The association between ketoacidosis and 25(OH)-vitamin D₃levels at presentation in children with type 1 diabetes mellitus

Abstract

Background: There is considerable evidence supporting the role of vitamin D deficiency in the pathogenesis of type 1 diabetes mellitus (T1DM). Vitamin D deficiency is also associated with impairment of insulin synthesis and secretion. There have been no formal studies looking at the relationship between 25(OH)‐vitamin D3 and the severity of diabetic ketoacidosis (DKA) in children at presentation with T1DM. Objective: To determine the relationship between measured 25(OH)‐vitamin D3 levels and the degree of acidosis in children at diagnosis with T1DM. Subjects: Children presenting with new‐onset T1DM at a tertiary children’s hospital. Methods: 25(OH)‐vitamin D3 and bicarbonate levels were measured in children at presentation with newly diagnosed T1DM. Those with suboptimal 25(OH)‐vitamin D3 levels (<50 nmol/L) had repeat measurements performed without interim vitamin D supplementation. Results: Fourteen of the 64 children had low 25(OH)‐vitamin D3 levels at presentation, and 12 of these had low bicarbonate levels (<18 mmol/L) (p = 0.001). Bicarbonate explained 20% of the variation in vitamin D level at presentation (partial r2 = 0.20, p < 0.001) and ethnic background a further 10% (partial r2 = 0.10, p = 0.002). The levels of 25(OH)‐vitamin D3 increased in 10 of the 11 children with resolution of the acidosis. Conclusions: Acid–base status should be considered when interpreting 25(OH)‐vitamin D3 levels in patients with recently diagnosed T1DM. Acidosis may alter vitamin D metabolism, or alternatively, low vitamin D may contribute to a child’s risk of presenting with DKA.

High Prevalence of Vitamin D Deficiency Among Saudi Children And Adolescents With Type 1 Diabetes In Albaha Region, Saudi Arabia

“…25-OH D deficiency has been prevalent upon the initial presentation of T1DM patients who presented with DKA, making it a contributing factor. However, that low levels improved spontaneously after correction of acidosis, the direct contribution of 25-OH D deficiency in the acute presentation of DKA remains controversial (39). Our result was similar to the results of Savastio et al who reported that, children with T1DM show a generalized 25OHD deficiency that impact on metabolic status and glycemic homeostasis and 25OHD levels were inversely related to diabetic ketoacidosis severity (p<0.05) (40).…”

Vitamin D Deficiency and Glycemic Status in Children and Adolescents with Type 1 Diabetes Mellitus

“…This observation may account the results of a previous multicenter study in Italy [29] and suggests the role of 25OHD deficiency as environmental factor triggering the development of diabetes and worsening the clinical presentation at onset. Indeed, as previously shown, the reduction of 25OHD levels seems to be higher in subjects with diabetic keto-acidosis at presentation [12–13]. …”

“…A recent meta-analysis of case-control studies in pediatric patients with T1DM showed 25OHD levels lower than 5.69 ng/ml in patients compared with healthy controls [11]. This reduction seems to be higher in subjects with diabetic ketoacidosis [12–13] and autoantibodies positivity [14]. Moreover, 25OHD status influences glucose homeostasis [15–21].…”

Does Vitamin D Affect Risk of Developing Autoimmune Disease?: A Systematic Review

“…It has also been shown that 25(OH)D levels are lower in individuals with poorly controlled type I diabetes(159), ketoacidosis(160, 161), incipient nephropathy or tubulointerstitial damage(150, 157). …”

“…Taken together, it is also apparent from these studies that ethnic origin (179), season of the year (180), and disability (163, 166), have strong effects on circulating vitamin D levels and it is not clear that all of these cross-sectional studies controlled for these important confounders. Additionally, disease activity and disability, glucocorticoid use(132), serum creatinine(132), microalbuminuria(157), ketoacidosis(160, 161), and use of hydroxychloroquine(135) influence circulating vitamin D levels. Hydroxychloroquine prescribed in several autoimmune diseases may inhibit the conversion of 25(OH) D to 1,25(OH) 2 D(135).…”