title: The role of vitamin D, obesity and physical exercise in regulation of glycemia in Type 2 Diabetes Mellitus patients.
abstract: OBJECTIVE
  The aims of this study were to determine the role of vitamin D, obesity and physical exercise in the regulation of glycemia in Type 2 Diabetes Mellitus patients in a highly consanguineous population.
  
  
  METHODS
  Case and control study.
  
  
  METHODS
  The survey was carried out at the Hamad General Hospital and Primary Health Care (PHC) centers in the State of Qatar.
  
  
  METHODS
  The study was conducted from November 2012 to June 2014 among subjects above 30 years of age. Of the 2224 registered with diagnosed diabetes and free diseases attending Hamad General Hospital and PHC centers agreed and gave their consent to study.
  
  
  METHODS
  Questionnaire included socio-demographic variables, body mass index (BMI), consanguinity, lifestyle habits, family history of diabetes, blood pressure and development of diabetes complications such as retinopathy, nephropathy, and neuropathy were collected at regular intervals throughout the follow-up. Univariate and multivariate statistical analysis were performed.
  
  
  RESULTS
  There were statistically significant difference between patients with diabetic and control in terms of ethnicity (p=0.012), level of education (p=0.002), occupation (p<0.001), monthly income (p<0.001), BMI(p=0.024), sport activity (p=0.018), cigarette smoking (p<0.001), consanguinity (p=0.029) and family history of Diabetes Mellitus (p<0.001) and co-morbidity hypertension (p=0.041). Further, the biochemistry values in the studied subjects with T2DM compared to healthy controls and the study revealed that serum Vitamin D, BMI, fasting glucose level, calcium, HbA1c, total cholesterol HDL, LDL, bilirubin, triglycerides, uric acid and blood pressure systolic and diastolic were higher in T2DM compared to their counterparts. Multivariate logistic regression showed that vitamin D deficiency ng/mL, Family History of T2DM, BMI (kg/m2) hypertension, consanguinity, income, mother occupation, ethnicity, educational level and Lack of physical exercise variables were significant predictors of diabetes. In the group of Diabetes Mellitus Type 2 patients, 39.3% as opposed to 51.2% in the control group had vitamin D deficiency, 25(OH) D3 levels≤10ng/ml (p<0.001). In the group of Diabetes Mellitus Type 2 patients, 34.6% as opposed to 37.9% in the control group had vitamin D insufficiency, 25(OH)D3 levels <20ng/ml (p < 0.001). In the group of Diabetes Mellitus Type 2 patients, 22.8% as opposed to 14.2% in the control group had vitamin D sufficiency, 25(OH)D3 levels >30 10ng/ml (p < 0.001).
  
  
  CONCLUSIONS
  Vitamin D, family history of diabetes, consanguinity marriages' and hereditary gene-environment interactions and physical exercise may also contribute to the current diabetes epidemic in Qatari's Arab populations.
authors.affiliation: Department of Biostatistics & Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, University of Manchester, Manchester, UK. Electronic address: abdulbari.bener@istanbul.edu.tr.
authors.forename: Abdulbari
authors.initials: A
authors.lastname: Bener
authors.affiliation: Qatar Diabetic Associations and Qatar Foundation, Doha, Qatar.
authors.forename: Abdulla O A A
authors.initials: AO
authors.lastname: Al-Hamaq
authors.affiliation: Department of Biostatistics & Medical Informatics, Cerrahpaşa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
authors.forename: Eda Merve
authors.initials: EM
authors.lastname: Kurtulus
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Heart Hospital, Hamad Medical Corporation,Qatar.
authors.forename: Waleed K
authors.initials: WK
authors.lastname: Abdullatef
authors.affiliation: Department of Endocrinology, Hamad General Hospital, Hamad Medical Corporation, Qatar.
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Zirie
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000032:analysis; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology* / Q000503:physiopathology; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D059647:Gene-Environment Interaction; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D007003:Hypoglycemia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D011379:Prognosis; D011780:Qatar / Q000453:epidemiology; D012307:Risk Factors; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications*; D014815:Vitamins
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D014807:Vitamin D; D014815:Vitamins; C517652:hemoglobin A1c protein, human
keywords: Diabetes mellitus; Epidemiology; Lipid profile; Physical exercise; Vitamin D