Vitamin D supplementation linked to halted diabetes progression
CHICAGO — Vitamin D supplementation in patients with prediabetes produced a decrease in the rate of progression to type 2 diabetes and increased the rate of return to normoglycemia, according to a presenter at the joint meeting of the International Congress of Endocrinology and the Endocrine Society.
“Looking at the Bloomberg map of vitamin D deficiency, India along with China have a very high prevalence of vitamin D deficiency and in India, specifically, 70% to 80% of our population are vitamin D deficient. Incidentally, the IDF map of diabetes show that these two countries constitute the diabetes capital of the world,” Deep Dutta, MD, DM, DNB, from the Institute of Post Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, in Calcutta, West Bengal, India, said during a presentation. “Our experience suggests that in our population, indeed vitamin D supplementation in prediabetes was beneficial in improving glycemic outcomes and we also observed an improvement in the inclement cytokine parameters.”
Dutta presented data on 136 individuals with impaired fasting glucose and glucose tolerance over the course of two OGTT tests, but without severe comorbidities.
The participants were randomized to three treatment groups. Those with serum 25 hydroxyvitamin D (25-[OH]D) ≤30 ng/ml were randomized to either Group A (n=55) where they received vitamin-D (60,000 U once weekly for 8 weeks, then monthly) and calcium (1,250 mg of calcium carbonate/day) supplementation or Group B (n=49) who received calcium monotherapy. Those with serum 25-(OH)D >30 ng/ml were also followed with calcium supplementation and formed Group C (n=32). Dutta presented more than 2 years of follow up in each group.
The data showed significant correlation between 25-(OH)D and insulin resistance (r=–0.42; P=.004), tumor necrosis factor-alpha (TNF-alpha; r=–0.31; P=.03) and C-reactive protein (r=–0.31; P=.03), after adjustment for BMI.
After follow-up and Cox regression analysis, Dutta said Group A had higher serum 25-(OH)D (P<.001), lower FPG (P=.023), TNF-alpha (P=.002) and interleukin-6 (P=.0005) as compared to Group B and Group C. Group A showed a lower level of progression from prediabetes to diabetes (6/55 vs. 13/49; P=.04) and a greater level of return to normoglycemia (23/55 vs. 10/49; P=.02). This significance did not persist after analyzed with Kaplan-Meier, though the trend did.
Cox regression analysis also pointed to 25-(OH)D and the 2-hour OGTT as independent predictors of progression to diabetes (P=.049 and P=.014, respectively) while hypertension and baseline 25-(OH)D predicted a return to normoglycemia (P=.043 and P=.046, respectively).
“There is urgent need for a large, multicenter trial in India similar to the [Diabetes Prevention Program] underway in the US,” Dutta said.
For More Information: Dutta D. Abstract OR13-5. Presented at: The joint meeting of the International Congress of Endocrinology and the Endocrine Society; June 21-24, 2014; Chicago.
Disclosures: Dutta reports no relevant financial relationships.