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Type 1 diabetes mellitus (T1DM) remains the most prevalent metabolic disorder among children and adolescents, carrying significant risks for acute complications like diabetic ketoacidosis.
Lower serum 25-hydroxyvitamin D levels are independently and strongly associated with poorer glycemic control in pediatric T1DM patients. Serum vitamin D status serves as a reliable diagnostic tool for risk stratification, with a specific clinical threshold identified for predicting suboptimal metabolic outcomes.
Type 1 diabetes mellitus (T1DM) remains the most prevalent metabolic disorder among children and adolescents, carrying significant risks for acute complications like diabetic ketoacidosis. Vitamin D serves as a vital steroid hormone with essential immunomodulatory and metabolic roles, yet its specific diagnostic utility in predicting long-term glycemic outcomes in pediatric populations requires rigorous clinical validation.
This study determined the prevalence of vitamin D deficiency in kids and adolescents dealing with T1DM and evaluated its independent association with poor glycemic control.
A cross-sectional study was conducted including 266 participants aged 1–18 years diagnosed with T1DM in Saudi Arabia. Serum 25-hydroxyvitamin D [25(OH)D] levels were assessed and segregated as deficient (<20 ng/mL), insufficient (20–29 ng/mL), or sufficient (≥30 ng/mL), while glycemic control was evaluated via glycated hemoglobin (HbA1c) levels. The statistical analysis utilized multivariable logistic regression to identify independent predictors, alongside receiver operating characteristic (ROC) curves and decision curve analysis to determine diagnostic accuracy and clinical utility.
The median participant age was 13 years, and 56.8% were male. Overall, 64.3% had suboptimal vitamin D status, including 30.1% with deficiency and 34.2% with insufficiency. Patients with poor glycemic control had markedly lower median serum 25(OH)D levels than those with controlled diabetes (21.0 ng/mL vs. 35.0 ng/mL). Serum 25(OH)D showed a strong inverse correlation with HbA1c (Spearman's ρ = −0.651).
Compared with sufficient vitamin D status, vitamin D insufficiency was independently linked with poor glycemic control (adjusted odds ratio [aOR]: 4.74), while vitamin D deficiency markedly increased the odds (aOR: 40.59). The optimal serum 25(OH)D cut-off for predicting poor glycemic control was 26.5 ng/mL, with 75.5% sensitivity and 82.2% specificity. Decision curve analysis illustrated greater net clinical benefit than treat-all or treat-none approaches across threshold probabilities of 32–85%.
Children and adolescents with T1DM frequently exhibited vitamin D deficiency or insufficiency, both of which were independently associated with poor glycemic control. Serum 25(OH)D demonstrated good diagnostic accuracy for identifying patients at risk of poor glycemic control. These findings support routine vitamin D assessment as a valuable adjunct for risk stratification and metabolic management in T1DM-affected children and adolescents.
Diagnostics
Diagnostic Value of Serum 25-Hydroxyvitamin D Levels in Predicting Poor Glycemic Control Among Children with Type 1 Diabetes Mellitus: A ROC Curve and Decision Curve Analysis
Youssef A. Alqahtani et al.
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