ArticleFrontiers in endocrinology2026
25-hydroxyvitamin D and the initial presentation of pediatric type 1 diabetes: associations with ketoacidosis severity and beta-cell function.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: This retrospective chart review investigated the relationship between 25-hydroxyvitamin D levels and the initial clinical and biochemical presentation of type 1 diabetes mellitus (T1DM) in children under 18 years of age, specifically: (1) presence or absence of diabetic ketoacidosis and the severity of diabetic ketoacidosis (DKA) - among those with DKA, and (2) beta-cell function. Methods: This study included 99 children with new-onset Type 1 Diabetes Mellitus (T1DM). Patients were diagnosed at our pediatric endocrinology practice at Northwell Health between June 2023 and February 2025. A diagnosis of T1DM at the time of presentation was confirmed by the presence of at least one positive diabetes-specific autoantibody, and all included patients were required to have a 25-hydroxyvitamin D level measured within two days of presentation. Data extracted from the electronic health record included demographics, 25-hydroxyvitamin D levels at diagnosis, hemoglobin A1C, measures of DKA severity (pH, bicarbonate, beta-hydroxybutyrate, and DKA severity categorization), and beta-cell function (insulin and C-peptide levels). Statistical analyses included univariate tests, Spearman correlations, and multivariable logistic regression adjusting for race, ethnicity, and insurance status. Results: Among 99 patients (mean age 10.3 ± 4.4 years, 50.5% female), 53.5% presented in DKA. After adjusting for race, ethnicity, and insurance status, higher 25-hydroxyvitamin D levels were significantly associated with less severe acidosis, showing moderate positive correlations with pH (rho=0.44, p<0.0001) and bicarbonate (rho=0.42, p<0.0001), and a weak negative correlation with beta-hydroxybutyrate (rho=-0.28, p=0.01), indicating higher 25-hydroxyvitamin D levels were associated with less severe acidosis. There was a significant association between 25-hydroxyvitamin D levels and presentation in DKA; each one-unit increase in 25-hydroxyvitamin D was associated with a 6% decrease in the odds of presenting in DKA (OR: 0.94, 95% CI: 0.89-0.99, p=0.03). 25-hydroxyvitamin D levels were significantly associated with DKA severity (p=0.01), with lower levels observed in patients with more severe DKA. No significant association was found between 25-hydroxyvitamin D levels and HbA1c or markers of beta-cell function. Discussion: These findings suggest a potential protective role of 25-hydroxyvitamin D against severe metabolic decompensation at T1DM onset, specifically relating to DKA, but not beta-cell function. Further research is needed to confirm these findings and explore the potential mechanisms and clinical implications.
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