Is There a Role for Dietary Supplements in the Management of Diabetes? Abstracts From Clinical Studies
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||Is There a Role for Dietary Supplements in the Management of Diabetes?|
Abstracts From Clinical Studies
Lessons from Observational Studies Evaluating Magnesium Intakes: Can They Predict Outcomes for Clinical Interventions?
W.H. Linda Kao, Ph.D
Type 2 diabetes mellitus imposes a substantial public health burden in the United States. It affects approximately 15 million Americans and leads to an excess risk of blindness, renal failure, lower extremity amputation, and cardiovascular disease. Several lines of evidence suggest a possible, novel risk factor for type 2 diabetes S magnesium deficiency. First, several large observational studies have demonstrated strong cross-sectional associations between low serum magnesium and type 2 diabetes. Second, in vitro studies have shown an effect of magnesium on the secretion of insulin by the pancreas and on the responsiveness to insulin by peripheral tissues. Third, magnesium supplementation prevents the development of diabetes in a rat model of spontaneous type 2 diabetes. Finally, clinical intervention studies demonstrated that daily magnesium supplementation can improve short-term insulin response and glucose handling in diabetic individuals. Results from large, prospective, observational studies of the associations between serum magnesium and magnesium intake and the risk of developing type 2 diabetes will be reviewed. Although results from these studies support the notion that low serum magnesium levels and low dietary magnesium intake may be important in the development of type 2 diabetes, whether pharmacologic doses of magnesium used as dietary supplement can reduce the long-term risk for type 2 diabetes remains to be investigated.
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Vitamin Interventions to Prevent the Onset or Complications of Diabetes
John J. Cunningham, Ph.D., FACN
Hyperglycemia resulting from pancreatic beta cell destruction (insulin-dependent , IDDM) or defective insulin receptor function (non insulin-dependent, NIDDM) causes the degenerative complications of diabetes mellitus. Intervention strategies include primary prevention and alterations of glucose metabolism. Tight" (euglycemic) glucose control is accomplished by customizing the insulin regimen, diet and lifestyle and is well documented to be effective in delaying the onset of complications. Niacinamide has been tested at a pharmacologic dose in at-risk siblings of IDDMS, such as in the CanENDIT and DENIS trials. The results to date will be reviewed. Vitamin C is an ëaldose reductase inhibitor" in the sorbitol pathway with a potential for efficacy. Vitamins C and E offer protection against the oxidatative glycation of proteins that may also contribute to the delay of clinical complications.
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Cunningham JJ. Micronutrients as nutriceutical interventions in diabetes mellitus.
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Pozzilli P, Brown PD, Kolb H: Meta-analysis of nicotinamide treatment in patients with recent onset insulin dependent diabetes. Diabetes Care 19:1357-1363, 1996
Manna R, Migliore A, Martini LS, Ponte E, Marietti G, Scuderi F, Cristiano G, Ghirlanda G, Gambassi G: Nicotinamide treatment in subjects at high risk of developing IDDM improves insulin secretion.Br J Clin Pract 46:177-179, 1997
Elliot RB, Pilcher C, Stewart A: The use of nicotinamade in the prevention of type I diabetes. Ann NY Acad Sci 696:333-341, 1993.
Elliot RB, Pilcher C, Fergusson DM, Stewart AW: A population based strategy to prevent insulin-dependent diabetes using nicotinimide. J Pediatr Endocr Met 9:501-509, 1996
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Sharma A, Kharb S, Chugh SN, Kakkar R, Singh G. Effect of glycemic control and vitamin E supplementation on total glutathione content in non-insulin-dependent diabetes mellitus. Ann Nutr Metab 44:11-13, 2000
Bursell S-E, Clermont A, Aiello LP, Aiello L, et al. High-dose vitami E supplementation normalizes retinal blood flow and creatinine clearance in patients with type 1 diabetes. Diabetes Care 22:1245- 1251, 1999.
Jain SK, McVie R, Jaramillo JJ, Palmer M, Smith T: Effect of modest vitamin E supplementation on glycated hemoglobin and triglyceride levels and red cell indices in type I diabetic patients. J Am Coll Nutr 15:458-461, 1996.
Cunningham JJ, Mearkle PL, Brown RG: Vitamin C: an aldose reductase inhibitor that normalizes erythrocyte sorbitol in insulin-dependent diabetes mellitus. J Am Coll Nutr 13:344-350, 1994.
Cunningham JJ: The glucose/insulin system and vitamin C: implications in insulin-dependent diabetes mellitus. J Am Coll Nutr 17:105-108, 1998.
Lessons From Micronutrient Studies In Patients With Glucose Intolerance and Diabetes Mellitus: Chromium and Vanadium
Henry C. Lukaski, Ph.D.
Public interest in the use of supplemental vanadium and chromium to ameliorate the symptoms of diabetes is burgeoning because of their putative action as insulin potentiating agents. Since 1980, evidence has accumulated to show that vanadium salts, vanadyl and vanadate, mimic insulin action in isolated cell systems and produce glucose-lowering effects when given to animals with diabetes. Supplementation of diabetic patients with vanadium salts in doses ranging from 25 to 100 mg of elemental vanadium daily for up to six weeks elicits partial normalization of glucose metabolic irregularities. Also, chromium supplements, specifically chromium picolinate, in amounts of 400 to 1000 mcg/d ameliorate glucose metabolic abnormalities in some patients with insulin resistance or type 2 diabetes. The doses of supplemental vanadium far exceed the apparent human vanadium requirement (10 mcg/d) whereas the levels of chromium supplementation surpass the safe and adequate intake level for chromium (50 to 200 mcg/d). Adverse effects of ingestion of these mineral supplements at these doses have been reported. Thus, doses of these minerals that elicit beneficial effects are pharmacologic and not nutritional.
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Anderson RA, N Cheng, NA Bryden, MM Polansky, N Cheng, J Chi, J Feng. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes 46: 1786-1791, 1997.
Cefalu WT, AD Bell-Farrow, J Stenger, ZQ Wang, T King, T Morgan, JG Terry. Effect of chromium picolinate on insulin sensitivity in vivo. J Trace Elem Exp Med 12: 71-83, 1999.
Cheng N, X Zhu, H Shi, W Wu, J Chi, J Cheng, RA Anderson. Follow-up survey of people in China with type 2 diabetes consuming supplemental chromium. J Trace Elem Exp Med 12: 55-60, 1999.
Davis CM, JB Vincent. Chromium oligopeptide activates insulin receptor kinase activity. Biochemistry 36: 4382-4385, 1997.
Davis CM, JB Vincent. Isolation and characterization of a biologically active chromium oligopeptide from bovine liver. Arch Biochem Biophys 339: 335-343, 1997.
Jovanovic L, M Guttierrez, CM Peterson. Chromium supplementation for women with gestational diabetes. J Trace Elem Exp Med 12: 91-97, 1999.
Lukaski HC. Chromium as a supplement. Ann Rev Nutr 19: 279-302, 1999.
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Ravina A, L Slezak, N Mirsky, RA Anderson. Control of steroid-induced diabetes with supplemental chromium. J Trace Elem Exp Med 12: 375-378, 1999.
Speetjens JK, RA Collins, JB Vincent, SA Wolski. The nutritional supplement chromium(III) tris(picolinate) cleaves DNA. Chem Res Toxicol 12: 483-487, 1999.
Stearns, DM. Is chromium a trace essential metal? Biofactors 11: 149-162, 2000.
Vincent JB. Mechanisms of chromium action: low-molecular weight-chromium-binding substance. J Am Coll Nutr 18: 6-12, 1999.
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Cohen N, M Halberstram, P Shilmovich, CJ Chang, H Sharnoon, L Rossetti. Oral vanadyl sulfate improves hepatic and peripheral insulin sensitivity in patients with non-insulin dependent diabetes mellitus. J Clin Invest 95: 2501-2509, 1995.
Goldfine AB, DC Simonson, F Folli, ME Patti, CR Kahn. Metabolic effects of vanadyl sulfate in humans with insulin-dependent and non insulin-dependent diabetes mellitus in vivo and in vitro studies. J Clin Endocrinol Metab 80: 3311-3320, 1995.
Goldfine AB, DC Simonson, F Folli, ME Patti, CR Kahn. In vivo and in vitro studies of vanadate in human and rodent diabetes mellitus. Mol Cell Biochem 153: 217-231, 1995.
Goldfine AB, ME Patti, L Zuberi, BJ Goldstein, R LeBlanc, EJ Landaker, ZY Jiang, GR Willsky, CR Kahn. Metabolic effects of vanadyl sulfate in humans with non-insulin dependent diabetes mellitus: in vivo and in vitro studies. Metabolism 49: 400-410, 2000.
Hamel FG, WC Duckworth. The relationship between insulin and vanadium metabolism in insulin target tissues. Mol Cell Biochem 153: 95-102, 1995.
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Verna S, MC Cam, JH McNeill. Nutritional factors that can favorably influence the glucose/insulin system: vanadium. J Am Coll Nutr 17: 11-18, 1998.
Is There a Role for Taurine Supplementation
in the Management of Diabetes?
Katherine Chauncey, PhD, RD, CDE
Taurine is a small sulfur-containing amino acid and is one of the most abundant free amino acids in humans. Its real importance has been recognized only within the past 25 years. Once considered non-essential, taurine is now considered "conditionally essential." In pre-term and term infants, taurine insufficiency results in impaired fat absorption, bile acid secretion, retinal function, and hepatic function, all of which can be reversed by taurine supplementation. An increasing body of data demonstrates that taurine at pharmacological concentrations alters carbohydrate metabolism. People with diabetes have lower than average blood levels of taurine, but whether this means they should take extra taurine is unclear. This presentation will describe the steps involved in designing and implementing a clinical trial to study taurine supplementation in patients with type 2 diabetes mellitus.
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