• The Association of Vitamin D Supplementation with Type I Diabetes in New Born and Pregnant Mothers: A systematic Review

      Slack, Marion; Herrier, Richard; Sarmadnia, Newsha; Slack, Marion; Herrier, Richard; College of Pharmacy, The University of Arizona (The University of Arizona., 2013)
      Specific Aims: To assess whether vitamin D supplementation is associated with a reduced risk of type I diabetes in infants. Methods: This study was a systematic review using Pubmed, Google Scholar and reference lists of retrieved articles. Only randomized controlled trials and prospective observational studies were considered for this study. Data were extracted and organized into tables. The data were organized into three categories; study characteristics, patient characterisitics and study outcomes. The main outcomes were association of type I diabetes with vitamin D deficiency and identify the proper dose of vitamin D in pediatric population. Main Results: A total of 3 randomized controlled trials and 2 prospective observational studies were found that met the inclusion criteria; retrospective studies and case control studies were excluded. Combining all studies, no association was seen between vitamin D supplement and control group. Most of the randomized control studies have not shown a statistically significant association between Hb A1C, C-Peptide and vitamin D level with type I diabetes. The Gabbay et al. study showed that vitamin D serum concentrations (25(OH)D3) in the cholecalciferol and placebo groups were not significant at 6 ( P= 0.93),12( P= 0.81), and 18 (P= 0.53) months of follow up. The vitamin D concentration was increased during the 6 months period compared to baseline value (Basal: 26.34ng/ml vs 6 months: 60.88 ng/mL; P <001). Also, Bizzarri et al. study showed that at 6, 12, and 24 months the A1C and insulin usage in both calcitrol and placebo groups were not different. On the other hand, the observational study by Vojtková et al. showed that two thirds of children with type I diabetes had insufficient vitamin D concentration and lower Z score of lumbar spine. Also, the Fronczak observational study showed that maternal Intake of vitamin D via food was significant in decrease of IA-2 autoantibodies in offspring ( HR=0.37;95%Cl 0.17-0.78). Variety of different dosage of vitamin D supplement has been used in primary literatures. The data from Wicklow and Hypponen et al. used 2000IU/d that decreased risk of type I diabetes in diabetes type I. Conclusion: Reported studies did not have consistent conclusion for association of type I diabetes and vitamin D. The data from the randomized clinical trials have shown that vitamin D supplementation can increase serum vitamin D >30 ng/ml but none support the use of vitamin D in prevention of type I diabetes. Given the lack of data to support the use of vitamin D to reduce the risk of type I diabetes, vitamin D supplementation should be used to supplement vitamin D levels in children not exposed to adequate sunlight. There is no clear recommendation dose for treatment and prevention of vitamin D supplementation for pediatric patients. Therefore, monitoring and routine measurements of vitamin D by physician can play an important role. More randomized control trials with large sample would be needed to answer all of the unknown questions regarding the dosage of vitamin D supplement.