الفهرس 
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Abstract
Vitamin D deficiency is a significant public health problem with great effects and multiple health impacts (skeletal and extra-skeletal) it is related to multiple chronic diseases, such as cognition, depression, osteoporosis, cardiovascular disease, hypertension, diabetes, and cancer.
Vitamin D deficiency and insufficiency are the most common features in type Summary 2 diabetes mellitus (T2DM) patients. Also, some researchers suggest that vitamin D deficiency is an important element of DKD. Relation between DM and VDD has been recorded from many observational studies, The main pathophysiologic mechanisms that connect between VDD and DM are dysregulation of pancreatic beta-cell function, impaired insulin sensitivity (insulin resistance), and increased systemic inflammation.
Vitamin D improves β cell function; insulin sensitivity/secretion and glucose tolerance thus reducing the risk of DM-related morbidity and mortality. Evidence suggesting a role of vitamin D in glucose homeostasis and insulin secretion are VDR presence on β cells and skeletal muscle, VDR responsive element in human insulin gene promoter, and expression of hydroxylase enzyme.
Vitamin D protects the kidney from injury caused by hyperglycemia. In patients with DKD vitamin D are very low due to the decrease in the synthesis and activity of 1-α hydroxylase in the proximal tubule cells and the decrease in the vitamin D receptor abundance.
This study aimed to evaluate the association between two VDR SNPs (FokI, ApaI) and vitamin D deficiency in Egyptian diabetic patients with T2DM and diabetic nephropathy receiving either conservative treatment or regular hemodialysis and their relation to vitamin D level, blood glucose, and kidney function.
group I (DM): included 75 type 2 diabetic patients (DM) males only, group II (DN): included 75 patients (diabetic nephropathy males only), group III (HD): included 75 patients (type 2 diabetic males with ESRD) under regular hemodialysis (HD) treatment.
The levels of blood glucose, renal markers, lipid profile, and vitamin D level were investigated.
This current study indicated that:
- Vitamin D deficiency was highly prevalent in our Egyptian patients with T2DM.
- All cases with DM, DN, and HD showed a statistically significant difference from the control group regarding FokI & ApaI polymorphic genotypes (P<0.05).
- Vitamin D has a large effect on insulin production and it′s deficiency increases T2DM risk disease.
- Low level of vitamin D increase the risk of insulin resistance and its progression.
- The distribution & frequency of the (ff) genotype of the FokI gene was higher in DM, DN, and HD patients compared with the control group, in contrast to (aa) genotypes were higher in the control group than in DM and DN patients.
- The (f) allele of FokI VDR polymorphism could be a risk factor for T2DM and diabetic nephropathy.
- Severity of T2DM increased FokI VDR polymorphism expression which could be a risk factor for diabetic kidney disease.
- Expression of (f) allele of FokI VDR polymorphism increased serum vitamin D level although, the expression of (a) allele of ApaI VDR polymorphism had no effect on serum vitamin D level.
- The (a) allele of ApaI VDR polymorphism could be a protective factor for Egyptian from T2DM and diabetic nephropathy.
- Severity of T2DM decreased (a) allele expression of ApaI VDR polymorphism which could be a protective factor from T2DM disease.
- Vitamin D had a negative correlation with blood glucose levels, kidney function parameters, and serum lipid profile except HDL-c, eGFR, and total calcium which increased in a high serum vitamin D level