Chromium supplementation improves fasting blood glucose levels in patients with

type 2- diabetes

Diabetes, particularly type II diabetes, is a severe disease condition which affects human health

worldwide, with a dramatically increasing trend in Asian countries, including China. 1 Chromium

complexes, with the most known representative chromium picolinate, have been listed as one of most

attractive health supplements to lessen this disease condition in western countries. 1

Chromium is a naturally occurring pyridine-2-carboxylic acid metabolite of tryptophan. 2 Picolinic

acid (a natural ligand that is an isomer of nicotinic acid) improves the bioavailability of chromium and is

an effective metal chelator. 2 Trivalent chromium is an essential nutrient that has a role in carbohydrate,

lipid, and nucleic acid metabolism by potentiating insulin action. 2 Chromium picolinate has been

evaluated in limited studies in patients with non-insulin-dependent diabetes mellitus (NIDDM) as a

possible adjunct to therapy to improve glucose tolerance. 2 The National Institutes of Health suggests the

values for adequate intake of chromium are: 35 g/day in males aged 1450 years, 2425 g/day in

females aged 1450 years, 2930 g/day during pregnancy, and 44-45 g/day in lactation. 3 The upper

limit for the chromium intake is not able to be defined due to insufficient data. 3 The most important

form of chromium in the human body is Cr+3. 3 Chromium however is found in many different oxidative

states which include the forms Cr-2 to Cr+6. 3 Chromium is one of the most studied supplements and has

been found to have a positive effect on fasting plasma glucose. 4 There is growing evidence that

chromium may facilitate insulin signaling and chromium supplementation therefore may improve

systemic insulin sensitivity. 4

Furthermore, chromium increases the number of insulin receptors and insulin binding at its site

of action. 5 Chromodulin is produced in response to insulin secretion which stimulates chromium uptake

by the beta cells. 6 Chromodulin then binds to the cytosolic beta subunits of the insulin receptor and
stimulates the kinase activity. 6 Chromate (CrO3) may inhibit the activity of phosphotyrosine

phosphatase to enhance the prolonged insulin signaling. 6

The purpose of this paper is to determine whether or not chromium supplementation improves

fasting blood glucose level in patients suffering from type 2 diabetes. Four different studies have been

chosen that will be explained further in this paper on what was analyzed, discovered, and concluded

based on the evidence of the experiments of each individual study.

I obtained my data and discovered many different data analysis online through different

databases and search engines. I first started with the University of North Floridas (UNF) library database

that gives access to many different health sites supplied with many different peer-reviewed articles.

Some of these articles found were meta-analysis, systematic reviews, randomized controlled trials,

cohort studies (prospective observational studies), case-control studies, cross-sectional studies, and also

case reports and series. Of all the good peer-reviewed articles I found and studies, I chose only nine to

give enough supportive evidence for the purpose of this paper. Of the nine I chose, four of them were

primary sources, and the others were a meta-analysis of review article that help support my introduction

and conclusion. Other databases and websites I used in collaboration with the UNF library were mayo

clinics access to a pharmaceutical database called Micromedex Solutions, science direct, pub-med, and

also I used our textbook from class. Some of the main search terms I did in my research included:

diabetes, mellitus, chromium, metabolic syndrome, micronutrients, benefit, study, supplement, safety,

glucose, control, and homeostasis.

To start, the first primary source that I found about chromium is about the beneficial effect of

chromium supplementation on glucose, hemoglobin A1C and lipid variables in individuals with newly

onset type-2 diabetes. Hemoglobin A1C is an important parameter used to evaluate long-term glycemic

control. 4 The type of experiment carried out in this study was a controlled single blind, prospective
study. A total of forty newly onset type-2 diabetics were selected for the study. After one month of

stabilization, the people were further randomly divided into two groups, a study group and a placebo

group. The study group received 9 g brewers yeast (42 g chromium) daily (taking 3 capsules three

times a day after each meal). The other placebo group received yeast that did not consist of chromium,

but looked and smelled similar to the experimental groups medication, for 3 months. Subjects were

instructed not to change their normal eating and living habits. The subjects were given a month supply

of the placebo or study medication, and received the next month supply on their next check-up. Body

mass index (BMI) and waist hip ratio were calculated using standard methods on check-ups. Blood

glucose estimation was done before breakfast and twice in a week by a glucometer provided to the

patients and documented at home to be brought to each appointment. The study lipid profile was

analyzed by using complete chemistry auto-analyzer and glycosylated hemoglobin A1C (HbA1C) by

employing ion exchange chromatography technique. Fasting blood glucose, HbA1C and lipid profile were

analyzed at beginning and completion of the study.

As a result of this study, the results revealed that the fasting blood glucose levels significantly

reduced in the subjects consuming yeast supplemented with chromium. 4 Also, the hemoglobin A1C

levels improved significantly in the experimental group taking the yeast capsules that had the chromium

in it. 4 The HbA1C levels in the experimental group went from 9.51 to 6.86. 4 The control group also went

down from 9.30 to 8.71, but not nearly as considerably as the experimental groups did. 4

Secondly, the next study I found on chromium discussed beneficial effects of oral chromium

picolinate supplementation on glycemic control in patients with type 2 diabetes. The type of study that

was performed was a single blind, controlled, and randomized clinical trial. The study consisted of a total

of seventy-one patients that were split into two different groups, one was the supplemented group and

the other was the control group. The patients that were included in the study had to meet all the
research protocol requirements by undergoing certain criteria, clinical and nutritional evaluations, and

blood analysis. The enrollment and procedures occurred from November 2011 to May 2013. Once the

groups were selected, the patients had to choose randomly from two different envelopes that contained

either chromium picolinate or the placebo. After selection, they participants were given a thirty-day

supply of the medication to take twice a day, one capsule after breakfast and one after dinner. The

experimental group that was receiving the chromium picolinate was getting a total daily dose of 600g.

This dosage was established per the literature that revealed doses up 1000g chromium picolinate a day

having no negative effects on patients. 7 Fasting and postprandial glucose, hemoglobin A1C, total

cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol,

triglycerides and serum ferritin were all evaluated at the first appointment and after 120 days after

treatment.

The results of this study were comparable to the results of the first study. Hemoglobin A1C levels

were significantly reduced in the experimental group, but differing from the first study, the control group

also showed significant improvement, therefore all test subjects showed an improvement in overall

glycemic control. Significant reduction (p < 0.01) in fasting and postprandial glucose was observed in the

patients that were administered 600g chromium picolinate a day over a four-month period. 7

Furthermore, the next study discusses the characterizations of the metabolic and physiologic

response to chromium supplementation in subjects with type 2 diabetes mellitus. The objective of the

study was to provide a comprehensive evaluation of chromium supplementation on metabolic

parameters in a cohort of type 2 diabetes mellitus subjects representing a wide phenotype range and to

evaluate changes in responders and non-responders. 8 The design was double-blind, randomized, and

placebo-controlled study. Type 2 diabetes mellitus subjects (aged 30-70 years of age) with a body mass

index range of 25 to 40 and a fasting plasma glucose of at least 6.94 mmol/L (125 mg/dL) were evaluated
for the study at the time of screening. 8 A total of 93 subjects with type 2 diabetes mellitus completed

the study successfully. Once the patients met the requirements, they were instructed on a weight

maintenance diet by the study dietitian. Hemoglobin A1C, oral glucose tolerance testing (OGTT), body

weight/fat distribution as assessed by abdominal computed tomography, dual-energy x-ray

absorptiometry scans, urinary and plasma chromium levels, and lastly insulin sensitivity as assessed with

hyper-insulinemic-euglycemic clamps were all obtained from each patient. 8 Each test subject received

1000g of chromium a day as the experimental or the placebo, which were chosen at random. Each

person had to come in for a monthly routine clinic visit to get a refill of medication. Twenty-four weeks

after randomization, subjects underwent another physiologic testing identical to that described for the

preintervention testing. 8 As the major objective of the study was to evaluate the role of chromium

supplementation on metabolic parameters in a cohort representing a wide phenotype range and range

of glycemic control. 8

This study explained how their subjects were characterized as responders and non-

responders. Responders were defined as insulin sensitivity change from baseline of at least 10% or

greater. 8 Non-responders were defined as insulin sensitivity change from baseline of less than 10%. 8 The

hemoglobin A1C and homeostasis of the subjects blood glucose levels had no significant change from

the beginning of the study to the end. 8 Also found was that chromium levels after supplementation do

not differ between responders and non-responders, and provides the first comprehensive assessment of

physiologic and biochemical characteristics of individuals who responded to chromium. 8 At

preintervention, responders had significantly lower insulin sensitivity and higher fasting glucose and A1C

levels when compared with placebo and non-responders. 8 Clinical response was significantly correlated

to the baseline insulin sensitivity, fasting glucose, and A1C. 8 There was no difference in chromium status

between responder and non-responders. 8

 The last study describes the effects of chromium supplementation on the glucose homeostasis

and anthropometry of type 2 diabetic patients. This double-blind clinical study was performed on a total

of 39 participants that included both sexes between the ages of 30-60 suffering from type 2 diabetes.

The study lasted 90 days and what was measured was biochemical (blood tests) and anthropometric

evaluation (measurements of the body), physical activity measurement, and estimated energy

consumption. 8 The type of chromium given, if not taking the placebo, was chromium nicotinate. All the

participants were split up into three different group that were taking a daily dose of 200g of chromium

nicotinate a day, 50g of chromium nicotinate a day, and 0g of chromium nicotinate a day (placebo

group). The progress of the study was examined and documented on day 0, day 45, and day 90.

Moreover, there was no significant difference in hemoglobin A1C levels in any of the test

subjects. 9 There was an improvement of weight reduction in the experimental group taking the 50g of

chromium nicotinate a day. 9 This weight loss helped these patients decrease insulin resistance and

obtain a better glycemic control. All though, this study was unable to show any significant improvement

in blood glucose homeostasis or insulin resistance by taking chromium. 9

Conclusively, the studies show a wide variety of evidence. The first study showed how the

patients taking the chromium had improved their overall glucose levels, but the placebo group had not

changed much. All though, the second study showed that the overall glucose levels had improved for

both the experimental group and the placebo group. The third study showed that there was no

difference in the subjects that were responsive and non-responsive to the chromium. Also, neither group

had significant changes of hemoglobin A1C levels or homeostasis of the subjects blood glucose levels

from the beginning of the study to the end. Lastly, the final study also showed no significant correlation

of chromium having a profound effect of homeostasis of blood glucose levels in any of the three groups

studied.
 Overall, there is a lot of supportive evidence that correlates with chromium supplementation

and how it improves fasting blood glucose levels in patients with type 2- diabetes. Unfortunately, there is

also some evidence in other studies that does not show very supportive evidence of chromium

supplementation helping with the homeostasis of blood glucose levels. Therefore, due to the evidence of

the four studies found, it is unclear of the significance of chromium and there is more research that is

necessary to perform.
 References

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