Associations between Vitamin D Status and Type 2 Diabetes Measures among Inuit in Greenland May Be Affected by Other Factors

OBJECTIVE:Epidemiological studies have provided evidence of an association between vitamin D insufficiency and type 2 diabetes. Vitamin D levels have decreased among Inuit in Greenland, and type 2 diabetes is increasing. We hypothesized that the decline in vitamin D could have contributed to the increase in type 2 diabetes, and therefore investigated associations between serum 25(OH)D3 as a measure of vitamin D status and glucose homeostasis and glucose intolerance in an adult Inuit population. METHODS:2877 Inuit (≥18 years) randomly selected for participation in the Inuit Health in Transition study were included. Fasting- and 2hour plasma glucose and insulin, C-peptide and HbA1c were measured, and associations with serum 25(OH)D3 were analysed using linear and logistic regression. A subsample of 330 individuals who also donated a blood sample in 1987, were furthermore included. RESULTS:After adjustment, increasing serum 25(OH)D3 (per 10 nmol/L) was associated with higher fasting plasma glucose (0.02 mmol/L, p = 0.004), 2hour plasma glucose (0.05 nmol/L, p = 0.002) and HbA1c (0.39%, p<0.001), and with lower beta-cell function (-1.00 mmol/L, p<0.001). Serum 25(OH)D3 was positively associated with impaired fasting glycaemia (OR: 1.08, p = 0.001), but not with IGT or type 2 diabetes. CONCLUSIONS:Our results did not support an association between low vitamin D levels and risk of type 2 diabetes. Instead, we found weak positive associations between vitamin D levels and fasting- and 2hour plasma glucose levels, HbA1c and impaired fasting glycaemia, and a negative association with beta-cell function, underlining the need for determination of the causal relationship

Association between serum 25(OH)D3 (nmol/L) and measures of glucose homeostasis in 2005–2010.

<p>Association between serum 25(OH)D3 (nmol/L) and measures of glucose homeostasis in 2005–2010.</p

Association between serum 25(OH)D3 (nmol/L) and glucose intolerance in 2005–2010.

<p>Association between serum 25(OH)D3 (nmol/L) and glucose intolerance in 2005–2010.</p

Characteristics of the study population in 1987 (N = 330) and 2005–2010 (N = 2877).

<p>Characteristics of the study population in 1987 (N = 330) and 2005–2010 (N = 2877).</p

Relation between serum 25(OH)D3 and HbA1c.

<p>Quadratic spline analysis showing the relation between serum 25(OH)D3 concentrations and HbA1c for a man aged 44 years, being full Inuit and smoker, and with a BMI of 26 kg/m² and a physical activity energy expenditure of 46 kJ/kg/day. The thick line represents the relation predicted, the full thin lines show the 95% confidence interval, and dotted lines show the 95% prediction interval. N = 2355.</p

Comparison of six electronic healthcare databases in Europe using standardized protocols: A descriptive study on the incidence of cancer

Background: There are several national cancer registries available across Europe, but information on cancer incidence from routine electronic healthcare record (EHR) databases (DBs), such as General Practitioners (GPs) and comparisons across different databases are rather scarce. It is important to compare this information, and also benchmark this against national registries in order to assess its usefulness for pharmacoepidemiological studies on cancer. Objectives: To investigate sources of variation in the incidence of Cancer across routine EHR DBs in Europe, using a standardized methodology. Methods: We used six EHR DBs from Spain-ES (BIFAP), the United Kingdom-UK (THIN and CPRD), the Netherlands-NL (Mondriaan: AHC and NPCRD), and Denmark-DK (National registrations of patients- NRP). Cancer incidences were calculated for the whole population between 2003 and 2008 and were stratified by sex, age and type of cancer (breast, prostate and colon). Overall incidence rates were age and sex standardized to the European 2008 reference population. Results: The initially observed variation in cancer incidence decreased after standardization and ranged for any cancer from 25.2/10,000 in the NL (NPCRD) in 2004, to 71.5/10,000 in the DK (NRP) in 2008. The incidence of cancer increased in DK and doubled in NPCRD between 2003 and 2008, but decreased in BIFAP and THIN. Cancer incidence was higher for women in all DBs, except for BIFAP and AHC. In 2008, the incidence of breast cancer was the highest in the NPCRD (37.6/10,000) and the lowest in BIFAP (9.1/ 10,000), while the incidence of prostate cancer was the highest in DK (15.9/10,000). No major differences were observed between countries regarding colon cancer. Conclusions: The incidence of cancer as measured in six routine EHR DBs differed between the four European countries using a standard methodology, despite the convergence seen after standardization for age and sex. Overall cancer incidence increased over time for most of the European countries, except for Spain. From our analysis we can infer that incidences are in line with the European cancer registries available

Comparison of six electronic healthcare databases in Europe using standardized protocols: A descriptive study on the incidence of cancer

Background: There are several national cancer registries available across Europe, but information on cancer incidence from routine electronic healthcare record (EHR) databases (DBs), such as General Practitioners (GPs) and comparisons across different databases are rather scarce. It is important to compare this information, and also benchmark this against national registries in order to assess its usefulness for pharmacoepidemiological studies on cancer. Objectives: To investigate sources of variation in the incidence of Cancer across routine EHR DBs in Europe, using a standardized methodology. Methods: We used six EHR DBs from Spain-ES (BIFAP), the United Kingdom-UK (THIN and CPRD), the Netherlands-NL (Mondriaan: AHC and NPCRD), and Denmark-DK (National registrations of patients- NRP). Cancer incidences were calculated for the whole population between 2003 and 2008 and were stratified by sex, age and type of cancer (breast, prostate and colon). Overall incidence rates were age and sex standardized to the European 2008 reference population. Results: The initially observed variation in cancer incidence decreased after standardization and ranged for any cancer from 25.2/10,000 in the NL (NPCRD) in 2004, to 71.5/10,000 in the DK (NRP) in 2008. The incidence of cancer increased in DK and doubled in NPCRD between 2003 and 2008, but decreased in BIFAP and THIN. Cancer incidence was higher for women in all DBs, except for BIFAP and AHC. In 2008, the incidence of breast cancer was the highest in the NPCRD (37.6/10,000) and the lowest in BIFAP (9.1/ 10,000), while the incidence of prostate cancer was the highest in DK (15.9/10,000). No major differences were observed between countries regarding colon cancer. Conclusions: The incidence of cancer as measured in six routine EHR DBs differed between the four European countries using a standard methodology, despite the convergence seen after standardization for age and sex. Overall cancer incidence increased over time for most of the European countries, except for Spain. From our analysis we can infer that incidences are in line with the European cancer registries available