Food and the Nutrition Care Process (14th

ed.). St. Louis: Elsevier Saunders.

Rosen C. J., Adams J. S., Bikle D. D. (2012). The nonskeletal effects of vitamin D: an Endocrine

Society scientific statement. Endocrine Reviews, 33 (3): 456–492. doi:

10.1210/er.2012-1000.