Trivalent chromium, a dietary supplement that potentiates the action of insulin, was not included in the program. Like metformin and troglitazone, trivalent chromium decreases insulin resistance and has an acceptable side-effect profile; furthermore, it is available at a fraction of their cost.
A USDA sponsored clinical study conducted in China suggests it may be possible to treat the disease with the micronutrient chromium.
Adult NIDDM patients receiving chromium picolinate (a bioavailable form of the element) saw their blood sugar levels drop to within the normal range after two or three months of daily therapy. No such improvement was seen in patients receiving a placebo. Glycated hemoglobin, considered the most sensitive measure of diabetes control dropped significantly in patients taking the supplement.
"By adding chromium picolinate to the diets of these Chinese patients, who were not well-controlled on medication alone, we were able to help them achieve a more normal lab profile," said Richard Anderson, Ph.D., the leading chromium researcher at the US. Department of Agriculture's Human Nutrition Research Center, Beltsville, Md. "We now need to see if these results can be replicated in patients with diabetes in this country."
"These are improvements to the level of good control. It's as good as what we currently have available--oral hypoglycemic agents, diet and exercise. If further research confirms these numbers, chromium supplements could be an add-on therapy to current treatments to further lower blood glucose, noted Lois Jovanovic-Peterson, a physician specializing in diabetes and a senior scientist at the Sansum Medical Research Foundation in Santa Barbara, Calif.
The people taking chromium also showed significant drops in cholesterol and plasma insulin. People with type II, or maturity-onset, diabetes produce more insulin than normal in the early stages of the disease, Anderson explained, because the hormone is less efficient at clearing glucose from the blood. Chromium apparently makes the hormone more efficient.
Every cell in the body depends on glucose for energy. Derived primarily from complex carbohydrates, like starch, in our diet, glucose is carried from the intestinal tract to your body’s cells by the blood. In order for glucose to pass into the cells a hormone called insulin, produced by the pancreas, must be present. If insulin is not present, or if it is not functioning properly, glucose will not be transported into the body’s cells. In type 2 diabetes, the pancreas is still able to produce insulin but the body’s cells become less and less responsive to it. Therefore, unlike type 1 diabetics (who are dependent upon daily insulin shots because their pancreas cannot produce the hormone), type 2 diabetics do not usually have to take insulin injections but can regulate their blood glucose levels by making lifestyle modifications – exercising more, eating a proper diet and using medications or nutritional supplements.
Chromium is an essential mineral that increases the effectiveness of insulin and helps sugar, or glucose, to get into body cells. Without chromium, insulin will not work properly. Most diets supply only about 30 micrograms of chromium per day, but persons who are diabetic may need many times that amount to effectively regulate their blood sugar levels.
The Diabetes Prevention Program (DPP) was a major clinical trial, or research study, aimed at discovering whether either diet and exercise or the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes in people with impaired glucose tolerance (IGT).
The answer is yes. In fact, the DPP found that over the 3 years of the study, diet and exercise sharply reduced the chances that a person with IGT would develop diabetes. Metformin also reduced risk, although less dramatically. The DPP resolved these questions so quickly that, on the advice of an external monitoring board, the program was halted a year early. The researchers published their findings in the February 7, 2002, issue of the New England Journal of Medicine.
The Diabetes Prevention Program (DPP) is a new, 150 million dollar, NIH-sponsored study designed to determine whether non-insulin-dependent diabetes mellitus can be prevented or delayed in persons with impaired glucose tolerance.
Trivalent chromium should have been included in the Diabetes Prevention Program
EXPERT SAID:
"There are several lines of evidence suggesting that higher doses of chromium supplements may be beneficial," says William Cefalu, MD, associate professor of medicine and director of the clinical trials unit at the University of Vermont College of Medicine in Burlington. Diabetes experts say 600 micrograms (mcg) a day have proven effective. (The animal studies suggesting a cancer link used much larger amounts than you would get from nutritional supplements.)
Chromium is important in glucose regulation. The most dramatic results showing how chromium affects glucose levels came from Richard Anderson, and Dr. Nanzheng Cheng who did a small double-blind, placebo-controlled clinical trial with 180 adult patients, with type 2 diabetes. All supplements (patients were on 200 mcg or 1000 mcg of chromium picolinate or a placebo) were taken for four months. The patients were also instructed not to change their customary diets, exercise regimens or medications. It was reported, "the use of chromium picolinate supplements significantly droped the level of glycated hemoglobin in type II diabetics". There were no changes in the glycated hemoglobin levels among patients in the placebo group. Fasting blood glucose and serum insulin levels apparently dropped significantly as well. This data is important to provide support in prescribing chromium picolinate. This was reported in the Diabetes Journal, a publication of the American Diabetes Association in 1997.
YOUR REFERENCES
McLead MN & Golden RN (2000) Chromium treatment of depression, international journal of Neuropsychopharmacology 3: 311-4, cited in Jamison JR (2003) Clinical guide to nutrition & dietary supplements in disease management, pg 257 Chrurchill Livingstone.
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