Potential role of vitamin D in patients with diabetes,dyslipidaemia,and COVlD-19

Ming-Ke Wang,Xue-Lu Yu,Li-Yun Zhou,Hong-Mei Si,Ju-Fen Hui,Ji-Shun Yang

Ming-Ke Wang,Xue-Lu Yu,Li-Yun Zhou,Hong-Mei Si,Ju-Fen Hui,Department of Disease Control and Prevention,Naval Medical Center of PLA,Naval Medical University,Shanghai 200052,China

Ji-Shun Yang,Medical Care Center,Naval Medical Center of PLA,Naval Medical University,Shanghai 200052,China

Abstract Coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus-2 has become a worldwide public health crisis.Studies have demonstrated that diabetes and dyslipidaemia are common comorbidities and could be high-risk factors for severe COVID-19.Vitamin D,a group of fatsoluble compounds responsible for intestinal absorption of calcium,magnesium,and phosphate,has been widely used as a dietary supplement for the prevention and treatment of numerous diseases,including infectious and non-infectious diseases,due to its high cost-effectiveness;safety;tolerability;and anti-thrombotic,anti-inflammatory,antiviral,and immunomodulatory properties.In this letter to the editor,we mainly discuss the potential role of vitamin D in patients with diabetes,dyslipidaemia,and COVID-19.

Key Words: Coronavirus disease 2019;Severe acute respiratory syndrome coronavirus-2;Vitamin D;Diabetes;Dyslipidaemia

TO THE EDlTOR

We read with great interest the recent article by Iglesiaset al[1]entitled “Retrospective analysis of antiinflammatory therapies during the first wave of coronavirus disease 2019(COVID-19)at a community hospital”,which demonstrated the survival benefit associated with anti-inflammatory therapy with glucocorticoids and revealed that combination treatment with tocilizumab and glucocorticoids could provide the most benefit in critically ill patients with COVID-19 caused by severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).However,monotherapy with tocilizumab as an interleukin 6(IL-6)antagonist was not associated with an increase in survival among critically ill patients with COVID-19,which could be explained by the fact that tocilizumab non-selectively blocks both antiinflammatory and pro-inflammatory actions of IL-6[2].Meanwhile,vitamin D,a group of fat-soluble compounds,may have advantages over tocilizumab as an IL-6 immunomodulator by potentially reducing the pro-inflammatory effects,but avoiding the deleterious effects on the anti-inflammatory actions of IL-6 in patients with COVID-19[2].Additionally,vitamin D could modulate the innate and adaptive immune responses,and its deficiency is associated with increased morbidity and mortality in SARS-CoV-2 infection[3].Vitamin D status may be a potential predictor of COVID-19 outcomes,and vitamin D supplementation could be a promising therapeutic and preventive method against COVID-19,due to its high cost-effectiveness;safety;tolerability;and anti-thrombotic,anti-inflammatory,antiviral,and immunomodulatory properties[3,4].

Another published article in your journal by Gkoufaet al[5]entitled “Elderly adults with COVID-19 admitted to intensive care unit: A narrative review” found that diabetes and hypercholesterolemia were common comorbidities in older patients with COVID-19 and these comorbidities were often associated with worse clinical outcome.Previous studies also showed that vitamin D deficiency was associated with diabetes and dyslipidaemia[6,7].Unfortunately,about 30%-50% of people in the world have vitamin D deficiency or insufficiency,and vitamin D deficiency has been a global health problem[8].Singhet al[3]reviewed the evidence of vitamin D deficiency in patients with diabetes and COVID-19,and they proposed that diabetes increased the tendency for infection and COVID-19,vitamin D deficiency was linked to both diabetes and an increased risk of infections,including COVID-19,and vitamin D supplementation may be a safe,cheap,and simple adjuvant therapy in patients with diabetes and COVID-19.Verdoiaet al[4]reviewed the mechanisms of action of vitamin D and its potential interaction with SARS-CoV-2 infection,and they reported that vitamin D plays an important protective role in the cardiovascular system,immune system,respiratory system,and glucose-lipid metabolism.Therefore,we hypothesize that vitamin D status has prognostic significance in diabetes and dyslipidaemia,and vitamin D supplementation could exert a triple preventive and therapeutic effect in patients with diabetes,dyslipidaemia,and COVID-19.

In summary,diabetes and dyslipidaemia are common comorbidities in patients with COVID-19.Patients with diabetes and dyslipidaemia are more prone to SARS-CoV-2 infection,and they have poor clinical outcomes.Vitamin D may be a potential prognostic factor and could be a promising preventive measure and treatment for patients with diabetes,dyslipidaemia,and COVID-19.Notably,hypervitaminosis D is a rare but potentially serious condition,and it should be avoided when recommending fat-soluble vitamin D supplementation in the era of COVID-19[9].Certainly,more robust studies are still required to ascertain the prognostic significance and one-arrow three-vulture effect of vitamin D in patients with diabetes,dyslipidaemia,and COVID-19.

ACKNOWLEDGEMENTS

We thank all colleagues,the reviewers,and the editors for improving our paper.

FOOTNOTES

Author contributions:Wang MK wrote the draft;Yu XL,Zhou LY,Si HM,and Hui JF collected the literature;Wang MK and Yang JS conceptualized the article and revised the manuscript;all authors have read and approved the final manuscript.

Supported byMajor Construction Program of Military Key Disciplines during the 13th Five-Year Plan Period,No.2020SZ21-15.

Conflict-of-interest statement:The authors declare that they have no conflict of interest to disclose.

Open-Access:This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers.It is distributed in accordance with the Creative Commons Attribution NonCommercial(CC BYNC 4.0)license,which permits others to distribute,remix,adapt,build upon this work non-commercially,and license their derivative works on different terms,provided the original work is properly cited and the use is noncommercial.See: https://creativecommons.org/Licenses/by-nc/4.0/

Country/Territory of origin:China

ORClD number:Ming-Ke Wang 0000-0001-9918-0491;Xue-Lu Yu 0000-0002-8527-2093;Li-Yun Zhou 0000-0003-1413-8679;Hong-Mei Si 0000-0003-1175-6594;Ju-Fen Hui 0000-0001-7816-0635;Ji-Shun Yang 0000-0001-7160-706X.

S-Editor:Liu JH

L-Editor:Wang TQ

P-Editor:Liu JH