INTRODUCTION:

Adiponectin is a secretory protein made by white adipose tissue adipocytes. It is related to balance factor C1q and the tumor necrosis subtype and related to the soluble collagen superfamily (TNF)¹. Because adiponectin exists in various isoforms and circulates in the blood, its biological roles are diverse. It has three dissimilar molecular weights; high-molecular weight (HMW) (multimer) middle-molecular weight (MMW) (hexamer), and low-molecular weight (LMW) (trimer)²^,³^,⁴.

Insulin resistance, glucose metabolism, and lipid metabolism have all been linked to HMW adiponectin in studies. According to the study, several adiponectin variants have been implicated in the genesis of a variety of illnesses⁵^,⁶^,⁷.

These variants have also been reported to influence inflammatory pathways as early stage reactants in both acute and chronic diseases. One of the most common causes of metabolic problems is a interruption in the synthesis of adiponectin variants⁸^,⁹.

Adiponectin, the most common adipokine in human blood, is released at a typical rate of 5–30 L/mL by adipose tissues. Adiponectin's biological functions include increasing fatty acid synthesis and suppressing gluconeogenesis in the liver¹⁰^,¹¹^,¹². Serum adiponectin levels are lower in obese, insulin-resistant, type 2 diabetes people, suggesting that adiponectin deficiency may play a role in obesity-related insulin resistance. Hepatic lipogenesis is reduced by adiponectin, but β-oxidation is increased.

Adiponectin has anti-diabetic, anti-inflammatory, and anti-atherogenic properties and acts as an insulin sensitizer. Its multifunctional properties make it an excellent target for metabolic diseases. Adiponectin's main function is energy homeostasis, with a new role as a "starvation gene" being hypothesized. Adiponectin regulates cell signaling in a variety of organs, including adipose tissue¹³^,¹⁴, skeletal muscle¹⁵^,¹⁶, vascular endothelium¹⁷^,¹⁸, and macrophages¹⁹^,²⁰, and has an insulin sensitizing impact²¹^,²²^,²³.

MATERIALS AND METHODS:

The study is a pre/post interventional study that extended over 8 weeks' duration. The study was conducted on adult patients with T2DM registered at Diabetic and Endocrine Diseases Clinic. The study included 80 patients; (34) males and (46) females. Their ages varied between 25 and 70 years with a mean age ±SD (52.73±11.029) for females and (50.41±11.028) for males diagnosed with T2DM patients, who have vitamin D deficiency (level was < 10ng/mL) and vitamin D insufficiency (level between 20 to 30 ng/mL).

The study excluded patients with other concomitant diseases like cardiovascular, thyroid, renal and hepatic problems, pregnant or lactating women were also exclusion criteria. In addition, patients treated with medications that affect glucose metabolism as steroids, neuroleptics and glucose altering medications at the last month, patients who have a sufficient level of vitamin D were excluded as well²⁴.

Patients were individually surveyed and data was gathered. The patient's name, age (in years), sex, domicile, diabetes history, drug used and dose frequency, concurrent illness, other drugs used, and drug side effects were all recorded on a health questionnaire form.

Following that, each patient had their fasting serum adiponectin and serum vitamin D levels measured. To measure the biochemical signatures recommended in this investigation, standard kits were employed, and tests were performed and analyzed according to the instructions included in each kit. The two measures listed were further measured before any administration and again after two months, which was the study period.

Following a 12-hour fast, a five-ml specimen of venous blood was taken from each patient using a sterile syringe (overnight fasting). The blood was left to clot at ambient temperature in a plain tube, and the serum was collected by centrifugation at 300rpm for 10 minutes, then kept frozen at -20o C for further analysis.

Statistical Analysis The mean and standard deviation (SD) are used to express the data. SPSS V25 was used to conduct the statistical analysis. At the 5% confidence level, the differences between the means were considered significant, and the level of significance was established at p0.05.

RESULTS:

The patients were 34 males and 46 females with a mean ages ±Std. (50.41±11.028) for males and (52.73±11.02) for females (Table .1)

Table 1. Description of gender and age of the enrolled patients.

Gender		Age (years)
Male n. (%)	34 (42.5%)	50.41 ± 11.02
Female n. (%)	46 (57.5%)	52.73 ± 11.02
Total	80 (100%)

After 8 weeks of treatment with vitamin D as an add-on to the conventional anti-diabetic drugs taken up by the patients there was a highly significant improvement in vitamin D level. The mean ±Std. of vitamin D at the base line was 14.76±6.02ng/ml and after 8 weeks' treatment was 42.865±12.012ng/ml.

For serum adiponectin level, the mean± Std. at baseline and after 8-week treatment with vitamin D was 7.31±1.56ng/ml and 9.70±3.26ng/ml respectively (Table.2)

The results, in summary, were:

1. The percent of the males was 42.5% with mean age ± Std. of 50.41±11.02, and the percent of the female was 57.5% with a mean age of 52.73 years ±11.02 (Table. 1).

2. Serum vitamin D level showed highly significantly increased after 8 weeks (Table.2)

3. Serum adiponectin also significantly improved after 8 weeks' treatment with vitamin D (Table.2)

Table 2. Serum vitamin D and adiponectin at the baseline and after 8 weeks treatment with vitamin D.

Parameter	Duration		p value (t-test)
Parameter	Base line	Week 8	p value (t-test)
Serum Vitamin D (ng/ml)	14.767 ± 6.025	42.865 ± 12.012	0.000**
Serum Adiponectin (ng/ml)	7.316 ± 1.563	9.705 ± 3.269	0.000**

DISCUSSION:

After 8 weeks of treatment with vitamin D, there was a highly significant elevation in serum vitamin D level with a weekly dose of 50.000 IU. The response was slightly different between males and females were the response in females was better than in male. Out of 46 female patients, only 2 (4.3%) stayed having insufficient level of vitamin D after 8 weeks of treatment. In male patients, from a total of 34 patients, there were 8 males (23.5%) patients who did not reach the normal values after 8 weeks' treatment. Similar results have been reported by other studies with different subject groups. Nasiroglu et al. 2019, had noticed that after six months of vitamin D3 supplementation in both overweight and obese subjects, the serum 25(OH)D3 increased¹⁵. Other studies concluded that after more than a months of vitamin D treatment among women with polycystic ovary syndrome (PCOS), the serum 25(OH) D3 increased²¹^,¹⁹^,¹⁷. Nevertheless, Gupta et al. 2017, study showed that the oral route dose of vitamin D did not give the satisfying improvement in the serum 25(OH)D3 level as that given by the intramuscular route that provides a statistically significant elevation in serum 25(OH)D3 level comparing with the base line serum level²⁵.

In this study, the weekly oral regimen was found to be effective in approaching the target level for 25(OH)D3 concentration which is above 30ng/ml. After 8 weeks' treatment with vitamin D there was a highly significant improvement of fasting serum adiponectin in which the mean ±Std. at base line level and after 8 weeks' treatment was 7.316±1.563 and 9.705±3.269 respectively. The results showed an increase in fasting adiponectin level in all female patients except 4 patients only who have shown a decrease in serum fasting adiponectin level after 8 weeks' treatment with vitamin D.

Seyyed et al. 2019, study supports finding, as by giving vitamin D supplementation to a vitamin D deficient women and comparing to placebo there was a significant increase to serum adiponectin after 8 weeks treatment with vitamin D²^,²³. Afshin Gharekhani et al. 2020, conducted a study on T2DM patients have given contradictory results to our study. The results showed a significant decline in circulating adiponectin after vitamin D treatment¹⁰.

Naini et al. 2016, study showed that administration of vitamin D supplements in end stage renal disease (ESRD) patients might lead to an increase in adiponectin level. This result may cause decrease in the risk of other ESRD complications, and since vitamin D has no side effects comparing to its benefit, it has been used to improve survival of the ESRD patients⁹.

A Breslavsky et al. 2013, concluded that the administration of vitamin D for 12 months was associated significantly with increasing 25(OH)D3 level and increased circulating adiponectin comparing to placebo group⁵, and this is another study that supports ours.

Seyed M. et al. 2016, found that there was no statistically significant increase in serum adiponectin after treating with 50000 IU of vitamin D for three months. According to their study, more researches are needed to evaluate the subject correctly².

CONCLUSION:

As a conclusion, vitamin D level corrected and became in sufficient values after treatment with 50.000IU vitamin D for 8 weeks. Also there is a highly significant improvement in serum adiponectin level after 8 weeks of vitamin D treatment.

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Received on 11.07.2021 Modified on 04.08.2021

Research J. Pharm.and Tech 2022; 15(3):1263-1266.

DOI: 10.52711/0974-360X.2022.00211