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Impacto da suplementação de vitamina D na Pré-diabetes: outcomes glicémicos e atraso na progressão para Diabetes Mellitus tipo 2
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| Documento em Acesso Embargado até dia 18-02-2028. Tente solicitar cópia ao autor carregando no ficheiro | 1.76 MB | Adobe PDF |
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Abstract(s)
Introdução: A pré-diabetes caracteriza-se por valores elevados de glicose e/ou HbA1c, inferiores aos dos critérios de Diabetes Mellitus, mas associados a maior risco para tal. A International Diabetes Federation estima um aumento global de casos de 537 para 643 milhões, entre 2021 e 2030. As medidas preventivas, como mudanças no estilo de vida e terapêuticas farmacológicas, podem reduzir complicações. Contudo, estas apresentam limitações, que passam pelas dificuldades de adesão/manutenção e custos. Dada a alta prevalência da diabetes e carga da doença associada, é relevante investigar alternativas adjuvantes. A vitamina D, uma hormona esteroide com recetores nas células ? pancreáticas e adipócitos, influencia a secreção e resposta tecidular à insulina, podendo interferir na progressão para diabetes. Objetivos: Avaliar o impacto da suplementação com vitamina D na pré-diabetes, em termos de outcomes glicémicos e no atraso da progressão para DM2. Métodos: Foi efetuada uma revisão sistemática, segundo a norma PRISMA, de ensaios clínicos aleatorizados, pesquisados nas bases de dados PubMed e Scopus, nos últimos 10 anos. A pergunta de investigação foi formulada, segundo a estratégia PICO, e foram utilizados os termos MeSH: “Vitamin D” AND “Prediabetic State”. Foram obtidos 345 artigos, que foram sequencialmente selecionados, segundo os critérios de inclusão e exclusão definidos. Resultados: Selecionaram-se 13 ensaios clínicos aleatorizados, com diferentes populações, nomeadamente, relativamente aos níveis basais de vitamina D endógena, que foram submetidas a intervenções heterogéneas quanto à dose de vitamina D administrada e tempo follow-up, entre outros. Observou-se impacto positivo ou nulo em outcomes como glicemia em jejum, HbA1c, HOMA-IR (índice de resistência à insulina) e progressão para diabetes. Discussão: A heterogeneidade entre os estudos limita a análise e extrapolação dos resultados. Enquanto alguns ensaios sugerem uma relação benéfica da vitamina D na melhoria dos parâmetros glicémicos e na redução do risco de progressão para diabetes, outros não encontraram diferenças significativas. Esta discrepância pode ser explicada por diferenças na dose utilizada, duração do acompanhamento e variabilidade nos níveis basais de vitamina D. Adicionalmente, a falta de padronização na metodologia dos ensaios dificulta a interpretação dos desfechos. Apesar disso, os resultados apontam para um potencial efeito protetor da suplementação de vitamina D na progressão da prédiabetes para diabetes, especialmente em populações com níveis basais baixos, no início dos estudos. Conclusão: Embora existam indícios promissores, a evidência disponível é limitada, dada a heterogeneidade dos estudos analisados. São necessários mais ensaios robustos e com melhor definição de níveis basais de 25(OH)D, doses de vitamina D e tempos de follow up, permitindo conclusões clínicas mais orientadas para o doente.
Introduction: Pre-diabetes is characterized by elevated glucose and/or HbA1c levels that do not meet the criteria for Diabetes Mellitus, yet are linked to a higher risk of developing it. The International Diabetes Federation estimates that global cases will rise from 537 to 643 million between 2021 and 2030. Preventive measures, including lifestyle changes and pharmacological therapies, can help reduce complications. However, these interventions come with limitations, such as challenges in adherence and maintenance, as well as costs. Considering the high prevalence of diabetes and its associated disease burden, it is important to explore adjuvant alternatives. Vitamin D, a steroid hormone with receptors on pancreatic ? cells and adipocytes, influences secretion and tissue response to insulin, and may interfere with the progression to diabetes. Objectives: To evaluate the impact of vitamin D supplementation on prediabetes, regarding glycemic outcomes and the delay of progression to type 2 diabetes. Methods: A systematic review was conducted according to PRISMA guidelines, analyzing randomized clinical trials retrieved from the PubMed and Scopus databases over the last 10 years. The research question was formulated, according to the PICO strategy, and the MeSH terms applied were: “Vitamin D” AND “Prediabetic State." A total of 345 articles were obtained, which were sequentially selected based on the established inclusion and exclusion criteria. Results: 13 randomized clinical trials were selected, with different populations, namely regarding baseline levels of endogenous vitamin D, which were subjected to heterogeneous interventions regarding the dose of vitamin D administered and followup time, among others. There was a positive or no impact on outcomes such as fasting blood glucose, HbA1c, HOMA-IR (insulin resistance index) and progression to diabetes. Discussion: The heterogeneity among studies limits the analysis and extrapolation of results. While some trials suggest a beneficial relationship between vitamin D and the improvement of glycemic parameters, as well as a reduction in the risk of progression to diabetes, others have reported no significant differences. This discrepancy may be attributed to variations in the dosage used, duration of follow-up, and variability in baseline vitamin D levels. Furthermore, the absence of standardization in trial methodology makes the interpretation of outcomes difficult. Despite this, the results indicate a potential protective effect of vitamin D supplementation on the progression from prediabetes to diabetes, particularly in populations with low baseline levels at the start of the studies. Conclusion: While there is promising evidence, the current data is limited due to the heterogeneity of the studies analyzed. More robust trials are needed with clearer definitions of baseline 25(OH)D levels, vitamin D doses, and follow-up durations, which would enable more patient-centered clinical conclusions.
Introduction: Pre-diabetes is characterized by elevated glucose and/or HbA1c levels that do not meet the criteria for Diabetes Mellitus, yet are linked to a higher risk of developing it. The International Diabetes Federation estimates that global cases will rise from 537 to 643 million between 2021 and 2030. Preventive measures, including lifestyle changes and pharmacological therapies, can help reduce complications. However, these interventions come with limitations, such as challenges in adherence and maintenance, as well as costs. Considering the high prevalence of diabetes and its associated disease burden, it is important to explore adjuvant alternatives. Vitamin D, a steroid hormone with receptors on pancreatic ? cells and adipocytes, influences secretion and tissue response to insulin, and may interfere with the progression to diabetes. Objectives: To evaluate the impact of vitamin D supplementation on prediabetes, regarding glycemic outcomes and the delay of progression to type 2 diabetes. Methods: A systematic review was conducted according to PRISMA guidelines, analyzing randomized clinical trials retrieved from the PubMed and Scopus databases over the last 10 years. The research question was formulated, according to the PICO strategy, and the MeSH terms applied were: “Vitamin D” AND “Prediabetic State." A total of 345 articles were obtained, which were sequentially selected based on the established inclusion and exclusion criteria. Results: 13 randomized clinical trials were selected, with different populations, namely regarding baseline levels of endogenous vitamin D, which were subjected to heterogeneous interventions regarding the dose of vitamin D administered and followup time, among others. There was a positive or no impact on outcomes such as fasting blood glucose, HbA1c, HOMA-IR (insulin resistance index) and progression to diabetes. Discussion: The heterogeneity among studies limits the analysis and extrapolation of results. While some trials suggest a beneficial relationship between vitamin D and the improvement of glycemic parameters, as well as a reduction in the risk of progression to diabetes, others have reported no significant differences. This discrepancy may be attributed to variations in the dosage used, duration of follow-up, and variability in baseline vitamin D levels. Furthermore, the absence of standardization in trial methodology makes the interpretation of outcomes difficult. Despite this, the results indicate a potential protective effect of vitamin D supplementation on the progression from prediabetes to diabetes, particularly in populations with low baseline levels at the start of the studies. Conclusion: While there is promising evidence, the current data is limited due to the heterogeneity of the studies analyzed. More robust trials are needed with clearer definitions of baseline 25(OH)D levels, vitamin D doses, and follow-up durations, which would enable more patient-centered clinical conclusions.
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Keywords
Estado Pré-Diabético Vitamina D Suplementos Nutricionais Diabetes Mellitus Prediabetic State Vitamin D Dietary Supplements