Skip to main content

Advertisement

Log in

Diabetes and the vitamin D connection

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Vitamin D deficiency, which is common in children and adults, causes rickets, osteomalacia, and osteoporosis. Most organs and immune cells have a vitamin D receptor, and some also have the capacity to metabolize 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D. 1,25-Dihydroxyvitamin D is a potent immunomodulator that also enhances the production and secretion of several hormones, including insulin. Vitamin D deficiency has been associated with increased risk of type 1 diabetes. Glycemic control and insulin resistance are improved when vitamin D deficiency is corrected and calcium supplementation is adequate. 25-Hydroxyvitamin D (measure of vitamin D status) of less than 20 ng/mL is vitamin D deficiency and 21 to 29 ng/mL is insufficiency. Children and adults need at least 1000 IU of vitamin D per day to prevent deficiency when there is inadequate sun exposure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Holick MF: Vitamin D deficiency. N Engl J Med 2007, 357:266–281.

    Article  PubMed  CAS  Google Scholar 

  2. Nagpal S, Na S, Rathnachalam R: Noncalcemic actions of vitamin D receptor ligands. Endocr Rev 2005, 26:662–687.

    Article  PubMed  CAS  Google Scholar 

  3. Li YC, Kong J, Wei M, et al.: 1,25-Dihydroxyvitamin D3 is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest 2002, 110:229–238.

    PubMed  CAS  Google Scholar 

  4. Bland R, Markovic D, Hills CE, et al.: Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in pancreatic islets. J Steroid Biochem Mol Biol 2004, 89–90:121–125.

    Article  PubMed  CAS  Google Scholar 

  5. Liu PT, Stenger S, Li H, et al.: Toll-like receptor Triggering of a vitamin D-mediated human antimicrobial response. Science 2006, 3:1770–1773.

    Article  CAS  Google Scholar 

  6. Feldman D, Zhao XY, Krishnan AV: Vitamin D and prostate cancer. Endocrinology 2000, 141:5–9.

    Article  PubMed  CAS  Google Scholar 

  7. Grant WB: An estimate of premature cancer mortality in the U.S. due to inadequate doses of solar ultraviolet-B radiation. Cancer 2002, 70:2861–2869.

    Google Scholar 

  8. Gorham ED, Garland CF, Garland FC, et al.: Optimal vitamin D status for colorectal cancer prevention: a quantitative meta-analysis. Am J Prev Med 2007, 32:210–216.

    Article  PubMed  Google Scholar 

  9. Moan J, Porojnicu AC, Dahlback A, Setlow RB: Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci U S A 2008, 105:668–673.

    Article  PubMed  CAS  Google Scholar 

  10. Pilz S, Dognig H, Winklhofer-Roob B, et al.: Low serum levels of 25-hydroxyvitamin D predict fatal cancer in patients referred to coronary angiography. Cancer Epidemiol Biomarkers Prev 2008, 17:1228–1233.

    Article  PubMed  CAS  Google Scholar 

  11. Heaney RP: Functional indices of vitamin D status and ramifications of vitamin D deficiency. Am J Clin Nutr 2004, 80(Suppl):1706S–1709S.

    PubMed  CAS  Google Scholar 

  12. Wang TJ, Pencina MJ, Booth SL, et al.: Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008, 117:503–511.

    Article  PubMed  CAS  Google Scholar 

  13. Dobnig H, Pilz S, Scharnagl H, et al.: Independent association of low serum 25-hydroxyvitami D and 1,25-dihydroxyvitamin D levels with all-cause and cardiovascular mortality. Arch Intern Med 2008, 168:1340–1349.

    Article  PubMed  CAS  Google Scholar 

  14. Ponsonby AL, Lucas RM, van der Mei IA: UVR, vitamin D and three autoimmune diseases—multiple sclerosis, type 1 diabetes, rheumatoid arthritis. Photochem Photobiol 2005, 81:1267–1275.

    Article  PubMed  CAS  Google Scholar 

  15. Merlino LA, Curtis J, Mikuls TR, et al.: Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 2004, 50:72–77.

    Article  PubMed  CAS  Google Scholar 

  16. Hypponen E, Laara E, Jarvelin MR, Virtanen SM: Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet 2001, 358:1500–1503.

    Article  PubMed  CAS  Google Scholar 

  17. Penna G, Amuchastegui S, Giarratana N, et al.: 1,25-Dihydroxyvitamin D3 selectively modulates tolerogenic properties in myeloid but not plasmacytoid dendritic cells. J Immunol 2007, 178:145–153.

    PubMed  CAS  Google Scholar 

  18. Inomata S, Kadowaki S, Yamatani T, et al.: Effect of 1 alpha (OH)-vitamin D3 on insulin secretion in diabetes mellitus. Bone Miner 1986, 1:187–192.

    PubMed  CAS  Google Scholar 

  19. 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. J Clin Endocrinol Metab 2007, 92:2017–2029.

    Article  PubMed  CAS  Google Scholar 

  20. Mohr SB, Garland CF, Gorham ED, Garland FC: The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide. Diabetologia 2008 June 12 (Epub ahead of print).

  21. Karvonen M, Viik-Kajander M, Molchanova E, et al.: Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 2000, 23:1516–1526.

    Article  PubMed  CAS  Google Scholar 

  22. Vitamin D supplement in early childhood and risk for type I (insulin-dependent) diabetes mellitus. The EURODIAB Substudy 2 Study Group [no authors listed]. Diabetologia 1999, 42:51–54.

    Article  Google Scholar 

  23. Stene LC, Joner G: Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study. Am J Clin Nutr 2003, 78:1128–1134.

    PubMed  CAS  Google Scholar 

  24. Stene LC, Barriga K, Norris JM, et al.: Perinatal factors and development of islet autoimmunity in early childhood: the diabetes autoimmunity study in the young. Am J Epidemiol 2004, 160:3–10.

    Article  PubMed  Google Scholar 

  25. Scragg R, Holdaway I, Singh V, et al.: Serum 25-hydroxyvitamin D3 levels decreased in impaired glucose tolerance and diabetes mellitus. Diabetes Res Clin Pract 1995, 27:181–188.

    Article  PubMed  CAS  Google Scholar 

  26. Isaia G, Giorgino R, Adami S: High prevalence of hypovitaminosis D in female type 2 diabetic population [letter]. Diabetes Care 2001, 24:1496.

    Article  PubMed  CAS  Google Scholar 

  27. Chiu KC, Chu A, Go VL, Saad MF: Hypovitaminosis D is associated with insulin resistance and beta cell dysfunction. Am J Clin Nutr 2004, 79:820–825.

    PubMed  CAS  Google Scholar 

  28. Ford ES, Ajani UA, McGurie LC, Liu S: Concentrations of serum vitamin D and the metabolic syndrome among U.S. adults. Diabetes Care 2005, 28:1228–1230.

    Article  PubMed  CAS  Google Scholar 

  29. Gedik O, Akalin S: Effects of vitamin D deficiency and repletion on insulin and glucagon secretion in man. Diabetologia 1986, 29:142–145.

    Article  PubMed  CAS  Google Scholar 

  30. Orwoll E, Riddle M, Prince M: Effects of vitamin D on insulin and glucagon secretion in non-insulin-dependent diabetes mellitus. Am J Clin Nutr 1994, 59:1083–1087.

    PubMed  CAS  Google Scholar 

  31. Borissova AM, Tankova T, Kirilov G, et al.: The effect of vitamin D3 on insulin secretion and peripheral insulin sensitivity in type 2 diabetic patients. Int J Clin Pract 2003, 57:258–261.

    PubMed  CAS  Google Scholar 

  32. Kumar S, Davies M, Zakaria Y, et al.: Improvement in glucose tolerance and beta-cell function in a patient with vitamin D deficiency during treatment with vitamin D. Postgrad Med J 1994, 70:440–443.

    Article  PubMed  CAS  Google Scholar 

  33. Pittas AG, Dawson-Hughes B, Li T, et al.: Vitamin D and calcium intake in relation to type 2 diabetes in women. Diabetes Care 2006, 29:650–656.

    Article  PubMed  CAS  Google Scholar 

  34. Hypponen E, Power C: Vitamin D status and glucose homeostasis in the 1958 British birth cohort. Diabetes Care 2006, 2244–2246.

  35. Scragg R, Sowers M, Bell C: Serum 25-hydroxyvitamin D, diabetes, and ethnicity in the Third National Health and Nutrition Examination Survey. Diabetes Care 2004, 27:2813–2818.

    Article  PubMed  CAS  Google Scholar 

  36. Institute of Medicine Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, and Institute of Medicine: Vitamin D. In Dietary Reference Intakes: For Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. Washington, DC: National Academies Press; 1999:250–287.

  37. Holick MF, Biancuzzo RM, Chen TC, et al.: Vitamin D2 is as effective as vitamin D3 in maintaining circulating concentrations of 25-hydroxyvitamin D. J Clin Endocrinol Metab 2008, 93:677–681.

    Article  PubMed  CAS  Google Scholar 

  38. Vieth R, Chan PCR, MacFarlane GD: Efficacy and safety of vitamin D3 intake exceeding the lowest observed adverse effect level. Am J Clin Nutr 2001, 73:288–294.

    PubMed  CAS  Google Scholar 

  39. Malabanan A, Veronikis IE, Holick MF: Redefining vitamin D insufficiency. Lancet 1998, 351:805–806.

    Article  PubMed  CAS  Google Scholar 

  40. Chapuy MC, Schott AM, Garnero P, et al.: Healthy elderly French women living at home have secondary hyperparathyroidism and high bone turnover in winter. J Clin Endocrinol Metab 1996, 81:1129–1133.

    Article  PubMed  CAS  Google Scholar 

  41. Holick MF, Siris ES, Binkley N, et al.: Prevalence of vitamin D inadequacy among postmenopausal North American women receiving osteoporosis therapy. J Clin Endocrinol Metab 2005, 90:3215–3224.

    Article  PubMed  CAS  Google Scholar 

  42. Heaney RP, Dowell MS, Hale CA, Bendich A: Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 2003, 22:142–146.

    PubMed  CAS  Google Scholar 

  43. Zhou C, Assem M, Tay JC, et al.: Steroid and xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug-induced osteomalacia. J Clin Invest 2006, 116:1703–1712.

    Article  PubMed  CAS  Google Scholar 

  44. Clemens TL, Henderson SL, Adams JS, Holick MF: Increased skin pigment reduces the capacity of skin to synthesis vitamin D3. Lancet 1982, 1:74–76.

    Article  PubMed  CAS  Google Scholar 

  45. Wortsman J, Matsuoka LY, Chen TC, et al.: Decreased bioavailability of vitamin D in obesity. Am J Clin Nutr 2000, 72:690–693. (Published erratum appears in Am J Clin Nutr 2003, 77:1342.)

    PubMed  CAS  Google Scholar 

  46. Tang HM, Cole DEC, Rubin LA, et al.: Evidence that vitamin D3 increases serum 25-hydroxyvitamin D more efficiently than does vitamin D2. Am J Clin Nutr 1998, 68:854–858.

    Google Scholar 

  47. Armas LA, Hollis B, Heaney RP: Vitamin D2 is much less effective than vitamin D3 in humans. J Clin Endocrinol Metab 2004, 89:5387–5391.

    Article  PubMed  CAS  Google Scholar 

  48. Schwalfenberg G: Vitamin D and diabetes. Improvement of glycemic control with vitamin D3 repletion. Can Fam Physician 2008, 54:864–866.

    PubMed  Google Scholar 

  49. Stene LC, Ulriksen E, Magnus P, Joner G: Use of cod liver oil during pregnancy associated with lower risk of type 1 diabetes in the offspring. Diabetologia 2000, 43:1093–1098.

    Article  PubMed  CAS  Google Scholar 

  50. Jun HS, Yoon JW: A new look at viruses in type 1 diabetes. Diabetes Metab Res Rev 2003, 19:8–31.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael F. Holick.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holick, M.F. Diabetes and the vitamin D connection. Curr Diab Rep 8, 393–398 (2008). https://doi.org/10.1007/s11892-008-0068-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-008-0068-0

Keywords

Navigation