张菊年,江 彤

维生素D是一种脂溶性维生素，其主要作用是调节钙磷代谢，促进肠道内钙磷的吸收，除了在骨骼健康和免疫调节中的作用外，近年来，维生素D在2型糖尿病发病中的作用引起了广泛关注。研究表明，维生素D缺乏与2型糖尿病患病率显著相关，低水平维生素D的人群中2型糖尿病的患病率明显增加，补充维生素D可以降低2型糖尿病发病率、改善胰岛素抵抗，并有助于减少糖尿病并发症的发生，然其机制尚未完全明确。本文将从维生素D代谢、2型糖尿病的发病机制、补充维生素D对2型糖尿病的获益效果等方面阐述维生素D与2型糖尿病关系的研究进展，以期为2型糖尿病的早期治疗及预防提供参考，并提出相应的干预策略。

2型糖尿病；维生素D；胰岛素抵抗；血糖控制

[1] 中华医学会糖尿病学分会;.中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021(04). [2] Wang L,Gao P,Zhang M,Huang Z,Zhang D,Deng Q,et al.Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013. Jama(2017)317:2515–23. [3] Petersmann A,Müller-Wieland D,Müller UA,Landgraf R,Nauck M,Freckmann G,Heinemann L,Schleicher E.Definition,Classification and Diagnosis of Diabetes Mellitus.Exp Clin Endocrinol Diabetes.2019 Dec;127(S 01):S1-S7. [4] 董晓颖,尹经霞,余丽,蒲丹岚,廖涌.美国糖尿病协会2024版糖尿病诊疗标准更新要点解读[J].现代医药卫生,2024,40(04):541-547. [5] Darenskaya MA,Kolesnikova LI,Kolesnikov SI.Oxidative Stress:Pathogenetic Role in Diabetes Mellitus and Its omplications and Therapeutic Approaches to Correction.Bull Exp Biol Med.2021 May;171(2):179-189. [6] 苏淑娇,李小凤.维生素D与2型糖尿病[J].中国临床研究,2022,35(07):948-951. [7] 中华医学会糖尿病学分会;.中国2型糖尿病防治指南(2020年版)[J].中华糖尿病杂志,2021(04). [8] Alonso N,Zelzer S,Eibinger G,Herrmann M.Vitamin D Metabolites:Analytical Challenges and Clinical Relevance.Calcif Tissue Int.2023 Feb;112(2):158-177. [9] Bikle D.D.Vitamin D and the Skin:Physiology and Pathophysiology.Rev.Endocr.Metab.Disord.2012;13:3–19. [10] Pop TL,Sîrbe C,Benţa G,Mititelu A,Grama A.The Role of Vitamin D and Vitamin D Binding Protein in Chronic Liver Diseases.Int J Mol Sci.2022 Sep 14;23(18):10705. [11] Bikle DD.Extra renal synthesis of 1,25-dihydroxyvitaminDand its health implications.Clin Rev Bone Miner Metab,7:114–125,2009. [12] Chun RF,Peercy BE,Orwoll ES,Nielson CM,Adams JS,Hewison M.VitaminDand DBP:the free hormone hypothesis revisited.J Steroid Biochem Mol Biol 144:132–137,2014. [13] [Alzohily B,AlMenhali A,Gariballa S,Munawar N,Yasin J,Shah I.Unraveling the complex interplay between obesity and vitamin D metabolism.Sci Rep.2024 Mar 30;14(1):7583. [14] Bikle D.,Christakos S.New Aspects of Vitamin D Metabolism and Action—Addressing the Skin as Source and Target.Nat. Rev.Endocrinol. [15] Ho lick MF,Binkley NC,Bischoff-Ferrari HA,Gordon CM,Hanley DA,Heaney RP,et al.Evaluation,Treatment,and Prevention of Vitamin D Deficiency:An Endocrine Society Clinical Practice Guideline.J Clin Endocrinol Metab(2011)96:1911–30. [16] Khundmiri S.J.,Murray R.D.,Lederer E.PTH and Vitamin D.Compr.Physiol.2016;6:561–601. [17] [Martin A.,David V.,Quarles L.D.Regulation and function of the FGF23/klotho endocrine pathways.Physiol.Rev.2012;92:131–155. [18] Muoio D.M.,Newgard C.B.Mechanisms of Disease:Molecular and Metabolic Mechanisms of Insulin Resistance and Beta-Cell Failure in Type 2 Diabetes.Nat.Rev.Mol.Cell Biol.2008;9:193–205. [19] Samuel V.T.,Shulman G.I.Mechanisms for insulin resistance:Common threads and missing links.Cell. [20] Park S.,Kim D.S.,Kang S.Vitamin D Deficiency Impairs Glucose-Stimulated Insulin Secretion and Increases Insulin Resistance by Reducing PPAR-γExpression in Nonobese Type 2 Diabetic Rats.J.Nutr.Biochem.2016;27:257–265. [21] Al Shoumer,K.;Al-Essa,T.Is There a Relationship between Vitamin D with Insulin Resistance and Diabetes Mellitus?World J.Diabetes 2015,6,1057. [22] Cojic M,Kocic R,Klisic A,Kocic G.The Effects of Vitamin D Supplementation on Metabolic and Oxidative Stress Markers in Patients With Type 2 Diabetes:A 6-Month Follow Up Randomized Controlled Study.Front Endocrinol(Lausanne).2021 Aug 19;12:610893. [23] Harrison SR,Li D,Jeffery LE,Raza K,Hewison M.Vitamin D,Autoimmune Disease and Rheumatoid Arthritis.Calcif Tissue Int.2020 Jan;106(1):58-75. [24] Saponaro F,Saba A,Zucchi R.An Update on Vitamin D Metabolism.Int J Mol Sci.2020 Sep 8;21(18):6573. [25] Klahold,E.;Penna-Martinez,M.;Bruns,F.;Seidl,C.;Wicker,S.;Badenhoop,K.Vitamin D in Type 2 Diabetes:Genetic Susceptibility and the Response to Supplementation.Horm.Metab.Res.2020,52,492–499. [26] Wenclewska S.,Szymczak-Pajor I.,Drzewoski J.,Bunk M.,Śliwińska A.Vitamin D Supplementation Reduces Both Oxidative DNA Damage and Insulin Resistance in the Elderly with Metabolic Disorders.Int.J.Mol.Sci.2019;20:2891. [27] Rafiq S,Jeppesen PB.Insulin Resistance Is Inversely Associated with the Status of Vitamin D in Both Diabetic and Non-Diabetic Populations.Nutrients.2021 May 21;13(6):1742. [28] Xu Z,Gong R,Luo G,Wang M,Li D,Chen Y,Shen X,Wei X,Feng N,Wang S.Association between vitamin D3 levels and insulin resistance:a large sample cross-sectional study.Sci Rep.2022 Jan 7;12(1):119. [29] Krul-Poel YH,Ter Wee MM,Lips P,et al.MANAGEMENT OF ENDOCRINE DISEASE:The effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus:a systematic review and meta-analysis[J].Eur J Endocrinol,2017,176(1):R1-R14. [30] Bouillon R,Manousaki D,Rosen C,Trajanoska K,Rivadeneira F,Richards JB.The health effects of vitamin D supplementation:evidence from human studies.Nat Rev Endocrinol.2022 Feb;18(2):96-110. [31] Zhang Y,Tan H,Tang J,et al.Effects of vitamin D supplementation on prevention of type 2 diabetes in patients with prediabetes:A systematic review and meta-analysis.Diabetes Care.2020;43(7):1650–1658. [32] Niroomand M,Fotouhi A,Irannejad N,et al.Does high-dose vitamin D supplementation impact insulin resistance and risk of development of diabetes in patients with pre-diabetes?A double-blind randomized clinical trial.Diabetes Res.Clin.Pract.2019;148:1–9. [33] Song Y,Wang L,Pittas AG,Del Gobbo LC,Zhang C,Manson JE,et al.Blood 25-hydroxy vitamin D levels and incident type 2 diabetes:a meta-analysis of prospective studies.Diabetes Care.(2013)36:1422–8.10.2337/dc12-0962. [34]El Hajj,C.;Chardigny,J.-M.;Boirie,Y.;Yammine,K.;Helou,M.;Walrand,S.Effect of Vitamin D Treatment on Glucose Homeostasis and Metabolism in Lebanese Older Adults:A Randomized Controlled Trial.J.Nutr.Health Aging2018,22,1128–1132. [35] Szymczak-Pajor I,Drzewoski J,Śliwińska A.The Molecular Mechanisms by Which Vitamin D Prevents Insulin Resistance and Associated Disorders.Int J Mol Sci.2020 Sep 11;21(18):6644. [36] Pittas AG,Harris SS,Stark PC,Dawson-Hughes B.The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults.Diabetes Care.2007;30:980–986. [37] Md Isa Z,Amsah N,Ahmad N.The Impact of Vitamin D Deficiency and Insufficiency on the Outcome of Type 2 Diabetes Mellitus Patients:A Systematic Review.Nutrients.2023 May 15;15(10):2310. [38] Ehrampoush E,Mirzay Razzaz J,Arjmand H,Ghaemi A,Raeisi Shahraki H,Ebrahim Babaei A,Osati S,Homayounfar R.The association of vitamin D levels and insulin resistance.Clin Nutr ESPEN.2021 Apr;42:325-332. [39] Jain SK,Micinski D,Huning L,et al.Vitamin D and L-cysteine levels correlate positively with GSH and negatively with insulin resistance levels in the blood of type 2 diabetic patients.Eur.J.Clin.Nutr.2014;68(10):1148–1153. [40] Chen X,Chu C,Doebis C,et al.Sex-dependent association of vitamin D with insulin resistance in humans.J.Clin.Endocrinol. Metab. 2021;106(9):e3739–e3747.

点击下载PDF