Vitamin D and Diabetic Complications: True or False Prophet?

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• 作者：Uazman Alam ; Vilashini Arul-Devah ; Saad Javed ; Rayaz A. Malik
• 关键词：Cardiovascular disease ; Diabetic nephropathy ; Diabetic neuropathy ; Diabetic retinopathy ; Pain ; RAAS inhibition ; Vitamin D
• 刊名：Diabetes Therapy
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：7
• 期：1
• 页码：11-26
• 全文大小：542 KB
• 刊物主题：Internal Medicine; Diabetes; Cardiology; Endocrinology;
• 出版者：Springer Healthcare
• ISSN：1869-6961

文摘

Vitamin D deficiency is now recognized as a condition of increasing prevalence worldwide. Vitamin D has an established role in calcium and bone metabolism; however, more recently associations with vitamin D deficiency and risk of developing diabetes, diabetes complications, and cardiovascular disease have all been acknowledged. The vitamin D receptor is ubiquitously expressed, and experimental, in vitro, and in vivo studies strongly suggest a role in regulating the transcription of multiple genes beyond calcium homeostasis. These include antiproliferative, immunomodulatory, angiogenic, inhibition of the renin–angiotensin–aldosterone system, and neurotrophic factor expression. Observational studies report a strong association between vitamin D deficiency and cardiovascular and metabolic disorders; however, there remains a paucity of large long-term randomized clinical trials showing a benefit with treatment. An increasing body of literature suggests a possible pathogenetic role of vitamin D in the long-term complications of diabetes and vitamin D deficiency may also exacerbate symptoms of painful diabetic peripheral neuropathy. It remains unknown if supplementation of vitamin D to normal or non-deficient levels alters pathogenetic processes related to diabetic microvascular complications. With the high prevalence of vitamin D deficiency in patients with diabetes and putative mechanisms linking vitamin D deficiency to diabetic complications, there is a compelling argument for undertaking large well-designed randomized controlled trials of vitamin D supplementation.