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补充维生素D与预防2型糖尿病的关系
Vitamin D Supplementation and Prevention of Type 2 Diabetes


Anastassios G. Pittas ... 糖尿病 • 2019.08.08
相关阅读
• 多不饱和脂肪酸、葡萄糖代谢和糖尿病之间的关系 • 补充维生素D是否越多越好 • 补充维生素D未能预防2型糖尿病 • 补充维生素D是否能够预防2型糖尿病? • 补充维生素D——VITAL研究的结果

摘要


背景

观察性研究支持较低的血液25-羟基维生素D水平与2型糖尿病风险之间的关联。然而,补充维生素D可否降低糖尿病风险尚未明确。

 

方法

我们将符合糖尿病前期3项血糖标准(空腹血糖水平,100~125 mg/dL;75 g口服葡萄糖负荷后2小时的血糖水平,140~199 mg/dL;糖化血红蛋白水平,5.7%~6.4%)中的至少2项,并且不符合糖尿病诊断标准的成人随机分组,分别每日接受4,000 IU维生素D3或安慰剂,而不考虑基线血清25-羟基维生素D水平。在此项至事件发生时间分析中,主要结局是新发糖尿病,我们将试验设计为事件驱动,糖尿病事件的目标数量为508。

 

结果

共有2,423名参与者接受了随机分组(维生素D组1,211名,安慰剂组1,212名)。截至第24个月,维生素D组的平均血清25-羟基维生素D水平为54.3 ng/mL(基线时为27.7 ng/mL),而安慰剂组为28.8 ng/mL(基线时为28.2 ng/mL)。经过中位2.5年随访,维生素D组293名参与者和安慰剂组323名参与者发生了糖尿病这一主要结局(分别为每100人-年9.39起事件和10.66起事件)。维生素D与安慰剂相比的风险比为0.88(95%置信区间[CI],0.75~1.04;P=0.12)。两组的不良事件发生率无显著差异。

 

结论

在未针对维生素D缺乏情况进行选择的2型糖尿病高危人群中,每日补充4,000 IU维生素D3与安慰剂相比未显著降低糖尿病风险(由美国国立糖尿病、消化和肾脏病研究所[National Institute of Diabetes and Digestive and Kidney Diseases]等资助;D2d在ClinicalTrials.org注册号为NCT01942694)。





作者信息

Anastassios G. Pittas, M.D., Bess Dawson-Hughes, M.D., Patricia Sheehan, R.N., M.P.H., M.S., James H. Ware, Ph.D., William C. Knowler, M.D., Dr.P.H., Vanita R. Aroda, M.D., Irwin Brodsky, M.D., Lisa Ceglia, M.D., Chhavi Chadha, M.D., Ranee Chatterjee, M.D., M.P.H., Cyrus Desouza, M.B., B.S., Rowena Dolor, M.D., John Foreyt, Ph.D., Paul Fuss, B.A., Adline Ghazi, M.D., Daniel S. Hsia, M.D., Karen C. Johnson, M.D., M.P.H., Sangeeta R. Kashyap, M.D., Sun Kim, M.D., Erin S. LeBlanc, M.D., M.P.H., Michael R. Lewis, M.D., Emilia Liao, M.D., Lisa M. Neff, M.D., Jason Nelson, M.P.H., Patrick O’Neil, Ph.D., Jean Park, M.D., Anne Peters, M.D., Lawrence S. Phillips, M.D., Richard Pratley, M.D., Philip Raskin, M.D., Neda Rasouli, M.D., David Robbins, M.D., Clifford Rosen, M.D., Ellen M. Vickery, M.S., and Myrlene Staten, M.D. for the D2d Research Group*
From Tufts Medical Center (A.G.P., L.C., P.F., J.N., E.M.V.), the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University (B.D.-H.), Brigham and Women’s Hospital (V.R.A.), and Harvard School of Public Health (J.H.W.), Boston, and the Spaulding Rehabilitation Network, Charlestown (P.S.) — all in Massachusetts; National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ (W.C.K.); the Maine Medical Center (I.B.) and the Maine Medical Center Research Institute (C.R.) — both in Scarborough; HealthPartners Institute, Minneapolis (C.C.); Duke University Medical Center, Durham, NC (R.C., R.D.); the University of Nebraska Medical Center and Omaha Veterans Affairs Medical Center, Omaha (C.D.); Baylor College of Medicine, Houston (J.F.), and the University of Texas Southwestern Medical Center, Dallas (P.R.) — both in Texas; MedStar Good Samaritan Hospital, Baltimore (A.G.), MedStar Health Research Institute, Hyattsville (J.P.), and the National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda (M.S.) — all in Maryland; Pennington Biomedical Research Center, Baton Rouge, LA (D.S.H.); the University of Tennessee Health Science Center, Memphis (K.C.J.); Cleveland Clinic, Cleveland (S.R.K.); Stanford University Medical Center, Stanford (S.K.), and the Keck School of Medicine of the University of Southern California, Los Angeles (A.P.) — both in California; Kaiser Permanente Center for Health Research–Northwest, Portland, OR (E.S.L.); the University of Vermont, Burlington (M.R.L.); Northwell Health Lenox Hill Hospital, New York (E.L.); Northwestern University, Chicago (L.M.N.); the Medical University of South Carolina, Charleston (P.O.); Emory University School of Medicine, Atlanta, and the Atlanta Veterans Affairs Medical Center, Decatur — both in Georgia (L.S.P.); AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL (R.P.); the University of Colorado Denver and the Veterans Affairs Eastern Colorado Health Care System, Denver (N.R.); and the University of Kansas Medical Center, Kansas City (D.R.). Address reprint requests to Dr. Pittas at the Division of Endocrinology, Diabetes, and Metabolism, Tufts Medical Center, 800 Washington St., Box 268, Boston, MA 02111, or at apittas@tuftsmedicalcenter.org. James H. Ware, Ph.D., is deceased. *A list of the members of the D2d Research Group is provided in the Supplementary Appendix, available at NEJM.org.

 

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