(06-03-13) Association of vitamin D deficiency with incidence of type 2 diabetes in high-risk Asian subjects1,2,3,4

1. Soo Lim,
2. Min Joo Kim,
3. Sung Hee Choi,
4. Chan Soo Shin,
5. Kyong Soo Park,
6. Hak Chul Jang,
7. Liana K Billings, and
8. James B Meigs
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Author Affiliations
1. 1From Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea (SL, MJK, SHC, and HCJ); Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (CSS and KSP); and Diabetes Research Center (LKB), General Medicine Division (SL and JBM), Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
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Author Notes
?? ↵2 SL and MJK contributed equally to this study.
?? ↵3 Supported by the National Research Foundation grant funded by the Korean government (2006-2005410), Seoul National University Bundang Hospital, and Seoul Research & Business Development program, Republic of Korea (10526). JBM was supported by the National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) K24 DK080140. LKB was supported by the Endocrine Society's Lilly Endocrine Scholar's Award, NIH Loan Repayment Award, NIDDK 1 L30 DK089944-01, and a Distinguished Clinical Scientist Award to David Altshuler from the Doris Duke Charitable Foundation.
?? ↵4 Address reprint requests and correspondence to HC Jang, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 300, Gumi-dong, Bundang-gu, Seongnam, Korea 463-707. E-mail: [email protected].
Abstract
Background: Recent studies suggest an association between 25-hydroxyvitamin D [25(OH)D] and type 2 diabetes (T2D) risk. However, prospective studies investigating the relation between vitamin D inadequacy and incidence of T2D incorporating obesity and dynamic measures of insulin resistance (IR) and pancreatic ?? cell function are limited.
Objective: We tested the hypothesis that baseline 25(OH)D is associated with the incidence of T2D in high-risk subjects for up to 5 y of follow-up, independently of obesity, baseline IR, and ?? cell function.
Design: We recruited 1080 nondiabetic Korean subjects [mean ?? SD age: 49.5 ?? 11.4 y] based on the presence of one or more risk factors for T2D, including obesity, hypertension, dyslipidemia, and/or family history of T2D. We measured anthropometric and biochemical indicators, HOMA2-IR, and the insulinogenic index (IGI; calculated as change in insulin at 30 min/change in glucose at 30 min) from a 75-g oral-glucose-tolerance test.
Results: Of the participants, 10.5% had a serum 25(OH)D deficiency (<10 ng/mL), 51.6% had an insufficiency (10.0?C19.9 ng/mL), and 38.0% had a sufficiency (??20 ng/mL), and the incidence of T2D at 32.3 ?? 15.6 mo (??SD) declined accordingly: 15.9%, 10.2%, and 5.4%, respectively (P < 0.001). After adjustment for age, sex, blood pressure, lifestyles, family history, season, parathyroid hormone, and high-sensitivity C-reactive protein, the participants with 25(OH)D deficiency had an increased risk of T2D independently of BMI, HOMA2-IR, and IGI; the HRs were 2.06 (95% CI: 1.22, 3.49) for 25(OH)D 10?C19.9 ng/mL compared with ??20 ng/mL and 3.23 (95% CI: 1.66, 6.30) for 25(OH)D <10 ng/mL compared with ??20 ng/mL.
Conclusion: The current prospective study suggests that vitamin D metabolism may play a role in T2D pathogenesis independently of known risk factors.

Source: Am J Clin Nutr March 2013 vol. 97 no. 3 524-530

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