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Forouhi NG, Menon RK, Sharp SJ, Mannan N, Timms PM, Martineau AR, Rickard AP, Boucher BJ, Chowdhury TA, Griffiths CJ, Greenwald SE, Griffin SJ, Hitman GA. Effects of vitamin D2 or D3 supplementation on glycaemic control and cardiometabolic risk among people at risk of type 2 diabetes: results of a randomized double-blind placebo-controlled trial. Diabetes Obes Metab 2016; 18:392-400. [PMID: 26700109 PMCID: PMC4950066 DOI: 10.1111/dom.12625] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 11/30/2015] [Accepted: 12/17/2015] [Indexed: 11/29/2022]
Abstract
AIMS To investigate the effect of short-term vitamin D supplementation on cardiometabolic outcomes among individuals with an elevated risk of diabetes. METHODS In a double-blind placebo-controlled randomized trial, 340 adults who had an elevated risk of type 2 diabetes (non-diabetic hyperglycaemia or positive diabetes risk score) were randomized to either placebo, 100,000 IU vitamin D2 (ergocalciferol) or 100,000 IU vitamin D3 (cholecalciferol), orally administered monthly for 4 months. The primary outcome was change in glycated haemoglobin (HbA1c) between baseline and 4 months, adjusted for baseline. Secondary outcomes included: blood pressure; lipid levels; apolipoprotein levels; C-reactive protein levels; pulse wave velocity (PWV); anthropometric measures; and safety of the supplementation. RESULTS The mean [standard deviation (s.d.)] 25-hydroxyvitamin D [25(OH)D]2 concentration increased from 5.2 (4.1) to 53.9 (18.5) nmol/l in the D2 group, and the mean (s.d.) 25(OH)D3 concentration increased from 45.8 (22.6) to 83.8 (22.7) nmol/l in the D3 group. There was no effect of vitamin D supplementation on HbA1c: D2 versus placebo: -0.05% [95% confidence interval (CI) -0.11, 0.02] or -0.51 mmol/mol (95% CI -1.16, 0.14; p = 0.13); D3 versus placebo: 0.02% (95% CI -0.04, 0.08) or 0.19 mmol/mol (95% CI -0.46, 0.83; p = 0.57). There were no clinically meaningful effects on secondary outcomes, except PWV [D2 versus placebo: -0.68 m/s (95% CI -1.31, -0.05); D3 versus placebo -0.73 m/s (95% CI -1.42, -0.03)]. No important safety issues were identified. CONCLUSIONS Short-term supplementation with vitamin D2 or D3 had no effect on HbA1c. The modest reduction in PWV with both D2 and D3 relative to placebo suggests that vitamin D supplementation has a beneficial effect on arterial stiffness.
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Affiliation(s)
- N G Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - R K Menon
- Blizard Institute, Queen Mary University of London, London, UK
| | - S J Sharp
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - N Mannan
- Blizard Institute, Queen Mary University of London, London, UK
| | - P M Timms
- Homerton University Hospital NHS Foundation Trust, London, UK
| | - A R Martineau
- Blizard Institute, Queen Mary University of London, London, UK
| | - A P Rickard
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - B J Boucher
- Blizard Institute, Queen Mary University of London, London, UK
| | - T A Chowdhury
- Blizard Institute, Queen Mary University of London, London, UK
- Barts Healthcare NHS Trust, London, UK
| | - C J Griffiths
- Blizard Institute, Queen Mary University of London, London, UK
| | - S E Greenwald
- Blizard Institute, Queen Mary University of London, London, UK
| | - S J Griffin
- Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - G A Hitman
- Blizard Institute, Queen Mary University of London, London, UK
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Lee JJ, Low JA, Croarkin E, Parks R, Berman AW, Mannan N, Steinberg SM, Swain SM. Evaluation of neuropathy in breast cancer patients treated with ixabepilone. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. J. Lee
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
| | - J. A. Low
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
| | - E. Croarkin
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
| | - R. Parks
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
| | - A. W. Berman
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
| | - N. Mannan
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
| | - S. M. Steinberg
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
| | - S. M. Swain
- Cancer Therapeutics Branch, CCR, NCI, NIH, Bethesda, MD; Cancer Therapy Evaluation Program, NCI, NIH, Bethesda, MD; Rehabilitation Medicine Dept, NIH, Bethesda, MD; MOCRU, CCR, NCI, NIH, Bethesda, MD; Data Management Section, CCR, NCI, NIH, Bethesda, MD
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Low JA, Wedam SB, Brufsky A, Berman A, Croarkin E, Parks R, Steinberg SM, Mannan N, Fojo T, Swain SM. A phase 2 trial of BMS-247550 (ixabepilone), an epothilone B analog, given daily x 5 in breast cancer. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- J. A. Low
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - S. B. Wedam
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - A. Brufsky
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - A. Berman
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - E. Croarkin
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - R. Parks
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - S. M. Steinberg
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - N. Mannan
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - T. Fojo
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
| | - S. M. Swain
- Cancer Therapeutics Branch, CCR, NCI, Bethesda, MD; Magee-Womens Hospital, University of Pittsburgh Cancer Inst, Pittsburgh, PA; Medical Oncology Clinical Research Unit, CCR, NCI, Bethesda, MD; Rehabilitation Medicine Dept, Clinical Center, NIH, Bethesda, MD; Biostatistics and Data Mgmt Section, CCR, NCI, Bethesda, MD
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Timms PM, Mannan N, Hitman GA, Noonan K, Mills PG, Syndercombe-Court D, Aganna E, Price CP, Boucher BJ. Circulating MMP9, vitamin D and variation in the TIMP-1 response with VDR genotype: mechanisms for inflammatory damage in chronic disorders? QJM 2002; 95:787-96. [PMID: 12454321 DOI: 10.1093/qjmed/95.12.787] [Citation(s) in RCA: 331] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Vitamin-D deficiency and vitamin-D receptor genotype (VDR) are risk factors for several disorders with inflammatory components, including coronary heart disease (CHD) and diabetes, though the mechanisms involved are unclear. AIM To examine the hypothesis that vitamin D status modulates the matrix metalloproteinase (MMP) system in a population with a high prevalence of vitamin D deficiency, a situation affecting susceptibility to CHD and diabetes. DESIGN Prospective cross-sectional, interventional and embedded studies. METHODS Circulating MMP2,9, the inhibitor TIMP-1 and C-reactive protein (CRP) were measured during studies of vitamin-D deficiency as a risk factor for type 2 diabetes and CHD in 171 healthy British Bangladeshi adults, free of known diabetes or major illness. Vitamin D status, VDR genotype, body-build, blood pressure, lipid and insulin profiles, glucose tolerance, fibrinogen, PAI-1, folate and homocysteine were measured. Vitamin-D-deficient subjects were re-assessed after 1 years' supplementation. MMP, TIMP-1 and CRP levels were measured in 41 subjects halfway through 5-year follow-up. Independent determinants of circulating concentrations of MMP9, TIMP-1 and CRP were assessed by multiple regression analysis. RESULTS Vitamin D status was the sole determinant of circulating MMP9 (inversely) and an independent determinant of CRP (inversely). Determinants of TIMP-1 were MMP9, systolic blood-pressure (directly) and VDR genotype (TaqI). Significant reductions in MMP9 (-68%), TIMP-1 (-38%) and CRP (-23%) concentrations followed vitamin-D supplementation. DISCUSSION Vitamin-D insufficiency is associated with increased circulating MMP2,9 and CRP, correctable by supplementation. This finding provides a possible mechanism for tissue damage in chronic inflammatory conditions, including CHD and diabetes.
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Affiliation(s)
- P M Timms
- Department of Clinical Biochemistry, Barts and The London, Queen Mary's School of Medicine and Dentistry, University of London, London, UK
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Abstract
Betel nut (Areca catechu) is chewed regularly by at least 10% of the world population, imported by immigrant users wherever they settle, and is the fourth most widely used addictive substance. It is thought, by users, to soothe the digestion and to be a stimulant and its use has a major role in social situations. Specific arecal alkaloids act as competitive inhibitors of GABA receptors and have widespread effects in the body, including actions on the brain, cardiovascular system, lungs, gut and pancreas. Nitrosated derivatives of arecal alkaloids, proven carcinogens inducing tumours throughout the upper gut and foregut derivatives in animals, are also associated with increased tumour risks in man. These nitrosated compounds are also diabetogenic in CD1 mice, producing a type 2 diabetes with obesity. Increased central obesity is found in association with betel usage in man as well as increases in circulating markers of inflammatory and cardiovascular damage. The effects of chronic betel usage in man are at least as diverse as those of smoking and the habit increases the risks of ill health.
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Affiliation(s)
- B J Boucher
- Department of Diabetes and Metabolic Medicine, Medical and Dental School, Queen Mary, University of London, Royal London Hospital, Whitechapel, London, UK
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Mannan N, Boucher BJ, Evans SJ. Increased waist size and weight in relation to consumption of Areca catechu (betel-nut); a risk factor for increased glycaemia in Asians in east London. Br J Nutr 2000; 83:267-75. [PMID: 10884715 DOI: 10.1017/s0007114500000349] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Type 2 diabetes is commoner in Asians than Caucasians. Many nitrosamines are diabetogenic, causing both type 2 and type 1 diabetes. Of CD1 mice fed with betel-nut or associated nitrosamines 8.5% develop glucose intolerance with marked obesity. Glycaemia and anthropometric risk markers for type 2 diabetes were therefore examined in relation to betel usage in 993 'healthy' Bangladeshis by one bilingual research-worker (N.M.). Of these, 12% had known diabetes. A further 145 of 187 subjects 'at-risk' of diabetes (spot glucose > 6.5 mmol/l < 2 h after food, or > 4.5 mmol/l > 2 h after food) had a second blood glucose sample taken; sixty-one were confirmed as 'at-risk', and had an oral glucose tolerance test; nine new diabetics were identified. Multiple regression analysis showed that spot blood glucose values decreased with time after eating (P = 0.0005) and increased independently with waist size (P = 0.0005) and age (P = 0.0005) without relationships to other aspects of the diet, season or smoking. Waist size was strongly related to betel usage independent of other factors such as age. Betel use interacted with sex, relating to increasing glycaemia only in females. Since waist and age were the major markers of increasing glycaemia we suggest that betel chewing, a habit common to about 10% of the world population (more than 200 million people) may contribute to the risk of developing type 2 diabetes mellitus.
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Affiliation(s)
- N Mannan
- Academic Medical Unit, St Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary Westfield College, UK
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Asindi AA, Bilal NE, Fatinni YA, Al-Shehri MA, Mannan N, Habeeb SM. Neonatal septicemia. Saudi Med J 1999; 20:942-946. [PMID: 27644716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
Full text is available as a scanned copy of the original print version.
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Affiliation(s)
- A A Asindi
- Department of Child Health, King Khalid University, College of Medicine, Abha, Kingdom of Saudi Arabia
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Hitman GA, Mannan N, McDermott MF, Aganna E, Ogunkolade BW, Hales CN, Boucher BJ. Vitamin D receptor gene polymorphisms influence insulin secretion in Bangladeshi Asians. Diabetes 1998; 47:688-90. [PMID: 9568705 DOI: 10.2337/diabetes.47.4.688] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G A Hitman
- Medical Unit (Whitechapel), St. Bartholomew's and The Royal London School of Medicine and Dentistry, UK.
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Boucher BJ, Mannan N, Noonan K, Hales CN, Evans SJ. Glucose intolerance and impairment of insulin secretion in relation to vitamin D deficiency in east London Asians. Diabetologia 1995; 38:1239-45. [PMID: 8690178 DOI: 10.1007/bf00422375] [Citation(s) in RCA: 233] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Vitamin D deficiency reduces insulin secretion and still occurs in East London Asians in whom the prevalence of diabetes mellitus is at least four times that of Caucasians. Vitamin D status was assessed in 44 of 65 non-diabetic subjects 'at risk' of diabetes (spot blood glucose level >6.0 mmol/l <2 h post cibum, or>4.6 mmol/l >2 h post cibum on two separate occasions) and in 15 of 60 age and sex-matched 'low-risk' control subjects who attended for oral glucose tolerance test (OGTT) after screening of 877 omnivorous subjects not known to have diabetes. It was found that 95% of at-risk and 80% of low-risk subjects were vitamin D deficient (serum 25-hydroxy-vitamin D <11 ng/ml). Diabetes was present in 16, impaired glucose tolerance in 12 and normoglycaemia in 19 at-risk subjects, imparied glucose tolerance in 2, and normoglycaemia in 13 low-risk subjects. Correlation of 30-min OGTT blood glucose, specific insulin and C-peptide levels with 25-hydroxy-vitamin D concentrations in 44 at-risk subjects were -0.31 (p=0.04), 0.59 (p=0.0001) and 0.44 (p=0.006). In 15 'not-at-risk' subjects 30-min OGTT specific insulin and C-peptide levels correlated with 25-hydroxy-vitamin D, r=0.39 (p=0.04) and 0.16 (p=0.43), respectively. Serum alkaline phosphatase concentration was higher in at-risk than not-at-risk subjects (59.6 vs 46.5 IU/l, p=0.012); corrected calcium concentrations were comparable (2.38 vs 2.39 mmol/l, p=0.7). Following treatment with 100,000 IU vitamin D by i.m. injection, specific insulin, C-peptide [30 min on OGTT] and 25-hydroxy-vitamin D concentrations had risen 8-12 weeks later [mean +/- DS] from 57 +/- 62 to 96.2 +/- 82.4 mU/l [p=0.0017], 1.0 +/- 0.4 to 1.7 +/- 0.8 pmol/ml [p=0.001] and 3.6 +/- 1.8 to 13.5 +/- 7.4 ng/ml [p=0.0001], (but not to low-risk group values of 179 +/- mU/l, 2.7 +/- 1.14 pmol/ml and 8.16 +/- 6.4 ng/ml), respectively. Both total serum alkaline phosphatase and corrected calcium concentrations rose following vitamin D treatment in the at-risk subjects by 11.1 +/- 8.22 (from 44 to 55 IU/l) and 0.15 +/- 0.18, (2.43 to 2.57 mmol/l), respectively (p=0.004). Abnormal glucose tolerance was unchanged by vitamin D treatment. The value of early and sustained repletion with vitamin D in diabetes prophylaxis should be examined in communities where vitamin D depletion is common.
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Affiliation(s)
- B J Boucher
- Academic Medical Unit, London Hospital Medical College, UK
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