维生素D治疗对糖尿病前期糖脂代谢及胰岛β细胞功能的影响

Effect of vitamin D treatment on glucose and lipid metabolism and islet function in prediabetic patients

目的 探讨维生素D治疗对糖尿病前期的糖脂代谢及胰岛β细胞功能的影响。方法 选取2019年12月至2020年12月在山东第一医科大学第二附属医院内分泌科就诊的糖尿病前期患者172例,在治疗前随机将患者分为试验组88例和对照组84例。两组均使用二甲双胍缓释片治疗,试验组在此基础上联合胆维丁乳(内含维生素D330万单位)治疗,疗程12个月。比较两组患者治疗前和治疗后血糖、血脂、糖化血红蛋白、胰岛素抵抗指数、胰岛β细胞功能指数(HOMA-β)、血清25羟维生素D[25(OH)D]等。结果 基线水平时试验组和对照组间各项指标比较,差异无统计学意义(P> 0.05),两组患者血清25(OH)D均低于正常值(30 ng/mL)。治疗12个月后,试验组血清25(OH)D达(31.39±1.50)ng/mL,对照组为(24.14±1.16)ng/mL,试验组明显高于对照组,差异有统计学意义(P <0.05),试验组有80人(91%)25(OH)D达到充足状态(> 30 ng/ml)。胆维丁乳治疗后试验组空腹血糖(fasting blood glucose,FPG)、2 h餐后血糖(postprandial blood sugar,PPG)降低,差异有统计学意义(P <0.05),HOMA-β和胰岛素抵抗指数(HOMA-IR)虽有改善,但差异无统计学意义(P> 0.05)。结论 补充一定剂量的维生素D制剂能改善糖尿病前期患者糖代谢状态,但对改善机体的胰岛素抵抗及胰岛β细胞功能不明显。

Objective:To investigate the effects of vitamin D treatment on glucose,lipid metabolism and β-cell function in prediabetic patients.Methods:From 2019 to 2020,We enrolled prediabetes who came from the Department of Endocrinology of the Second Affiliated Hospital of Shandong First Medical University.Before treatment,the patients were randomly divided into treatment group(n=88)and control group(n=84).The treatment group was orally given vitamin D3and the control group was orally given the same appearance of placebo capsule.At baseline and after intervention for 12 months,the fasting plasma glucose(FPG),2 hour postprandial plasma glucose(2h PPG),triglycerides(TG),total cholesterol(TC),glycosylated hemoglobin(Hb-A1c),fasting insulin(FINS),homeostasis model assessment insulin resistance(HO-MA-IR),βcell function index(HOMA-β),serum 25(OH)D and so on.Results:At baseline,there was no significant difference between the experimental group and the control group(P > 0.05).The serum 25(OH)D of the experimental group and control group in baseline were both below normal level(30 ng/ml).After 12 months of treatment,the serum 25(OH)D of the experimental group was31.391.50ng/ml,while that of the control group was 24.141.16 ng/ml.The serum 25(OH)D of the experimental group was significantly higher than that of the control group,and the difference was statistically significant(P < 0.05),There were 80people in the experimental group(about 91% of the experimental group)who had achieved a status of serum vitamin D adequate(> 30 ng/ml).FPG2h PPG decreased after treatment,with significant difference(P < 0.05),but no differences were observed in HOMA-βand HOMA-IR(P > 0.05).Conclusion:Supplementation of vitamin D can improve glucose in prediabetic patients,but has no significant effect on insulin resistance and islet β-cell function.