James Gormley10.01.03
Today, according to the U.S. Centers for Disease Control and Prevention (CDC), 17 million Americans have diabetes. Diagnosed in 11 million people and undiagnosed in an estimated 6 million others,nearly 9% of all Americans ages 20 to 64 have this disease. Diabetes is the sixth leading cause of death and people with diabetes are twice as likely to die than are those without the disease.
The World Health Organization (WHO) estimates that the global diabetes figure could reach 300 million people by 2025. There is a growing recognition of the fact that there are 95 million Americans with some degree of insulin resistance, 102 million adults at risk for cardiovascular disease and 108 million people who are overweight.
What's worse is the disease is having a major impact on the world's children. Related to that is overweight and obesity. Over the last 25 years the number of children who are overweight has tripled-22% are overweight. Further, 13% of children ages six to 11 and 14% of children ages 12 to 19 are obese. Sixty percent of overweight children ages five to 10 have at least one risk factor for cardiovascular disease (CVD), while 25% have over two risk factors. Tied to obesity, sugar-packed diets and physical inactivity, type 2 diabetes in children is now the "new children's epidemic," a disease which used to develop almost exclusively in adulthood.
Insulin resistance is at the core of the diabetes, pre-diabetes and a host of related diseases. According to the American Association of Endocrinologists (AACE), metabolic syndrome (also called Syndrome X) is an epidemic condition that is estimated to affect one in three Americans.
Syndrome X is a metabolic disorder that underlies some of the most serious, chronic and costly diseases in the U.S. First identified by researchers at Stanford University, Syndrome X is a constellation of conditions brought on by insulin resistance. Symptoms of this disorder include visceral obesity, dyslipidemia, hypertension and glucose intolerance.
Although most people with insulin resistance can, in the early stages, usually produce enough insulin to mask outright symptoms of poor insulin and glucose control, some will eventually develop type 2 diabetes. Nevertheless, the majority of these patients are still at significantly increased risk for heart attack, stroke and other diseases.
Some of the complications from diabetes include diabetic retinopathy, which causes blindness or severe vision impairment in about 2% and 10% of patients, respectively; diabetic neuropathy, a condition that assails approximately 50% of people with diabetes, causing sensory loss and damage to the limbs, in addition to impotence; diabetic foot disease, which can lead to amputation of a lower limb; heart disease, which accounts for about 50% of all deaths among people with diabetes; stroke; kidney failure and dental disease.
As of May 2003, diabetes' total measurable direct and indirect annual costs-medical care, medical services, short-term and long-term disability and premature death-totaled $132 billion. With one million new cases of diabetes diagnosed each year, by 2050 it is estimated that 29 million people will have the disease.
A blue-ribbon panel of diabetes experts estimates that the total annual costs for hospitalized patients with diabetes exceed $90 billion. This panel also found that "resource consumption and length of stay for a person with diabetes exceeds that of a comparable patient without diabetes by 30-40%."
Robert Stone, executive vice-president of Nashville, TN-based American Healthways and president of the Disease Management Association of America, who commissioned the expert panel, said, according to the report, "Because the admitting diagnosis typically is not diabetes, hospital administrators and health plan financial executives rarely see the high costs that failure to manage diabetes in the hospital can precipitate."
What can be done outside of targeted diabetes disease management programs? Two landmark lifestyle intervention programs may provide some answers.
Diabetes Prevention Program (DPP). According to the NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), "millions of overweight Americans at high risk for type 2 diabetes can delay, and possibly prevent, the disease with moderate diet and exercise," pointing to a landmark study conducted by W.C. Knowler, et al., in the February 7, 2002, edition of the New England Journal of Medicine.
The study, which was spearheaded, in part, by Massachusetts General Hospital's David Nathan, M.D., randomly assigned 3234 overweight non-diabetic people who had elevated fasting and post-load plasma glucose concentrations [impaired glucose tolerance] to one of three treatment protocols: a lifestyle modification program (with goals of at least 7% weight loss, by completion, and at least 150 minutes of physical activity per week); metformin (850 mg twice daily) or a placebo. At entry, the mean age of participants was 51 years, and the mean body-mass index (BMI) was 34. Of note, 68% of the participants were women and 45% were members of high-risk ethnic groups: black, Hispanic, Asian American and Pacific Islanders and Native Americans. The average follow-up was 2.8 years.
According to the authors, the lifestyle intervention reduced the incidence of diabetes by 58%. In contrast, metformin only reduced the incidence by 31%. The authors concluded that the "lifestyle intervention was significantly more effective than metformin." In fact, said Dr. Nathan, the lifestyle intervention "was most effective in people aged 60 and older, who lowered the risk of developing diabetes by 71%." Although metformin achieved some success overall, "it was relatively ineffective in older volunteers and in those who were less overweight," according to Dr. Nathan.
Diabetes Control and Complications Trial (DCCT). The DCCT was a clinical study carried out from 1983 to 1993 by the NIDDK. The largest, most comprehensive diabetes study ever conducted, the DCCT involved 1441 young adults with type 1 diabetes via 29 medical centers across the U.S. and Canada. At start, the participants had diabetes for at least one year, but no longer than 15 years, and were required to have no, or only early signs of, diabetic eye disease.
The study compared the effects of two treatment approaches-standard therapy and intensive control-on the complications of diabetes, randomly assigning participants to one of two treatment groups. The patients were followed for a mean of 6.5 years.
While the standard therapy involved one or two daily injections of insulin, the intensive treatment regimen included the following components:
Testing blood glucose levels four or more times per day;
Four daily insulin injections or use of an insulin pump;
Adjustment of insulin doses according to food intake and exercise;
A diet and exercise plan; and
Monthly visits to a healthcare team composed of a physician, nurse educator, dietitian and behavioral therapist.
Intensive treatment resulted in a 76% reduced risk of eye disease, a 60% reduced risk of nerve disease and a 50% reduced risk of kidney disease. The intensive regimen was also associated with greater improvements in blood pressure, ratio of HDL to LDL, urinary albumin excretion (reducing albuminuria by 54%) and glycosylated hemoglobin levels.
The natural products industry is uniquely positioned to provide consumers scientifically validated dietary supplements that provide measurable benefits in health areas that directly, or indirectly, are associated with glucose control and insulin metabolism.
Although literally hundreds of vitamins, minerals, botanicals and specialized compounds can be identified to help with health markers related to diabetes and its associated conditions, a National Library of Medicine PubMed (MEDLINE) search yielded research predominantly using a select group ofsupplements. What follows is an outline of supplements and compounds that (1) have recent published or public-grant-supported studies relating to diabetes and (2) are also brands available from their manufacturers (in cases of proprietary compounds) as finished products.
Alpha lipoic acid. A 2003 animal study, "demonstrates," say the authors, "that alpha lipoic acid supplementation prevents development of hypertension and hyperglycemia," most likely via its antioxidative effects. A rat study from 2002 that appeared in the Journal of the American Society of Nephrology found that the "combined antioxidant and [blood-sugar-lowering] actions [] may contribute to its utility in preventing [liver] injury and other complications of diabetes."
Vitamin C. An animal study from 2002 found that after one month oral vitamin C significantly lowered arterial blood pressure in a group of patients, ages 45 to 70, with type 2 diabetes (versus placebo group).
Vitamin E. A 2002 review article found that "epidemiological evidence indicates [that] low vitamin E intake [is] a risk factor [for] development of type 2 diabetes." A Chinese animal-model study published that same year, observed that "joint supplementation of vitamin C [and] vitamin E, [or] separately, could hold back abnormal glucose metabolism [e.g., levels of glycated hemoglobin A1c] in diabetic rats and "protect the kidney from damage under hyperglycemia."
Chromium. A 2003 study found that people with type 2 diabetes who took chromium picolinate (1000 mcg a day) had a mean increase in insulin sensitivity of almost 9%, while the placebo group had a mean decrease of 3.6%; insulin-stimulated Akt activation was also significantly increased by the end of the study in the supplemented group. In September 2003, the National Institutes of Health (NIH) awarded Dr. William Cefalu of Louisiana State University's Pennington Biomedical Research Center a "substantial grant" to evaluate the use of chromium picolinate supplementation in people with type 2 diabetes.
Magnesium. According to a 2003 study, patients with type 2 diabetes who supplement each day with magnesium are able to achieve "improved insulin-mediated glucose uptake." The authors also said that "the benefits deriving from daily magnesium supplementation are [] supported by epidemiological studies showing that [daily] magnesium intake [is] predictive of a lower incidence of [type 2 diabetes]." Another study published this year from New Delhi found that magnesium supplementation in patients with type 2 diabetes resulted in "a significant" fall in LDL (or "bad") cholesterol and triglyceride levels and a rise in HDL (or "good") cholesterol within one to two months of the treatment start.
Zinc. In 2003, a study was published that looked at Tunisians with type 2 diabetes. In this study, people with type 2 diabetes received 30 mg per day of zinc gluconate or a placebo. Blood tests revealed valuable improvements in measures of antioxidative activity, including those related to superoxide dismutase (SOD) and glutathione peroxidase. In a 2001 animal study, zinc supplementation significantly reduced hyperglycemia and hyperinsulimenia in diabetic mice, suggesting that zinc has a role in pancreatic function.
Bitter melon. Indian researchers this year published a study, which included the administration of Momordica charantia (bitter melon) to diabetic rats. In this study, bitter melon reduced fasting glucose levels by 48%. A 2001 mouse study from Japan also looked at bitter melon in animals with type 2 diabetes and hyperinsulinemia. After three weeks, mice that received the supplement experienced reduced blood glucose and beneficially increased levels of a glucose transporter protein, GLUT4. The authors concluded that "the antidiabetic effect of [bitter melon] is derived, at least in part, from a decrease in insulin resistance."
Fenugreek. In a 2002 study, an extract of fenugreek seeds (Trigonella foenum graecum) was given to experimentally pre-diabetic and diabetic animals. The treatment produced significantly improved insulin response and blood glucose. The authors speculated that "the effect may [be due to] increasing the sensitivity of tissues to available insulin." Normal and diabetic rats received an extract of fenugreek for 30 days in a study from 2001. The treated diabetic animals held back what would have been free-radical-caused lipid peroxidation and depletion of antioxidants in the liver, kidney and pancreas.
Gymnema sylvestre. In a Japanese study from 2000, an extract of Gymnema sylvestre was given to diabetic mice. The extract reduced blood glucose levels and improved endogenous insulin synthesis. The authors concluded that, "The insulin-releasing action of [Gymnema] may contribute to the antihyperglycemic effect" and has potential to help combat obesity and hyperglycemia.
Research continues to demonstrate that science-based dietary supplements, combined with physical activity and a balanced diet, provide American consumers with an opportunity to significantly decrease their odds for developing type 2 diabetes. Research also seems to be pointing toward supplements that can improve quality-of-life in those that already have the disease. NW
About the author:
James Gormley is an industry expert, commentator and author. He also serves as director of trade communications for Purchase, N.Y.-based Nutrition 21, Inc. Before joining Nutrition 21, he served as editor-in-chief for Better Nutrition magazine from 1995 to 2002. He can be reached at jgormley@nutrition21.com.
The World Health Organization (WHO) estimates that the global diabetes figure could reach 300 million people by 2025. There is a growing recognition of the fact that there are 95 million Americans with some degree of insulin resistance, 102 million adults at risk for cardiovascular disease and 108 million people who are overweight.
What's worse is the disease is having a major impact on the world's children. Related to that is overweight and obesity. Over the last 25 years the number of children who are overweight has tripled-22% are overweight. Further, 13% of children ages six to 11 and 14% of children ages 12 to 19 are obese. Sixty percent of overweight children ages five to 10 have at least one risk factor for cardiovascular disease (CVD), while 25% have over two risk factors. Tied to obesity, sugar-packed diets and physical inactivity, type 2 diabetes in children is now the "new children's epidemic," a disease which used to develop almost exclusively in adulthood.
Syndrome X
Insulin resistance is at the core of the diabetes, pre-diabetes and a host of related diseases. According to the American Association of Endocrinologists (AACE), metabolic syndrome (also called Syndrome X) is an epidemic condition that is estimated to affect one in three Americans.
Syndrome X is a metabolic disorder that underlies some of the most serious, chronic and costly diseases in the U.S. First identified by researchers at Stanford University, Syndrome X is a constellation of conditions brought on by insulin resistance. Symptoms of this disorder include visceral obesity, dyslipidemia, hypertension and glucose intolerance.
Although most people with insulin resistance can, in the early stages, usually produce enough insulin to mask outright symptoms of poor insulin and glucose control, some will eventually develop type 2 diabetes. Nevertheless, the majority of these patients are still at significantly increased risk for heart attack, stroke and other diseases.
Some of the complications from diabetes include diabetic retinopathy, which causes blindness or severe vision impairment in about 2% and 10% of patients, respectively; diabetic neuropathy, a condition that assails approximately 50% of people with diabetes, causing sensory loss and damage to the limbs, in addition to impotence; diabetic foot disease, which can lead to amputation of a lower limb; heart disease, which accounts for about 50% of all deaths among people with diabetes; stroke; kidney failure and dental disease.
A Public Health Burden Emerges
As of May 2003, diabetes' total measurable direct and indirect annual costs-medical care, medical services, short-term and long-term disability and premature death-totaled $132 billion. With one million new cases of diabetes diagnosed each year, by 2050 it is estimated that 29 million people will have the disease.
A blue-ribbon panel of diabetes experts estimates that the total annual costs for hospitalized patients with diabetes exceed $90 billion. This panel also found that "resource consumption and length of stay for a person with diabetes exceeds that of a comparable patient without diabetes by 30-40%."
Robert Stone, executive vice-president of Nashville, TN-based American Healthways and president of the Disease Management Association of America, who commissioned the expert panel, said, according to the report, "Because the admitting diagnosis typically is not diabetes, hospital administrators and health plan financial executives rarely see the high costs that failure to manage diabetes in the hospital can precipitate."
What can be done outside of targeted diabetes disease management programs? Two landmark lifestyle intervention programs may provide some answers.
Lifestyle Interventions
Diabetes Prevention Program (DPP). According to the NIH National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), "millions of overweight Americans at high risk for type 2 diabetes can delay, and possibly prevent, the disease with moderate diet and exercise," pointing to a landmark study conducted by W.C. Knowler, et al., in the February 7, 2002, edition of the New England Journal of Medicine.
The study, which was spearheaded, in part, by Massachusetts General Hospital's David Nathan, M.D., randomly assigned 3234 overweight non-diabetic people who had elevated fasting and post-load plasma glucose concentrations [impaired glucose tolerance] to one of three treatment protocols: a lifestyle modification program (with goals of at least 7% weight loss, by completion, and at least 150 minutes of physical activity per week); metformin (850 mg twice daily) or a placebo. At entry, the mean age of participants was 51 years, and the mean body-mass index (BMI) was 34. Of note, 68% of the participants were women and 45% were members of high-risk ethnic groups: black, Hispanic, Asian American and Pacific Islanders and Native Americans. The average follow-up was 2.8 years.
According to the authors, the lifestyle intervention reduced the incidence of diabetes by 58%. In contrast, metformin only reduced the incidence by 31%. The authors concluded that the "lifestyle intervention was significantly more effective than metformin." In fact, said Dr. Nathan, the lifestyle intervention "was most effective in people aged 60 and older, who lowered the risk of developing diabetes by 71%." Although metformin achieved some success overall, "it was relatively ineffective in older volunteers and in those who were less overweight," according to Dr. Nathan.
Diabetes Control and Complications Trial (DCCT). The DCCT was a clinical study carried out from 1983 to 1993 by the NIDDK. The largest, most comprehensive diabetes study ever conducted, the DCCT involved 1441 young adults with type 1 diabetes via 29 medical centers across the U.S. and Canada. At start, the participants had diabetes for at least one year, but no longer than 15 years, and were required to have no, or only early signs of, diabetic eye disease.
The study compared the effects of two treatment approaches-standard therapy and intensive control-on the complications of diabetes, randomly assigning participants to one of two treatment groups. The patients were followed for a mean of 6.5 years.
While the standard therapy involved one or two daily injections of insulin, the intensive treatment regimen included the following components:
Testing blood glucose levels four or more times per day;
Four daily insulin injections or use of an insulin pump;
Adjustment of insulin doses according to food intake and exercise;
A diet and exercise plan; and
Monthly visits to a healthcare team composed of a physician, nurse educator, dietitian and behavioral therapist.
Intensive treatment resulted in a 76% reduced risk of eye disease, a 60% reduced risk of nerve disease and a 50% reduced risk of kidney disease. The intensive regimen was also associated with greater improvements in blood pressure, ratio of HDL to LDL, urinary albumin excretion (reducing albuminuria by 54%) and glycosylated hemoglobin levels.
The Promise of Dietary Supplements
The natural products industry is uniquely positioned to provide consumers scientifically validated dietary supplements that provide measurable benefits in health areas that directly, or indirectly, are associated with glucose control and insulin metabolism.
Although literally hundreds of vitamins, minerals, botanicals and specialized compounds can be identified to help with health markers related to diabetes and its associated conditions, a National Library of Medicine PubMed (MEDLINE) search yielded research predominantly using a select group ofsupplements. What follows is an outline of supplements and compounds that (1) have recent published or public-grant-supported studies relating to diabetes and (2) are also brands available from their manufacturers (in cases of proprietary compounds) as finished products.
Alpha lipoic acid. A 2003 animal study, "demonstrates," say the authors, "that alpha lipoic acid supplementation prevents development of hypertension and hyperglycemia," most likely via its antioxidative effects. A rat study from 2002 that appeared in the Journal of the American Society of Nephrology found that the "combined antioxidant and [blood-sugar-lowering] actions [] may contribute to its utility in preventing [liver] injury and other complications of diabetes."
Vitamin C. An animal study from 2002 found that after one month oral vitamin C significantly lowered arterial blood pressure in a group of patients, ages 45 to 70, with type 2 diabetes (versus placebo group).
Vitamin E. A 2002 review article found that "epidemiological evidence indicates [that] low vitamin E intake [is] a risk factor [for] development of type 2 diabetes." A Chinese animal-model study published that same year, observed that "joint supplementation of vitamin C [and] vitamin E, [or] separately, could hold back abnormal glucose metabolism [e.g., levels of glycated hemoglobin A1c] in diabetic rats and "protect the kidney from damage under hyperglycemia."
Chromium. A 2003 study found that people with type 2 diabetes who took chromium picolinate (1000 mcg a day) had a mean increase in insulin sensitivity of almost 9%, while the placebo group had a mean decrease of 3.6%; insulin-stimulated Akt activation was also significantly increased by the end of the study in the supplemented group. In September 2003, the National Institutes of Health (NIH) awarded Dr. William Cefalu of Louisiana State University's Pennington Biomedical Research Center a "substantial grant" to evaluate the use of chromium picolinate supplementation in people with type 2 diabetes.
Magnesium. According to a 2003 study, patients with type 2 diabetes who supplement each day with magnesium are able to achieve "improved insulin-mediated glucose uptake." The authors also said that "the benefits deriving from daily magnesium supplementation are [] supported by epidemiological studies showing that [daily] magnesium intake [is] predictive of a lower incidence of [type 2 diabetes]." Another study published this year from New Delhi found that magnesium supplementation in patients with type 2 diabetes resulted in "a significant" fall in LDL (or "bad") cholesterol and triglyceride levels and a rise in HDL (or "good") cholesterol within one to two months of the treatment start.
Zinc. In 2003, a study was published that looked at Tunisians with type 2 diabetes. In this study, people with type 2 diabetes received 30 mg per day of zinc gluconate or a placebo. Blood tests revealed valuable improvements in measures of antioxidative activity, including those related to superoxide dismutase (SOD) and glutathione peroxidase. In a 2001 animal study, zinc supplementation significantly reduced hyperglycemia and hyperinsulimenia in diabetic mice, suggesting that zinc has a role in pancreatic function.
Bitter melon. Indian researchers this year published a study, which included the administration of Momordica charantia (bitter melon) to diabetic rats. In this study, bitter melon reduced fasting glucose levels by 48%. A 2001 mouse study from Japan also looked at bitter melon in animals with type 2 diabetes and hyperinsulinemia. After three weeks, mice that received the supplement experienced reduced blood glucose and beneficially increased levels of a glucose transporter protein, GLUT4. The authors concluded that "the antidiabetic effect of [bitter melon] is derived, at least in part, from a decrease in insulin resistance."
Fenugreek. In a 2002 study, an extract of fenugreek seeds (Trigonella foenum graecum) was given to experimentally pre-diabetic and diabetic animals. The treatment produced significantly improved insulin response and blood glucose. The authors speculated that "the effect may [be due to] increasing the sensitivity of tissues to available insulin." Normal and diabetic rats received an extract of fenugreek for 30 days in a study from 2001. The treated diabetic animals held back what would have been free-radical-caused lipid peroxidation and depletion of antioxidants in the liver, kidney and pancreas.
Gymnema sylvestre. In a Japanese study from 2000, an extract of Gymnema sylvestre was given to diabetic mice. The extract reduced blood glucose levels and improved endogenous insulin synthesis. The authors concluded that, "The insulin-releasing action of [Gymnema] may contribute to the antihyperglycemic effect" and has potential to help combat obesity and hyperglycemia.
Providing Hope
Research continues to demonstrate that science-based dietary supplements, combined with physical activity and a balanced diet, provide American consumers with an opportunity to significantly decrease their odds for developing type 2 diabetes. Research also seems to be pointing toward supplements that can improve quality-of-life in those that already have the disease. NW
About the author:
James Gormley is an industry expert, commentator and author. He also serves as director of trade communications for Purchase, N.Y.-based Nutrition 21, Inc. Before joining Nutrition 21, he served as editor-in-chief for Better Nutrition magazine from 1995 to 2002. He can be reached at jgormley@nutrition21.com.