1. Vitamin D: A New Frontier in Diabetes Management Contact Information: Patrick.Nguyen@uth.tmc.eduPatrick.Nguyen@uth.tmc.edu Background Acknowledgement Methods Results Conclusions Patrick Nguyen, B.S., Michelle R. Klawans, M.P.H., Thomas F. Northrup, Ph.D., Angela L. Stotts, Ph.D., Bal Reddy, M.D. & Amber Zulfiqar, M.D. Aims Results (Cont.) Fatigue is a common symptom of type-2 diabetes, and can be associated with low vitamin D levels. Guidelines for standard of care in regards to serum 25-OH- vitamin D levels in type-2 diabetic patients have not been established. A prospective study examining the effects of vitamin D and calcium intake in women suggests a potential beneficial role of vitamin D and calcium intake in reducing the risk of type-2 diabetes (Pittas 2006). Lower serum vitamin D levels may be linked with higher hemoglobin A1c levels. To assess the association between serum 25-OH-vitamin D levels and hemoglobin A1c levels in type-2 diabetic patients, while controlling for Framingham risk factors. To gather preliminary data for conducting a more thorough and systematic investigation of serum 25-OH-vitamin D in type-2 diabetic patients for potentially establishing standards of care for this patient group in our clinic. This study utilized a retrospective, cross-sectional chart review design in order to collect data on A1c and vitamin D levels in diabetic patients seeking care at a university-based family medicine clinic. Patients aged 18-95 years who were diagnosed with type-2 diabetes (ICD9 code 250.0) and who received care in the clinic between January 2012 and December 2013 (N=238) had their electronic medical records reviewed. Along with vitamin D and A1c levels, additional information abstracted from the EMR included gender, race/ethnicity, relationship status, BMI, triglycerides, and steroid usage. A strong correlation exists between cardiovascular disease and diabetes, so data on Framingham risk factors (age, HDL cholesterol, total cholesterol, smoking status, systolic blood pressure, and hypertension medication status) were collected and taken into account to reduce confounding (Pencina et al., 2009 & Cardiovascular 2013). Multivariate logistic regression was conducted in order to examine the relationship between vitamin D and A1c levels, controlling for Framingham risk factors, using SAS 9.4 (Cary, NC). The mean 25-OH vitamin D level in the sample of 234 patients was 26.5 ng/mL (SD: 13.5). The odds of having an A1c level of 7% or lower increased by 4.4% (OR=1.044; 95% CI: 1.020-1.069, p<0.001) for each 1 ng/mL increase in serum 25-OH vitamin D. After controlling for Framingham risk scores, the results revealed that the odds of having an A1c level of 7% or lower increased by 4.5% (OR=1.045; 95% CI: 1.016-1.075, p= 0.002) for each 1 ng/mL increase in serum 25-OH vitamin D. 62% of people with a 25 OH-vitamin D level of 25 ng/ml or more had A1c levels at or below 7.0%. There was a significant association between vitamin D and A1c levels in type-2 diabetic patients. The data were statistically significant even after controlling for Framingham risk factors. A majority of patients (62%) at A1c goal (<7%) had vitamin D levels of 25ng/ml or more. The data suggest a potential threshold for treatment with supplemental vitamin D and warrants further research. Thank you to the clinic staff of the UT Physicians Family Medicine Clinic at the Texas Medical Center for their assistance with this project. Major targets and actions of vitamin D3 on peripheral tissues. APC, antigen ‐ presenting capacity; Ig, immunoglobulin; NK, natural killer cells; PTH, parathyroid hormone (Palomer et al., 2008). The University of Texas Health Science Center at Houston, McGovern Medical School Department of Family & Community Medicine Odds of Having A1c ≤ 7% as Vitamin D Increases After Controlling for Framingham Scores Odds Ratio Estimates Odds Ratio 95% Confidence Interval Vitamin D1.0451.0161.075 Framingham Score0.9600.9051.018 Odds of Having A1c ≤ 7% as Vitamin D Increases Odds Ratio Estimates Odds Ratio 95% Confidence Interval Vitamin D1.0441.0201.069 Conflicts of Interest & References The authors have no competing interests to declare. References are available upon request from the 1 st author. Table 1. Bivariate logistic regression analysis calculating the odds of having an A1C level ≤ 7% as serum 25-OH vitamin D increases. Table 2. Multivariate logistic regression analysis calculating the odds of having an A1C level ≤ 7% as serum 25-OH vitamin D increases while controlling for Framingham risk score.