A recent study has revealed that nearly half of all patients with type 2 diabetes (T2D) experience micronutrient deficiencies, with women experiencing these deficiencies more frequently than men and the situation being particularly alarming in the Americas, the researchers said.
Previous studies have reported varying prevalence rates of micronutrient deficiencies in patients with T2D, posing a significant challenge for physicians and policymakers in formulating nutritional recommendations for diabetes management.
Medscape reports that for the latest findings, the researchers conducted a meta-analysis of studies published in several languages between 1998 and 2023 to estimate the prevalence of micronutrient deficiencies in patients with T2D.
Results of the study, which was led by Daya Krishan Mangal, International Institute of Health Management Research University, Jaipur, India, were published in BMJ Nutrition, Prevention & Health.
Vitamins
Patients with T2D (age, ≥ 18 years) of all sexes and ethnicities and with or without complications were included, and the analysis was performed on cross-sectional, longitudinal, and cohort studies as well as randomised controlled trials.
Deficiencies of minerals or electrolytes and vitamins (A, B complex, C, D, E, and K) were assessed.
Subgroup analyses examined variations in the prevalence of micronutrient deficiencies across sexes, diabetic complications, hospital vs community settings, and World Health Organisation (WHO) regions including the Americas, Europe, the Eastern Mediterranean Region, Southeast Asia, the Western Pacific Region and Africa.
They identified 132 datasets from 127 eligible studies (including 52 501 patients in total).
Among patients with T2D, the pooled prevalence of micronutrient deficiency was 45.30%, with notable heterogeneity observed among the studies; among those with diabetic complications, 40% had micronutrient deficiency.
A sex-specific analysis (62 studies for men and 63 for women) showed that the prevalence of micronutrient deficiency was slightly lower in men than in women (42.53% vs 48.62%, respectively). Additionally, among specific nutrients, the prevalence of deficiency was highest for vitamin D (60.45%; 66 studies), followed by magnesium (41.95%; 16 studies), iron (27.81%; three studies), and vitamin B12 (22.01%; 34 studies).
The prevalence of micronutrient deficiency varied across WHO regions, they reported, with the highest prevalence found in the Americas (54.04%).
“The treatment of type 2 diabetes often tends to focus on energy metabolism and macronutrients, but the identification of a higher prevalence of specific micronutrient deficiencies in those affected is a reminder that optimising overall nutrition should always be a priority,” said Shane McAuliffe, a visiting senior academic associate, NNEdPro Global Institute for Food, Nutrition and Health.
“The findings should help to focus research and policy initiatives aimed at furthering our understanding of the causes and effects of these deficiencies and the potential for targeted and tailored interventions,” he added.
Limitations
Most studies were hospital-based, with inherent selection bias, which limited generalisability to the broader population. The cross-sectional nature of the included studies made it challenging to establish causality between micronutrient deficiency and poor glycaemic control.
None of the studies evaluated the effect of various confounding factors arising from place, person, and time distribution of patients with T2D.
Study details
Burden of micronutrient deficiency among patients with type 2 diabetes: systematic review and meta-analysis
Daya Krishan Mangal, Nida Shaikh, Himanshu Tolani et al.
Published in BMJ Nutrition, Prevention & Health on 29 January 2025
Abstract
Background
Micronutrient deficiencies are a significant issue worldwide, particularly in South Asia and sub-Saharan Africa. These deficiencies can impact glucose metabolism and insulin signalling pathways, potentially leading to the beginning and advancement of type 2 diabetes (T2D). This study is a comprehensive assessment of the burden of multiple micronutrient deficiencies among T2D patients. The aim of the study is to resolve conflicting evidence from previous studies that mainly focused on one specific micronutrient.
Methods
The systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines and the Cochrane Handbook. This comprehensive literature search explored Embase, ProQuest, PubMed, Scopus, Cochrane Library, Google Scholar, LILACS and the grey literature, and studies that met the inclusion criteria. A pre-piloted data extraction sheet was used to extract data for relevant study outcomes and characteristics. Results were produced by R V.4.3.2 (R Core Team 2023 using general packages such as tidyverse, and specific packages such as meta and metafor.
Results
The analysis included 132 studies with 52 501 participants. The pooled prevalence of multiple micronutrient deficiency (vitamins, minerals and electrolytes) was 45.30% (95% CI 40.35% to 50.30%) among T2D patients. The pooled prevalence (48.62%, 95% CI 42.55 to 54.70) was higher in women with T2D than in men. Vitamin D was the most prevalent micronutrient deficiency (60.45%, 95% CI 55% to 65%), followed by magnesium (41.95%, 95% CI 27% to 56%). B12 deficiency (28.72%, 95% CI 21.08% to 36.37%) was higher in the metformin consuming group. The prevalence of micronutrient deficiency varied across WHO regions.
Conclusion
Micronutrient deficiencies were common in T2D patients, the most common being vitamin D deficiency. Women were more likely to be affected by micronutrient deficiency than men. These studies were hospital based and the findings of this systematic review may be used with caution due to inherent selection bias. Diversity of foods, lifestyle choices and cultural practices may contribute to geographic variations in micronutrient deficiency.
Medscape article – Around 50% Diabetes Patients Face Micronutrient Deficiency (Open access)
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