Protective effects of 1-α-hydroxyvitamin D3 on residual β-cell function in patients with adult-onset latent autoimmune diabetes (LADA)
Protective effects of 1-α-hydroxyvitamin D3 on residual β-cell function in patients with adult-onset latent autoimmune diabetes (LADA)
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DOI：
10.1002/dmrr.977
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发表时间：
2009-07-01
影响因子：
8
通讯作者：
Zhou, Zhiguang
中科院分区：
文献类型：
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作者：
Li, Xia;Liao, Lan;Zhou, Zhiguang
背景以往的体外和体内研究表明，维生素D可以防止胰腺β细胞的破坏，降低自身免疫性糖尿病的发病率。在患有1型糖尿病的儿童中，维生素D治疗对残余β细胞功能产生中度保护作用，并且已被证明是安全的。因此，我们假设维生素D可能对成人隐匿性自身免疫性糖尿病（LADA）患者的β细胞功能具有保护作用，LADA是一种缓慢进展的自身免疫性1型糖尿病。方法35例LADA患者随机分为单独皮下胰岛素组（n = 18）和胰岛素加1-α-羟基维生素D3组（n = 18）（1-α（OH）D3; 0.5 μ g/天）（n = 17）1年。结果在12个月的干预过程中，胰岛素+1-α（OH）D3组空腹和75 g葡萄糖负荷后2 h血浆G肽水平保持稳定，而单纯胰岛素组空腹和75 g葡萄糖负荷后2 h血浆G肽水平下降（P = 0.006）。70%的1-α（OH）D3治疗患者在治疗1年后维持或增加了FCP浓度，而仅用胰岛素治疗的患者仅22%维持稳定的FCP水平（P < 0.01）。对糖尿病病程不同的LADA亚组的进一步分析表明，仅在糖尿病病程不超过1年的患者中，1-α（OH）D3加胰岛素组的胰岛β细胞功能得到了更好的保护（如FCP和PCP水平显著较高所反映的）。结论1-α（OH）D3联合胰岛素治疗LADA患者可保护胰岛β细胞功能。版权所有（c）2009约翰威利父子有限公司。
Background Previous in vitro and in vivo studies have demonstrated that vitamin D could prevent pancreatic beta-cell destruction and reduce the incidence of autoimmune diabetes. In children with type 1 diabetes, vitamin D treatment produces moderate protective effects on residual beta-cell function and has proven to be safe. Therefore, we hypothesized that vitamin D might have protective effects on beta-cell function in patients with latent autoimmune diabetes in adults (LADA), a form of slowly progressive autoimmune type 1 diabetes.Methods Thirty-five patients with LADA were randomly assigned to receive subcutaneous insulin alone (n = 18) or insulin plus 1-alpha-hydroxyvitamin D3 (1-alpha(OH)D3; 0.5 mu g per day) (n = 17) for 1 year. Plasma G-peptide levels in fasting state (FCP) and 2 h after 75-g glucose load (PCP) were measured every 6 months with radioimmunoassay.Results Both FCP and PCP levels stayed steady in the insulin plus 1-alpha(OH)D3 group, while FCP decreased in insulin-alone group (P = 0.006) during the 12-month intervention. Seventy percent of patients treated with 1-alpha(OH)D3 maintained or increased their FCP concentrations after 1 year of treatment, while only 22% of patients treated with insulin alone maintained stable FCP levels (P < 0.01). Further analysis on LADA subgroups with different durations of diabetes demonstrated that islet beta-cell function was better preserved (as reflected by significantly higher FCP and PCP levels) in the 1-alpha(OH)D3 plus insulin group only in patients with diabetes duration no longer than 1 year. No severe side effects were observed in any group.Conclusion Our data suggest that 1-alpha(OH)D3 plus insulin therapy can preserve pancreatic beta-cell function in patients with LADA. Copyright (c) 2009 John Wiley & Sons, Ltd.