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Chromium picolinate and type 2 diabetes

Miami Research Associates, 6280 Sunset Drive, #600, Miami, FL 33143 E-mail: dkalman{at}miamiresearch.com

Dear Sir:

The article by Althuis et al (1) in a recent issue of the Journal appears to be an imbalanced review of the publications to date regarding the potential benefit of chromium picolinate in persons with type 2 diabetes. Among the current published works, there are at least 9 noteworthy reports of clinical trials that show the relative efficacy of chromium picolinate (2–10). These studies concentrated on the effects of chromium picolinate on markers of blood glucose or on insulin regulation in subjects with type 2 diabetes or in persons with induced diabetes. The major fault in the conclusions of Althuis et al is that no studies of persons with diabetes were included in their final analysis.

In reading the 9 reports, it is easy to see that 1349 total subjects were studied over the past 10 y. With such a large number of subjects having participated in single- and double-blind trials, the findings are consistent: chromium picolinate has a positive effect on fasting insulin values and on hemoglobin A₁C. The data also indicate that, when used with standard treatments, chromium picolinate improves clinical results (eg, those for biguanides, sulfonylureas, or metformin alone) (10). Additional benefits have been found with chromium picolinate supplementation for coronary disease risk profiles [ie, lipids and lipoprotein(a)] that are important in the diabetic and nondiabetic communities. It is agreed that the dose for clinical benefit has not been universal, ranging from 200 to 1000 µg, but this only shows that "one size does not fit all," and thus a dose that is dependent on body surface area is indicated.

In any event, with the relative safety and inexpensiveness of chromium picolinate, there seems to be no reason for it not to be used in people who have poor blood sugar control or insulin resistance syndrome (11, 12). The benefit-to-risk ratio favors benefit. Continued research on the positive effects of chromium picolinate on biomarkers of blood sugar regulation is needed to expand the body of evidence for its utility as an adjunctive treatment of conditions that affect blood glucose. In addition, because the current data imply that some people respond better to chromium picolinate than do others (nonresponders), it may be that a test to identify the best candidates for treatment with chromium picolinate is indicated. However, we as scientists and clinicians cannot dismiss the current body of work that indicates the efficacy of this mineral, nor should we dismiss consumer support for this product as being without merit.

REFERENCES

1. Althuis MD, Jordon NE, Ludington EA, Wittes JT. Glucose and insulin responses to dietary chromium supplements: a meta analysis. Am J Clin Nutr 2002;76:148–55.[Abstract/Free Full Text]
2. Anderson RA, Cheng N, Bryden NA, Polansky MM, Chi J, Feng J. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes 1997;46:1786–91.[Abstract]
3. Bahadori B, Wallner S, Hacker C, Boes U, Komorowski JR, Wascher TC. Effects of chromium picolinate on insulin levels and glucose control in obese patients with type-II diabetes mellitus. Diabetes 1999;48(suppl):A349 (abstr).
4. Cefalu WT, Bell-Farrow AD, Stegner J, et al. Effect of chromium picolinate on insulin sensitivity in vivo. J Trace Elem Exp Med 1999;12:71–83.
5. Cheng N, Zhu X, Shi H, et al. Follow-up survey of people in China with type 2 diabetes mellitus consuming supplemental chromium. J Trace Elem Exp Med 1999;12:55–60.
6. Evans GW. The effect of chromium picolinate on insulin controlled parameters in humans. Int J Biosoc Res 1989;11:163–80.
7. Jovanovic-Peterson L, Gutierrez M, Peterson CM. Chromium supplementation for women with gestational diabetes mellitus. J Trace Elem Exp Med 1999;12:91–7.
8. Lee NA, Reasner CA. Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM. Diabetes Care 1994;17:1449–52.[Abstract]
9. Ravina A, Slezak L, Mirsky N, Bryden NA, Anderson RA. Reversal of corticosteroid-induced diabetes mellitus with supplemental chromium. Diabet Med 1999;16:164–7.[Medline]
10. Ravina A, Slezak L, Rubal A, Mirsky N. Clinical use of the trace element chromium (III) in the treatment of diabetes mellitus. J Trace Elem Exp Med 1995;8:183–90.
11. Anderson RA. Chromium, glucose intolerance and diabetes. J Am Coll Nutr 1998;17:548–55.[Abstract/Free Full Text]
12. Nielson F. Controversial chromium: does the superstar mineral of the mountebanks receive appropriate attention from clinicians and nutritionists. Nutr Today 1996;31:226–33.

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