Vitamin D and Calcium Homeostasis in Relation to Type 2 Diabetes

描述(申请人提供)：2型糖尿病(T2 DM)的发病率正以惊人的速度在全国和全球范围内增长，仅在美国每年就有100多万新确诊病例。虽然减肥已被证明在延缓糖尿病方面是成功的，但它很难实现并长期保持。因此，迫切需要识别体重非依赖的环境因素和易于修改的危险因素，以防止T2 DM发病率的增加。根据动物和人体研究，包括我们自己的观察数据，维生素D和钙是两种被怀疑为糖尿病风险修饰物的营养因素。然而，我们对维生素D和钙对糖尿病风险的临床效应的大小的认识存在严重差距，包括对它们与T2 DM相关的潜在生理作用机制的不确定性。目前，缺乏数据限制了维生素D和钙作为预防T2 DM的可行营养干预措施的有用性。这项拟议研究的中心假设是，维生素D和钙缺乏是T2 DM发生的危险因素，这种风险是由胰岛β细胞功能、胰岛素敏感性和全身炎症的变化介导的。我们计划通过采用双重方法(观察性研究和实验人体试验)来验证我们的主要假设，以实现以下两个具体目标。(1)。在一个大型前瞻性队列中对妇女进行嵌套病例对照研究设计，评估维生素D状况和T2 DM风险之间的关联程度，护士健康研究。工作假设是，维生素D状态，如通过血清25OHD水平来衡量，与T2 DM的风险呈负相关。这种联系将被量化(2)。在一项为期3个月的随机安慰剂对照试验中，确定维生素D和钙补充剂对β细胞功能、胰岛素敏感性、糖耐量和全身炎症的影响。这是一项为期3个月的随机安慰剂对照试验，受试者服用维生素D3和碳酸钙(2x2因子设计)。工作假设是维生素D和钙的补充改善了β细胞功能和胰岛素敏感性(主要结果)，以及全身炎症和葡萄糖耐量(次要结果)。我们的结果将提供新的和重要的数据，为合理地将这些营养物质整合到传统医疗中以减轻T2 DM负担奠定基础。

DESCRIPTION (provided by applicant): The incidence of type 2 Diabetes Mellitus (t2DM) is increasing at an alarming rate both nationally and worldwide with more than 1 million new cases per year diagnosed in the US alone. Although weight- loss has been shown to be successful in delaying diabetes, it is difficult to achieve and maintain long- term. Therefore, identification of weight-independent environmental and easily modified risk factors is urgently needed to prevent the increase in the incidence of t2DM. Vitamin D and calcium are two nutritional factors that have been suspected as modifiers of diabetes risk based on animal and human studies including our own observational data. However, there are critical gaps in our knowledge about the magnitude of the clinical effect of vitamin D and calcium on diabetes risk, including uncertainty about their potential physiologic mechanism of action in relation to t2DM. Currently, this lack of data limits the usefulness of vitamin D and calcium as feasible nutritional interventions for prevention of t2DM. The central hypothesis of the proposed study is that, vitamin D and calcium insufficiency are risk factors for the development of t2DM and that the risk is mediated by changes in pancreatic beta- cell function, insulin sensitivity, and systemic inflammation. We plan to test our main hypothesis by pursuing a dual approach (observational study and experimental human trial) to achieve the following 2 specific aims. (1). Assess the magnitude of the association between vitamin D status and risk of t2DM in a nested case-control study design in women in a large prospective cohort, the Nurses' Health Study. The working hypothesis is that vitamin D status, as measured by serum 25OHD level, is inversely associated with t2DM risk. The association will be quantified (2). Determine the effects of vitamin D and Calcium supplementation on beta-cell function, insulin sensitivity, glucose tolerance and systemic inflammation in a 3-month randomized placebo-controlled trial of adults at risk for t2DM given vitamin D3 and calcium carbonate (2x2 factorial design). The working hypothesis is that vitamin D and calcium supplementation improves beta-cell function and insulin sensitivity (primary outcomes) and systemic inflammation and glucose tolerance (secondary outcomes). Our results will provide novel and important data that will serve as the foundation for the rational integration of these nutrients into conventional medical care to ameliorate t2DM burden.