Vitamin D, Parathyroid Hormone, Insulin Sensitivity and Islet β-Cell Secretory Function in Diabetic Patients from South Kivu in the Democratic Republic of Congo: Cross-Sectional Study
Background: The role of vitamin D and parathyroid hormone in the metabolic profile of type 2 diabetes mellitus in sub-Saharan Africa has not been adequately assessed. The aim of this study was to determine the prevalence of low vitamin D level and secondary hyperparathyroidism and their association with insulin sensitivity and β-cell secretory function among Congolese type 2 diabetics. Methodology: Fasting glycaemia, fasting insulin, 25OH D3 and human parathyroid hormone (hPTH) were measured in one hundred and eighty-four type 2 diabetic patients followed as outpatients in South Kivu. Levels of 25OH D3 < 30 ng/ml and hPTH > 65 pg/ml defined low vitamin D and elevated parathyroid hormone levels, respectively. The HOMA model was used to measure insulin sensitivity and β-cell secretory function. Results: Medians (IQR) were 25.3 (20.4 - 32.4) ng/ml for 25OH D3 and 53.7 (38.4 - 115.7) pg/ml for hPTH. 58.7% of diabetics had insulin resistance, 126 (68.5%) had low vitamin D and 80 (43.5%) had hyperparathyroidism. In multivariate analysis, hPTH (partial r = −0.28; p = 0.0002) and 25OH D3 (partial r = 0.16; p = 0.03) showed an independent association with insulin sensitivity after adjustment for body mass index and waist circumference. Finally, hPTH (partial r = 0.27; p = 0.0002) was the sole determinant of β-cell secretory function. Conclusions: This study confirms the high prevalence of low vitamin D level and secondary hyperparathyroidism and their association with insulin resistance and impaired islet β-cell secretory function among Congolese with type 2 diabetes mellitus. Vitamin D and calcium supplementation should be envisaged for cases of deficiency in this region.
Amrein, K., Scherkl, M., Hoffmann, M., Neuwersch-Sommeregger, S., Köstenberger, M., Tmava Berisha, A., et al. (2020) Vitamin D Deficiency 2.0: An Update on the Current Status Worldwide. European Journal of Clinical Nutrition, 74, 1498-1513. https://doi.org/10.1038/s41430-020-0558-y
[3]
Cashman, K.D. (2020) Vitamin D Deficiency: Defining, Prevalence, Causes, and Strategies of Addressing. Calcified Tissue International, 106, 14-29. https://doi.org/10.1007/s00223-019-00559-4
[4]
Lips, P., Eekhoff, M., Van Schoor, N., Oosterwerff, M., De Jongh, R., Krul-Poel, Y., et al. (2017) Vitamin D and Type 2 Diabetes. The Journal of Steroid Biochemistry and Molecular Biology, 173, 280-285. https://doi.org/10.1016/j.jsbmb.2016.11.021
[5]
Sacerdote, A., Dave, P., Lokshin, V. and Bahtiyar, G. (2019) Type 2 Diabetes Mellitus, Insulin Resistance, and Vitamin D. Current Diabetes Reports, 19, Article No. 101. https://doi.org/10.1007/s11892-019-1201-y
[6]
Abugoukh, T.M., Al Sharaby, A., Elshaikh, A.O., Joda, M., Madni, A., Ahmed, I., et al. (2022) Does Vitamin D Have a Role in Diabetes? Cureus, 14, E30432. https://doi.org/10.7759/cureus.30432
[7]
Barnett, M.J. (2023) Association between Primary Hyperparathyroidism and Secondary Diabetes Mellitus: Findings from a Scoping Review. Cureus, 15, E40743. https://doi.org/10.7759/cureus.40743
[8]
Ljunghall, S., Palmér, M., Akerström, G. and Wide, L. (1983) Diabetes Mellitus, Glucose Tolerance and Insulin Response to Glucose in Patients with Primary Hyperparathyroidism before and after Parathyroidectomy. European Journal of Clinical Investigation, 13, 373-377. https://doi.org/10.1111/j.1365-2362.1983.tb00116.x
[9]
Mogire, R.M., Mutua, A., Kimita, W., Kamau, A., Bejon, P., Pettifor, J.M., et al. (2020) Prevalence of Vitamin D Deficiency in Africa: A Systematic Review and Meta-Analysis. The Lancet Global Health, 8, E134-E142. https://doi.org/10.1016/S2214-109X(19)30457-7
[10]
Goedecke, J.H. and Mendham, A.E. (2022) Pathophysiology of Type 2 Diabetes in Sub-Saharan Africans. Diabetologia, 65, 1967-1980. https://doi.org/10.1007/s00125-022-05795-2
[11]
Santosa, A., Wall, S., Fottrell, E., Högberg, U. and Byass, P. (2014) The Development and Experience of Epidemiological Transition Theory over Four Decades: A Systematic Review. Global Health Action, 7, Article No. 23574. https://doi.org/10.3402/gha.v7.23574
[12]
Karau, P.B., Kirna, B., Amayo, E., Joshi, M., Ngare, S. and Muriira, G. (2019) The Prevalence of Vitamin D Deficiency among Patients with Type 2 Diabetes Seen at a Referral Hospital in Kenya. The Pan African Medical Journal, 34, Article No. 38. https://doi.org/10.11604/pamj.2019.34.38.18936
[13]
Said, J., Lagat, D., Kimaina, A. and Oduor, C. (2021) Beta Cell Function, Insulin Resistance and Vitamin D Status among Type 2 Diabetes Patients in Western Kenya. Scientific Reports, 11, Article No. 4084. https://doi.org/10.1038/s41598-021-83302-0
[14]
He, X., Luo, Y., Hao, J., Wang, C., Gan, K., Zhen, Y., et al. (2022) Association between Serum Vitamin D Levels and Ketosis Episodes in Hospitalized Patients with Newly Diagnosed Ketosis-Prone Type 2 Diabetes. Diabetes, Metabolic Syndrome and Obesity, 15, 3821-3829. https://doi.org/10.2147/DMSO.S389609
[15]
Bihehe, D.M., Bwihangane, A.B., Mbo, J.-P.M., Muhindo, C.T., Hermans, M. and Katchunga, P.B. (2024) Dynamics in the Prevalence of Insulin Resistance between 2005 and 2023 in Type 2 Diabetics in South Kivu in the East of the Democratic Republic of Congo: Cross-Sectional Studies. Journal of Diabetes Mellitus, 14, 28-40. https://doi.org/10.4236/jdm.2024.141004
[16]
Katchunga, P., Masumbuko, B., Belma, M., Kashongwe Munogolo, Z., Hermans, M.P. and M’Buyamba-Kabangu, J.R. (2012) Age and Living in an Urban Environment Are Major Determinants of Diabetes among South Kivu Congolese Adults. Diabetes & Metabolism, 38, 324-331. https://doi.org/10.1016/j.diabet.2012.02.008
[17]
American Diabetes Association (2022) Standards of Medical Care in Diabetes-2022. Diabetes Care, 45, S1-S2. https://doi.org/10.2337/dc22-Sint
[18]
Alberti, K.G., Zimmet, P., Shaw, J. and IDF Epidemiology Task Force Consensus Group (2005) The Metabolic Syndrome: A New Worldwide Definition. The Lancet, 366, 1059-1062. https://doi.org/10.1016/S0140-6736(05)67402-8
[19]
Alberti, G., Eckel, R., Grundy, S., Zimmet, P., Cleeman, J., Donato, K., et al. (2009) Harmonizing the Metabolic Syndrome. A Joint Interim Statement of the I.D.F Task Force on Epidemiology and Prevention, NHL and Blood Institute, AHA, WHF, IAS, and IA For the Study of Obesity. Circulation, 120, 1640-1645. https://doi.org/10.1161/CIRCULATIONAHA.109.192644
[20]
Holick, M.F., Binkley, N.C., Bischoff-Ferrari, H.A., Gordon, C.M., Hanley, D.A., Heaney, R.P., et al. (2011) Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96, 1911-1930. https://doi.org/10.1210/jc.2011-0385
[21]
Hermans, M.P. (2007) Diabetic Macro- and Micro Vascular Disease in Type 2 Diabetes. Diabetes and Vascular Disease Research, 4, S7-S11. https://doi.org/10.3132/dvdr.2007.019
[22]
Safi, S. and Ouleghzal, H. (2015) Serum Vitamin D Status in Moroccan Patients with Type 2 Diabetes Mellitus. Medecine des Maladies Metaboliques, 9, 67-72. https://doi.org/10.1016/S1957-2557(15)30018-3
[23]
Al-Timimi, D.J. and Ali, A.F. (2013) Serum 25(OH) D in Diabetes Mellitus Type 2: Relation to Glycaemic Control. Journal of Clinical and Diagnostic Research, 7, 2686-2688. https://doi.org/10.7860/JCDR/2013/6712.3733
[24]
Lee, J.I., Oh, S.J., Ha, W.C., Kwon, H.S., Sohn, T.S., Son, H.S., et al. (2012) Serum 25-Hydroxyvitamin D Concentration and Arterial Stiffness among Type 2 Diabetes. Diabetes Research and Clinical Practice, 95, 42-47. https://doi.org/10.1016/j.diabres.2011.09.006
[25]
Zoppini, G. and Galletti, A. (2015) Lower Levels of 25-Hydroxyvitamin D3 Are Associated with a Higher Prevalence of Micro Vascular Complications in Patients with Type 2 Diabetes. BMJ Open Diabetes Research & Care, 3, e000058. https://doi.org/10.1136/bmjdrc-2014-000058
[26]
Kos, E., Liszek, M.J., Emanuele, M.A., Durazo-Arvizu, R. and Camacho, P. (2012) Effect of Metformin Therapy on Vitamin D and Vitamin B12 Levels in Patients with Type 2 Diabetes Mellitus. Endocrine Practice, 18, 179-184. https://doi.org/10.4158/EP11009.OR
[27]
Bellan, M., Guzzaloni, G., Rinaldi, M., Merlotti, E., Ferrari, C., Tagliaferri, A., et al. (2014) Altered Glucose Metabolism Rather than Naive Type 2 Diabetes Mellitus (T2DM) Is Related to Vitamin D Status in Severe Obesity. Cardiovascular Diabetology, 13, Article No. 57. https://doi.org/10.1186/1475-2840-13-57
[28]
Mitri, J. and Pittas, A.G. (2014) Vitamin D and Diabetes. Endocrinology and Metabolism Clinics of North America, 43, 205-232. https://doi.org/10.1016/j.ecl.2013.09.010
[29]
Chang, E., Donkin, S.S. and Teegarden, D. (2009) Parathyroid Hormone Suppresses Insulin Signaling in Adipocytes. Molecular and Cellular Endocrinology, 307, 77-82. https://doi.org/10.1016/j.mce.2009.03.024
[30]
Karampela, I., Sakelliou, A., Vallianou, N., Christodoulatos, G.S., Magkos, F. and Dalamaga, M. (2021) Vitamin D and Obesity: Current Evidence and Controversies. Current Obesity Reports, 10, 162-180. https://doi.org/10.1007/s13679-021-00433-1
[31]
Zhou, A. and Hyppönen, E. (2023) Vitamin D Deficiency and C-Reactive Protein: A Bidirectional Mendelian Randomization Study. International Journal of Epidemiology, 52, 260-271. https://doi.org/10.1093/ije/dyac087
[32]
Li, X., Liu, Y., Zheng, Y., Wang, P. and Zhang, Y. (2018) The Effect of Vitamin D Supplementation on Glycemic Control in Type 2 Diabetes Patients: A Systematic Review and Meta-Analysis. Nutrients, 10, Article No. 375. https://doi.org/10.3390/nu10030375
