Category Archives: Prevention of T2 Diabetes

Does Weight Loss Prevent Type 2 Diabetes?

Finger-pricking four times a day gets old real quick!

Finger-pricking four times a day gets old real quick!

I found an interesting statistic in a scientific journal article last year:

Every 2.2 pound (1 kg) loss of excess weight lowers the risk of developing type 2 diabetes by 16%.

That tidbit was embedded in another article with a focus on regain of lost weight over time.  The “16% per kilogram” number sounded too good to be true, and I had never heard it before.  So I did some digging and found the source of the statistic.  Ain’t the Internet wunnerful?

The origin of the 16% figure is the Diabetes Prevention Program Research Group.  Investigators enrolled 1,079 middle-aged (mean 50.6 years) study participants and followed them over 3 years, noting the effects of exercise, percentage of fat in the diet, and weight loss on the subsequent development of diabetes.  Average body mass index was 33.9.  (A 5-foor, 4-inch person weighing 197 pounds (89.5 kg) has a BMI of 33.9).  Sixty-eight percent of participants were women.  The investigators’ goal for this group of overweight people was for loss of 7% of body weight through diet, physical activity, and periodic counseling sessions.  Average weight loss over the course of three years was 9 pounds (4.1 kg).

None of the study participants had diabetes at the time of enrollment.  But, by design, they all had laboratory-proven “impaired glucose tolerance.”  Impaired glucose tolerance is a form of “pre-diabetes.”  It is determined by giving a  75-gram dose of glucose by mouth, then measuring blood glucose (sugar) 2 hours later.  A blood glucose level under 140 is normal.  If the level is 140-199, you have impaired glucose tolerance.

Having impaired glucose tolerance means that study participants’ glucose (sugar) metabolism was already abnormal.  They were at higher than average risk of developing diabetes, compared with both average-weight healthy people and overweight people without impaired glucose tolerance.  This is a great cohort to study for development of diabetes.  But the finding that “every 2.2 pounds of weight loss lowers the risk of diabetes by 16%” applies to this particular group with impaired glucose tolerance, not the general overweight population.

A total of 153 participants developed diabetes over the course of 3 years.  Loss of excess weight was by far the best predictor of lowered diabetes risk, compared with regular exercise and lowering percentage of dietary fat.

Yes, weight loss does prevent diabetes in some, probably many, overweight people.  The specific degree of reduced risk depends on numerous factors, such as age, sex, genetics, degree of weight loss, and pre-existing impaired glucose tolerance.

Steve Parker, M.D.

Reference: Hamman, Richard, et al.  Effect of Weight Loss With Lifestyle Intervention on Risk of Diabetes.  Diabetes Care, 29, (2006): 2,102-2,107.

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Filed under Overweight and Obesity, Prevention of T2 Diabetes, Weight Loss

Do Vitamin D and Calcium Supplements Cut Risk of Diabetes?

Cliffs of Dover: Pure White Calcium Carbonate

Cliffs of Dover: Pure White Calcium Carbonate

Several studies have associated vitamin D and calcium intake with lower risk of developing type 2 diabetes.  After reading that the Institute of Medicine in 2010 will probably increase the recommended amounts of vitamin D for every one, I decided to review the literature pertinent to diabetes.

Over the last 10 years, studies have associated low blood levels of vitamin D with a higher risk of cardiovascular disease, death, type 2 diabetes, some cancers, infections, autoimmune diseases, frequent falls in the elderly, and dementia.

The Institute of Medicine (in the U.S.) currently recommends 200 IU (international units) per day for people under 50, 400 IU for people 50-70, with an upper intake level of 2,000 IU per day.  I assume those amounts refer to a combination of food (or supplements) and the vitamin D your skin makes (but how do we know that?). 

The new recommendation is expected to be around 1,000-2,000 IU per day.  It’s quite difficult to get close to that just with food.  With adequate sun exposure, we can make some vitamin D.  But the dermatologists have scared us out of the sun with horror stories of skin cancer.  I’ve seen some tragic cases in my own patients.  Skin covered with sunscreen doesn’t make vitamin D.  It can be difficult to get enough sun exposure, especially at higher latitudes in winter

I reviewed scientific articles pertinent to tyepe 2 diabetes via PubMed and list the best ones for you below.   The evidence in favor of using vitamin D and calcium supplements to prevent diabetes is weak, but may be correct. 

I found nothing to suggest that high vitamin D and calcium intake (whether food or supplements) helps control established cases of diabetes. 

Take-Home Points 

If you want to prevent type 2 diabetes with supplements, 1000 IU of vitamin D and 800-1000 mg of elemental calcium daily might help.  The evidence is not strong.  It might help; it might not.  But it’s unlikely to hurt.  Check with your personal physician first.  More studies are needed.  Calcium supplements are routinely recommended by expert nutrition panels for people over 60 to prevent osteoporosis.  The vitamin D supplement may be healthy in other ways.

Who, in particular, might want to prevent type 2 diabetes?  People with . . .

I’m sufficiently convinced about the nondiabetic vitamin D benefits that I’m going to start taking 1,000 IU per day.

Steve Parker, M.D.,

References:

Pittas, Anastassios, et al.  The effects of calcium and vitamin D supplementatinon on blood glucose and markers of inflammatin in nondiabetic adults.  Diabetes Care, 30 (2007): 980-9896.

Chowdhurry, T.A., et al.  Vitamin D and type 2 diabetes: Is there a link?  Primary Care Diabetes, April 21, 2009 (Epub ahead of print).

Pittas, Anastassios, et al.  Vitamin D and calcium intake in relation to type 2 diabetes in women.  Diabetes Care, 29 (2006): 650-656.

Knept, P., et al.  Serum vitamin D and subsequent occurrence of type 2 diabetes.  Epidemiology, 19 (2008): 666-671.

de Boer, I.H., et al.  Calcium plus vitamin D supplementation and hte risk of incident diabetes in the Womens’ health Initiative.  Diabetes Care, 31 (2008): 701-707. (Epub January 30, 2008).

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Filed under Causes of Diabetes, Prevention of T2 Diabetes