A lack of essential vitamins and minerals is common in people with type 2 diabetes, with Vitamin D being the most common ‘missing’ nutrient, a new study has found.
The findings, published in BMJ Nutrition Prevention & Health, show that 45 per cent of people with type 2 diabetes suffer from a micronutrient deficiency. Women and patients taking metformin are at greater risk of these deficiencies, termed ‘hidden hunger’ by the research team.
Micronutrient deficiencies are a global issue that can impact glucose metabolism and insulin signalling pathways, potentially leading to the onset and advancement of type 2 diabetes. This study builds on previous work that concentrated on specific micronutrients to understand the global prevalence of deficiencies in all micronutrients.
The researchers undertook a systematic review and meta-analysis of 132 studies involving 52,501 participants, published between 1998 and 2023. Except for three, all of the studies were hospital-based.
Micronutrient deficiencies
The pooled analysis suggested that micronutrient deficiencies, including a lack of vitamins, minerals, and electrolytes, are common among people with type 2 diabetes. Overall, 45 per cent of type 2 diabetes patients experienced micronutrient deficiencies, with women and metformin users being the most commonly affected.
Vitamin D was deficient in 60 per cent of people with type 2 diabetes and was the most common missing micronutrient, followed by magnesium and iron, which were lacking in 42 per cent and 28 per cent of participants, respectively.
The global prevalence of B12 deficiency was 29 per cent, and higher among patients taking metformin for their diabetes.
‘Hidden hunger’
The researchers suggest that the prevalence of ‘hidden hunger’ varied worldwide and was most likely linked to variations in dietary habits, lifestyle choices, and cultural practices. Among nations, America had the highest prevalence of missing micronutrients, with 54 per cent of the type 2 diabetes population lacking essential vitamins and minerals.
Most of the studies in the review were cross-sectional, making causality difficult to establish. It is currently unclear whether a micronutrient deficiency precedes the onset of type 2 diabetes or is a result of the condition. The researchers also suggest further research is necessary since the review was primarily based on hospital data and may include an inherent selection bias.
‘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,’ said Shane McAuliffe, visiting senior academic associate, NNEdPro Global Institute for Food, Nutrition and Health, commenting on the review.
He added: ‘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.’
Potential for personalised intervention
The research has the potential to guide future investigations, focus policy initiatives, and further understand nutrient deficiencies. It could also aid in the development of targeted and personalised patient interventions.
Reference: Burden of micronutrient deficiency among patients with type 2 diabetes: systematic review and meta-analysis https://doi.org/10.1136/bmjnph-2024-000950
