Vitamin D status in children and adolescents with type 2 diabetes in a sun-rich environment

Background: In obese children, hypovitaminosis D has been found to be associated with common risk factors for type 2 diabetes including abnormal fasting insulin, glucose and hemoglobin A1c. Adult type 2 diabetics have a lower vitamin D levels but this has not been documented in children/ adolescents who reside in a sun-rich environment. Objective: The purpose of this study was to estimate the prevalence of vitamin D insufficiency/deficiency in children with type 2 diabetes in a sun-rich environment. Materials and Methods: Children (N = 48) diagnosed with type 2 diabetes who had serum 25-hydroxyvitamin D level data available from a clinical visit (2008-2012). Results were obtained from a retrospective chart review. Vitamin D deficiency was defined as 25-hydroxyvitamin D level ≤ 50 nmol/L and insufficiency ≤ 75 nmol/L. Obesity was defined as body mass index (BMI) >95% and overweight as BMI >85<95% for age and sex. Results: The majority of the population was non-Hispanic black (73%), followed by 22% Hispanic, and 4% non-Hispanic white. Mean age was 15.0 years (range 8.7-18.5 years). Forty subjects (83%) were obese (mean BMI 96.1%). Mean 25-hydroxyviatmin D level was 47.4 nmol/L. The majority (97%) were vitamin D insufficient and 62% were vitamin D deficient. Correlation with BMI z-score was not significant. Vitamin D status did not vary by race. Conclusions: Vitamin D deficiency is extremely common in a sun-rich environment among adolescents with type 2 diabetes, independent of BMI or race. Type 2 diabetes may be an added risk for vitamin D deficiency among obese, multiethnic children/adolescents even in a sun-rich environment. IntroductIon More than half of children and adolescents in the United States have vitamin D insufficiency, also known as hypovitaminosis D1. Hypovitaminosis D in children has been increasingly associated with a variety of nonskeletal conditions such as multiple sclerosis, wheezing illnesses, type 1 diabetes, and cardiovascular disease1-3. In children and adolescents, low vitamin D levels have been associated with risk factors for type 2 diabetes including abnormal insulin sensitivity, fasting glucose, fasting insulin levels, and hemoglobin A1c4-6. Several studies have documented a high prevalence of vitamin D deficiency among adult subjects with type 2 diabetes7. However, there are no studies to date that show a difference in vitamin D status in children with type 2 diabetes including among multiethnic children. We sought to determine the vitamin D status in a clinical sample of multiethnic children with type 2 diabetes who reside in a sun-rich environment. PAtIents And Methods