Gönül KOÇ, Gül GÜRSOY, Besime HALİS, Hanife ÇOPUR, Ahmet YILDIRIM, Süheyla GÖRAR, Cavit ÇULHA, Yalçın ARAL

GESTASYONEL DİYABETES MELLİTUS İLE D VİTAMİNİ, KALSİTONİN VE PARATHORMON İLİŞKİSİ

ÖZET: Amaç: D vitamininin glukoz metabolizmasında önemli rol oynadığına dair kanıtlar artmaktadır. Kalsitonin ve paratiroid hormonu, gestasyonel diyabette tam olarak araştırılmamıştır. Çalışmamızın amacı gestasyonel diyabetes mellitusta (GDM) D vitamini, kalsitonin ve paratiroid hormonununun etkilerini araştırmaktır. Gereç ve Yöntemler: Retrospektif olarak yaz sezonunda 50 normal glukoz metabolizması (NGT) olan ve 50 gestasyonel diyabetli (GDM), toplam 100 gebe kadının demografik ve antropometrik parametrelerini, vitamin D, Aktif vitamin D, kalsitonin ve paratiroid hormon düzeylerini değerlendirdik. Kadınları yaş, parite, örtülü olup olmama, vücut kitle indeksi (VKİ) ve vitamin D düzeylerine göre sınıflandırdık ve tüm parametreleri karşılaştırdık, daha sonra tüm parametrelerin diyabetik grupta ve alt gruplarda korelasyonunu araştırdık. Bulgular: GDM grubunda ve ayrıca ileri yaş, multipar, örtülü ve obez GDM alt gruplarında 25 hidroksi vitamin D düzeyi istatistiksel anlamlı olmayan derecede düşüktü. Kalsitonin ve paratiroid hormon düzeyleri iki grupta farklı değildi. D vitamini eksikliği olan ve obez GDM alt gruplarının kalsitonin seviyeleri, kendi karşıt alt gruplarından belirgin olarak daha yüksekti. GDM'de, Vit D eksikliği olan, yaşlı veya örtülü GDM alt gruplarında kalsitonin ile VKİ arasında pozitif bir korelasyon vardı. Vitamin D ile C peptid arasında ise sadece obez GDM alt grubunda pozitif korelasyon saptandı. GDM alt grupları ve kalsiyum metabolizma hormonlarını içeren lojistik regresyon analizinde, genç yaş hariç (OR= 0.116 (% 95 CI = 0.04-0.338, p = <0.001)), VitD, aktif VitD, kalsiyum ve PTH'nin GDM öngörme üzerine etkisi yoktu. Sonuç: Yaz mevsiminde GDM hastalarımızda D vitamini, parathormon ve kalsitonin düzeylerinde anlamlı bir fark bulunamamasına rağmen, D vitaminin obez GDM hastalarında rol oynayabileceğini düşündük. Ayrıca Cal ve PTH'nin gestasyonel diabetes mellitusta rolü olmadığı sonucuna vardık. Tüm gebelik ve doğum sonrası dönemleri ve mevsimsel farklılıkları içeren geniş çaplı prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

gestasyonel diabetes mellitus, vitamin D, kalsitonin, parathormon

RELATIONSHIP BETWEEN GESTATIONAL DIABETES MELLITUS AND VITAMIN D, CALCITONIN AND PARATHORMONE

ABSTRACT: Objective: There is growing evidence that Vitamin D has important role in glucose metabolism. Calcitonin and parathyroid hormone were not fully investigated in gestational diabetes mellitus (GDM). The aim of our study was to investigate the effects of vitamin D, calcitonin (Cal) and parathormone in GDM. Material and Methods: We evaluated retrospectively demographic and anthropometric parameters, vitamin D, active vitamin D, calcitonin and parathormone levels of 100 pregnant women including 50 with normal glucose metabolism and 50 with GDM whose ages and body mass indices (BMI) were similar in summer season. We classified the women according to age, parity, being veiled, BMI and vitamin D levels, and compared all parameters, then searched the correlation of all the parameters in groups and subgroups. Results: 25 hydroxy vitamin D (VitD) levels were non-significantly low in GDM and also in older, multiparous, veiled and obese GDM subgroups. Calcitonin and parathormone levels were not different in two groups. Vitamin D-deficient and obese GDM subgroups had significantly higher calcitonin levels than their opposite subgroups. There was a positive correlation between Cal and BMI in GDM, in Vit D deficient, older, or veiled GDM subgroups. Positive correlation between vitamin D and C peptide was found in only obese GDM. In logistic regression analysis including GDM subgroups and calcium metabolism hormones, except younger age (OR=0.116 (95% CI=0.04-0.338, p=<0.001)), VitD, active VitD, Cal, and PTH had no effect on GDM prediction. Conclusion: Although we could not find a significant difference in VitD, Cal and PTH levels of our GDM patients in summer season, we thought that VitD could play a role in obese GDM patients.We also concluded that Cal and PTH did not have roles in gestational diabetes mellitus. Larger, carefully designed studies including throughout pregnancy and postpartum periods and seasonal variations are required.

Keywords:

gestational diabetes mellitus, Vitamin D, calcitonin, parathormone,

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