The relationship of vitamin D levels with hemogram parameters and metabolic parameters in patients with type 2 diabetes

Introduction: The prevalence of vitamin D deficiency and Type 2 Diabetes (T2DM), are health issues that have shown rapid growth in recent years. T2DM is associated with very serious complications. Many environmental and genetic factors, including diabetes history in first-class relatives, obesity, sedentary life, emotional stress can cantribute to the development of T2DM. Chronic inflammation and susceptibility to contamination are among characteristics of T2DM. It has been noted in alot of reports that vitamin D deficiency may also be associated with T2DM. Vitamin D deficiency, due to immunomodulatory effect of the vitamin D, is related with high serum inflammatory marker levels. Inflammatory markers derived from hemogram have also been associated with diabetes and its complications in recent years. Therefore, in our study, we aimed to evaluate the relationship between vitamin D level, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR) and other hemogram parameters, and metabolic markers such as uric acid, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) in T2DM patients. Material and Method: Patients diagnosed with T2DM and over 18 years of age, whom visited outpatient Internal Medicine clinics of Bolu Abant İzzet Baysal University hospital between February 2022 and July 2022 were enrolled to the study. Sociodemographic characteristics, laboratory data and anthropometric measurements of the patients were recorded. According to the serum vitamin D level, patients were divided into two groups as low vitamin D and normal vitamin D group. According to glycosylated hemoglobin (HbA1c) level, well (HbA1c<7%) and poor (HbA1c≥7%) diabetic control groups were also separated from two more conservative groups. General characteristics of patient groups and laboratory data were compared. Results: Present study included 240 T2DM patients; 170 in vitamin D deficient group and 70 in normal vitamin D group. Age was not different between vitamin D deficiency and normal vitamin D groups (p=0.29). Gender was also not different among study groups (p=0.1). Similarly, anthropometric measurements were similar in vitamin D deficency and normal vitamin D groups (p>0.05 for all). There was no significant difference between low vitamin D and normal vitamin D groups in terms of Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), uric acid, blood urea and Glomerular Filtration Rate (GFR) levels (p>0.05 for all). HbA1c was significantly higher in vitamin d deficient group compared to those with normal vitamin D levels (p=0.005). However, fasting blood glucose (FBG) was not different between the groups (p=0.15). Of the serum lipid parameters, only triglyceride (TG) level was significantly different between the two groups (p=0.006). The Hb level of vitamin d deficiency group was significantly lower than that of the normal vitamin D group (p=0.006). Higher levels of NLR were noted in vitamin d deficient patients compared to the subjects with normal vitamin D levels (p=0.025). There was no difference between the two groups in terms of hemogram and other markers derived from hemogram (p>0.05 for all). There was a negative negative correlation between vitamin D level and HbA1c in the study cohort (r=-0.20, p=0.02). In addition, there were positive correlation between NLR and HbA1c (r= 0.30, p<0.001). NLR showed a significant negative correlation with serum vitamin D level (r=-0.10, p=0.01). The sensitivity and specificity of HbA1c (below 7,15% cut off value) in predicting vitamin D deficiency were 69% and 50%, respectively (AUC: 0.6, p=0.006, 95% CI: 0.54-0.69). The sensitivity and specificity of NLR in predicting vitamin D deficiency were 60% and 49%, respectively (AUC: 0.59, p=0.03, 95% CI: 0.51-0.67). The sensitivity and specificity of NLR (over the 1.84% cut-off value) in predicting poor diabetic control were 72% and 45%, respectively (AUC: 0.67, p<0.001, 95% CI: 0.60-0.74). The sensitivity and specificity of vitamin D (lower than 17.9 ng/mL cut-off value) in predicting poor diabetic control were 47% and 71%, respectively (AUC: 0.55, p=0.02, 95% CI: 0.47-0.63). Conclusion: Present study revealed negative effects low serum vitamin D levels on diabetic control in patients with T2DM. Low serum vitamin D levels have been reported in patients with poor diabetic control. Therefore, we succest accesstment of serum vitamin D in diabetic patients with high HbA1c levels. Low serum vitamin D was also associated with high NLR in diabetic subjects. Therefore we find that high blood NLR can predict hipovitaminozis D. Smilarly serum vitamin D is related with serum triglyceride levels. Thus, low serum vitamin D may increase the risk of hypertriglyceridemia in diabetic popülation. Neverthless further studies with larger cohort are needed to Access the association with been serum vitamin D and metabolic/ inflammatory markers in T2DM patients. KEYWORDS: Type 2 Diabetes, Vitamin D, Inflammation, Hemogram, Neutrophil-Lymphocyte Ratio (NLR), Triglyceride