Prevalence and Factors Related to Hypovitaminosis D in Type 2 Diabetes Mellitus Patients with Depression

Rudi Putranto, Siti Setiati, Martina W Nasrun, Fiastuti Witjaksono, Suzanna Immanuel, Imam Subekti, Kuntjoro Harimurti, Agus Siswanto, Hamzah Shatri, Suhendro Suwarto

Abstract


Background: The prevalence of hypovitaminosis D (hypoD) in patients with type 2 diabetes mellitus (T2DM) and depression has not been documented. In addition, the risk factors are unknown. This study aimed to identify the prevalence of and risk factors for hypoD in patients with T2DM who also have depression. Methods: 118 patients with T2DM who visited the outpatient endocrinology clinics at Cipto Mangunkusumo National Hospital between December 2019-September 2022 provided the clinical and demographic data for this cross- sectional study, including body mass index, blood pressure, glycosylated haemoglobin (HbA1c), lipid profiles, therapy, gender, age, marital status, and educational background. We used The Beck Depression Inventory II (BDI II) to evaluate depression. We used enzyme-linked immunosorbent assay kit to assess the dependent variable: serum vitamin D. We characterized serum vitamin D levels into three groups (normal, 30 ng/mL; insufficient, 20-29 ng/mL; deficient, 20 ng/mL). We also used analyses of variance to examine the anthropometric, clinical, and biochemical factors between the three groups. Results: 118 subjects with T2DM. Their median age was 56 years old (48, 75-60 years old), with a BDI II score of 17 (15-19), and a serum concentration of vitamin D. The D level was 18.3 ng/mL (9.17–29.46 ng/mL). Only 21.8% of patients with T2DM and depression had sufficient levels of vitamin D. We used multivariable analysis of variance model to examine the associations between age, BDI II score, HbA1c, and systolic and diastolic blood pressure with vitamin D level. Age and BDI II score both had a statistically significant effect on vitamin D levels. Conclusion: This cross-sectional study discovered that patients with T2DM and depression had a high prevalence (77.7%) of hypoD. Age and BDI II score both affected differences in vitamin D levels with statistical significance.


Keywords


hypovitaminosis; type 2 diabetes mellitus; depression

References


Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014;144 Pt A:138–45.

DeLuca G, Kimball S, Kolasinski J, Ramagopalan S, Ebers G. the role of vitamin D in nervous system health and disease. Neuropathology and Applied Neurobiology. 2013;39(5):458–84.

Hoang MT, Defina LF, Willis BL, Leonard DS, Weiner MF, Brown ES. Association between low serum 25-hydroxyvitamin D and depression in a large sample of healthy adults: the Cooper Center longitudinal study. Mayo Clin Proc. 2011;86(11):1050–5.

Armstrong DJ, Meenagh GK, Bickle I, Lee ASH, Curran ES, Finch MB. Vitamin D deficiency is associated with anxiety and depression in fibromyalgia. Clin Rheumatol. 2007;26(4):551–4.

Hoogendijk WJG, Lips P, Dik MG, Deeg DJH, Beekman ATF, Penninx BWJH. Depression is associated with decreased 25-hydroxyvitamin D and increased parathyroid hormone levels in older adults. Arch Gen Psychiatry. 2008;65(5):508–12.

Patrick RP, Ames BN. Vitamin D and the omega-3 fatty acids control serotonin synthesis and action, part 2: relevance for ADHD, bipolar disorder, schizophrenia, and impulsive behavior. FASEB J. 2015;29(6):2207–22.

Pittampalli S, Mekala HM, Upadhyayula S, Lippmann S. Does vitamin D deficiency cause depression? Prim Care Companion CNS Disord. 2018;20(5):17l02263.

Mezza T, Muscogiuri G, Sorice GP, et al. Vitamin D deficiency: A new risk factor for type 2 diabetes. Annals of Nutrition and Metabolism. 2012;61(4):337–48.

Fondjo LA, Sakyi SA, Owiredu WK, et al. Evaluating vitamin D status in pre-and postmenopausal type 2 diabetics and its association with glucose homeostasis. BioMed research international. 2018;2018.

Gao Y, Zheng T, Ran X, et al. Vitamin D and incidence of prediabetes or type 2 diabetes: a four-year follow-up community-based study. Disease Markers. 2018;2018.

Lips P, Eekhoff M, van Schoor N, et al. Vitamin D and type 2 diabetes. J Steroid Biochem Mol Biol. 2017;173:280–5.

Nouwen A, Adriaanse MC, van Dam K, et al. Longitudinal associations between depression and diabetes complications: a systematic review and meta-analysis. Diabetic Medicine. 2019;36(12):1562–72.

Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. The Journal of Clinical Endocrinology & Metabolism. 2007;92(6):2017–29.

Menon V, Kar SK, Suthar N, Nebhinani N. Vitamin D and depression: a critical appraisal of the evidence and future directions. Indian Journal of Psychological Medicine. 2020;42:11–21.

Penckofer S, Kouba J, Byrn M, Estwing Ferrans C. Vitamin D and depression: where is all the sunshine? Issues Ment Health Nurs. 2010;31(6):385–93.

Rafiq S, Jeppesen PB. Is hypovitaminosis D related to incidence of type 2 diabetes and high fasting glucose level in healthy subjects: A systematic review and meta- analysis of observational studies. Nutrients. 2018;10(1).

Heath AK, Williamson EJ, Hodge AM, et al. Vitamin D status and the risk of type 2 diabetes: The Melbourne Collaborative Cohort Study. Diabetes Research and Clinical Practice. 2019;149:179–87.

Standards of Medical Care in Diabetes-2022. A bridged for primary care providers. Clin Diabetes. 2022;40(1):10–38.

Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BMJ. 2010;340.

Upton J. Beck depression inventory (BDI). Encyclopedia of behavioral medicine. 2020;202–3.

AlQuaiz AM, Kazi A, Fouda M, Alyousefi N. Age and gender differences in the prevalence and correlates of vitamin D deficiency. Archives of Osteoporosis. 2018;13(1):49.

Yildiz Z, Hürmeydan Ö, Madenci ÖÇ, Orçun A, Yücel N. Age, gender and season dependent 25(OH)D levels in children and adults living in Istanbul. Turkish Journal of Biochemistry. 2020;45(5):533–41.

Yu HJ, Kwon MJ, Woo HY, Park H. Analysis of 25-hydroxyvitamin D status according to age, gender, and seasonal variation. J Clin Lab Anal. 2016;30(6):905–11.

Thurayya Albolushi, Manal Bouhaimed, Thurayya Albolushi, Manal Bouhaimed, Jeremey Spencer. Lower blood vitamin D levels are associated with depressive symptoms in a population of older adults in Kuwait: A cross-sectional study. Nutrients. 2022;14:1548.

khan B, Shafiq H, Abbas S, et al. Vitamin D status and its correlation to depression. Annals of General Psychiatry. 2022;21(1):32.

Yao Y, Fu S, Zhang H, et al. The prevalence of depressive symptoms in Chinese longevous persons and its correlation with vitamin D status. BMC Geriatrics. 2018;18(1):198.

Lee DM, Vanderschueren D, Boonen S, et al. Association of 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D and parathyroid hormone with mortality among middle-aged and older European men. Age and ageing. 2014;43(4):528–35.

Zhao H , Zhen Y, Wang Z, Qi L, Li Y, Ren L, Chen S. The relationship between vitamin d deficiency and glycated hemoglobin levels in patients with type 2 diabetes mellitus. Diabetes Metabolic Syndrome Obesity. 2020;13.

Buhary BM, Almohareb O, Aljohani N, et al. Association of glycosylated hemoglobin levels with vitamin D status. J Clin Med Res. 2017;9(12):1013–8.

Mehta V, Agarwal S. Does vitamin D deficiency lead to hypertension? Cureus. 2017;9(2):e1038.

Vaidya A, Forman JP. Vitamin D and hypertension. Hypertension. 2010;56(5):774–9.

He S, Hao X. The effect of vitamin D3 on blood pressure in people with vitamin D deficiency: A system review and meta-analysis. Medicine. 2019;98:e15284.

Zhang D, Cheng C, Wang Y, et al. Effect of vitamin D on blood pressure and hypertension in the general population: An update meta-analysis of cohort studies and randomized controlled trials. Prev Chronic Dis. 2020;17:E03.

Wang Y, Si S, Liu J, et al. The associations of serum lipids with vitamin D status. PLoS One. 2016;11(10):e0165157.

Jaydip Ray Chaudhuri, K Rukmini Mridula, Alluri Anamika, et al. Deficiency of 25- hydroxyvitamin D and dyslipidemia in Indian subjects. Journal of Lipids. 2013 Dec 18.

Anantharamakrishnan B, Benansia J. Association between vitamin D level and serum lipid parameters among indian adults working in it sector: a retrospective observational study. medRxiv [Internet]. 2020; Available from: https://www.medrxiv.org/content/early/2020/10/21/2020.10.20.20215624

de Oliveira C, Hirani V, Biddulph JP. Associations between vitamin D levels and depressive symptoms in later life: evidence from the English Longitudinal Study of Ageing (ELSA). The Journals of Gerontology: Series A. 2018;73(10):1377–82.

Ismail M, Seif MH, Metwally N, et al. Prevalence and determinants of depression among patients with Type 2 diabetes mellitus attending family medicine clinics in Qatar. American Journal of Medicine Open. 2022;100014.

Putranto R, Harimurti K, Setiati S, et al. The effect of vitamin D supplementation on symptoms of depression in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials. Acta Med Indones. 2022;54(4):574–84.

Pittas AG, Kawahara T, Jorde R, et al. Vitamin D and risk for type 2 diabetes in people with prediabetes: a systematic review and meta-analysis of individual participant data from 3 randomized clinical trials. Annals of Internal Medicine. 2023;176(3):355–63.


Full Text: PDF

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.