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Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes

OBJECTIVE: To evaluate vitamin D as a predictor of all-cause mortality, progression from normoalbuminuria to micro- or macroalbuminuria, and the development of background or proliferative retinopathy in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: A prospective observational follow-up...

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Autores principales: Joergensen, Christel, Hovind, Peter, Schmedes, Anne, Parving, Hans-Henrik, Rossing, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114500/
https://www.ncbi.nlm.nih.gov/pubmed/21525501
http://dx.doi.org/10.2337/dc10-2459
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author Joergensen, Christel
Hovind, Peter
Schmedes, Anne
Parving, Hans-Henrik
Rossing, Peter
author_facet Joergensen, Christel
Hovind, Peter
Schmedes, Anne
Parving, Hans-Henrik
Rossing, Peter
author_sort Joergensen, Christel
collection PubMed
description OBJECTIVE: To evaluate vitamin D as a predictor of all-cause mortality, progression from normoalbuminuria to micro- or macroalbuminuria, and the development of background or proliferative retinopathy in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: A prospective observational follow-up study in which an inception cohort of type 1 diabetic patients was followed from onset of diabetes diagnosed between 1979 and 1984. Plasma vitamin D [25(OH)D3] levels were determined by high performance liquid chromatography/tandem mass spectrometry in 227 patients before the patients developed microalbuminuria. Values equal to or below the 10% percentile (15.5 nmol/L) were considered severe vitamin D deficiency. RESULTS: Median (range) vitamin D was 44.6 (1.7–161.7) nmol/L. Vitamin D level was not associated with age, sex, urinary albumin excretion rate (UAER), or blood pressure. During follow-up, 44 (18%) patients died. In a Cox proportional hazards model, the hazard ratio for mortality in subjects with severe vitamin D deficiency was 2.7 (1.1–6.7), P = 0.03, after adjustment for UAER, HbA(1c), and conventional cardiovascular risk factors (age, sex, blood pressure, cholesterol, smoking). Of the 220 patients, 81 (37%) developed microalbuminuria and 27 (12%) of these progressed to macroalbuminuria. Furthermore, 192 (87%) patients developed background retinopathy, whereas 34 (15%) progressed to proliferative retinopathy. Severe vitamin D deficiency at baseline did not predict the development of these microvascular complications. CONCLUSIONS: In patients with type 1 diabetes, severe vitamin D deficiency independently predicts all-cause mortality but not development of microvascular complications in the eye and kidney. Whether vitamin D substitution in type 1 diabetic patients can improve the prognosis remains to be investigated.
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spelling pubmed-31145002012-05-01 Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes Joergensen, Christel Hovind, Peter Schmedes, Anne Parving, Hans-Henrik Rossing, Peter Diabetes Care Original Research OBJECTIVE: To evaluate vitamin D as a predictor of all-cause mortality, progression from normoalbuminuria to micro- or macroalbuminuria, and the development of background or proliferative retinopathy in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS: A prospective observational follow-up study in which an inception cohort of type 1 diabetic patients was followed from onset of diabetes diagnosed between 1979 and 1984. Plasma vitamin D [25(OH)D3] levels were determined by high performance liquid chromatography/tandem mass spectrometry in 227 patients before the patients developed microalbuminuria. Values equal to or below the 10% percentile (15.5 nmol/L) were considered severe vitamin D deficiency. RESULTS: Median (range) vitamin D was 44.6 (1.7–161.7) nmol/L. Vitamin D level was not associated with age, sex, urinary albumin excretion rate (UAER), or blood pressure. During follow-up, 44 (18%) patients died. In a Cox proportional hazards model, the hazard ratio for mortality in subjects with severe vitamin D deficiency was 2.7 (1.1–6.7), P = 0.03, after adjustment for UAER, HbA(1c), and conventional cardiovascular risk factors (age, sex, blood pressure, cholesterol, smoking). Of the 220 patients, 81 (37%) developed microalbuminuria and 27 (12%) of these progressed to macroalbuminuria. Furthermore, 192 (87%) patients developed background retinopathy, whereas 34 (15%) progressed to proliferative retinopathy. Severe vitamin D deficiency at baseline did not predict the development of these microvascular complications. CONCLUSIONS: In patients with type 1 diabetes, severe vitamin D deficiency independently predicts all-cause mortality but not development of microvascular complications in the eye and kidney. Whether vitamin D substitution in type 1 diabetic patients can improve the prognosis remains to be investigated. American Diabetes Association 2011-05 2011-04-20 /pmc/articles/PMC3114500/ /pubmed/21525501 http://dx.doi.org/10.2337/dc10-2459 Text en © 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Original Research
Joergensen, Christel
Hovind, Peter
Schmedes, Anne
Parving, Hans-Henrik
Rossing, Peter
Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes
title Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes
title_full Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes
title_fullStr Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes
title_full_unstemmed Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes
title_short Vitamin D Levels, Microvascular Complications, and Mortality in Type 1 Diabetes
title_sort vitamin d levels, microvascular complications, and mortality in type 1 diabetes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114500/
https://www.ncbi.nlm.nih.gov/pubmed/21525501
http://dx.doi.org/10.2337/dc10-2459
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