T2DM Presentation (1)
Transcript of T2DM Presentation (1)
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Date April 8, 2013
Type 2 DiabetesGroup 2
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Obesity: It’s a BIG problem
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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
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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?
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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
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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
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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
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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
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Mechanism
Figure 1
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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
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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
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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
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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
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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
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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
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Results
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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
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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.
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Conclusion
Both studies supportthe originalhypotheses thatvitamin D andmagnesium
correlation with type2 diabetes
Confirmed
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Mechanism: Magnesium
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Mechanism: Vitamin D
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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
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Other Prevention Methods andTreatments
Prevention: Healthy Lifestyle
Diet
Exercise
Treatments:
Oral medications (Metformin)
Insulin injections
Bariatric surgery
Biotin
Chromium
Zinc
Aloe Vera Gel
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Questions?