t2dm presentation (1)

7/27/2019 T2DM Presentation (1)

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Date April 8, 2013

Type 2 DiabetesGroup 2



Obesity: It’s a BIG problem



Type 2 Diabetes

β cell dysfunction and insulin resistance

High levels of circulating glucose

Increased risk for other health concerns

Treatments:

Weight loss and introduction of physical activity

Link to Vitamin D deficiency

Link to Magnesium Deficiency



Vitamin D Introduction

Several past studies have shown a correlation between T2DM andvitamin D deficiency

Vitamin D has been seen to play a functional role in glucose tolerancethrough its effect on both (1) insulin secretion and (2) insulinsensitivity.

Both T2DM and vitamin D deficiency share common risk factors

including race, obesity, aging and low physical activity

This study observes the supplementation effect vitamin D has on

insulin resistance in T2DM.

Why study vitamin D?

What is the objective?



Methods of Research

Single blind, 100 participants with T2DM, aging 30-70 years old

Gathered physiological levels in order to have all participantsassessed at baseline

Participant’s diet and medicine intake was unchanged throughout theduration of the study

50,000 units of D3 were given weekly for 2 months

Physiological levels were assessed again in order to determine results



Results

Table 1 Comparison of biochemical characteristics (mean± SD) inpatients with diabetes type 2 before and after treatment with vitamin Dfor 8 weeks

Variable Before treatment After treatment P-value

FPG(mg/dl) 138.48±36.74 131.02±39 0.05

(mmol/l) 7.6±2.04 7.27±2.16

Insulin(μIu/ml) 10.76±8.9 8.6±8.25 0.02

HOMA-IR 3.57±3.18 2.89±3.28 0.008

25(OH)D (ng/ml) 43.03±19.28 60.12±17.2 0.02

(nmol/l) 107.5±48.2 150.3±43



Results

Table 3 Comparison of lipid profile in patients with diabetes type 2before and after treatment with vitamin D (mean± SD) for 8 weeks

Variable (mg/dl) Before treatment After treatment P-value

T-COL 191.1±32.2 180.2±31.0 0.3

TAG 234.4±73.3 201.0±65.1 0.2

LDL-C 109.5±26.4 103.0±23.2 0.5

HDL-C 42.5±8.1 38.2±7.2 0.3



Vitamin D Supplementation Effects

Mechanisms:

Presence of vitamin D receptors on pancreatic β cells

Calcium is increased due to vitamin D intake leading to glucosetransporting to the muscle

Presence of vitamin D response element in the insulin gene

Insulin resistance significantly affected by vitamin D (in concentrations between 40-60 ng/ml)

Glucose homeostasis: insulin resistance decreased with vitamin Dsupplementation



Mechanism

Figure 1



Limitations

Study did not evaluate the effects of placebo on FPG, insulin, or HOMA-IR

Small sample size (100 participants)

The dietary intake among the individuals may vary



Magnesium Methods

2 Studies Included in the Research:

Nurse’s Health Study (NHS)

Healthy Professional’s Follow-Up Study (HPFS)

Both Updated Every 2 Years

Persons Excluded From Study:

History of CVD, Diabetes, & Cancer

After Exclusions For Present Analysis:

85,060 Women Followed Over 18 Years

42,872 Men Followed Over 12 Years



Magnesium Methods

Food Frequency Questionnaire (FFQ)

Common Unit/Portion Size Estimated for Each Food

Nutrient Intake Computed by Multiplying the Frequency of Consumptionx Nutrient Content of Specified Portions

Other Factors Measured:

Magnesium Supplementation

Measurement of Non-Dietary Factors



Magnesium Methods

Ascertainment of Diabetes:

Survey given every 2 years to determine if subject had been diagnosed withDiabetes

Subjects had to meet the following criteria to be considered diabetic:

Elevated Plasma Glucose (>140mg/dl)

Elevated Plasma Glucose in Absence of Symptoms

Treatment with Hypoglycemic Therapy (Insulin or Oral Hypoglycemic Agents



Magnesium Methods

Statistical Data:

Participants divided into quintiles of total Magnesium intake

Relative risk computed as incidence rate of diabetes in each quintile/incidence rate in lowest quintile of intake

Likelihood ratio x² used to assess significance of interactions between Magnesium intake and variables used

Adjusted Variables:

BMI

Family History

Smoking History

Alcohol intake

Diet



Results

An inverse association seen between Mg intake and type 2 diabetesrisk

Relative risk (RR) for type 2 diabetes was 0.66 (P>.001) in womenand 0.67 (P>.001) in men in highest Mg intake groups compared tolowest

Result still significant when adjusted for confounding factors

Findings support dietary recommendation of increased consumptionof foods high in Mg



Results



Results - discussion

Results consistent with other experimentalstudies showing protective role of Mgagainst diabetes

cofactor role of Mg in carbmetabolism

tyrosine-kinase in insulinpostreceptor pathway in muscle

cell

Limitations:

self-reporting

initial health differences



Conclusion

Vitamin D

Vitamin D supplementation results in

significant improvements in serum FPG,

insulin and in HOMA-IR thus reducinginsulin resistance in T2DM.

Magnesium

Diets high in magnesium rich foods

reduce risk of T2DM due to an inverse

association between magnesium intakeand diabetes risk.



Conclusion

Both studies supportthe originalhypotheses thatvitamin D andmagnesium

correlation with type2 diabetes

Confirmed



Mechanism: Magnesium



Mechanism: Vitamin D



Future Studies

Vitamin D

-Placebo group on FPG, insulin, or HOMA-IR

-Larger sample size

Magnesium

-Medical professionals confirm diagnosis

vs. self-diagnosis

-Randomized clinical trials

-Utilized same time frame



Other Prevention Methods andTreatments

Prevention: Healthy Lifestyle

Diet

Exercise

Treatments:

Oral medications (Metformin)

Insulin injections

Bariatric surgery

Biotin

Chromium

Zinc

Aloe Vera Gel



Questions?

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