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Role of Micronutrients in the Long-Term Management of Type 2 Diabetes: A Narrative Review


Affiliations
1 Consultant Endocrinologist, Nair Hospital, Dr A L Nair Road, Mumbai Central, Mumbai - 400008, Maharashtra, India
2 Jethwani Hospital, Rajkot, Gujarat, India
3 MMI Narayana Hospital, Raipur, Chhattisgarh, India
4 Dr Prakash Diabetes Specialities Center, Anisabad, Patna, Bihar, India
     

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Oxidative stress is known to play a vital role in the pathogenesis of diabetes as well as the development of diabetic complications. Antioxidants seem to be a potential treatment option for the prevention of complications associated with diabetes. Therefore, it is prudent to explore the role of antioxidants in the prevention and management of diabetes and its complications. Moreover, micronutrient deficiencies are common in patients with type 2 diabetes and tend to play pivotal roles in developing and progressing this chronic disease. Hence, the present review was performed to explore the role of micronutrient supplementation in the prevention and management of diabetes and its complications. In the article, the authors discuss the role of micronutrient deficiencies in diabetes and discuss the published evidence on whether these micronutrients have a role in preventing and managing diabetes and its complications. The micronutrients discussed in this article include vitamin B complex, vitamin C, vitamin D, vitamin E, zinc, and chromium. Based on the available literature, there is insufficient evidence to determine the potential role of micronutrient supplementation in patients with diabetes. However, micronutrients may serve as potential adjunctive treatment options in diabetes patientsand their use must be tailored, depending on the patient’s diabetic status, age, micronutrient dose, duration of diabetes, and deficiency status. Micronutrient supplementation in diabetes may also be considered as an adjunct treatment option for select groups vulnerable to deficiency states. More studies are needed to ascertain their exact role in diabetes prevention and management.



Keywords

Diabetes, micronutrients, complications, vitamins, minerals
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  • Kaur B, Henry J. Micronutrient status in type 2 diabetes: a review. Adv Food Nutr Res.2014;71:55-100.

  • Asmat U, Abad K, Ismail K. Diabetes mellitus and oxidative stress—A concise review. Saudi Pharm J. 2016;24(5):54753.

  • Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2013;36(11):3821-42.

  • Via M. The malnutrition of obesity: micronutrient deficiencies that promote diabetes. ISRN Endocrinol. 2012;2012:103472.

  • Ekpenyong CE. Micronutrient deficiency, a novel nutri-tional risk factor for insulin resistance and Syndrom X. Arch Food Nutr Sci. 2018;2:016-030.

  • Valdés-Ramos R, Guadarrama-López AL, MartínezCarrillo BE, Benítez-Arciniega AD. Vitamins and type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2015;15(1):54-63.

  • Lykstad J, Sharma S. Biochemistry, Water Soluble Vitamins. Treasure Island (FL): Stat Pearls Publishing; 2020 Jan.

  • Rajalakshmy P. Role of micronutrients on Type II diabetes mellitus. Acta Scientific Nutritional Health. 2019;3(10):44-7.

  • Chehade JM, Sheikh-Ali M, Mooradian AD. The role of micronutrients in managing diabetes. Diabetes Spectrum. 2009;22(4):214-8.

  • O’Leary F, Samman S. Vitamin B12 in health and disease. Nutrients. 2010; 2(3):299-316.

  • Pawlak R. Vitamin B12 for diabetes patients treated with metformin. J Fam Med Dis Prev. 2017;3(2):057.

  • Gupta JK, Sana QS. Potential benefits of methylcobalamin: A review. Austin J Pharmacol Ther. 2015;3(3):1076.

  • Kibirige D, Mwebaze R. Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? J Diabetes MetabDisord. 2013;12(1):17.

  • Hansen CS, Jensen JS, Ridderstråle M, Vistisen D, Jørgensen ME, Fleischer J. Vitamin B12 deficiency is associated with cardiovascular autonomic neuropathy in patients with type 2 diabetes. J Diabetes Complications. 2017;31(1):202-8.

  • Yanni AE, Kokkinos A, Psychogiou G, Binou P, Kartsioti K, Chatzigeorgiou A,et al. Daily consumption of fruit-flavored yoghurt enriched with vitamins B contributes to lower energy intake and body weight reduction, in type 2 diabetic patients: a randomized clinical trial. Food Funct. 2019;10(11):7435-43.

  • Dakshinamurti K. Vitamins and their derivatives in the prevention and treatment of metabolic syndrome diseases (diabetes). Can J PhysiolPharmacol. 2015;93(5):355-62.

  • González-Ortiz M, Martínez-Abundis E, Robles-Cervantes JA, Ramírez-Ramírez V, Ramos-Zavala MG. Effect of thiamine administration on metabolic profile, cytokines and inflammatory markers in drug-naïve patients with type 2 diabetes. Eur J Nutr. 2011;50(2):145-9.

  • Gargari BP, Aghamohammadi V, Aliasgharzadeh A. Effect of folic acid supplementation on biochemical indices in overweight and obese men with type 2 diabetes. Diabetes Res Clin Pract. 2011;94(1):33-8.

  • Asbaghi O, Ashtary-Larky D, Bagheri R, Moosavian SP, Olyaei HP, Nazarian B, et al. Folic Acid Supplementation Improves Glycemic Control for Diabetes Prevention and Management: A Systematic Review and Dose-Response Meta-Analysis of Randomized Controlled Trials. Nutrients. 2021 Jul;13(7):2355.

  • Chauhan A, Patil A, Bhosale U, Bhat S. Screening and assessment of polyneuropathy in diabetic patients and the effect of vitamin B12 administration on the course of neuropathy. J Clin Diagnos Res. 2018;12(8):FC10-FC13.

  • Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan. 2005;14(2):48-54.

  • Li S, Chen X, Li Q, Du J, Liu Z, Peng Y, et al. Effects of acetyl‐ L‐carnitine and methylcobalamin for diabetic peripheral neuropathy: a multicenter, randomized, double‐blind, controlled trial. J Diabetes Investig. 2016;7(5):777-85.

  • Haupt E, Ledermann H, Köpcke W. Benfotiamine in the treatment of diabetic polyneuropathy – a three-week randomized, controlled pilot study (BEDIP Study). Int J Clin Pharmacol Ther. 2005;43(2):71-7.

  • Keche YN, Yegnanarayan R, Bhat S. Effect of vitamin B12 supplementation on glycemic control in poorly controlled hyperhomocysteinemic type 2 diabetic patients. Bangladesh J Pharmacol.2016;11:50-3.

  • Luong KV, Nguyen LT. The Impact of Thiamine Treatment in the Diabetes Mellitus. J Clin Med Res. 2012 Jun;4(3):15360.

  • Chambial S, Dwivedi S, Shukla KK, John PJ, Sharma P. Vitamin C in Disease Prevention and Cure: An Overview. Indian J Clin Biochem. 2013;28(4):314–328.

  • Dakhale GN, Chaudhari HV, Shrivastava M. Supplementation of vitamin C reduces blood glucose and improves glycosylated hemoglobin in type 2 diabetes mellitus: a randomized, double-blind study. Adv Pharmacol Sci.2011;2011:195271. doi: 10.1155/2011/195271.

  • Ekpenyong CE. Is there a role for micronutrient deficiency in the pathogenesis and complications of type 2 diabetes mellitus? Facts, controversies and conclusions. EC Nutrition. 2020;15.1:01-12.

  • Gillani SW, Sulaiman SAS, Abdul MIM, Baig MR. Combined effect of metformin with ascorbic acid versus acetyl salicylic acid on diabetes-related cardiovascular complication; a 12-month single blind multicenter randomized control trial. Cardiovasc Diabetol. 2017;16(1):103.

  • Rafighi Z, Arab S, Mohd Yusof R, Shiva A. The effect of vitamin C and E on lipid profile in people with type 2 diabetes mellitus. Global J Health Sci. 2011;3(2):69-74.

  • Chen J, Wu J, Kong D, Yang C, Yu H, Pan Q, et al. The Effect of Antioxidant Vitamins on Patients with Diabetes and Albuminuria: A Meta-Analysis of Randomized Controlled Trials. J Ren Nutr. 2020 Mar;30(2):101-110.

  • Jovičić S, Ignjatović S, Majkić-Singh N. Biochemistry and metabolism of vitamin D. J Med Biochem 2012;31(4):309-15.

  • Wu C, Qiu S, Zhu X, Li L. Vitamin D supplementation and glycemic control in type 2 diabetes patients: A systematic review and meta-analysis. Metabolism. 2017;73: 67-76.

  • Krul-Poel YH, Wee MM, Lips P, Simsek S. Management of Endocrine Disease: The effect of vitamin D supplementation on glycaemic control in patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Eur J Endocrinol. 2017;176(1):R1-R14.

  • Jafari T, Faghihimani E, Feizi A, Iraj B, Javanmard SH, Esmaillzadeh A, et al. Effects of vitamin D-fortified lowfat yogurt on glycemic status, anthropometric indexes, inflammation, and bone turnover in diabetic postmenopausal women: a randomised controlled clinical trial. Clin Nutr. 2016;35(1):67-76.

  • Nikooyeh B, Neyestani TR, Tayebinejad N, Alavi-Majd H, Shariatzadeh N, Kalayi A, et al. Daily intake of vitamin D- or calcium-vitamin D-fortified Persian yogurt drink (doogh) attenuates diabetes-induced oxidative stress: evidence for antioxidative properties of vitamin D. J Hum Nutr Diet. 2014;27 Suppl 2:276-83.

  • Tabesh M, Azadbakht L, Faghihimani E, Tabesh M, Esmaillzadeh A.Effects of calcium plus vitamin D supplementation on anthropometric measurements and blood pressure in vitamin D insufficient people with type 2 diabetes: a randomized controlled clinical trial. J Am Coll Nutr. 2015;34(4):281-9.

  • Ryu OH, Chung W, Lee S, Hong KS, Choi MG, Yoo HJ. The effect of high-dose vitamin D supplementation on insulin resistance and arterial stiffness in patients with type 2 diabetes. Korean J Intern Med. 2014 Sep;29(5):620–629.

  • Liyanage P, Lekamwasam S, Weerarathna TP, Liyanage C. Effect of vitamin D therapy on urinary albumin excretion, renal functions, and plasma renin among patients with diabetic nephropathy: a randomized, double-blind clinical trial. J Postgrad Med. 2018;64(1):10-5.

  • Chokhandre MK, Mahmoud MI, Hakami T, Jafer M, Inamdar AS. Vitamin D & its analogues in type 2 diabetic nephropathy: a systematic review. J Diabetes MetabDisord.2015;14:58.

  • Byrn MA, Adams W, Penckofer S, Emanuele MA. Vitamin D supplementation and cognition in people with type 2 diabetes: a randomized control trial. J Diabetes Res. 2019.doi: https://doi.org/10.1155/2019/5696391

  • Niki E, Abe K. Vitamin E: Structure, Properties and Functions. In: Niki E, editor. Vitamin E: Chemistry and Nutritional Benefits. Cambridge: Royal Society of Chemistry; 2019. p. 1-11.

  • Xu R, Zhang S, Tao A, Chen G, Zhang S. Influence of vitamin E supplementation on glycaemic control: a meta-analysis of randomised controlled trials. PLoS One. 2014;9(4):e95008.

  • Hor CP, Fung WY, Ang HA, Lim SC, Kam LY, Sim SW, Lim LH, Choon WY, Wong JW, Ch’ng ASH, Beh KKM, Wee HC, Ong LM, Khan NAK, Syed Sulaiman SA, Shuaib IL, Bakar A, Yusof Y, Mohd Yusof Y, Abu Bakar F, Tang WS, Teh HL, Abdul Wahid N, Saaidin S, Idris N, Yoon CK, Ong HN, Ganapathy JT, Loo CE, Samy MM, Zainal H, Sree Dharan SC, Ooi BY, Teoh PY, Tye YL, Yeoh CA, Low DW, Looi I, Yuen KH; Vitamin E in Neuroprotection Study (VENUS) Investigators. Efficacy of oral mixed tocotrienols in diabetic peripheral neuropathy: a randomized clinical trial. JAMA Neurol. 2018;75(4):444-52.

  • Jain AB, Jain VA. Vitamin E, its beneficial role in diabetes mellitus (DM) and its complications. J Clin Diagn Res. 2012;6(10):1624-8.

  • Rajanandh MG, Kosey S, Prathiksha G. Assessment of antioxidant supplementation on the neuropathic pain score and quality of life in diabetic neuropathy patients – a randomized controlled study. Pharmacol Rep. 2014;66(1):44-8.

  • Kambe T, Tsuji T, Hashimoto A, Itsumura N. The Physiological, Biochemical, and Molecular Roles of Zinc Transporters in Zinc Homeostasis and Metabolism. Physiol Rev 2015;95(3):749-784.

  • Wang X, Wu W, Zheng W, Fang X, Chen L, Rink L, et al. Zinc supplementation improves glycemic control for diabetes prevention and management: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr. 2019;110(1):76-90.

  • Capdor J, Foster M, Petocz P, Samman S. Zinc and glycemic control: a meta-analysis of randomised placebo-controlled supplementation trials in humans. J Trace Elem Med Biol. 2013;27(2):137-42.

  • Nazem MR, Asadi M, Jabbari N, Allameh A. Effects of zinc supplementation on superoxide dismutase activity and gene expression, and metabolic parameters in overweight type 2 diabetes patients: a randomized, double-blind, controlled trial. Clin Biochem.2019;69:15-20.

  • Kim J, Lee S. Effect of zinc supplementation on insulin resistance and metabolic risk factors in obese Korean women. Nutr Res Pract. 2012;6(3):221-5.

  • Vincent JB. The biochemistry of chromium. J Nutr. 2000;130(4):715-8.

  • Yanni AE, Stamataki NS, Konstantopoulos P, Stoupaki M, Abeliatis A, Nikolakea I, et al. Controlling type‑2 diabetes by inclusion of Cr‑enriched yeast bread in the daily dietary pattern: a randomized clinical trial. Eur J Nutr. 2018;57(1):259-67.

  • No authors listed. A scientific review: the role of chromium in insulin resistance. Diabetes Educ. 2004;Suppl:2-14.

  • Sharma S, Agrawal RP, Choudhary M, Jain S, Goyal S, Agarwal V. Beneficial effect of chromium supplementation on glucose, A1C and lipid variables in individuals with newly onset type-2 diabetes. J Trace Elem Med Biol. 2011;25(3):149-53.


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  • Role of Micronutrients in the Long-Term Management of Type 2 Diabetes: A Narrative Review

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Authors

Nikhil M Bhagwat
Consultant Endocrinologist, Nair Hospital, Dr A L Nair Road, Mumbai Central, Mumbai - 400008, Maharashtra, India
Pratap Jethwani
Jethwani Hospital, Rajkot, Gujarat, India
Kalpna Dash
MMI Narayana Hospital, Raipur, Chhattisgarh, India
AS Prakash
Dr Prakash Diabetes Specialities Center, Anisabad, Patna, Bihar, India

Abstract


Oxidative stress is known to play a vital role in the pathogenesis of diabetes as well as the development of diabetic complications. Antioxidants seem to be a potential treatment option for the prevention of complications associated with diabetes. Therefore, it is prudent to explore the role of antioxidants in the prevention and management of diabetes and its complications. Moreover, micronutrient deficiencies are common in patients with type 2 diabetes and tend to play pivotal roles in developing and progressing this chronic disease. Hence, the present review was performed to explore the role of micronutrient supplementation in the prevention and management of diabetes and its complications. In the article, the authors discuss the role of micronutrient deficiencies in diabetes and discuss the published evidence on whether these micronutrients have a role in preventing and managing diabetes and its complications. The micronutrients discussed in this article include vitamin B complex, vitamin C, vitamin D, vitamin E, zinc, and chromium. Based on the available literature, there is insufficient evidence to determine the potential role of micronutrient supplementation in patients with diabetes. However, micronutrients may serve as potential adjunctive treatment options in diabetes patientsand their use must be tailored, depending on the patient’s diabetic status, age, micronutrient dose, duration of diabetes, and deficiency status. Micronutrient supplementation in diabetes may also be considered as an adjunct treatment option for select groups vulnerable to deficiency states. More studies are needed to ascertain their exact role in diabetes prevention and management.



Keywords


Diabetes, micronutrients, complications, vitamins, minerals

References