Decreased Serum Concentrations of 25-Hydroxycholecalciferol Are Associated With Increased Risk of Progression to Impaired Fasting Glucose and Diabetes
- Anat Tsur, MD1⇓,
- Becca S. Feldman, SCD2,
- Ilan Feldhammer, MA3,
- Moshe B. Hoshen, PHD2,
- Gil Leibowitz, MD4⇓ and
- Ran D. Balicer, MD, PHD, MPH2,5
- 1Diabetes and Endocrinology Clinic, Clalit Health Services, Jerusalem, Israel
- 2Clalit Research Institute and Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
- 3Department of Research and Information, Chief Physician Office, Clalit Health Services, Tel Aviv, Israel
- 4Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- 5Epidemiology Department, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Corresponding authors: Anat Tsur, , and Gil Leibowitz, .
A.T. and B.S.F. contributed equally to this study.
OBJECTIVE To study the association between vitamin D status and the risk of incident impaired fasting glucose (IFG) and diabetes in a population-based cohort of diabetes-free subjects.
RESEARCH DESIGN AND METHODS In a historical prospective cohort study of subjects from the Clalit Health Services database, which includes information on nearly 4 million people, diabetes-free subjects aged 40–70 years with serum 25-hydroxyvitamin D (25-OHD) measurements available were followed up for 2 years to assess the development of IFG and diabetes in five 25-OHD subgroups: ≥25, 25.1–37.5, 37.6–50, 50.1–75, and >75 nmol/L.
RESULTS The baseline cohort included 117,960 adults: 83,526 normoglycemic subjects and 34,434 subjects with IFG. During follow-up, 8,629 subjects (10.3% of the normoglycemic group) developed IFG, and 2,162 subjects (1.8% of the total cohort) progressed to diabetes. A multivariable model adjusted for age, sex, population group, immigrant status, BMI, season of vitamin D measurement, LDL and HDL cholesterol, triglycerides, estimated glomerular filtration rate, history of hypertension or cardiovascular disease, Charlson comorbidity index, smoking, and socioeconomic status revealed an inverse association between 25-OHD and the risk of progression to IFG and diabetes. The odds of transitioning from normoglycemia to IFG, from normoglycemia to diabetes, and from IFG to diabetes in subjects with a 25-OHD level ≤25 nmol/L were greater than those of subjects with a 25-OHD level >75 nmol/L [odds ratio 1.13 (95% CI 1.03–1.24), 1.77 (1.11–2.83), and 1.43 (1.16–1.76), respectively].
CONCLUSIONS Vitamin D deficiency appears to be an independent risk factor for the development of IFG and diabetes.
G.L. and R.D.B. share senior authorship.
- Received June 4, 2012.
- Accepted November 1, 2012.
- © 2013 by the American Diabetes Association.
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