Diabetes is at epidemic proportions in this country. It is estimated that 17 million Americans have either type 1 or type 2 diabetes, and almost 6 million people have the disease but have not been diagnosed.1 Approximately 8.6 percent of the adult population is diabetic; the condition is slightly more prevalent among women than men. The economic cost of caring for people with diabetes is estimated to be $132 billion per year.2

Diabetes occurs when the body does not produce enough, or properly use, insulin. The actual cause of diabetes is unknown, but genetics and factors such as obesity, lack of exercise and improper diet appear to play significant roles. Type 1 diabetes occurs when the body does not produce insulin. Because insulin is required for cellular glucose uptake, blood sugar levels increase, necessitating daily insulin injections. The American Diabetes Association estimates 5 percent to 10 percent of Americans diagnosed with diabetes have type 1. Type 2 diabetes results from insulin resistance, a condition in which the body fails to properly use insulin, combined with relative insulin deficiency. People with this condition often can manage their blood sugar levels with dietary modifications, lifestyle changes or medication. Approximately 90 percent to 95 percent of Americans diagnosed with diabetes have type 2, and the prevalence is escalating.

There is also a condition known as prediabetes, which has been termed syndrome X or metabolic syndrome. It is defined as impaired glucose tolerance with elevated insulin levels, and it occurs because of cellular insensitivity to insulin activity. The ADA estimates that at least 16 million Americans have this condition. Many of them will develop type 2 diabetes if their metabolic syndrome is not corrected.

Defending Against Diabetes
The body requires certain nutrients to control glucose metabolism, especially chromium, zinc and vitamins B and C. Chromium, a trace mineral, is of particular importance because it is mobilized when either glucose or insulin enter the bloodstream. In fact, chromium helps insulin function most efficiently.3 Insulin is a hormone that regulates several body functions, but its most noteworthy role is getting glucose into cells and keeping blood sugar levels normal.

True chromium deficiency is unlikely in the United States; however, insufficient intake is certainly possible. Many American adults may not get the 20 to 30 micrograms recommended by the Washington, D.C.-based Institute of Medicine.⁴ Brewer's yeast, oysters, liver and potatoes are rich food sources of chromium. Seafood, chicken, meat, whole grains and bran are intermediate sources, and fruits, vegetables and dairy products contain lower amounts of chromium. But the typical Western diet is dominated by refined sugar, which some researchers suggest depletes the body's chromium stores.⁵

Because the typical diet contains low levels of chromium, and dietary sources are not readily absorbed,⁶ supplementation may benefit individuals with diabetes.⁵ In fact, in the chromium studies that yielded positive results, subjects received most of their chromium from supplements, not foods.⁶ Chromium picolinate, chromium polynicotinate, chromium chloride and high-chromium yeast are the primary forms available as nutrition supplements in either combination formulas or stand-alone nutrients.⁷ Chromium picolinate is the form that has been used in the majority of scientific research.

The Chromium Connection
Chromium's possible relevance in controlling diabetes has prompted much research. In a four-month trial involving 180 Chinese men and women with type 2 diabetes, researchers compared the effects of 200 mcg or 1,000 mcg chromium picolinate and placebo. Results showed markers of long-term blood sugar control improved significantly after two months in the group receiving 1,000 mcg, and in both chromium groups after four months. Among those in the group taking the higher dose of chromium, researchers also noted lower fasting glucose levels.8

In a follow-up survey, researchers monitored 833 people with type 2 diabetes for up to 10 months after chromium supplementation. The subjects took 500 mcg of chromium picolinate in addition to their hypoglycemic medicine and/or insulin. Fasting and postprandial (after meal) glucose levels improved significantly in more than 90 percent of patients and remained lower for one to 10 months following supplementation. Patients also reported improvements in symptoms: 443 subjects felt fatigued before supplementation compared with 52 afterwards. The number of subjects reporting excessive thirst dropped from 334 to 47, with similar numbers regarding frequent urination. The researchers reported similar results in both men and women. "These data confirm the safety and beneficial effects of supplemental chromium and demonstrate that beneficial effects of supplemental chromium observed in a few months are also present after 10 months," they concluded.⁹

In another study, researchers found that 200 mcg daily doses of chromium decreased insulin or oral medication requirements among the 243 patients with either type 1 or type 2 diabetes by 57 percent in adult-onset cases and 34 percent in childhood-onset cases. The researchers noted that placebo was ineffective and that more women than men responded favorably to the chromium supplements.10

Richard Anderson, Ph.D., a lead scientist at the Beltsville Human Nutrition Research Center in Beltsville, Md., has studied the nutritional role of chromium and other trace elements in human health and disease. In 1998, he published a review of chromium as it relates to glucose intolerance and diabetes. 11 "Chromium picolinate has been shown to be more effective than other types of chromium in improving the variables associated with diabetes," Anderson wrote, "with more improvements occurring in higher doses." Overall, studies showed improvements in glucose and cholesterol levels in people receiving 200 mcg chromium picolinate per day, "with a better response at 1,000 mcg daily." Anderson concludes, "The benefits of chromium supplementation seem to be related to the form and amount of chromium, with many studies demonstrating the positive effects of chromium supplementation in individuals with type 2 diabetes in a dose-dependent fashion."

Gina J. Ryan, Pharm.D., of the Southern School of Pharmacy at Mercer University in Atlanta, and colleagues recently reviewed the chemistry, pharmacology, efficacy and safety of chromium for treating type 2 diabetes. In reviewing pertinent research published between 1996 and 2002, the researchers found the essential nutrient has a key role in lipid and glucose metabolism. They concluded chromium appears to be a safe supplement and may have a role as adjunctive therapy for treatment of type 2 diabetes, adding that additional large-scale, long-term, randomized, double-blind studies examining the effect of various doses and forms of chromium are needed.12

A Weighty Risk
Obesity is known to complicate syndrome X and compound the risk and intensity of diabetes. The relationship between being overweight or obese and type 2 diabetes—as well as hypertension and coronary heart disease—is probably due in part to insulin resistance.13 For insulin-resistant and hyperinsulinemic people, weight loss is particularly beneficial. Some studies indicate chromium, when combined with dietary modifications and moderate exercise, can assist weight loss.

In 1999, researchers conducted a randomized, double-blind, placebo-controlled crossover study. Twenty overweight black women received either placebo or 200 mcg chromium three times a day for two months, then the alternate. The researchers determined that 600 mcg of niacin-bound chromium, combined with moderate diet and exercise, positively influenced weight loss and body composition. They concluded, "Niacin-bound chromium given to modestly dieting-exercising black women caused a significant loss of fat and sparing of muscle compared to placebo." Benefits lasted longer than the supplementation period, indicating a carryover effect. Subjects' blood chemistries revealed no significant adverse effects from the two-month supplementation period.14

Temporary Diabetic Conditions
Certain physical conditions or courses of medication can cause diabetes symptoms. Pregnant women are often at risk for gestational diabetes (diabetes symptoms present only during pregnancy). According to the ADA, gestational diabetes affects about 4 percent of all pregnant women; there are about 135,000 cases in the United States each year. In one study, researchers divided 30 women with gestational diabetes into three groups. Ten women received 4 mcg chromium picolinate daily per kilogram of body weight, 10 received 8 mcg/kg daily and 10 received placebo. After eight weeks, the supplemented groups achieved significantly improved glucose and insulin levels compared with both their baseline levels and with the placebo group. The group receiving 8 mcg chromium had significantly lower postprandial glucose levels than those receiving 4mcg chromium. The authors concluded, "Chromium supplementation for gestational diabetic women improves glucose tolerance and lowers hyperinsulinemia."¹⁵

Type 2 diabetes can also result from using corticosteroids or glucocorticoids (hydrocortisone, prednisone or dexamethasone) because these drugs counteract insulin. The treatment plan for steroid-induced diabetes is the same as for type 2 diabetes—diet, exercise and sometimes medication—but this drug-induced condition typically goes away when the steroids are discontinued. In a small, preliminary study, researchers examined chromium losses two days before corticosteroid treatment and for three days after. They gave three patients with steroid-induced diabetes 600 mcg chromium picolinate. What they found was urinary chromium losses increased in the first three days following steroid treatment. Chromium supplementation reduced fasting blood glucose values and the need for hypoglycemic drugs. The researchers concluded corticosteroids increase chromium losses, and steroid-induced diabetes can be reversed with chromium supplementation. They also acknowledge further follow-up double-blind studies are needed to confirm these results.16

Minimizing The Effects
Diabetes is devastating because of its consequences. The condition often leads to hypertension, lipid disorders, cardiovascular disease, blindness, skin problems, nerve damage, kidney disorders and loss of limbs. Although it appears chromium picolinate may benefit your customers with type 2 diabetes, supplementation represents just one facet of treatment. Urge your customers to seek medical advice for managing the condition. Registered dietitians can personalize a menu plan, for example. And encourage them to get good advice on exercise, foot care and medicine as well.

Pat Baird is a registered dietitian, nutrition consultant and author of four books. She is a member and fellow of the American Dietetic Association.

References

1. National Institute of Diabetes & Digestive & Kidney Diseases. (http://diabetes.niddk.nih.gov/dm/pubs/statistics/ index.htm#11). May 2003.

2. American Diabetes Association. Economic costs of diabetes in the US in 2002. Diabetes Care 2003;26:917-32.

3. Anderson RA. Nutritional factors influencing the glucose/insulin system: chromium. J Am Coll Nutr 1997;16:404-10.

4. Dietary Reference Intakes (vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc), 6:1­6:22. Institute of Medicine, National Academy Press, 2001.

5. Toepher EW, et al. Chromium in foods related to biological activity. J Agric Food Chem 1973;21(1):69-73.

6. Webb D. Chromium connection: promising health roles surface at expert summit. Environmental Nutr 2003 Jun;26(6):1,4.

7. PDR for Nutritional Supplements, First Edition. Medical Economics/Thompson Healthcare, 2001.

8. Anderson RA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type II diabetes. Diabetes 1997;46(11):1786-91.

9. Cheng N, et al. Follow-up survey of people in China with type 2 diabetes mellitus consuming supplemental chromium. J Tr Elem Exp Med 1999;12:55-60.

10. Ravina A, et al. Chromium in the treatment of clinical diabetes mellitus. Harefauh 1993;125(5-6):142-5.

11. Anderson RA. Chromium, glucose intolerance and diabetes. J Am Coll Nutr 1998;17(6):548-55.

12. Ryan GJ, et al. Chromium as adjunctive treatment for type 2 diabetes. Ann Pharmacother 2003 Jun;37(6):876-85.

13. Reaven GM. Importance of identifying the overweight patient who will benefit the most by losing weight. Ann Intern Med 2003 Mar 4;138(5):420-3.

14. Crawford V, et al. Effects of niacin-bound chromium supplementation on body composition in overweight African-American women. Diabetes Obes Metab 1999;1:1-7.

15. Jovanovic-Peterson L, et al. Chromium supplementation for women with gestational diabetes mellitus. J Tr Elem Exp Med 1999;12:17-83.

16. Ravina A, et al. Reversal of corticosteroid-induced diabetes mellitis with supplemental chromium. Diabet Med 1999;16:164-7.

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