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Abstract：
BACKGROUND: Significant links between low serum levels of vitamin D3 and insufficient glycemic control in patients with type 2 diabetes mellitus (T2DM) have been reported previously in the literature. However, there is no exciting evidence on the association between glycated hemoglobin (HbA1c) and vitamin D levels in T2DM individuals in our nation (Yemen). This study aimed to investigate the relationship between HbA1c and vitamin D levels in T2DM patients in a resource-limited setting.
METHODS: A retrospective cross-sectional study was conducted at the Al-Raffa Center, Ibb, Yemen between June 2018 and September 2023 including 396 patients diagnosed with T2DM. The patient characteristics, comorbidities, HbA1c, and vitamin D levels were gathered from patients\' medical profiles. Linear regression analysis was used to find the factors associated with vitamin D deficiency (serum 25(OH)D levels < 20 ng/mL) among T2DM patients. Subsequently, the correlation between HbA1c and vitamin D levels was examined using receiver operating characteristic (ROC) curve analysis.
RESULTS: The mean age was 44.6 ±14.6 years and most of them (n= 227, 57.3%) were female and from a rural area (n= 229, 57.8%). Comorbidities were hypertension, dyslipidemia disease, and cardiovascular disease in 176 (44.4%), 63 (15.9%), and 88 (22.2%) cases, respectively. The mean HbA1c was 8.1 ±2.5%. The mean vitamin D level was 26.9 ±16.5 ng/mL and low vitamin D was present in 260 (65.7%) (vitamin D deficiency in 160 (40.4%) and vitamin D insufficiency in 100 (25.3%) cases). In regression analysis, obesity (>30 kg/m2) (odds ratio (OR): 299.49; 95% confidence interval (CI): 72.66 - 1234.42, p <0.0001), higher HbA1c levels (OR: 1.61; 95% CI: 1.26 - 2.05, p =0.0001), and urban residence (OR: 23.98; 95% CI: 5.62 - 102.42, p <0.0001) were associated with vitamin D deficiency. There was a negative correlation between the vitamin D level and HbA1c which was statistically significant (correlation coefficient r: -0.5452; 95% CI: -0.6109 to -0.4720, p <0.0001). Using the ROC analysis, the serum vitamin D value of ≤18.42 ng/ml was the best cut-off point to predict hyperglycemia (area under the curve: 0.633, 95% CI: 0.672 to 0.770, sensitivity: 52%, specificity: 84.71 %, Yoden\'s index: 0.3671, p <0.001). Based on this cut-off, 39.4% of individuals (37.5% in the normoglycemic group and 90.9% in the hyperglycemic group) were vitamin D deficient.
CONCLUSIONS: In this study, low vitamin D was common among T2DM patients, especially those with poor glycemic control. We observed a link between HbA1c levels, urban residency, and BMI with vitamin D deficiency in T2DM patients. The association was distinguished by low vitamin D levels and elevated HbA1c. Additionally, we found that the serum vitamin D value of ≤18.42 ng/ml was the best cut-off point to predict hyperglycemia in T2DM patients with moderate agreement. To manage their disease, patients with T2DM should take their medications as prescribed and live a healthy lifestyle. This will increase their overall health, especially their vitamin D levels.
METHODS: A retrospective cross-sectional study was conducted at the Al-Raffa Center, Ibb, Yemen between June 2018 and September 2023 including 396 patients diagnosed with T2DM. The patient characteristics, comorbidities, HbA1c, and vitamin D levels were gathered from patients\' medical profiles. Linear regression analysis was used to find the factors associated with vitamin D deficiency (serum 25(OH)D levels < 20 ng/mL) among T2DM patients. Subsequently, the correlation between HbA1c and vitamin D levels was examined using receiver operating characteristic (ROC) curve analysis.
RESULTS: The mean age was 44.6 ±14.6 years and most of them (n= 227, 57.3%) were female and from a rural area (n= 229, 57.8%). Comorbidities were hypertension, dyslipidemia disease, and cardiovascular disease in 176 (44.4%), 63 (15.9%), and 88 (22.2%) cases, respectively. The mean HbA1c was 8.1 ±2.5%. The mean vitamin D level was 26.9 ±16.5 ng/mL and low vitamin D was present in 260 (65.7%) (vitamin D deficiency in 160 (40.4%) and vitamin D insufficiency in 100 (25.3%) cases). In regression analysis, obesity (>30 kg/m2) (odds ratio (OR): 299.49; 95% confidence interval (CI): 72.66 - 1234.42, p <0.0001), higher HbA1c levels (OR: 1.61; 95% CI: 1.26 - 2.05, p =0.0001), and urban residence (OR: 23.98; 95% CI: 5.62 - 102.42, p <0.0001) were associated with vitamin D deficiency. There was a negative correlation between the vitamin D level and HbA1c which was statistically significant (correlation coefficient r: -0.5452; 95% CI: -0.6109 to -0.4720, p <0.0001). Using the ROC analysis, the serum vitamin D value of ≤18.42 ng/ml was the best cut-off point to predict hyperglycemia (area under the curve: 0.633, 95% CI: 0.672 to 0.770, sensitivity: 52%, specificity: 84.71 %, Yoden\'s index: 0.3671, p <0.001). Based on this cut-off, 39.4% of individuals (37.5% in the normoglycemic group and 90.9% in the hyperglycemic group) were vitamin D deficient.
CONCLUSIONS: In this study, low vitamin D was common among T2DM patients, especially those with poor glycemic control. We observed a link between HbA1c levels, urban residency, and BMI with vitamin D deficiency in T2DM patients. The association was distinguished by low vitamin D levels and elevated HbA1c. Additionally, we found that the serum vitamin D value of ≤18.42 ng/ml was the best cut-off point to predict hyperglycemia in T2DM patients with moderate agreement. To manage their disease, patients with T2DM should take their medications as prescribed and live a healthy lifestyle. This will increase their overall health, especially their vitamin D levels.
摘要：
背景：先前文献中已经报道了2型糖尿病（T2DM）患者血清维生素D3水平低与血糖控制不足之间的显著联系。然而,在我国(也门)T2DM患者中,没有令人兴奋的证据表明糖化血红蛋白(HbA1c)与维生素D水平之间存在关联.本研究旨在探讨资源有限的T2DM患者HbA1c与维生素D水平之间的关系。
方法：在Al-Raffa中心进行了一项回顾性横断面研究，Ibb,也门在2018年6月至2023年9月期间，包括396例诊断为T2DM的患者。病人的特点,合并症,HbA1c,和维生素D水平是从患者的医学资料中收集的。线性回归分析2型糖尿病患者维生素D缺乏(血清25(OH)D水平<20ng/mL)的相关因素。随后，采用受试者工作特征(ROC)曲线分析检验HbA1c与维生素D水平的相关性.
结果：平均年龄为44.6±14.6岁，其中大多数（n=227，57.3％）是女性，来自农村地区（n=229，57.8％）。合并症是高血压，血脂异常疾病，和心血管疾病176例（44.4%），63（15.9%），88例(22.2%)，分别。平均HbA1c为8.1±2.5%。平均维生素D水平为26.9±16.5ng/mL，260例（65.7％）维生素D低（160例（40.4％）维生素D缺乏和100例（25.3％）维生素D不足）。在回归分析中，肥胖（>30kg/m2）（优势比（OR）：299.49;95％置信区间（CI）：72.66-1234.42，p<0.0001），HbA1c水平较高（OR：1.61；95%CI：1.26-2.05，p=0.0001），和城市居住（OR：23.98;95％CI：5.62-102.42，p<0.0001）与维生素D缺乏有关。维生素D水平与HbA1c呈负相关，具有统计学意义（相关系数r：-0.5452；95%CI：-0.6109～-0.4720，p<0.0001）。使用ROC分析，血清维生素D值≤18.42ng/ml是预测高血糖的最佳临界点(曲线下面积:0.633,95%CI:0.672~0.770,灵敏度:52%,特异性：84.71%，约登指数：0.3671，p<0.001）。基于这个截止，39.4％的个体（正常血糖组为37.5％，高血糖组为90.9％）缺乏维生素D。
结论：在这项研究中，低维生素D在T2DM患者中很常见，尤其是那些血糖控制不佳的人。我们观察到HbA1c水平之间的联系，城市居住权,2型糖尿病患者的BMI与维生素D缺乏。这种关联的特点是维生素D水平低和HbA1c升高。此外,我们发现,在中度一致的T2DM患者中,血清维生素D值≤18.42ng/ml是预测高血糖的最佳临界点.为了控制他们的疾病，2型糖尿病患者应按照处方服用药物,并过上健康的生活方式.这将增加他们的整体健康，尤其是他们的维生素D水平。
方法：在Al-Raffa中心进行了一项回顾性横断面研究，Ibb,也门在2018年6月至2023年9月期间，包括396例诊断为T2DM的患者。病人的特点,合并症,HbA1c,和维生素D水平是从患者的医学资料中收集的。线性回归分析2型糖尿病患者维生素D缺乏(血清25(OH)D水平<20ng/mL)的相关因素。随后，采用受试者工作特征(ROC)曲线分析检验HbA1c与维生素D水平的相关性.
结果：平均年龄为44.6±14.6岁，其中大多数（n=227，57.3％）是女性，来自农村地区（n=229，57.8％）。合并症是高血压，血脂异常疾病，和心血管疾病176例（44.4%），63（15.9%），88例(22.2%)，分别。平均HbA1c为8.1±2.5%。平均维生素D水平为26.9±16.5ng/mL，260例（65.7％）维生素D低（160例（40.4％）维生素D缺乏和100例（25.3％）维生素D不足）。在回归分析中，肥胖（>30kg/m2）（优势比（OR）：299.49;95％置信区间（CI）：72.66-1234.42，p<0.0001），HbA1c水平较高（OR：1.61；95%CI：1.26-2.05，p=0.0001），和城市居住（OR：23.98;95％CI：5.62-102.42，p<0.0001）与维生素D缺乏有关。维生素D水平与HbA1c呈负相关，具有统计学意义（相关系数r：-0.5452；95%CI：-0.6109～-0.4720，p<0.0001）。使用ROC分析，血清维生素D值≤18.42ng/ml是预测高血糖的最佳临界点(曲线下面积:0.633,95%CI:0.672~0.770,灵敏度:52%,特异性：84.71%，约登指数：0.3671，p<0.001）。基于这个截止，39.4％的个体（正常血糖组为37.5％，高血糖组为90.9％）缺乏维生素D。
结论：在这项研究中，低维生素D在T2DM患者中很常见，尤其是那些血糖控制不佳的人。我们观察到HbA1c水平之间的联系，城市居住权,2型糖尿病患者的BMI与维生素D缺乏。这种关联的特点是维生素D水平低和HbA1c升高。此外,我们发现,在中度一致的T2DM患者中,血清维生素D值≤18.42ng/ml是预测高血糖的最佳临界点.为了控制他们的疾病，2型糖尿病患者应按照处方服用药物,并过上健康的生活方式.这将增加他们的整体健康，尤其是他们的维生素D水平。
