Vitamin D and type 2 diabetes: a systematic review

Background/Objectives: Vitamin D may modify the risk of type 2 diabetes mellitus. The aim of this review was to examine the association between vitamin D status and incident type 2 diabetes, and the effect of vitamin D supplementation on glycemic outcomes. Methods: We performed a systematic review of English-language studies using MEDLINE through February 2011. Longitudinal cohort studies reporting associations between vitamin D status and incident type 2 diabetes, and randomized controlled trials (RCTs) of vitamin D supplementation, were included. Study characteristics and results were extracted, and study quality was assessed. Results: A total of 8 observational cohort studies and 11 RCTs were included. In meta-analyses of observational studies, vitamin D intake 4500 international units (IU)/day decreased the risk of type 2 diabetes by 13% compared with vitamin D intake <200 IU/day. Individuals with the highest vitamin D status (425 ng/ml) had a 43% lower risk of developing type 2 diabetes (95% confidence interval 24, 57%) compared with those in the lowest group (<14 ng/ml). In post hoc analyses from eight trials among participants with normal glucose tolerance at baseline and in three small underpowered (n = 32-62) trials of patients with established type 2 diabetes, there was no effect of vitamin D supplementation on glycemic outcomes. In two trials among patients with baseline glucose intolerance, vitamin D supplementation improved insulin resistance. Conclusions: Vitamin D may play a role in type 2 diabetes; however, to better define the role of vitamin D in the development and progression of type 2 diabetes, high-quality observational studies and RCTs that measure blood 25-hydroxyvitamin D concentration and clinically relevant glycemic outcomes are needed. European Journal of Clinical Nutrition (2011) 65, 1005-1015; doi: 10.1038/ejcn.2011.118; published online 6 July 2011