Current Diabetes Reports

, 8:393 | Cite as

Diabetes and the vitamin D connection



Vitamin D deficiency, which is common in children and adults, causes rickets, osteomalacia, and osteoporosis. Most organs and immune cells have a vitamin D receptor, and some also have the capacity to metabolize 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. 1,25-Dihydroxyvitamin D is a potent immunomodulator that also enhances the production and secretion of several hormones, including insulin. Vitamin D deficiency has been associated with increased risk of type 1 diabetes. Glycemic control and insulin resistance are improved when vitamin D deficiency is corrected and calcium supplementation is adequate. 25-Hydroxyvitamin D (measure of vitamin D status) of less than 20 ng/mL is vitamin D deficiency and 21 to 29 ng/mL is insufficiency. Children and adults need at least 1000 IU of vitamin D per day to prevent deficiency when there is inadequate sun exposure.

References and Recommended Reading

  1. 1.
    Holick MF: Vitamin D deficiency. N Engl J Med 2007, 357:266–281.PubMedCrossRefGoogle Scholar
  2. 2.
    Nagpal S, Na S, Rathnachalam R: Noncalcemic actions of vitamin D receptor ligands. Endocr Rev 2005, 26:662–687.PubMedCrossRefGoogle Scholar
  3. 3.
    Li YC, Kong J, Wei M, et al.: 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002, 110:229–238.PubMedGoogle Scholar
  4. 4.
    Bland R, Markovic D, Hills CE, et al.: Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in pancreatic islets. J Steroid Biochem Mol Biol 2004, 89–90:121–125.PubMedCrossRefGoogle Scholar
  5. 5.
    Liu PT, Stenger S, Li H, et al.: Toll-like receptor Triggering of a vitamin D-mediated human antimicrobial response. Science 2006, 3:1770–1773.CrossRefGoogle Scholar
  6. 6.
    Feldman D, Zhao XY, Krishnan AV: Vitamin D and prostate cancer. Endocrinology 2000, 141:5–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Grant WB: An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer 2002, 70:2861–2869.Google Scholar
  8. 8.
    Gorham ED, Garland CF, Garland FC, et al.: Optimal vitamin D status for colorectal cancer prevention: a quantitative meta-analysis. Am J Prev Med 2007, 32:210–216.PubMedCrossRefGoogle Scholar
  9. 9.
    Moan J, Porojnicu AC, Dahlback A, Setlow RB: Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci U S A 2008, 105:668–673.PubMedCrossRefGoogle Scholar
  10. 10.
    Pilz S, Dognig H, Winklhofer-Roob B, et al.: Low serum levels of 25-hydroxyvitamin D predict fatal cancer in patients referred to coronary angiography. Cancer Epidemiol Biomarkers Prev 2008, 17:1228–1233.PubMedCrossRefGoogle Scholar
  11. 11.
    Heaney RP: Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 2004, 80(Suppl):1706S–1709S.PubMedGoogle Scholar
  12. 12.
    Wang TJ, Pencina MJ, Booth SL, et al.: Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008, 117:503–511.PubMedCrossRefGoogle Scholar
  13. 13.
    Dobnig H, Pilz S, Scharnagl H, et al.: Independent association of low serum 25-hydroxyvitami D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008, 168:1340–1349.PubMedCrossRefGoogle Scholar
  14. 14.
    Ponsonby AL, Lucas RM, van der Mei IA: UVR, vitamin D and three autoimmune diseases—multiple sclerosis, type 1 diabetes, rheumatoid arthritis. Photochem Photobiol 2005, 81:1267–1275.PubMedCrossRefGoogle Scholar
  15. 15.
    Merlino LA, Curtis J, Mikuls TR, et al.: Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 2004, 50:72–77.PubMedCrossRefGoogle Scholar
  16. 16.
    Hypponen E, Laara E, Jarvelin MR, Virtanen SM: Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001, 358:1500–1503.PubMedCrossRefGoogle Scholar
  17. 17.
    Penna G, Amuchastegui S, Giarratana N, et al.: 1,25-Dihydroxyvitamin D3 selectively modulates tolerogenic properties in myeloid but not plasmacytoid dendritic cells. J Immunol 2007, 178:145–153.PubMedGoogle Scholar
  18. 18.
    Inomata S, Kadowaki S, Yamatani T, et al.: Effect of 1 alpha (OH)-vitamin D3 on insulin secretion in diabetes mellitus. Bone Miner 1986, 1:187–192.PubMedGoogle Scholar
  19. 19.
    Pittas AG, Lau J, Hu FB, Dawson-Hughes B: The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007, 92:2017–2029.PubMedCrossRefGoogle Scholar
  20. 20.
    Mohr SB, Garland CF, Gorham ED, Garland FC: The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide. Diabetologia 2008 June 12 (Epub ahead of print).Google Scholar
  21. 21.
    Karvonen M, Viik-Kajander M, Molchanova E, et al.: Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 2000, 23:1516–1526.PubMedCrossRefGoogle Scholar
  22. 22.
    Vitamin D supplement in early childhood and risk for type I (insulin-dependent) diabetes mellitus. The EURODIAB Substudy 2 Study Group [no authors listed]. Diabetologia 1999, 42:51–54.CrossRefGoogle Scholar
  23. 23.
    Stene LC, Joner G: Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study. Am J Clin Nutr 2003, 78:1128–1134.PubMedGoogle Scholar
  24. 24.
    Stene LC, Barriga K, Norris JM, et al.: Perinatal factors and development of islet autoimmunity in early childhood: the diabetes autoimmunity study in the young. Am J Epidemiol 2004, 160:3–10.PubMedCrossRefGoogle Scholar
  25. 25.
    Scragg R, Holdaway I, Singh V, et al.: Serum 25-hydroxyvitamin D3 levels decreased in impaired glucose tolerance and diabetes mellitus. Diabetes Res Clin Pract 1995, 27:181–188.PubMedCrossRefGoogle Scholar
  26. 26.
    Isaia G, Giorgino R, Adami S: High prevalence of hypovitaminosis D in female type 2 diabetic population [letter]. Diabetes Care 2001, 24:1496.PubMedCrossRefGoogle Scholar
  27. 27.
    Chiu KC, Chu A, Go VL, Saad MF: Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 2004, 79:820–825.PubMedGoogle Scholar
  28. 28.
    Ford ES, Ajani UA, McGurie LC, Liu S: Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care 2005, 28:1228–1230.PubMedCrossRefGoogle Scholar
  29. 29.
    Gedik O, Akalin S: Effects of vitamin D deficiency and repletion on insulin and glucagon secretion in man. Diabetologia 1986, 29:142–145.PubMedCrossRefGoogle Scholar
  30. 30.
    Orwoll E, Riddle M, Prince M: Effects of vitamin D on insulin and glucagon secretion in non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1994, 59:1083–1087.PubMedGoogle Scholar
  31. 31.
    Borissova AM, Tankova T, Kirilov G, et al.: The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients. Int J Clin Pract 2003, 57:258–261.PubMedGoogle Scholar
  32. 32.
    Kumar S, Davies M, Zakaria Y, et al.: Improvement in glucose tolerance and beta-cell function in a patient with vitamin D deficiency during treatment with vitamin D. Postgrad Med J 1994, 70:440–443.PubMedCrossRefGoogle Scholar
  33. 33.
    Pittas AG, Dawson-Hughes B, Li T, et al.: Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care 2006, 29:650–656.PubMedCrossRefGoogle Scholar
  34. 34.
    Hypponen E, Power C: Vitamin D status and glucose homeostasis in the 1958 British birth cohort. Diabetes Care 2006, 2244–2246.Google Scholar
  35. 35.
    Scragg R, Sowers M, Bell C: Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care 2004, 27:2813–2818.PubMedCrossRefGoogle Scholar
  36. 36.
    Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, and Institute of Medicine: Vitamin D. In Dietary Reference Intakes: For Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1999:250–287.Google Scholar
  37. 37.
    Holick MF, Biancuzzo RM, Chen TC, et al.: Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008, 93:677–681.PubMedCrossRefGoogle Scholar
  38. 38.
    Vieth R, Chan PCR, MacFarlane GD: Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 2001, 73:288–294.PubMedGoogle Scholar
  39. 39.
    Malabanan A, Veronikis IE, Holick MF: Redefining vitamin D insufficiency. Lancet 1998, 351:805–806.PubMedCrossRefGoogle Scholar
  40. 40.
    Chapuy MC, Schott AM, Garnero P, et al.: Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 1996, 81:1129–1133.PubMedCrossRefGoogle Scholar
  41. 41.
    Holick MF, Siris ES, Binkley N, et al.: Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005, 90:3215–3224.PubMedCrossRefGoogle Scholar
  42. 42.
    Heaney RP, Dowell MS, Hale CA, Bendich A: Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003, 22:142–146.PubMedGoogle Scholar
  43. 43.
    Zhou C, Assem M, Tay JC, et al.: Steroid and xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug-induced osteomalacia. J Clin Invest 2006, 116:1703–1712.PubMedCrossRefGoogle Scholar
  44. 44.
    Clemens TL, Henderson SL, Adams JS, Holick MF: Increased skin pigment reduces the capacity of skin to synthesis vitamin D3. Lancet 1982, 1:74–76.PubMedCrossRefGoogle Scholar
  45. 45.
    Wortsman J, Matsuoka LY, Chen TC, et al.: Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000, 72:690–693. (Published erratum appears in Am J Clin Nutr 2003, 77:1342.)PubMedGoogle Scholar
  46. 46.
    Tang HM, Cole DEC, Rubin LA, et al.: Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr 1998, 68:854–858.Google Scholar
  47. 47.
    Armas LA, Hollis B, Heaney RP: Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 2004, 89:5387–5391.PubMedCrossRefGoogle Scholar
  48. 48.
    Schwalfenberg G: Vitamin D and diabetes. Improvement of glycemic control with vitamin D3 repletion. Can Fam Physician 2008, 54:864–866.PubMedGoogle Scholar
  49. 49.
    Stene LC, Ulriksen E, Magnus P, Joner G: Use of cod liver oil during pregnancy associated with lower risk of type 1 diabetes in the offspring. Diabetologia 2000, 43:1093–1098.PubMedCrossRefGoogle Scholar
  50. 50.
    Jun HS, Yoon JW: A new look at viruses in type 1 diabetes. Diabetes Metab Res Rev 2003, 19:8–31.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group LLC 2008

Authors and Affiliations

  1. 1.Department of Medicine, Section of Endocrinology, Nutrition, and DiabetesBoston University School of MedicineBostonUSA

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