The Impact of Vitamin D Status on Glycemic Control in Saudi Children and Adolescents with Type 1 Diabetes Mellitus

Abstract

Objectives

This study aims to assess the 25-hydroxyvitamin D (25-OH VitD) status in children and adolescents with type 1 diabetes mellitus and to identify the correlation between 25-OH VitD levels and glycosylated hemoglobin (HbA1c) levels.

Methods

A cross-sectional study was conducted in the King Abdulaziz Medical City, Jeddah, Saudi Arabia. The study included 146 eligible patients. Serum 25-OH VitD < 50 nmol/L indicated below normal vitamin D level.

Results

All participants were Saudis, 63.0% were children, and 37.0% were adolescents (52.7% were male and 47.3% were female). The mean of HbA1c levels was 9.85 ± 1.79% and 25-OH VitD levels was 35.54 ± 13.88 nmol/L. The prevalence of 25-OH VitD inadequacy was 84.2%, with a mean 25-OH VitD levels of 31.22 ± 9.82 nmol/L. There was no significant correlation between 25-OH VitD levels and HbA1c levels (p = 0.14). On the other hand, the correlation was significantly negative between 25-OH VitD levels and daily insulin dose (p < 0.001), diabetes duration (p < 0.001), age (p < 0.001), and body mass index (p = 0.001), while it was significantly positive with dairy products intake per mL per day (p < 0.001). Furthermore, multiple regression analysis demonstrated that age, daily insulin dose, and gender were the factors that were associated adversely and significantly with 25-OH VitD levels (p = 0.001, p = 0.008, p = 0.002), respectively.

Conclusion

Although vitamin D levels did not correlate significantly with HbA1c levels in this study, the findings of a significant inverse correlation of vitamin D levels with insulin requirements, in addition to a high prevalence of vitamin D levels inadequacy in children and adolescents with T1DM, indicate the importance of maintaining adequate vitamin D levels in this population.

Keywords

type 1 diabetes - vitamin D status - HbA1c - correlation - glycemic control - children - adolescents

Authors' Contributions

N.A. contributed to the study design, data collection, data analysis, and manuscript writing and submission. M.E. and N.F. contributed to the study design revision, data collection, and data review. N.K. and A.B. contributed to the data review and the manuscript drafting. N.E. contributed to data analysis and manuscript drafting. A.H. and D.A. contributed to the questionnaire design and the literature searches. All authors reviewed and approved the manuscript.

Compliance with Ethical Principles

The study proposal was approved (IRB# C/098/11) by the International Medical Research Centre board, Jeddah, Saudi Arabia. A written informed content was optioned from all participant's guardians.

Publikationsverlauf

Artikel online veröffentlicht:
23. Mai 2025

• References

• 1 Nakashima A, Yokoyama K, Yokoo T, Urashima M. Role of vitamin D in diabetes mellitus and chronic kidney disease. World J Diabetes 2016; 7 (05) 89-100
• 2 de Boer IH, Sachs MC, Cleary PA. et al; Diabetes Control and Complication Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group. Circulating vitamin D metabolites and kidney disease in type 1 diabetes. J Clin Endocrinol Metab 2012; 97 (12) 4780-4788
• 3 Aljabri KS, Bokhari SA, Alqurashi KA, Vitamin D. Status in Saudi patients with type 1 diabetes mellitus. OJEMD 2013; 3 (02) 137-143
• 4 Sambas OZ, Makeen AZ, Yamani AS, Alghamdi AA, Makeen RZ. Prevalence of vitamin D deficiency in type 1DM a control cross sectional study held in middle and west regions of Saudi Arabia. Int J Adv Res (Indore) 2017; 5 (02) 1321-1325
• 5 Bin-Abbas BS, Jabari MA, Issa SD, Al-Fares AH, Al-Muhsen S. Vitamin D levels in Saudi children with type 1 diabetes. Saudi Med J 2011; 32 (06) 589-592
• 6 Rasoul MA, Al-Mahdi M, Al-Kandari H, Dhaunsi GS, Haider MZ. Low serum vitamin-D status is associated with high prevalence and early onset of type-1 diabetes mellitus in Kuwaiti children. BMC Pediatr 2016; 16 (95) 95
• 7 Franchi B, Piazza M, Sandri M, Mazzei F, Maffeis C, Boner AL. Vitamin D at the onset of type 1 diabetes in Italian children. Eur J Pediatr 2014; 173 (04) 477-482
• 8 Al Sawah S, Compher CW, Hanlon AL, Lipman TH. 25-Hydroxyvitamin D and glycemic control: a cross-sectional study of children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2016; 115: 54-59
• 9 Azab SF, Saleh SH, Elsaeed WF, Abdelsalam SM, Ali AA, Esh AM. Vitamin D status in diabetic Egyptian children and adolescents: a case-control study. Ital J Pediatr 2013; 39: 73
• 10 Williams K, Thomson D, Seto I. et al; StaR Child Health Group. Standard 6: age groups for pediatric trials. Pediatrics 2012; 129 (3, Suppl 3): S153-S160
• 11 CDC. . US: 2000 Growth Charts for the United States: Methods and Development; Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2002 . Accessed April 2018 at: https://www.cdc.gov/nchs/data/series/sr_11/sr11_246.pdf
• 12 CDC. . US: Body Mass Index: Considerations for Practitioners. Department of Health and Human Services, Centers for Disease Control and Prevention. Accessed March 2017 at: https://www.cdc.gov/obesity/downloads/bmiforpactitioners.pdf
• 13 Chamberlain JJ, Rhinehart AS, Shaefer Jr CF, Neuman A. Diagnosis and management of diabetes: synopsis of the 2016 American Diabetes Association standards of medical care in diabetes. Ann Intern Med 2016; 164 (08) 542-552
• 14 LeBlanc E, Chou R, Zakher B, Daeges M, Pappas M. . Evidence synthesis No. 119. Screening for vitamin D deficiency: Systematic review for the U.S. preventive services task force recommendation. 2014 . Accessed March 2018 at: https://pubmed.ncbi.nlm.nih.gov/25521000/
• 15 American Association of Clinical Endocrinologists. Vitamin D deficiency. Accessed December 2019 at: https://www.aace.com/sites/default/files/2019-02/Vitamin_D_eficiency_formatted.pdf
• 16 Al-Ghamdi AH, Fureeh AA, Alghamdi JA. et al. High prevalence of vitamin D deficiency among Saudi children and adolescents with type 1 diabetes in Albaha region, Saudi Arabia. IOSR-JPBS 2017; 12 (01) 05-10
• 17 Thnc O, Cetinkaya S, Kizilgün M, Aycan Z. Vitamin D status and insulin requirements in children and adolescent with type 1 diabetes. J Pediatr Endocrinol Metab 2011; 24 (11-12): 1037-1041
• 18 Bae KN, Nam H, Rhie YJ, Song DJ, Lee KH. Low levels of 25-hydroxyvitamin D in children and adolescents with T1DM: a single center experience. Ann Pediatr Endocrinol Metab 2018; 23: 21-27
• 19 Talaat IM, Nasr A, Alsulaimani AA. et al. Association between type 1, type 2 cytokines, diabetic autoantibodies and 25-hydroxyvitamin D in children with type 1 diabetes. J Endocrinol Invest 2016; 39 (12) 1425-1434
• 20 Mutlu A, Mutlu GY, Özsu E, Çizmecioğlu FM, Hatun Ş. Vitamin D deficiency in children and adolescents with type 1 diabetes. J Clin Res Pediatr Endocrinol 2011; 3 (04) 179-183
• 21 Lu L, Yu Z, Pan A. et al. Plasma 25-hydroxyvitamin D concentration and metabolic syndrome among middle-aged and elderly Chinese individuals. Diabetes Care 2009; 32 (07) 1278-1283
• 22 Sharifi F, Mousavinasab N, Mellati AA. Defining a cutoff point for vitamin D deficiency based on insulin resistance in children. Diabetes Metab Syndr 2013; 7 (04) 210-213
• 23 Kelishadi R, Salek S, Salek M, Hashemipour M, Movahedian M. Effects of vitamin D supplementation on insulin resistance and cardiometabolic risk factors in children with metabolic syndrome: a triple-masked controlled trial. J Pediatr (Rio J) 2014; 90 (01) 28-34
• 24 Al-Agha AE, Ahmad IA. Association among vitamin D deficiency, type 1 diabetes mellituis and glycemic control. J Diabetes Metab 2015; 6 (09) 2155-6156
• 25 Kaddam IM, Al-Shaikh AM, Abaalkhail BA. et al. Prevalence of vitamin D deficiency and its associated factors in three regions of Saudi Arabia. Saudi Med J 2017; 38 (04) 381-390
• 26 Mansour MM, Alhadidi KM. Vitamin D deficiency in children living in Jeddah, Saudi Arabia. Indian J Endocrinol Metab 2012; 16 (02) 263-269
• 27 Al-Daghri NM, Al-Saleh Y, Khan N. et al. Sun exposure, skin color and vitamin D status in Arab children and adults. J Steroid Biochem Mol Biol 2016; 164: 235-238
• 28 Valtueña J, González-Gross M, Huybrechts I. et al. Factors associated with vitamin D deficiency in European adolescents: the HELENA study. J Nutr Sci Vitaminol (Tokyo) 2013; 59 (03) 161-171
• 29 Al-Othman A, Al-Musharaf S, Al-Daghri NM. et al. Effect of physical activity and sun exposure on vitamin D status of Saudi children and adolescents. BMC Pediatr 2012; 12: 92
• 30 USDA. US: 2015–2020 Dietary Guidelines for Americans. 8th ed. Dietary Guidelines.gov. [Accessed February 2017 at: https://health.gov/dietaryguidelines/2015/guidelines/