Vitamin D Deficiency Linked to Diabetic Retinopathy

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Low vitamin D levels may be tied to development of diabetic retinopathy.
Low vitamin D levels may be tied to development of diabetic retinopathy.

ORLANDO, Fla. — A new meta-analysis of 9 large observational studies suggests that there is a significant association between vitamin D deficiency and diabetic retinopathy. 

The authors of the meta-analysis reported at the American Association of Clinical Endocrinologists (AACE) 25th Annual Scientific & Clinical Congress that there was a quantifiable statistically significant difference in mean serum vitamin D levels between patients with diabetic retinopathy and control groups. Consequently, they called for patients with diabetes who have low vitamin D levels to be screened for diabetic retinopathy.

“Our study shows that patients with diabetic retinopathy tend to have vitamin D deficiency, while patients without diabetic retinopathy tend to have normal vitamin D. Although this is a meta-analysis of observational studies, it signifies a role of future research on vitamin D supplementation use to prevent or slow progression of diabetic retinopathy in patients with diabetes,” said study author Anawin Sanguankeo, MD, an internal medicine resident at Bassett Medical Center, Cooperstown, New York.

Currently, the role of vitamin D in the pathogenesis of diabetic retinopathy remains unknown. Dr Sanguankeo and his colleagues performed a systematic review and meta-analysis to comprehensively determine the strength of association between vitamin D deficiency and diabetic retinopathy. They examined whether there were any significant differences in serum vitamin D levels between patients with diabetic retinopathy and controls. 

“There is a statistically significant association between diabetic retinopathy and vitamin D deficiency with each severity of diabetic retinopathy, with a pooled odds ratio (OR) of 1.39 for any type of diabetic retinopathy,” Dr Sanguankeo told Endocrinology Advisor. “It is possible that with further study, there may be an important role for the supplementation of vitamin D and other anti-angiogenic vitamins in the medical management of diabetic retinopathy.”

The ORs were 1.21 for non-proliferative diabetic retinopathy and 1.32 for proliferative diabetic retinopathy. The overall OR was 1.44, and there was a statistically significant lower serum vitamin D level in patients with diabetic retinopathy compared with control groups in subgroups of non-proliferative and proliferative diabetic retinopathy.

There was an overall mean difference was –2.22 ng/mL lower in patients with diabetic retinopathy, suggesting that vitamin D may play a role in the development of diabetic retinopathy in patients with diabetes.

Diabetic retinopathy is the leading cause of blindness for individuals aged 20 to 64 in the United States, noted Dr Sanguankeo. He said vitamin D deficiency has been associated with impairment of insulin secretion, metabolic syndrome, and systemic diabetic retinopathy progression. 

The role of vitamin D in cellular inflammation pathways, endothelial cell proliferation, and angiogenesis is well-established, but its role in diabetic retinopathy has been obscured in clinical studies due to a host of issues. Dr Sanguankeo said previous clinical studies have been limited because of varied diabetic retinopathy classifications, and differing patient ethnic populations.

Reference

  1. Upala S, Zhang J, Sanguankeo A. Abstract 309. The Relationship Between Vitamin D Deficiency and Diabetic Retinopathy: A Systematic Review and Meta-Analysis. Presented at: AACE 25th Annual Scientific & Clinical Congress; May 25-29, 2016; Orlando, FL.
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