Calcium and phosphate concentrations and future development of type 2 diabetes: The Insulin Resistance Atherosclerosis Study

Carlos Lorenzo, Anthony J. Hanley, Marian J. Rewers, Steven M. Haffner

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Aims/hypothesis: Low phosphate and high calcium concentrations have been linked to altered glucose tolerance and reduced insulin sensitivity in non-diabetic individuals. The aim of this study was to examine the relationships of calcium and phosphate levels and the calcium-phosphate product with the development of type 2 diabetes. Methods: Participants were 863 African-Americans, Hispanics and non-Hispanic whites in the Insulin Resistance Atherosclerosis Study who were free of diabetes at baseline. The mean follow-up period was 5.2 years. The insulin sensitivity index (SI) and acute insulin response (AIR) were directly measured using the frequently sampled IVGTT. Results: Calcium concentration (OR per 1 SD unit increase, 1.26 [95% CI 1.04, 1.53]) and calcium-phosphate product (OR 1.29 [95% CI 1.04, 1.59]) were associated with incident diabetes after adjustment for demographic variables, family history of diabetes, and 2 h glucose. The relationship between phosphate concentration and progression to diabetes was close to statistical significance (OR 1.21 [95% CI 0.98, 1.49]). Calcium concentration (OR 1.37 [95% CI 1.09, 1.72]) and calcium-phosphate product (OR 1.39 [95% CI 1.09, 1.77]) remained associated with incident diabetes after additional adjustment for BMI, plasma glucose, SI, AIR, C-reactive protein, estimated GFR, diuretic drugs and total calcium intake. Conclusions/interpretation: Elevated serum calcium and calcium-phosphate product are associated with increased risk of developing type 2 diabetes independently of measured glucose, insulin secretion and insulin resistance. Future studies need to analyse the role of calcium-phosphate homeostasis in the pathophysiology of diabetes.

Original languageEnglish (US)
Pages (from-to)1366-1374
Number of pages9
JournalDiabetologia
Volume57
Issue number7
DOIs
StatePublished - 2014

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Type 2 Diabetes Mellitus
Insulin Resistance
Atherosclerosis
Calcium
Glucose
Insulin
calcium phosphate
Hispanic Americans
Diuretics
African Americans
C-Reactive Protein
Homeostasis
Phosphates
Demography
Serum
Pharmaceutical Preparations

Keywords

  • Clinical science
  • Epidemiology
  • Human
  • Insulin sensitivity and resistance
  • Pathogenic mechanisms
  • Prediction and prevention of type 2 diabetes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Calcium and phosphate concentrations and future development of type 2 diabetes : The Insulin Resistance Atherosclerosis Study. / Lorenzo, Carlos; Hanley, Anthony J.; Rewers, Marian J.; Haffner, Steven M.

In: Diabetologia, Vol. 57, No. 7, 2014, p. 1366-1374.

Research output: Contribution to journalArticle

Lorenzo, Carlos ; Hanley, Anthony J. ; Rewers, Marian J. ; Haffner, Steven M. / Calcium and phosphate concentrations and future development of type 2 diabetes : The Insulin Resistance Atherosclerosis Study. In: Diabetologia. 2014 ; Vol. 57, No. 7. pp. 1366-1374.
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abstract = "Aims/hypothesis: Low phosphate and high calcium concentrations have been linked to altered glucose tolerance and reduced insulin sensitivity in non-diabetic individuals. The aim of this study was to examine the relationships of calcium and phosphate levels and the calcium-phosphate product with the development of type 2 diabetes. Methods: Participants were 863 African-Americans, Hispanics and non-Hispanic whites in the Insulin Resistance Atherosclerosis Study who were free of diabetes at baseline. The mean follow-up period was 5.2 years. The insulin sensitivity index (SI) and acute insulin response (AIR) were directly measured using the frequently sampled IVGTT. Results: Calcium concentration (OR per 1 SD unit increase, 1.26 [95{\%} CI 1.04, 1.53]) and calcium-phosphate product (OR 1.29 [95{\%} CI 1.04, 1.59]) were associated with incident diabetes after adjustment for demographic variables, family history of diabetes, and 2 h glucose. The relationship between phosphate concentration and progression to diabetes was close to statistical significance (OR 1.21 [95{\%} CI 0.98, 1.49]). Calcium concentration (OR 1.37 [95{\%} CI 1.09, 1.72]) and calcium-phosphate product (OR 1.39 [95{\%} CI 1.09, 1.77]) remained associated with incident diabetes after additional adjustment for BMI, plasma glucose, SI, AIR, C-reactive protein, estimated GFR, diuretic drugs and total calcium intake. Conclusions/interpretation: Elevated serum calcium and calcium-phosphate product are associated with increased risk of developing type 2 diabetes independently of measured glucose, insulin secretion and insulin resistance. Future studies need to analyse the role of calcium-phosphate homeostasis in the pathophysiology of diabetes.",
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