Vitamin D supplementation may lower diabetes risk for the more than 10 million adults with prediabetes

1. Vitamin D supplementation may lower diabetes risk for the more than 10 million adults with prediabetes
Patients should weigh the benefits and harms of vitamin D supplementation with their physician
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3018
Editorial: https://www.acpjournals.org/doi/10.7326/M23-0220
URL goes live when the embargo lifts
A review of clinical trials has found that higher vitamin D intake was associated with a 15 percent decreased likelihood for developing type 2 diabetes in adults with prediabetes. The review is published in Annals of Internal Medicine.

Vitamin D is a fat-soluble vitamin available in or added to some foods, as a supplement, or produced by the body when ultraviolet rays from sunlight strike the skin. Vitamin D has many functions in the body, including a role in insulin secretion and glucose metabolism. Observational studies have found an association between having a low level of vitamin D in the blood and high risk for developing diabetes.

Researchers from Tufts Medical Center conducted a systematic review and meta-analysis of three clinical trials comparing vitamin D supplement impacts on diabetes risk. The authors found that over a three-year follow-up period, new-onset diabetes occurred in 22.7 percent of adults who received vitamin D and 25 percent of those who received placebo, which is a 15 percent relative reduction in risk. According to the authors, extrapolating their findings to the more than 374 million adults worldwide who have prediabetes suggests that inexpensive vitamin D supplementation could delay the development of diabetes in more than 10 million people.

In an accompanying editorial, authors from University College Dublin and Food Safety Authority of Ireland, highlight that previous data have demonstrated significant adverse effects for high vitamin D intake. They argue that professional societies promoting vitamin D therapy have an obligation to warn physicians about both required vitamin D intake and safe limits. They advise that this very-high-dose vitamin D therapy might prevent type 2 diabetes in some patients but may also cause harm.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Anastassios G. Pittas, MD, MS, please contact Jeremy Lechen at jlechan@tuftsmedicalcenter.org.
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2. Risk-based lung cancer screening more cost-effective than age, smoking history-based screening
Abstract: https://www.acpjournals.org/doi/10.7326/M22-2216

Editorial: https://www.acpjournals.org/doi/10.7326/M23-0230
URL goes live when the embargo lifts
An analysis of lung cancer screening methods found that risk-based lung cancer screening was more cost-effective than age and smoking history-based screening methods. The analysis is published in the Annals of Internal Medicine.

In 2021, the U.S. Preventive Services Task Force (USPSTF) issued their updated recommendation on lung cancer screening that lowers the starting age from 55 to 50 years and the minimum cumulative smoking exposure from 30 to 20 pack-years (categorical age-smoking strategies). However, prior studies suggest that risk-based lung cancer screening that defines screening eligibility based on personal lung cancer risk scores using validated prediction models averts more lung cancer deaths and results in fewer radiation-related deaths than categorical age-smoking strategies.

A team of researchers for the National Cancer Institute (NCI)-sponsored consortium, Cancer Intervention and Surveillance Modelling Network (CISNET) Lung Group used data from the National Lung Screening Trial to evaluate and compare the cost-effectiveness of risk model–based lung cancer screening strategies versus the USPSTF recommendation and to explore optimal risk thresholds. The CISNET Lung group previously helped the decision-making of USPSTF on their recommendation on the national lung cancer screening guidelines in 2013 and 2021 through a comparative modeling approach used in this study. The data showed that risk-based screening was associated with more quality-adjusted life-years (QALY) and cost-savings compared with categorical age-smoking strategies. The authors note that risk model–based screening strategies were consistently more cost-effective than the 2021 USPSTF recommendation under varying modeling assumptions, including when a minimum 5-year life expectancy was included as an eligibility criterion and when imperfect adherence was implemented.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Summer S. Han, Ph.D., please email summer.han@stanford.edu or contact Ms. Courtney Lodato at CLodato@stanfordhealthcare.org.
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Brief Research Report:
Firearm Owners' Preferences for Locking Devices: Results of a National Survey
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3113
URL goes live when the embargo lifts
Researchers from the University of Colorado Anschutz Medical Campus surveyed over 2,100 firearm-owning adults in the United States to describe preferences about personal firearm locking devices. The data showed varied preferences among those respondents. This data could directly inform health care- and community-based programs to provide free or discounted locking devices to U.S. gun owners.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Marian E. Betz, MD, MPH, please email Julia Milzer at julia.milzer@cuanschutz.edu.
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Also new in this issue:
Ending Medical Complicity with Skilled Nursing Facility Discrimination Against People with Opioid Use Disorder
Shawn M. Cohen, MD; Rebekah Joab, JD; Kathryn M. Bolles, MD; Sally Friedman, JD; and Simeon D. Kimmel, MD, MA
Ideas and Opinions
Abstract: https://www.acpjournals.org/doi/10.7326/M22-3049