Can vitamin D replacement reduce insulin resistance in South Asians with vitamin D deficiency?

Abstract

BackgroundThe incidence of Type 2 Diabetes Mellitus (T2DM) is increasing rapidly, therefore there is a need to detect this disease earlier and more efficiently, and also to identify novel risk factors that may aid both its detection and prevention.Aims: 1) To discuss the benefits and disadvantages of using HbA1c for diagnosis of T2DM and impaired glucose regulation (IGR).2) To explore the impact on prevalence of using HbA1c to detect T2DM and IGR in global and local populations.3) To determine if diagnostic cut-points are equivalent in different ethnic groups 4) To determine the use of the triglyceride-to-HDL ratio and its association with insulin resistance and whether statins and liver enzymes predict T2DM. 5) To investigate if Vitamin D deficiency has a role in the prevention of T2DM by designing a 6 month randomised controlled trial on vitamin D replacement.Key findings: 1) Using HbA1c for diagnosis has some logistical advantages over glucose testing, but may not detect the same people as having T2DM or IGR.2) In Leicestershire, using HbA1c will increase numbers of people with T2DM and IGR. On global level, there will be regional variation on the effect on prevalence.3) HbA1c, fasting and two hour plasma glucose are independently higher in South Asians (SA). Complications of T2DM may begin earlier in SA.4) The triglyceride-to-HDL ratio associates with insulin resistance in Europeans and SA men but not women. Statin therapy reduces the risk of incident T2DM.Liver enzymes predict T2DM in Europeans but not SA.

Understanding the emergence of the tobacco industry's use of the term tobacco harm reduction in order to inform public health policy

“…82 Likewise, documents suggest that in 2000 PMI had had dialogue on reduced harm product development with IOM, Health Canada, the EU Commission, World Health Organization (WHO), among others, 83 and had approached the DH to set up a meeting ‘to share further information’ on reduced harm products. 84–86 On 12 November 2001 DH representatives visited PMI's R&D facility in Germany, INBIFO. 87 Whereas, in the 1970s and 1980s, PMI had attempted to ensure its ownership of INBIFO was kept secret (a time when the tobacco industry was still claiming that evidence of the toxic effects of smoking was inconclusive), 87 PMI now welcomed government officials to this facility to discuss its harm reduction programme.…”