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Vitamin D deficiency tied to risk for diabetes death

Issue: October 2019

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Adults with vitamin D deficiency are more likely to die of complications from diabetes during 10 years of follow-up when compared with vitamin D-sufficient adults, according to study data presented at the European Association for the Study of Diabetes annual meeting.

Rodrig Marculescu

“The inverse correlation of blood vitamin D levels with the risk for death has been confirmed in hundreds of studies from all over the globe and in meta-analyses thereof,” Rodrig Marculescu, MD, associate professor at the Medical University of Vienna, told Endocrine Today. “The question of causality has also been answered positively with a high degree of confidence by several high-quality meta-analyses of randomized controlled intervention studies, most prominently from the Cochrane Collaboration. However, most data available stem mainly from older cohorts with relatively little evidence for younger age groups. Also, the association of blood vitamin D levels with different causes of death has not been investigated in very much detail, yet. These are the two aspects we wanted to further clarify with our present investigation.”

Marculescu and colleagues analyzed data from 78,581 patients who had a vitamin D measurement at General Hospital of Vienna between 1991 and 2011 (mean age, 51 years; 31.5% men). Researchers matched data with the Austrian national register of deaths, excluding deaths within the first 3 years, and followed patients for up to 20 years (mean follow-up, 10.5 years). The researchers defined vitamin D deficiency as a level below 50 nmol/L; low and high vitamin D levels were calculated at 10 nmol/L and 90 nmol/L, respectively. Researchers used Fine-Gray regression models to estimate mortality risk based on vitamin D level, adjusted for sex, age and year and month of blood draw.

Within the cohort, 11,877 patients died during follow-up. Among these patients, those with a 25-hydroxyvitamin D level of less than 10 nmol/L were nearly three times more likely to die vs. those with a normal vitamin D level, although mortality risk varied by age. The HR for mortality was 2.7 (95% CI, 2.1-3.4) for adults younger than 45 years, 2.9 (95% CI, 2.6-3.4) for adults aged 45 to 60 years, and 2 (95% CI, 1.8-2.3) for adults aged 60 to 75 years.

Among individuals with a vitamin D level of at least 90 nmol/L, researchers observed up to a 40% reduced risk for all-cause mortality, with HRs of 0.7 for adults aged 45 years and younger (95% CI, 0.6-0.9), 0.6 for adults aged 45 to 60 years (95% CI, 0.5-0.7) and 0.7 for adults aged 60 to 75 years (95% CI, 0.7-0.8).

 

Adults with vitamin D deficiency are more likely to die of complications from diabetes during 10 years of follow-up when compared with vitamin D-sufficient adults.

Source: Adobe Stock

In analyses stratified by cause of death, researchers found that the strongest effect size was for diabetes, with an HR of 4.4 (95% CI, 3.1-6.3).

“In terms of cause-specific mortality, we found, surprisingly, only a relatively modest relationship for cancer and cardiovascular disease,” the researchers wrote in an abstract. “The strongest association, accounting for most of the effect on overall mortality, was found for other causes of death, with strongest effect sizes for diabetes.”

In a press release, the researchers noted that plotting the risk for death according to vitamin D level in various subgroups did not demonstrate increased mortality risk at vitamin D levels above 100 nmol/L, diminishing concerns about a possible negative effect of vitamin D in the higher concentration range.

“Vitamin D supplementation should be further extended and intensified, especially during childhood and at younger age,” Marculescu said. “Regarding dosage, the authoritative clinical practice guideline from the Endocrine Society, published in 2011, is an excellent guide. In my personal opinion, everyone should be regarded and/or regard oneself as at risk for vitamin D deficiency and supplement accordingly.” – by Regina Schaffer

Reference:

Marculescu R, et al. Abstract 325. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 16-20, 2019; Barcelona, Spain.

Disclosure: Marculescu reports no relevant financial disclosures.