Medical Professional Publications

Vitamin D and the “Honeymoon” Period of Type 1 Diabetes

(From the September 2015 Issue of PediatricsOnline)

People newly diagnosed with type 1 diabetes may have a “honeymoon” period of partial clinical remission (PCR), during which insulin secretion normalizes and the body’s systemic inflammatory response diminishes. Past studies have found a link between vitamin D and these same markers of PCR – improved beta cell function and attenuation of the inflammatory response.

This raised a question in the minds of endocrinologists at Nationwide Children’s Hospital: Would vitamin D supplementation increase the frequency of PCR in children and adolescents?

A pilot study conducted at Nationwide Children’s and presented in June at the American Diabetes Association’s 75th Scientific Sessions found that it is possible, but larger studies are needed to reach clearer conclusions.

“We saw a higher frequency of the honeymoon period in children receiving supplementation, but the difference did not reach statistical significance,” says Kathryn Obrynba, MD, an endocrinologist at Nationwide Children’s and the study’s lead researcher. “It might with a larger cohort.”

The study followed 35 patients (median age 11.6 years) with new onset type 1 diabetes. One group of 17 patients took 3000 IU of cholecalciferol daily; the second group of 18 patients received a placebo. Both groups were assessed at three, six and nine months after diagnosis for PCR. The groups were also assessed at diagnosis and nine months for beta-cell function, systemic inflammation and 25-OHD levels.

There was no statistical difference in PCR frequency between the two groups, but the frequency was higher in the supplementation group at every assessment: 88 vs. 69 percent at three months, 60 vs. 50 percent at six months and 33 vs. 14 percent at nine months. There were no statistical differences in inflammatory markers or beta-cell function between groups. In all patients, 25-OHD deficiency was common at diagnosis, with 25-OHD values increasing over time, but the values were similar between groups.

The 25-OHD results indicate that there may have been poor adherence to the vitamin D supplementation, according to Dr. Obrynba. Other variables that may have affected this study’s results includes small sample size, and optimal vitamin D dosage could be addressed in subsequent studies.

Dr. Obrynba says that she would like to continue her work on vitamin D and PCR.

“A large multi-center study would be ideal,” she says.

Obrynba K, Hoffman R. Effect of vitamin D supplementation on frequency of partial clinical remission period in children and adolescents with newly diagnosed type 1 diabetes. Abstract presented at: American Diabetes Association’s 75th Scientific Sessions; June 5-9, 2015; Boston, Massachusetts.

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