Differential effects of different vitamin D replacement strategies in patients with diabetes

Uazman Alam, Agnes W S Chan, April Buazon, Cristiano Van Zeller, Jacqueline L. Berry, Ravinder S. Jugdey, Omar Asghar, John Kennedy Cruickshank, Ioannis N. Petropoulos, Rayaz Malik

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Abstract

Background The optimal treatment regimen for correcting vitamin D insufficiency in diabetic patients has not been established. Methods Two hundred and forty four adult diabetic patients with vitamin D insufficiency were enrolled to receive: Ergocalciferol (D2) 50,000 IU daily over 10 days (500,000 IU) followed by Calcichew D3 (calcium carbonate/Cholecalciferol) BID (~ 24,000 IU cholecalciferol/month) (ECC) (n = 53); Cholecalciferol (D3) 40,000 IU daily over 10 days (400,000 IU) followed by Calcichew D3 BID (~ 24,000 IU cholecalciferol/month) (CCC) (n = 94) or Cholecalciferol 40,000 IU daily over 10 days (400,000 IU) followed by Cholecalciferol 40,000 IU monthly (CC) (n = 97). The 25(OH)D, HbA1c, lipids, blood pressure and eGFR were assessed at baseline and after a mean follow up of 8.0 ± 4.0 months. Results Treatment increased 25(OH)D concentrations significantly in ECC (17.4 ± 13.8 vs 29.9 ± 9.6 ng/ml, P < 0.0001), CCC (14.2 ± 6.6 vs 30.9 ± 13.1 ng/ml, p < 0.0001) and CC (13.5 ± 8.4 vs 33.9 ± 14.4 ng/ml, P < 0.0001). The relative increase in 25(OH)D was significantly lower with ECC compared to CC (+ 14.6 ± 12.2 vs + 20.6 ± 15.0, P = 0.01) and the majority of subjects in the ECC group (63%) remained vitamin D deficient (25(OH)D < 30 ng/ml) compared to CCC (46%) and CC (36%) (P = 0.0005). Conclusion This study demonstrates that relatively aggressive treatment regimens of both vitamin D2 and D3 increase 25(OH)D concentrations in diabetic patients, but the ability to raise 25(OH)D status to 'sufficient' levels is inadequate in a large proportion of individuals.

Original languageEnglish
Pages (from-to)66-70
Number of pages5
JournalJournal of Diabetes and its Complications
Volume28
Issue number1
DOIs
Publication statusPublished - Jan 2014
Externally publishedYes

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Cholecalciferol
Vitamin D
Ergocalciferols
Calcium Carbonate
Therapeutics

Keywords

  • Cholecalciferol
  • Diabetes
  • Ergocalciferol
  • Vitamin D

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Medicine(all)

Cite this

Differential effects of different vitamin D replacement strategies in patients with diabetes. / Alam, Uazman; Chan, Agnes W S; Buazon, April; Van Zeller, Cristiano; Berry, Jacqueline L.; Jugdey, Ravinder S.; Asghar, Omar; Cruickshank, John Kennedy; Petropoulos, Ioannis N.; Malik, Rayaz.

In: Journal of Diabetes and its Complications, Vol. 28, No. 1, 01.2014, p. 66-70.

Research output: Contribution to journalArticle

Alam, U, Chan, AWS, Buazon, A, Van Zeller, C, Berry, JL, Jugdey, RS, Asghar, O, Cruickshank, JK, Petropoulos, IN & Malik, R 2014, 'Differential effects of different vitamin D replacement strategies in patients with diabetes', Journal of Diabetes and its Complications, vol. 28, no. 1, pp. 66-70. https://doi.org/10.1016/j.jdiacomp.2013.09.003
Alam, Uazman ; Chan, Agnes W S ; Buazon, April ; Van Zeller, Cristiano ; Berry, Jacqueline L. ; Jugdey, Ravinder S. ; Asghar, Omar ; Cruickshank, John Kennedy ; Petropoulos, Ioannis N. ; Malik, Rayaz. / Differential effects of different vitamin D replacement strategies in patients with diabetes. In: Journal of Diabetes and its Complications. 2014 ; Vol. 28, No. 1. pp. 66-70.
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abstract = "Background The optimal treatment regimen for correcting vitamin D insufficiency in diabetic patients has not been established. Methods Two hundred and forty four adult diabetic patients with vitamin D insufficiency were enrolled to receive: Ergocalciferol (D2) 50,000 IU daily over 10 days (500,000 IU) followed by Calcichew D3 (calcium carbonate/Cholecalciferol) BID (~ 24,000 IU cholecalciferol/month) (ECC) (n = 53); Cholecalciferol (D3) 40,000 IU daily over 10 days (400,000 IU) followed by Calcichew D3 BID (~ 24,000 IU cholecalciferol/month) (CCC) (n = 94) or Cholecalciferol 40,000 IU daily over 10 days (400,000 IU) followed by Cholecalciferol 40,000 IU monthly (CC) (n = 97). The 25(OH)D, HbA1c, lipids, blood pressure and eGFR were assessed at baseline and after a mean follow up of 8.0 ± 4.0 months. Results Treatment increased 25(OH)D concentrations significantly in ECC (17.4 ± 13.8 vs 29.9 ± 9.6 ng/ml, P < 0.0001), CCC (14.2 ± 6.6 vs 30.9 ± 13.1 ng/ml, p < 0.0001) and CC (13.5 ± 8.4 vs 33.9 ± 14.4 ng/ml, P < 0.0001). The relative increase in 25(OH)D was significantly lower with ECC compared to CC (+ 14.6 ± 12.2 vs + 20.6 ± 15.0, P = 0.01) and the majority of subjects in the ECC group (63{\%}) remained vitamin D deficient (25(OH)D < 30 ng/ml) compared to CCC (46{\%}) and CC (36{\%}) (P = 0.0005). Conclusion This study demonstrates that relatively aggressive treatment regimens of both vitamin D2 and D3 increase 25(OH)D concentrations in diabetic patients, but the ability to raise 25(OH)D status to 'sufficient' levels is inadequate in a large proportion of individuals.",
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AU - Alam, Uazman

AU - Chan, Agnes W S

AU - Buazon, April

AU - Van Zeller, Cristiano

AU - Berry, Jacqueline L.

AU - Jugdey, Ravinder S.

AU - Asghar, Omar

AU - Cruickshank, John Kennedy

AU - Petropoulos, Ioannis N.

AU - Malik, Rayaz

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N2 - Background The optimal treatment regimen for correcting vitamin D insufficiency in diabetic patients has not been established. Methods Two hundred and forty four adult diabetic patients with vitamin D insufficiency were enrolled to receive: Ergocalciferol (D2) 50,000 IU daily over 10 days (500,000 IU) followed by Calcichew D3 (calcium carbonate/Cholecalciferol) BID (~ 24,000 IU cholecalciferol/month) (ECC) (n = 53); Cholecalciferol (D3) 40,000 IU daily over 10 days (400,000 IU) followed by Calcichew D3 BID (~ 24,000 IU cholecalciferol/month) (CCC) (n = 94) or Cholecalciferol 40,000 IU daily over 10 days (400,000 IU) followed by Cholecalciferol 40,000 IU monthly (CC) (n = 97). The 25(OH)D, HbA1c, lipids, blood pressure and eGFR were assessed at baseline and after a mean follow up of 8.0 ± 4.0 months. Results Treatment increased 25(OH)D concentrations significantly in ECC (17.4 ± 13.8 vs 29.9 ± 9.6 ng/ml, P < 0.0001), CCC (14.2 ± 6.6 vs 30.9 ± 13.1 ng/ml, p < 0.0001) and CC (13.5 ± 8.4 vs 33.9 ± 14.4 ng/ml, P < 0.0001). The relative increase in 25(OH)D was significantly lower with ECC compared to CC (+ 14.6 ± 12.2 vs + 20.6 ± 15.0, P = 0.01) and the majority of subjects in the ECC group (63%) remained vitamin D deficient (25(OH)D < 30 ng/ml) compared to CCC (46%) and CC (36%) (P = 0.0005). Conclusion This study demonstrates that relatively aggressive treatment regimens of both vitamin D2 and D3 increase 25(OH)D concentrations in diabetic patients, but the ability to raise 25(OH)D status to 'sufficient' levels is inadequate in a large proportion of individuals.

AB - Background The optimal treatment regimen for correcting vitamin D insufficiency in diabetic patients has not been established. Methods Two hundred and forty four adult diabetic patients with vitamin D insufficiency were enrolled to receive: Ergocalciferol (D2) 50,000 IU daily over 10 days (500,000 IU) followed by Calcichew D3 (calcium carbonate/Cholecalciferol) BID (~ 24,000 IU cholecalciferol/month) (ECC) (n = 53); Cholecalciferol (D3) 40,000 IU daily over 10 days (400,000 IU) followed by Calcichew D3 BID (~ 24,000 IU cholecalciferol/month) (CCC) (n = 94) or Cholecalciferol 40,000 IU daily over 10 days (400,000 IU) followed by Cholecalciferol 40,000 IU monthly (CC) (n = 97). The 25(OH)D, HbA1c, lipids, blood pressure and eGFR were assessed at baseline and after a mean follow up of 8.0 ± 4.0 months. Results Treatment increased 25(OH)D concentrations significantly in ECC (17.4 ± 13.8 vs 29.9 ± 9.6 ng/ml, P < 0.0001), CCC (14.2 ± 6.6 vs 30.9 ± 13.1 ng/ml, p < 0.0001) and CC (13.5 ± 8.4 vs 33.9 ± 14.4 ng/ml, P < 0.0001). The relative increase in 25(OH)D was significantly lower with ECC compared to CC (+ 14.6 ± 12.2 vs + 20.6 ± 15.0, P = 0.01) and the majority of subjects in the ECC group (63%) remained vitamin D deficient (25(OH)D < 30 ng/ml) compared to CCC (46%) and CC (36%) (P = 0.0005). Conclusion This study demonstrates that relatively aggressive treatment regimens of both vitamin D2 and D3 increase 25(OH)D concentrations in diabetic patients, but the ability to raise 25(OH)D status to 'sufficient' levels is inadequate in a large proportion of individuals.

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