OBJECTIVELow vitamin D levels predict the development of diabetes. This double-blind, randomized, control study in subjects with prediabetes and hypovitaminosis D evaluated whether high doses of vitamin D for 1 year affected insulin secretion, insulin sensitivity, and the development of diabetes.RESEARCH DESIGN AND METHODSA total of 1,551 subjects ≥40 years of age not known to have diabetes were screened with A1C levels. Subjects with A1C levels of 5.8–6.9% underwent an oral glucose tolerance test (OGTT). Subjects with prediabetes and 25-OH vitamin D (25-OHD) levels <30 ng/mL were randomized to receive weekly placebo (n = 53) or vitamin D (n = 56) with doses based on body weight and baseline 25-OHD levels. OGTTs were performed 3, 6, 9, and 12 months later. Insulin secretion and sensitivity were measured, and the proportion of subjects developing diabetes was assessed.RESULTS25-OHD levels rapidly rose from 22 to nearly 70 ng/mL after vitamin D supplementation with a mean weekly dose of 88,865 IU. There were no differences between the placebo and vitamin D groups regarding fasting plasma glucose, 2-h glucose, or insulin secretion and sensitivity or in the percent developing diabetes or returning to normal glucose tolerance. No subjects experienced increased serum or urinary calcium levels. At 12 months, A1C levels were significantly slightly less (0.2%) in the vitamin D group.CONCLUSIONSIn individuals with prediabetes and hypovitaminosis D, doses of vitamin D supplementation designed to raise serum 25-OHD levels into the upper-normal range for 1 year had no effect on insulin secretion, insulin sensitivity, or the development of diabetes compared with placebo administration.

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OBJECTIVETo determine whether pharmacological treatment of depression in low-income minorities with diabetes improves A1C and quality of life (QOL).RESEARCH DESIGN AND METHODSThis was a 6-month, randomized, double-blind, placebo-controlled trial. Patients were screened for depression using Whooley's two-question tool at a county diabetes clinic. Depression was confirmed (or not) with the Computerized Diagnostic Interview Survey (CDIS) software program, and the severity of depression was assessed monthly by the Hamilton Depression Scale (HAM-D). Depressed subjects with A1C levels ≥8.0% were randomly assigned to receive either sertraline or placebo. Diabetes care was provided by nurses following detailed treatment algorithms who were unaware of therapy for depression.RESULTSA total of 150 subjects answered positively to at least one question on Whooley's questionnaire. The positive predictive value for depression diagnosed by CDIS was 69, 67, and 84% for positive answers to question 1 only, question 2 only, or both, respectively. Of the 89 subjects who entered the study, 75 completed. An intention-to-treat analysis revealed significant differences between baseline and 6 months in HAM-D and pain scores, QOL, and A1C and systolic blood pressure levels in both groups, with no differences between groups for the first three but a significantly greater decrease with sertraline in A1C and systolic blood pressure levels. Changes in HAM-D scores and A1C levels were significantly correlated in all subjects (P = 0.45 [P < 10−6]).CONCLUSIONSIn this low-income minority population, pharmacological treatment of depression significantly improved A1C and systolic blood pressure levels compared with placebo.

These data suggest that self-report of adherence to ADHD medications may be a useful and expedient way of assessing adherence, and that assessment and counseling about adherence may be an important part of treatment. Future research using an objective indicator of adherence is needed to follow up on these findings.

OBJECTIVETo describe the clinical experience and the pharmacokinetics of U-500 regular insulin in severely insulin-resistant obese type 2 diabetic patients.RESEARCH DESIGN AND METHODSPatients requiring >200 units of insulin with A1C levels >8.0% were switched to U-500 regular insulin. For the pharmacokinetic study, fasting subjects received 100 units of U-500 regular insulin subcutaneously, and samples drawn before and every 30–60 min for glucose, insulin, and C-peptides until glucose fell below 100 mg/dl.RESULTSU-500 regular insulin doses were adjusted using the same approach as for adjusting NPH insulin doses. Mean values at baseline and at minimum A1C levels were, respectively, A1C 9.9 and 7.1%, 3.2 and 3.3 units/kg, and weight 98.6 and 102.8 kg. Pharmacokinetically, insulin concentrations rose briskly by 30 min and remained elevated for at least 7 h.CONCLUSIONSUncontrolled severely insulin-resistant obese type 2 diabetic patients can be satisfactorily controlled with U-500 regular insulin.

Background Low vitamin D levels are associated with minority subjects, the metabolic syndrome and inflammation. The effect of vitamin D supplementation on markers of inflammation has not been well studied. Objective To evaluate the effects of high doses of vitamin D supplementation for 1 year on serum biomarkers of inflammation in Latino and African-American subjects with pre-diabetes and hypovitaminosis D. Participants and methods Latino (N =69) and African-American (N = 11) subjects who had both pre-diabetes and hypovitaminosis D with a mean age of 52.0 years, a BMI of 32.7 kg/m2 and 70% of whom were female were randomized to receive weekly doses (mean ± SD) of vitamin D (85,300 IU ± 16,000) or placebo oil for 1 year. Serum levels of interleukin-6, tumor necrosis factor, highly sensitive C-reactive protein), plasminogen activator inhibitor 1, and insulin-like growth factor - 1 were measured at baseline, 6 and 12 months. Results Serum 25-OH vitamin D levels of 22 ng/ml at baseline quickly rose to nearly 70 ng/ml in subjects receiving vitamin D and did not change in the placebo group. Two-way repeated measures ANOVA showed no differences between the 2 groups in any of the five selected parameters. Conclusion High dose vitamin D supplementation for 1 year in minority subjects with pre-diabetes and hypovitaminosis D failed to affect serum biomarkers of inflammation.

Objectives It is imperative that individual differences in the cultural contexts of adolescent mothers, whose parenting is often linked to poor child outcomes, be better understood, especially amongst Puerto Rican-origin mothers who experience high rates of poverty. Behaviors that mothers use to elicit compliance from their children are important to investigate, because children’s ability to engage in regulated, compliant behavior has long term consequences for their adjustment. This study tested whether mothers’ orientation to both American and Latino cultures influenced the associations between such maternal behaviors and compliant and defiant child behaviors. Method The sample included 123 young, Puerto Rican-origin mothers and their 24-month old toddlers. Behaviors coded from a toy clean-up task measured maternal guidance and control and child compliance and defiance, and acculturation and enculturation were measured with a self-report questionnaire. Results Maternal guidance predicted more child compliance, with no significant variations by cultural orientation; however, mothers who were more enculturated had children who were more compliant. As predicted, mothers’ more frequent use of control was related to more child defiance for mothers reporting high levels of acculturation, and not for less acculturated mothers. Conclusions Findings support the hypothesis that individual differences in cultural orientation influence variations in associations between certain maternal and child behaviors.

Highlights The anti‐inflammatory agent, hydroxychloroquine, improved glycemic control in type 2 diabetes patients when used as a third‐line agent added to metformin and a sulfonylurea. In comparison to pioglitazone, hydroxychloroquine lowered hemoglobin A1c levels less effectively and did not improve insulin sensitivity, but also did not cause any weight gain, hypoglycemia, or pedal edema. In this small, proof‐of‐concept study, hydroxychloroquine was well tolerated and may be an alternative treatment choice in combination with other agents.