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Despite promising results from previous observational studies, a major new study suggests that taking a vitamin D supplement does not reduce the risk of type 2 diabetes. Researchers investigated the impact of higher levels of diabetes. high than usual vitamin D on the onset of type 2 diabetes in adults with a sufficient level of vitamin D and at risk of contracting the disease.
The vitamin D and type 2 diabetes study, dubbed D2d, was published in June 2019 in The New England Journal of Medicine (NEJM)And the authors presented their findings at the 79th Scientific Session of the American Diabetes Association (ADA) at the Moscone Convention Center in San Francisco.
"You can be sure that for an American population, taking vitamin D will not reduce the risk by 25% or more," said Myrlene A. Staten, MD, scientist of the D2d project of the National Institute of diabetes, digestion and kidneys. Diseases (NIDDK), which funded the study.
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The study, the largest clinical study ever devoted to the effects of vitamin D supplementation on the onset of diabetes, targeted a large number of people at risk for type 2 diabetes. According to the study's authors, More than 84 million Americans – about 1 in 3 people over the age of 20 – are at risk of developing diabetes. In recent years, experts have explored various approaches to reduce or delay the onset of the disease.
Researchers started D2d because of previous observational studies, including one published in December 2014 in the journal Diabetic treatments, Which suggests that a low level of vitamin D is badociated with a range of health problems, including diabetes. According to the authors, the recommended daily intake (RDA) for vitamin D is 600 international units (IU) per day for adults up to the age of 70 and 800 IU per day for older adults. However, nutrients are generated in the body during sun exposure and many people are not adequately exposed to the sun to avoid becoming deficient.
"Observational studies are important for generating hypotheses and ideas about what could be," says Dr. Staten. "But many factors can affect the observational studies.There is no way of knowing if changing the levels – giving them a vitamin D pill will make a difference.You must confirm the studies of observation with controlled trials. "
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Why D2d was a different type of study on vitamin D and type 2 diabetes
The researchers designed D2d to thoroughly examine the utility of vitamin D supplementation via the reference research format: the randomized clinical trial. By launching the study in 2013, researchers recruited 2,423 people at risk for diabetes, a definition based on compliance with at least two of the three glycemic criteria. They randomly badigned participants to a daily pill of 4,000 IU vitamin D or a placebo pill. Then they followed subjects for diabetes development for two to five years and underwent blood tests every six months. The researchers recommended participants to avoid taking any other medication specific to diabetes or for weight loss.
The researchers designed this study to detect a 25% or greater reduction in the risk of developing diabetes badociated with vitamin D, but they did not observe any such reduction. Fewer people taking the vitamin D supplement developed diabetes compared to the placebo group – 24.2% versus 26.7% – but this difference was not statistically significant.
"The D2d trial was a randomized, well-conducted controlled trial that addressed an important hypothesis in diabetes prevention," states Deborah J. Wexler, MD, the author of a commentary on the ############################################################################ Study, also published in June 2019 in The New England Medical Journal. Dr. Wexler, who did not participate in the study, is an badociate professor of medicine at Harvard Medical School and clinical co-director of the Mbadachusetts General Hospital Diabetes Center in Boston. "The potential benefit of vitamin D for the prevention of diabetes, if it exists, is modest and obviously does not relate to a population rich enough in vitamin D."
The ability of vitamin D supplementation to prevent the onset of type 2 diabetes in this study may be due to the large number of people participating in the trial who already had sufficient levels of vitamin D, report the authors.
"If you are deficient in vitamin D, you must take vitamin D to reach a sufficient level," said Staten.
"Our trial suggests that diabetes can be avoided if you are deficient, but we can not be firm in this result, which is a very sweet conclusion."
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The data also hinted that vitamin D supplementation could confer a lower level of risk, such as a 10% reduced risk, according to Staten. "The test was designed to detect a 25% reduction," said Staten, adding that it was possible for vitamin D to lower the risk of diabetes by a lower percentage, although the team did not did not do any such test.
The D2d results were not totally surprising. A review published in October 2014 in the Journal of Clinical Endocrinology & Metabolism studied studies comparing the effect of vitamin D supplementation with placebo or non-vitamin D supplement in adults with normal blood glucose, prediabetes or type 2 diabetes, and found that no effect of vitamin D supplementation on blood sugar or diabetes prevention.
What to know if you are looking to help prevent type 2 diabetes
At the moment, people at risk for diabetes can adopt proven lifestyle modification practices, such as following a healthy diet and exercising regularly, to reduce their risk, said Wexler in the report. NEJM comment. A healthy diet is rich in fresh, whole foods, rich in nutrients and low in processed foods, packed and high in saturated or trans fats, added sugars and sodium, notes the National Institute of Diabetes and Digestive Diseases. kidney. With regard to exercise, experts recommend a combination of strength training and cardiovascular exercise, equal to at least two hours and 30 minutes a week, according to the Department of Health and Human Services.
The Centers for Disease Control and Prevention (CDC) note that the Diabetes Prevention Program is a very effective public-private partnership aimed at helping people at risk of type 2 diabetes to avoid developing the disease through modifiable risk factors, such as diet and exercise.
"In the diabetes prevention program, the risk of progression to type 2 diabetes over 2.8 years was 58% lower with a lifestyle intervention compared to placebo and 31% with metformin." compared to placebo, with a similar size treatment. as in the D2d test, "writes Wexler.
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Vitamin D research will continue, however. D2d researchers are studying the role of vitamin D in the way the body uses and creates insulin, as well as its impact on other conditions, such as heart disease and cancer.
"There are other disciplines that look at these kinds of results," says Staten. "Maybe we did not have a major effect, but who knows for them?"
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