Vitamin-D Supplementation in Prediabetes Reduced Progression to type2 Diabetes through Decreased Insulin Resistance and Systemic Inflammation: An Open Label Randomized Prospective Study from Eastern India

Presentation Number: OR13-5
Date of Presentation: June 21st, 2014

Deep Dutta*1, Samim Ali Mondal2, Indira Maisnam2, Satinath Mukhopadhyay3 and Subhankar Chowdhury2
1Institute of Post Graduate Medical Education & Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Calcutta, West Bengal, India, 2Institute of Post Graduate Medical Education & Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Calcutta, India, 3Institute of Postgraduate Medical Education & Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Calcutta, India

Abstract

Objective:

Indian individuals with prediabetes (IPD) have one of the highest rates of progression (≈18% per year) to type2 diabetes (T2DM). Since vitamin-D deficiency has been linked to prediabetes, we aimed to evaluate role of vitamin-D supplementation on progression to T2DM and/ or reversal to normoglycemia in IPD.

Methods:

IPD with persistent impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) over 2 oral glucose tolerance test (OGTT), without any severe co-morbid state or drug intake, having serum 25-OH-vitamin-D (25OHD) ≤30ng/ml were randomized into Group-A [received vitamin-D (cholecalciferol 60,000 U once weekly for 8 weeks then monthly) and calcium (1250mg of calcium carbonate/day equivalent to elemental calcium 500mg) supplementation] and Group-B (received calcium only). IPD with serum 25OHD>30ng/ml were also followed with calcium supplementation (Group-C). All received therapeutic lifestyle modification. OGTT, insulin, 25OHD, lipids, interleukin-6 (IL6), tumor necrosis factor-α (TNF-α) and hsCRP were done at baseline and annually. Data from IPD with at least 1-year follow up were analyzed.  The trial is registered with clinical trial registry of India at ctri.nic.in (CTRI/2011/091/000192).

Results:

1946 individuals were initially screened, of which 498 underwent OGTT-1 and 301 underwent OGTT-2. 125 out of 170 finally included IPD (73.52%) had 25OHD ≤30ng/ml. Mean follow-up in Group-A (n=55), B (n=49) and C (n=32) was 28.2±8.83, 29.15±7.69 and 27.51±7.8 months respectively. 25OHD had significant correlation with HOMA2-IR (r=-0.42; P=0.004), TNFα (r=-0.31; P=0.03) and hsCRP (r=-0.31; P=0.03), after adjusting for BMI.

At the end of study, Group-A IPD had significantly higher serum 25OHD (p<0.001), lower FBG (p=0.023), 2hPGBG (p<0.001), TNFα (p=0.002) and IL-6 (p=0.0005) as compared to Group-B and C. Group-A IPD as compared to Group-B had significantly lower progression to diabetes (6/55 vs. 13/49; P=0.04), and higher reversal to normoglycemia (23/55 vs. 10/49; P=0.02). Cox regression revealed baseline 25OHD [Exp(B)=0.921; P=0.049] and 2hPGBG [Exp(B)=1.033; P=0.014] independently predicted progression to diabetes. Hypertension [Exp(B)=0.416; P=0.043] and baseline 25OHD [Exp(B)=1.054; P=0.046] predicted reversal to normoglycemia.

Conclusion:

Vitamin-D supplementation in IPD decreased the rate of progression to diabetes and increased reversal to normoglycemia, presumably by an improvement in IR and systemic inflammation.

 

Nothing to Disclose: DD, SAM, IM, SM, SC