Vitamin D and type 2 diabetes: New insights MedTwitter
from Japan that tested a synthetic analog of a vitamin D. These three trials in aggregate had an average of about 3 years' duration.
The hazard ratio in the meta-analysis was 0.88 or a modest risk reduction that just met statistical significance for the intention-to-treat unadjusted analysis. After adjustment for other diabetes risk factors, it was 0.85 with a confidence interval of 0.75 to 0.96. The trials weren't large enough or long enough to do a rigorous assessment of safety, but they didn't see any clear safety signals looking at hypercalcemia and.
The authors did see effect modification by body mass index , as has been seen in many other vitamin D trials. We've seen in ourthat BMI modified the effect of vitamin D for total invasive cancer, cancer death, autoimmune diseases, and some other outcomes. They saw that among those who had a BMI below the median of 31, there was a significant 24% reduction in risk. But those who had a BMI at the median of 31 or above had no reduction whatsoever in diabetes risk. Their hazard ratio was 1.01.
The synthetic analog trial results had a similar hazard ratio, but there was no modifying effect of BMI. The authors postulate that this is because vitamin D3, the cholecalciferol, requires conversion to 25-hydroxyvitamin D in the liver and other tissues, and that theexpression, so a high BMI may actually interfere with the ability to convert to the biologically active form of vitamin D.
These doses of vitamin D are on the high side. In fact, they're quite similar to the tolerable upper intake level set by the National Academy of Medicine — five to six times the recommended dietary allowance in the general population guidelines. So, clearly we need more research in terms of the safety of long-term use of vitamin D at these higher doses.
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