VITAMIN D ROLE AND USE IN PREDIABETES

Objective: To review the role of vitamin D in prediabetes on the basis of evidence from human studies. Methods: English-language literature in MEDLINE (January 1969-July 2009) was searched for observational studies and randomized controlled trials of vitamin D deficiency and treatment in prediabetes, including impaired fasting glucose, impaired glucose tolerance, and metabolic syndrome. Search terms included hyperglycemia, glucose, glycohemoglobin, insulin resistance, diabetes, homeostasis model assessment, insulin secretion, vitamin D, and related terms. Publications were also identified from review articles and references in the found articles. Abstracts, conference proceedings, case reports, and letters were excluded. Articles concerning only type 1 and type 2 diabetes, hemodialysis, or hyperparathyroidism and studies in children were also excluded. Results: Vitamin D insufficiency is defined by a circulating 25-hydroxyvitamin D concentration less than 30 ng/mL, and it is prevalent in the United States (77% of the population). Most cross-sectional and prospective studies in various populations show inverse association between circulating 25-hydroxyvitamin D and fasting plasma glucose, impaired glucose tolerance, hemoglobin A(lc), metabolic syndrome, and incidence of prediabetes. A few clinical trials suggest beneficial effect of vitamin D supplementation in prediabetes, including improved insulin secretion, basal fasting insulin sensitivity, and postprandial peripheral insulin resistance. The limitations of the studies are small sample size, short duration of follow-up, lack of control groups, and inability to achieve vitamin D sufficiency with treatment. Conclusion: Available data suggest that achieving vitamin D sufficiency may be beneficial in patients with prediabetes, although clinical trials are needed to provide evidence-based recommendations. (Endocr Pract. 2010;16:476-485)