Study: Vitamin D and calcium combination may prevent Type 2 diabetes
CHICAGO — Vitamin D and calcium supplementation along with diet and exercise may prevent Type 2 diabetes in prediabetic individuals who have insufficient vitamin D in their bodies, a study from India suggests. The results were presented Saturday at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago.
Vitamin D deficiency has been linked to prediabetes, which is a blood-glucose, or sugar-, level that is too high, but not high enough to be considered diabetes. It is unclear, however, if bringing low vitamin D blood levels to normal through supplementation will affect progression to diabetes.
In the new study, every unit increase in vitamin D level after supplementation of the vitamin decreased the risk of progression to diabetes by 8%, the authors reported.
“Without healthy lifestyle changes, nothing works to prevent diabetes in at-risk individuals,” said the lead author, Deep Dutta, a research officer at the Institute of Postgraduate Medical Education & Research and Seth Sukhlal Karnani Memorial Hospital in Calcutta, India. “However, our results are encouraging because the addition of vitamin D and calcium supplements is easy and low in cost.”
“If our results are confirmed in a large multicenter trial,” Dutta said, “vitamin D supplementation would provide us with a new tool in the armamentarium of diabetes prevention strategies.”
The West Bengal chapter of the Research Society for the Study of Diabetes in India funded this study. Of 170 individuals with prediabetes who had not taken vitamin D supplements in the past six months, 125 had vitamin D deficiency or insufficiency, which the researchers defined as a vitamin D blood level (25-hydroxyvitamin D) of 30 ng/mL or less. These 125 study subjects were randomly assigned to 1-of-2 treatment groups. In the first group, 68 subjects received ready-to-mix, powdered vitamin D3 at a dose of 60,000 International Units once weekly for eight weeks and then monthly. They also received a daily 1,250-mg calcium carbonate tablet.
The other group of 57 subjects received only calcium supplements. Both groups received advice to eat a healthy, calorie-appropriate diet and to engage in brisk exercise for 30 minutes each day.
The researchers analyzed results for subjects who had at least a year of follow-up tests. After an average of nearly two years and four months’ follow-up, only 6-of-55 subjects (10.9%) in the group that received vitamin D plus calcium supplementation had become diabetic, whereas diabetes developed in 13-of-49 individuals (26.5%) in the calcium-alone group. Blood sugar levels reportedly became normal in about twice as many people in the vitamin D group as in the group that did not get vitamin D supplementation: 23-of-55 subjects versus 10-of-49 subjects, respectively (41.8% versus 20.4%).
At the end of the study, those who received vitamin D supplementation had much higher vitamin D levels in the blood and lower fasting blood-glucose levels compared with the other group. Every unit (i.e., 1 ng/mL) increase in vitamin D in the body was associated with a 5.4% increased chance of reversal to normal blood-sugar levels, Dutta reported.
He said the greater reversal to normal blood sugar in the vitamin D group presumably occurred through improvements in their insulin resistance and inflammation.
Survey: Two-thirds of Type 1 diabetics don’t use blood glucose meters to download data
CHICAGO – Almost 70% of adults with Type 1 diabetes never use their blood glucose self-monitoring devices or insulin pumps to download historical data about their blood-sugar levels and insulin doses — information that likely would help them manage their disease better. These new survey results, which were presented Sunday at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago, also found that only 12% of patients regularly review their past glucose and insulin pump data at home.
“This research highlights the fact that these devices used to manage Type 1 diabetes are not being used to their full potential,” said Jenise Wong, the study’s principal investigator and an assistant adjunct professor of pediatrics at the University of California, San Francisco. “These devices can be useful not only for real-time disease self-management, but also in helping to review past data to guide future treatment decision-making.”
Glucose-monitoring devices include continuous glucose monitors, which automatically measure blood-sugar levels every few minutes via a sensor inserted under the skin, and blood=glucose meters, used with a fingerstick drop of blood. People with diabetes also use insulin pumps to deliver basal insulin and insulin boluses for high blood-sugar levels or when they eat carbohydrates. These devices typically collect and store information, such as the response of glucose levels to physical activity and food, as well as the individual’s carbohydrate intake and insulin doses. Most insulin-dependent patients use the information displayed on the screen to make immediate decisions about insulin dosing, according to Wong.
She said many healthcare providers encourage their diabetic patients to download the information from their devices to their computers and look at the data collected for the past few days, weeks or months. “However, we know very little about how often people with Type 1 diabetes look at their past data on their own between visits with their providers,” Wong said.
Through an online survey, Wong and her colleagues asked 155 adults with Type 1 diabetes how often they download the past data from their glucose-monitoring devices. Seventy-seven survey participants were men, and 78 were women, and their average age was 34.5 years.
Nearly all subjects used a glucose meter, and many used more than one device. A total of 106 individuals used an insulin pump, which either communicated with a glucose meter or allowed the user to manually enter glucose values from a glucose meter. Forty-three used continuous glucose monitors.
The researchers found that only 31% of survey respondents (48-of =0154) reported ever downloading past data from their devices at home. Even fewer did so four or more times a year and actually read the information before giving it to their healthcare provider: 12%, or 18-of-154 participants. Users of continuous glucose monitors regularly downloaded and reviewed their data more often than users of the other devices: 28% versus 5% to 7%.
Older adults also were more likely to download their past data, Wong said. For every decade increase in age, there was 1.5 times the chance of the patient downloading and reviewing data from any device.
“Future studies are needed to understand why people with Type 1 diabetes rarely look at past data from their blood-glucose monitoring devices,” she said.
Few diabetes devices work with smartphones. Wong speculated that patients might find it too technically complicated to download and review the data, or they might not find the data helpful or may not understand how to use the past data to help them manage their diabetes in the future.
Study: Soy protein does not reduce testosterone levels in men with Type 2 diabetes
CHICAGO, Ill. — Soy protein supplements, which contain natural estrogens, do not reduce testosterone levels in men with Type 2 diabetes who already have borderline-low testosterone, according to a new study. The results were presented Saturday at the joint meeting of the International Society of Endocrinology and the Endocrine Society: ICE/ENDO 2014 in Chicago.
“Because soy contains phytoestrogens that are similar to the female hormone estrogen, it was not known whether consumption of soy could reduce testosterone levels in men with Type 2 diabetes, who are at increased risk of low testosterone,” stated the study’s lead investigator, Thozhukat Sathyapalan, an endocrinologist researcher at Hull York Medical School, University of Hull, Hull, United Kingdom.
“It was important to know this because prior studies have found that daily consumption of soy reduces the risk of Type 2 diabetes and heart problems. Our study found that soy protein and phytoestrogen supplementation is safe in diabetic men and may improve their diabetes control and their risk factors for heart disease.”
Their study included 210 men ages 55 years to 70 years who had Type 2 diabetes and a borderline-low total testosterone level: less than or equal to 12 nanomoles per liter (nmol/L) or 345.8 nanograms per deciliter. For three months, the men ate two cereal bars a day, each containing 30 g of soy protein. The bars in one group of 100 men contained 66 mg of soy phytoestrogens, which is equivalent to the amount in soy supplements or in a typical Southeast Asian diet. The second group of 100 men received soy protein bars in which phytoestrogens were removed. Patients were asked to avoid eating foods containing soy.
The men had testosterone blood tests before and after treatment at the same time of day. Both groups experienced an increase in total testosterone level, the investigators reported. On average, testosterone level increased from 9.8 nmol/L to 11.3 nmol/L in the soy protein-phytoestrogen group and from 9.2 nmol/L to 10.3 nmol/L in the group receiving only soy protein.
Sathyapalan said it is unclear why testosterone levels rose, but it could be a direct effect of soy.
Soy protein with phytoestrogens also improved diabetes control much better than did soy protein alone. Specifically, the first group significantly lowered their fasting blood glucose (sugar) levels and hemoglobin A1c, a measure of blood-sugar control over the past three months, as well as fasting insulin levels and estimated insulin resistance, which showed an improved use of the hormone insulin. Neither group lost or gained weight, according to Sathyapalan.
In addition, the phytoestrogen-containing soy protein reportedly led to better improvements in certain cardiovascular risk factors, he said. These included triglycerides — a type of fat in the blood — and high-sensitivity C-reactive protein, which measures inflammation in the body and is a predictor of heart disease risk. Total cholesterol and “bad” (LDL) cholesterol levels rose (i.e., worsened) in both groups but not enough to be statistically significant, according to Sathyapalan.
Both soy protein supplements significantly improved diastolic blood pressure (i.e., the bottom number in a blood pressure reading) but not systolic blood pressure (i.e., the top number).