Is there a relationship between vitamin D with insulin resistance and diabetes mellitus?

Abstract

Available data suggest a possible link between abnormal vitamin D level and abnormal glucose homeostasis, two of the most common chronic medical conditions. Both conditions are associated with inflammation, and the exact mechanism for role of either on the other is not well clear. Literature investigating the link between vitamin D and either pre-diabetic states or diabetes is reviewed. Vitamin D deficiency is detrimental to insulin synthesis and secretion in animal and human studies. In humans, it has been shown by majority of observational studies, that vitamin D is positively correlated with insulin sensitivity and its role is mediated both by direct mechanism through the availability of vitamin D receptors in several tissues and indirectly through the changes in calcium levels. Large number of, but not all, variable samples cross sectional human trials have demonstrated an inverse relation between vitamin D status and impaired glucose tolerance, insulin resistance or diabetes. To compliment this conclusively, evidence from intervention studies is critically warranted before we can frankly state that vitamin D plays a role in diabetes prevention or treatment. Absence of both sizable prospective observational trials utilizing 25(OH)D as the main variable and the non-availability of randomized studies specifically designed to assess the effects of vitamin D on pre-diabetes and diabetes states, are the main obstacles to draw solid and conclusive relationships.

Keywords: Insulin resistance; Type 2 diabetes; Vitamin D.

Figure 1

Schematic overview of the metabolism of vitamin D. Synthesis of vitamin D3 starts in the skin where 7-dehydrocholesterol is converted into vitamin D3 in response to UVB exposure. Vitamin D3 is hydroxylated by 25-hydroxylases in the liver. The resulting 25-hydroxyvitamin D3 is then hydroxylated in the kidney by 1α hydroxylase, to produce the final activated product, 1,25-dihydroxyvitamin D3.