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Alicia Walker NTR 404 Journal Articles

The Efficacy and Safety of a High Dose of Vitamin D in Mothers with Gestational Diabetes Mellitus: A Randomized Controlled Clinical Trial This study was done to see the efficacy of 300,000 IU Vitamin D injected intramuscularly in women with gestational diabetes mellitus (GDM). GDM was diagnosed using an oral glucose tolerance test during the 24th-28th week gestation. Changes in the mothers Vitamin D metabolism during pregnancy causes some mothers to become deficient (needed in breast milk and skeletal development in fetus). Sufficient levels of Vitamin D have been suggested to have a protective effect against GDM. This study was a randomized clinical trial that included 45 participants, which were all pregnant women with GDM. Their median age was around 30. They were randomly divided into an intervention group and a control group. The two groups median BMI is relatively close. They had actually started with 48 people, and created two groups of 24, but 3 dropped out of the control group because they didnt qualify. Individuals werent accepted if they had thyroid, kidney, or liver diseases (including malabsorption). So the intervention group consisted of 24 women, and the control group consisted of 21 women. Before testing, both groups had blood taken to use in HbA1c, serum 25(OH)D3, PTH levels, serum calcium and phosphorus testing. These tests results were pretty even between the two groups. The intervention group was given an injection of 300,000 IU Vitamin D intramuscularly and the control group was not. Ten days after the injections, both groups are tested again. These tests include HbA1c, serum 25(OH)D3, PTH levels, serum calcium and phosphorus . Then, another round of tests were

done at 12 weeks after the injection. No signs of hypercalcemia, hyperphatemia, or hypervitaminosis. Therefore, they declared the 300,000 IU of Vitamin D to be safe to the mother and infants. This study discusses previous studies done that involved 600,000 IU of Vitamin D as the dosage and there were results of hypercalcemia, so this dosage was deemed unsafe. In the beginning around 80% of all the participants were Vitamin D deficient (either mild or moderate). So if the groups are equal, then each side should be about 80% deficient. When tested after 10 days, the intervention group had increased serum 25(OH)D3,.decreased PTH levels, and increased calcium levels. Only 4.2% of the intervention group remained Vitamin D deficient, as compared to 71.4% of the control group. After 12 weeks, the intervention groups serum 25(OH)D3 went from a median of 24.25 nmol/l to 62.10 nmol/l. Looking at these results, this study deemed that the 300,000 IU Vitamin D injected intramuscularly is safe for a duration of time in between injections but more work needs to be done before it is a recommendation to all individuals. Vitamin D and Glycemic Control in Diabetes Mellitus Type 2 Mild to moderate deficiencies in Vitamin D have been proposed to be a risk factor for type 2 diabetes mellitus. A mild deficiency is termed 12.5-24.9 nmol/l for serum 25(OH)D3, a mild deficiency is termed 25-34.9 nmol/l. Sufficient levels of Vitamin D (35 nmol/l and greater serum 25(OH)D3) have been shown to lower the risk of type 2 diabetes mellitus and gestational diabetes mellitus in high risk patients. Vitamin has been shown to act in glucose homeostasis by interacting with insulin through enzymes and receptors. Vitamin D in involved in the expression of 1-alpha-hydroxylase, which is involved in insulin secretion. Deficiency of this vitamin may be related to impaired secretion of insulin. Also, Vitamin D has been shown to act in insulin receptors on cells, and deficiency may be related to insulin resistance by cells.

In this study, 240 people were tested and it was conducted over a year. 120 individuals had and were being treated for type 2 diabetes mellitus, and 120 individuals who were not diagnosed with this. 25(OH)D3 serum levels and HbA1c were measured in both groups. 7/120 individuals in the non-diabetic group, and 21/120 individuals from the diabetic group were deemed Vitamin D deficient (moderate and mild). 28/120 individuals in the non-diabetic group, and 17/120 individuals from the diabetic group were deemed Vitamin D insufficient. This study found that 25(OH)D3 is inversely related to HbA1c levels. This implies that Vitamin D may affect glucose control in type 2 diabetes mellitus. This study discusses other studies that have found similar attributes on Vitamin D. However, it also states that there have been studies that showed no correlation. This study states that its implications are therapeutic and no recommendations should be made necessarily until more work has been done on the subject. After reading both articles, this topic sounds very interesting and like it has potential. However, I also agree that more work needs to be done, and I would prefer more time so that long term effects can be observed. It wouldnt make a change to my recommendations as of now. I went to relate this topic to those covered in Krause, but found no direct connection. This idea seems recent; both articles were published in 2013 and no real recommendations are even advised according to these two articles. However, Krause does discuss that if deficiencies are occurring, a multivitamin may be needed. This addresses the fact that deficiencies in vitamins and minerals may have negative effects towards diabetes (Krause 687).