Abstract
THE ROLE OF VITAMIN D DEFICIENCY IN PRESENCE AND SEVERITY OF DIABETIC RETINOPATHY

Prempal Kaur*, Baljinderpal Singh, Bhavkaran Singh Bal and Vishal Brar

ABSTRACT

Diabetes mellitus (DM) continues to be a tremendous health burden in the world affecting about 415 million adults which is likely to reach 642 million in 2040. It is estimated that 318 million people have impaired glucose tolerance. DM leads to significant amount of morbidity and mortality with a rate of one death every 6 seconds.[1] DM is the the second leading cause of new blindness as a result of diabetic retinopathy.[2] Though hyperglycemia ,hypertension and dyslipidemia are established risk factors but pathophysiology of retinopathy progression is still not completely understood. There is increasing evidence that vitamin D deficiency (VDD) may play a role in the pathogenesis and progression of diabetic retinopathy.(DR)[3,4] VDD is now being recognized as a major global health problem Approximately 1 billion people worldwide have VDD.[5,6] It has been reported that patients with diabetes or impaired glucose tolerance have low concentrations of circulating 25-OH vitamin D in the blood than non diabetics.[7,8] Vitamin D(VD) plays important part in glucose metabolism from direct stimulation of insulin receptors to increased uptake of glucose by peripheral tissues and improving insulin resistance. It is also necessary for normal insulin release and maintenance of glucose tolerance. thus has a significant role in onset and progression of type 2 DM.[9-12] Longer duration of diabetes, poor glycemic control and hypertension are well established strong risk factors for the development and progression of DR[13] but many recent studies have suggested significant correlation between low VD levels and prevalence of diabetic microangiopathy.[7,14,15,16] Vitamin D plays a role in the pathogenesis of diabetic retinopathy by its immunomodulatory, down regulation of renin angiotensin system, anti-inflammatory and antiangiogenic effects[17] VDD has been associated with development and progression of microvascular complications due to increased and uncontrolled angiogenesis and endothelial dysfunction[18,19] VDD has also been implicated in the development of hypertension which is an established risk factor of DR.[20] Thus it can be anticipated that vitamin D supplementation would lead to an improvement in blood sugar levels and optimum control of blood pressure which ultimately would slow the progression of retinopathy.

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