Micronutrient deficiencies, such as low vitamin D and magnesium, are alarmingly common in people with type 2 diabetes, affecting nearly half globally
Women and those in the Americas are at higher risk, and the study underscores the importance of addressing not just energy metabolism but also overall nutrition. Researchers call for targeted interventions and further studies to explore the causes and solutions to these deficiencies.
Micronutrient Deficiency in Type 2 Diabetes
Micronutrient deficiencies, where levels of essential vitamins and minerals are too low for proper bodily function, are commonly found in people with type 2 diabetes, according to a pooled data analysis published today (January 28) in the journal BMJ Nutrition, Prevention & Health.
The analysis highlights vitamin D as the most commonly deficient micronutrient, with women at greater risk than men. These deficiencies, often referred to as “hidden hunger,” pose a significant health challenge.
Researchers explain that type 2 diabetes is influenced by factors such as genetic predisposition, environmental conditions, sedentary lifestyles, unhealthy diets, and obesity. Previous studies suggest that micronutrients play a critical role in the disease’s development, potentially impacting glucose metabolism and insulin signaling pathways.
Exploring Global Data on Micronutrient Deficiencies
To estimate the global prevalence of micronutrient deficiencies in people with type 2 diabetes, researchers reviewed databases to identify relevant studies and pooled the available data for analysis.
The final analysis included 132 studies involving 52,501 participants, published in multiple languages between 1998 and 2023. Nearly all the studies (except for three) were conducted in hospital settings.
The analysis revealed that 45% of people with type 2 diabetes globally have micronutrient deficiencies (vitamins, minerals, and electrolytes), with the prevalence slightly lower (40%) among those with diabetes-related complications. Regional differences were attributed to varying dietary habits, lifestyle factors, and cultural practices.
Vitamin D deficiency was the most common, affecting 60.5% of individuals with type 2 diabetes. Magnesium deficiency was also widespread, affecting 42%, while iron deficiency impacted 28%. Vitamin B12 deficiency was reported in 29% of participants and was even more frequent among those taking metformin.
Regional and Gender Differences in Deficiency Rates
Further stratification of the pooled data showed that prevalence was higher in women with the condition than in men at nearly 49%, and highest among patients in the Americas (54%).
Most of the included studies were cross-sectional, making it difficult to establish causality, nor was it clear whether the micronutrient deficiency preceded poor glycaemic control or was a consequence of it, caution the researchers.
And as there are no valid population-based studies looking at micronutrient deficiency, it’s impossible to draw comparisons between patients with type 2 diabetes and the general population, they add.
Implications for Research and Policy
“This systematic review exemplifies the double burden of malnutrition in action, whereby nutritional deficiencies and diet-related non-communicable diseases, such as type 2 diabetes, co-exist,” comments Shane McAuliffe, Visiting Senior Academic Associate, NNEdPro Global Institute for Food, Nutrition and Health, which co-owns the journal.
“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 optimizing overall nutrition should always be a priority.
“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.”
Reference: “Burden of micronutrient deficiency among patients with type 2 diabetes: systematic review and meta-analysis” by Daya Krishan Mangal, Nida Shaikh, Himanshu Tolani, Diksha Gautam, Anuj Kumar Pandey, Yeshwanth Sonnathi, Shiv Dutt Gupta, Sanjay Kalra, Kamlesh Chand Sharma, Jagdish Prasad, Rajeev Tewari and Fahmina Anwar, 28 January 2025, BMJ Nutrition Prevention & Health.
DOI: 10.1136/bmjnph-2024-000950
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4 Comments
100% right for type 2 diabetic including related, no doctor advised & focused on vitamin intake and diet but focused only increased or decreased the medicine only instead to aware the patient about its diet plan.
Interesting data. That said, the researchers make an unnecessary assumption, that deficiencies are a direct result of malnutrition.
The most common deficiency they found was Vitamin D. Low levels of vitamin D can be caused by illness, and not necessarily the reverse. Obesity is a common risk factor for diabetes, and obesity also strongly correlates with a vitamin D deficiency. Advanced age also correlates with diabetes and lower vitamin D levels. Also, metformin seems to block B12 absorption, which is used to treat diabetes, so deficiencies can be caused by the treatment. Overnutrition is also a known cause of diabetes (type 2), and it can be hard to increase serum levels of a nutrient when intake is already too high. Prescribing supplements or better nutrition may not actually address the cause of the deficiency, as absorption may be the problem, or competing supplements (eg. zinc versus copper), or food or supplement quality (eg. vitamin D2), or disease, or treatment of the disease, or even genetic differences.
Instead of the focus on nutrition, I think this metastudy has made an excellent argument for testing individual patients for deficiencies. I think I’ve made a good case for testing nutrient levels after any intervention.
Older generations, especially those away from beaches, commonly do less sunbathing as they age. Plus, many tend to avoid excess sun exposure as their skin sensivity changes. Also, many are lactose-intolerant, or age into such sensitivity, so that fortified milk is not in their diet. Your spot-on overnutrition notion is about an ambient risk as the vitamin supplement industry markets high dose versions, as if more is better. Vitaminosis, a negative result of excess vitamins and/or minerals, can be a serious health threat, especially for the elderly and those with weakened health. Full-panel blood testing should be a regular part of health monitoring.
As we get older we need to use supplements as we develop certain illnesses and we have to avoid our usual food sources it is totally appropriate to add some chromium and zinc and other micronutrients to your diet don’t expect your doctor to tell you this you have to tell your doctor that’s what you’re doing and then quota Journal ask him if he’s read it