Association Between Vitamin D Status and Diabetic Complications in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study in Hunan China

Abstract

Background: Vitamin D status has been linked to diabetes-related complications due to multiple extraskeletal effects. We aimed to investigate the association between vitamin D deficiency (VDD) and diabetic vascular complications, including diabetic retinopathy (DR), diabetic kidney disease (DKD), and diabetic foot ulcers (DFU). Methods: A total of 4,284 Chinese patients with type 2 diabetic mellitus (T2DM) were enrolled into the cross-sectional study. VDD was defined as serum 25-hydroxyvitamin D <50 nmol/L. Demographic data, physical measurements, laboratory measurements, comorbidities, and related medications were collected and analyzed by VDD status. Poisson regression with robust variance estimation and binary logistic regression were performed to explore the relationship between VDD and diabetic complications. Results: The prevalence of VDD, DR, DKD, DFU accounted to 71.7% (95% confidence intervals [CI]: 70.3-73.0%), 28.5% (95% CI: 27.2-29.9%), 28.2% (95% CI: 26.8-29.5%), and 5.7% (95% CI: 5.1-6.5%), respectively. The prevalence ratios (95% CI) for DR and DKD by VDD status, adjusted for demographics, physical measurements, laboratory measurements, related complications, and comorbidities, and medications, were 1.093 (0.983-1.215) and 1.041 (0.937-1.156), respectively. The odds ratio (95% CI) for DFU by VDD status was 1.656 (1.159-2.367) in the final adjusted model. Meanwhile, the prevalence of VDD was significantly higher in patients with DFU compared with patients without DFU. Conclusions: The present study firstly indicated that VDD was significantly associated with a higher prevalence of DFU among Chinese T2DM patients. The association between VDD status and DR or DKD was not significant when adjusting for all potential covariates. Vitamin D screening or supplementation may be beneficial to prevent DFU and improve the prognosis of T2DM patients.

Keywords: cross-sectional study; diabetic foot ulcers; diabetic kidney disease; diabetic retinopathy; vitamin D deficiency.

Figure 1

Prevalence ratios of DR by VDD status among the study population. Model 1: crude, unadjusted; model 2: adjusted for age, sex; model 3: adjusted for age, sex, duration of diabetes, smoking status, drinking status, BMI, and waist-hip ratio; model 4: model 3 + albumin, triglycerides, HDL-C, glycemic control, HOMA2-IR, serum calcium, serum phosphorus, serum uric acid, serum creatine, 24HUALB; model 5: model 4 + diabetic complications (DKD, DFU, DPN), related comorbidities (coronary heart disease, cerebrovascular disease, and hypertension), and medications (BPLT, LLT and GLT).

Figure 2

Prevalence ratios of DKD by VDD status among the study population. Model 1: crude, unadjusted; model 2: adjusted for age, sex; model 3: adjusted for age, sex, duration of diabetes, smoking status, drinking status, BMI and waist-hip ratio; model 4: model 3 + albumin, total cholesterol, LDL-C, glycemic control, HOMA2-IR, serum calcium, serum phosphorus, serum uric acid, serum creatine, 24HUALB; model 5: model 4 + diabetic complications (DR, DFU, DPN), related comorbidities (coronary heart disease, cerebrovascular disease, and hypertension), and medications (BPLT, LLT, and GLT).

Figure 3

Odds ratio of DFU by VDD status among the study population. Model 1: crude, unadjusted; model 2: adjusted for age, sex; model 3: adjusted for age, sex, duration of diabetes, smoking status, drinking status, family history of diabetes, BMI and waist-hip ratio; model 4: model 3 + albumin, triglycerides, total cholesterol, HDL-C, LDL-C, serum calcium, serum creatinine, 24HUALB; model 5: model 4 + diabetic complications (DR, DKD, DPN), related comorbidities (coronary heart disease, cerebrovascular disease, and hypertension), and medications (BPLT, LLT and GLT).