T-lymphocyte and Glycemic Status After Vitamin D Treatment in Type 1 Diabetes: A Randomized Controlled Trial With Sequential Crossover

Diabetes Metab Res Rev. 2017 Mar;33(3). doi: 10.1002/dmrr.2865. Epub 2016 Dec 6.

Abstract

Background: Type 1 diabetes mellitus (T1D) is mediated by autoaggressive T effector cells with an underlying regulatory T-cell (Treg) defect. Vitamin D deficiency is highly prevalent in T1D, which can aggravate immune dysfunction. High-dose vitamin D treatment may enhance Tregs and improve metabolism in T1D patients.

Methods: In a randomized double-blind placebo-controlled trial with crossover design, patients received either for 3 months cholecalciferol 4000 IU/d followed by 3 months placebo or the sequential alternative. Thirty-nine T1D patients (19 women and 20 men) completed the trial.

Results: Primary outcome was a change of Tregs, secondary HbA1C, and insulin demand. Effects were evaluated based on intra-individual changes between treatment and placebo periods for outcome measures. Exploratory analyses included vitamin D system variant genotyping and C-peptide measurements. Median 25(OH)D3 increased to 38.8 ng/ml with males showing a significantly stronger increase (p = .003). T-lymphocyte profiles did not change significantly (p > 2); however, the intra-individual change of Tregs between males and females was different with a significantly stronger increase in men (p = .017), as well as between genotypes of the vitamin D receptor (Apa, Taq, and Bsm: genotypes aa, TT, and bb; p = .004-0.015). Insulin demands declined significantly (p = .003-.039) and HbA1C improved (p < .001). Random C-peptide levels were low but rising (median, 0.125 ng/ml; range, 0.02-0.3) in 6 patients. No toxicity was observed.

Conclusion: A daily vitamin D dose of 4000 IU for 3 months was well tolerated and enhanced Tregs in males. Glucometabolic control improved in all. Subsequent larger trials need to address ß-cell function and genotyping for individualized vitamin D doses.

Keywords: T regulatory cells; cholecalciferol; glucometabolism; type 1 diabetes; vitamin D; vitamin D genotype.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / analysis
  • Blood Glucose / analysis*
  • Cross-Over Studies
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • Glycated Hemoglobin A / analysis
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • T-Lymphocytes, Regulatory / immunology*
  • Vitamin D / therapeutic use*
  • Vitamin D Deficiency / drug therapy*
  • Vitamin D Deficiency / etiology
  • Vitamins / therapeutic use

Substances

  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Vitamins
  • hemoglobin A1c protein, human
  • Vitamin D