Why Type 2 diabetes patients need more than just blood sugar monitoring

By Vijay Kumar MalesuReviewed by Susha Cheriyedath, M.Sc.Jan 28 2025

New research reveals that hidden hunger—deficiencies in key vitamins and minerals—is silently worsening Type 2 diabetes, affecting nearly half of patients worldwide. What does this mean for diabetes care and prevention?

Study: Burden of micronutrient deficiency among patients with type 2 diabetes: systematic review and meta-analysis. Image Credit: Halfpoint / Shutterstock

In a recent study published in the journal BMJ Nutrition, Prevention & Health, a group of researchers estimated the burden of micronutrient deficiencies in patients with Type 2 Diabetes Mellitus (T2DM) and identified key patterns across demographics and geographic regions.

Background

Did you know that nearly half of individuals with T2DM lack essential vitamins and minerals like vitamin D and magnesium, which are critical for blood sugar regulation and insulin function? Despite this alarming reality, most patients remain unaware of these deficiencies.

Urbanization, sedentary lifestyles, and the prevalence of processed diets have only worsened the crisis. For instance, individuals heavily reliant on fast food often miss out on crucial nutrients, intensifying diabetes-related complications. Micronutrient deficiencies (MNDs) are a silent epidemic, undermining metabolic health and quality of life. Yet, the broader burden of MNDs among T2DM patients remains underexplored, with most research narrowly focusing on single nutrients.

As global diabetes rates surge and lifestyle diseases dominate healthcare agendas, uncovering the true scale of this issue has never been more urgent. Emerging evidence indicates that micronutrient deficiencies may disrupt glucose metabolism and insulin signaling pathways, further contributing to the onset and progression of T2DM. Addressing these deficiencies is needed to improve disease management, prevent complications, and enhance millions of lives worldwide.

About the study

This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted across databases such as PubMed, Scopus, and Cochrane Library for studies published between 1998 and 2023.

Studies were included if they assessed the prevalence of micronutrient deficiencies among individuals aged 18 years or older with T2DM. Eligible study designs encompassed cross-sectional and cohort studies. Studies focusing on gestational diabetes, Type 1 diabetes, or individuals younger than 18 were excluded. Data extraction was performed using a standardized sheet capturing study characteristics, participant demographics, and prevalence data.

Statistical analyses were conducted using R software (version 4.3.2), applying a random-effects model to pool prevalence rates. Heterogeneity was evaluated using the I-squared statistic, while publication bias was assessed with Egger’s test. Subgroup analyses were carried out to explore differences by sex, geographic region, and presence of diabetes-related complications. Sensitivity analyses were performed to ensure the accuracy of the results. Notably, the researchers highlighted the inherent limitations of hospital-based studies, which could overestimate prevalence rates due to selection bias.

Diagnostic criteria for micronutrient deficiencies varied among studies, but consistency in measurement units was maintained during data synthesis.

Study Results

The systematic review analyzed 132 studies encompassing data from 52,501 participants. The pooled prevalence of multiple micronutrient deficiencies among T2DM patients was 45.3% (95% confidence interval [CI]: 40.35% to 50.30%). Deficiencies were more prevalent in women (48.62%, 95% CI: 42.55% to 54.70%) compared to men (42.53%, 95% CI: 36.34% to 48.72%). Vitamin D deficiency emerged as the most common, affecting 60.45% (95% CI: 55% to 65%) of patients. Magnesium deficiency was the second most prevalent at 41.95% (95% CI: 27% to 56%). Among metformin users, vitamin B12 deficiency was notably higher (28.72%, 95% CI: 21.08% to 36.37%) compared to the general T2DM population.

Geographically, the prevalence of MNDs varied across World Health Organization (WHO) regions. The Americas reported the highest prevalence (54.04%, 95% CI: 35.03% to 72.48%), followed by Southeast Asia (49.73%, 95% CI: 38.88% to 60.60%). Hospital-based studies consistently reported higher prevalence rates (46%, 95% CI: 41% to 51%) compared to community-based studies (22%, 95% CI: 6% to 46%), underscoring potential selection bias. The absence of large, population-based studies makes it difficult to compare prevalence rates between T2DM patients and the general population. Furthermore, subgroup analyses revealed that T2DM patients with complications had a higher prevalence of MNDs (40%, 95% CI: 29.38% to 50.28%).

Meta-regression analyses identified a slight upward trend in MND prevalence over time, particularly for vitamin D and B12, although these trends were not statistically significant. Funnel plots and Egger’s test confirmed the presence of publication bias, but sensitivity analyses validated the overall accuracy of the pooled estimates. Despite considerable heterogeneity among studies (I-squared = 99%), consistent patterns across subgroups underscored the widespread nature of this issue. Variability was attributed to differences in diagnostic criteria, population characteristics, and dietary patterns across regions.

Conclusions

The findings underscore a high burden of MNDs among T2DM patients, with nearly half experiencing deficiencies in essential nutrients like vitamin D and magnesium. Women and those with diabetic complications are particularly vulnerable. These deficiencies not only exacerbate disease progression but also contribute to long-term complications, emphasizing the need for targeted interventions.

Geographic variations highlight the influence of regional dietary habits and healthcare disparities, suggesting the need for culturally tailored nutritional policies. In addition, future research must focus on well-designed, population-based studies to provide generalizable data and clarify causality between micronutrient deficiencies and T2DM progression. Given the predominance of hospital-based studies, future research should include community-based cohorts to enhance generalizability. Policymakers, clinicians, and researchers must prioritize addressing MNDs as part of comprehensive diabetes care to mitigate the growing burden of T2DM.