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Vitamin D insufficiency in infants with increased risk of developing type 1 diabetes: a secondary analysis of the
An Jacobs1, Maarten Warnants2, Veronika Vollmuth3
1Department of Pediatric Endocrinology and Diabetes, KU Leuven University Hospitals Leuven, Leuven, Belgium an.k.jacobs@gmail.com.
Insights
Vitamin D insufficiency is common in high-risk infants for type 1 diabetes. Current treatment guidelines appear ineffective, suggesting a need for increased vitamin D supplementation, particularly during winter months.
Area of Science:
- Pediatrics
- Endocrinology
- Immunology
Background:
- Vitamin D insufficiency (VDI) is a potential factor in type 1 diabetes (T1D) development.
- Investigating VDI in high-risk infants is crucial for understanding T1D pathogenesis.
- Local variations in vitamin D supplementation guidelines may impact outcomes.
Purpose of the Study:
- To assess the prevalence and persistence of VDI in infants at high genetic risk for T1D.
- To evaluate the effectiveness of current VDI treatment protocols within a primary prevention study.
- To inform potential adjustments in vitamin D supplementation strategies for this vulnerable population.
Main Methods:
- The POInT Study enrolled infants aged 4-7 months with high genetic risk for T1D.
- Vitamin D levels were monitored from enrollment until 3 years of age.
- VDI was defined as <30 ng/mL and treated per local guidelines; recovery required levels ≥30 ng/mL at the next visit.
Main Results:
- VDI was observed in 24.7% of visits across 1050 infants.
- Over 46% of VDI cases did not resolve by the subsequent visit.
- Risk factors for VDI included winter season, higher weight, older age, and country (England); winter VDI increased the risk of non-recovery.
Conclusions:
- Vitamin D insufficiency is frequent in infants at increased risk for T1D.
- Current treatment guidelines for VDI in this cohort appear insufficient.
- Increased vitamin D supplementation, especially in winter and after VDI diagnosis, is recommended.
Background:
Vitamin D insufficiency (VDI) may be a factor in the development of type 1 diabetes (T1D). The aim of this study is to investigate the presence and persistence of VDI in a large cohort of infants with increased risk of developing T1D, in light of the differences in local supplementation guidelines.
Methods:
In the POInT Study, a multicentre primary prevention study between February 2018 and March 2021 in Germany, Poland, Belgium, England and Sweden, including infants aged 4-7 months at high genetic risk of developing β-cell autoantibodies, vitamin D levels were analysed at each study visit from inclusion (4-7 months) until 3 years, with an interval of 2 months (first three visits) or 4-6 months (visits 4-8). The protocol actively promotes vitamin D sufficiency to optimise immune tolerance. VDI was defined as a concentration below 30 ng/mL and was treated according to local guidelines of participating centres. Recovery from VDI was defined as a concentration above or equal to 30 ng/mL on the subsequent visit after VDI.
Results:
1050 infants were included, of which 5937 vitamin D levels were available for analyses. VDI was observed in 1464 (24.7%) visits and 507 (46.1%) of these were not resolved at the next visit. The risk of having VDI was independently associated with season (higher in winter), weight (higher with increased weight), age (higher with increased age) and country (higher in England). The risk of not recovering from VDI was independently associated with the season of the previously determined VDI, which was higher if VDI was identified in winter.
Conclusions:
VDI is frequent in infants with increased risk of developing T1D. Treatment guidelines for VDI do not seem effective. Increasing supplementation dosages in this patient population seems warranted, especially during winter, and increasing dosages more aggressively after VDI should be considered.
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