OBJECTIVE-Accumulating epidemiological evidence suggests that hypovitaminosis D may be associated with type 2 diabetes and related metabolic risks. However, prospective data using the biomarker serum 25-hydroxyvitamin D [25(OH)D] are limited and therefore examined in the present study.
RESEARCH DESIGN AND METHODS-A total of 524 randomly selected nondiabetic men and women, aged 40 -69 years at baseline, with measurements for serum 25(OH)D and IGF-1 in the population-based Ely Study, had glycemic status (oral glucose tolerance), lipids, insulin, anthropometry, and blood pressure measured and metabolic syndrome risk (metabolic syndrome z score) derived at baseline and at 10 years of follow-up. Baseline 25(OH)D was associated inversely with 10-year risk of hyperglycemia (fasting glucose:  ϭ Ϫ0.0023, P ϭ 0.019; 2-h glucose:  ϭ Ϫ0.0097, P ϭ 0.006), insulin resistance (fasting insulin  ϭ Ϫ0.1467, P ϭ 0.010; homeostasis model assessment of insulin resistance [HOMA-IR]:  ϭ Ϫ0.0059, P ϭ 0.005), and metabolic syndrome z score ( ϭ Ϫ0.0016, P ϭ 0.048) after adjustment for age, sex, smoking, BMI, season, and baseline value of each metabolic outcome variable. Associations with 2-h glucose, insulin, and HOMA-IR remained significant after further adjustment for IGF-1, parathyroid hormone, calcium, physical activity, and social class.
RESULTS-CONCLUSIONS-This prospective study reports inverse associations between baseline serum 25(OH)D and future glycemia and insulin resistance. These associations are potentially important in understanding the etiology of abnormal glucose metabolism and warrant investigation in larger, specifically designed prospective studies and randomized controlled trials of supplementation. Diabetes 57:2619-2625, 2008 T hough the most well-known role of vitamin D is the regulation of calcium absorption and bone metabolism, it is becoming clear that this hormone has pleiotropic effects with possible roles in the pathogenesis of cancer (1), cardiovascular disease (2), multiple sclerosis (3), and type 1 diabetes (4). Recent epidemiological evidence (5-9) also points to a potential association of vitamin D insufficiency with adverse metabolic risk, including that for type 2 diabetes (10,11). While the exact mechanisms that underlie the multiple effects of vitamin D on different tissues are not currently understood, one unifying factor is the expression of vitamin D receptors (VDRs) in Ͼ30 tissues, including pancreatic islet cells (12). There is some evidence that polymorphisms in the VDR gene may be associated with insulin resistance, insulin secretion, and fasting glucose concentrations