Prevalence of vitamin D deficiency in pre-type 1 diabetes and its association with disease progression
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Vitamin D deficiency is common in people with type 1 diabetes, but its role in disease progression is unclear. Our aim was to assess the prevalence of vitamin D deficiency in prediabetes (defined as the presence of multiple islet autoantibodies), and investigate whether or not progression to type 1 diabetes is faster in children with vitamin D deficiency and multiple islet autoantibodies.
Levels of 25-hydroxyvitamin D [25(OH)D] were measured in 108 children with multiple islet autoantibodies within 2 years of islet autoantibody seroconversion, in 406 children who remained islet autoantibody-negative and in 244 patients with newly diagnosed type 1 diabetes. Children with multiple islet autoantibodies were prospectively followed for a median of 5.8 years (interquartile range 3.4–8.6 years) to monitor progression to type 1 diabetes.
In the cross-sectional analysis, 25(OH)D levels were lower and the prevalence of vitamin D deficiency (<50 nmol/l) was higher in children with prevalent multiple islet autoantibodies than in islet autoantibody-negative children (59.9 ± 3.0 vs 71.9 ± 1.5 nmol/l; p < 0.001; 39.8% vs 28.3%; p = 0.021). The differences in vitamin D levels between the groups were greatest in summer. The cumulative incidence of type 1 diabetes at 10 years after seroconversion was similar between children with vitamin D deficiency and those with sufficient vitamin D levels (51.8% [95% CI 29.3, 74.3] vs 55.4% [95% CI 35.5, 72.3], p = 0.8).
Vitamin D levels were lower in children with multiple islet autoantibodies and in children with type 1 diabetes than in autoantibody-negative children. However, vitamin D deficiency was not associated with faster progression to type 1 diabetes in children with multiple islet autoantibodies.
Keywords25(OH)D Islet autoimmunity Type 1 diabetes Vitamin D
We thank C. Ried, A. Wosch, L. Lachmann, F. Haupt, M. Scholz, A. Gavrisan, A. Knopff, S. Krause, C. Matzke, V. Dietrich and J. Stock for data collection and expert technical assistance, R. Chmiel and A. Huppert for clinical care of the children, R. Puff for laboratory management and A. Beyerlein for statistical assistance (all from Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg, Germany). We also thank all of the children, paediatricians and family doctors for participating in the BABYDIAB, BABYDIET and TEENDIAB studies and all of the clinics who enrolled children into DiMelli.
The work was supported by grants from the Kompetenznetz Diabetes mellitus (Competence Network for Diabetes mellitus), funded by the Federal Ministry of Education and Research (FKZ 01GI0805-07, FKZ 01GI0805), from Deutsche Forschungsgemeinschaft (DFG ZI-310/14-1 to -4) and the Juvenile Diabetes Research Fund (JDRF-No 17-2012-16).
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
JR and CW collected and reviewed the data, performed statistical analyses, interpreted the results and drafted the manuscript. SS assisted with follow-up assessments and data collection, and critically reviewed the manuscript for intellectual content. KW, EZG and MK contributed to statistical analyses, interpreted the results, and critically reviewed the manuscript for intellectual content. A-GZ is the principal investigator of the BABYDIAB, BABYDIET, TEENDIAB and DiMelli studies, designed the studies, wrote the manuscript and critically reviewed it for intellectual content. A-GZ had primary responsibility for the final content of the manuscript. All authors read and approved the final version.
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