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Multivitamins and Type 2 Diabetes

Introduction

Several micronutrients enhance insulin action and/or are associated with potential benefit in reducing the onset or progression of diabetes, and they may play an adjunctive role with established therapies. Several intervention studies have examined the effects of single and combined micronutrient supplements in diabetic patients with varying results. To date, no clinical trials testing the therapeutic effects of a standard multivitamin in subjects with Type 2 diabetes have been published.

Micronutrient needs of diabetics

There is emerging evidence that diabetes leads to the depletion of the cellular antioxidant system and increases the level of reactive oxygen species [1]. Supplementation with combinations of the antioxidant micronutrients at > RDA levels might be helpful as an adjunct in treating diabetic patients and their complications [2, 3].

There is also evidence that the need for some micronutrients may be higher among diabetics, possibly due to genetic factors. For example, a vitamin D receptor gene polymorphism, common in both types of diabetes, may lead some patients to have higher vitamin D requirements [4-6]. Observational studies have also shown that low vitamin D status is linked with Type 1 and Type 2 diabetes, glucose tolerance, insulin secretion and sensitivity among all age groups [7]. Chromium is considered a glucose tolerance factor and may contribute to the prevention and/or treatment of Type 2 diabetes.

Epidemiological evidence

Lopez-Ridaura et al. [8] reported no association between the use of multivitamin supplements and the risk of developing diabetes in pooled data from the Nurses’ Health Study and the Health Professions Follow-Up Study. At baseline participants had no history of diabetes, CVD or cancer. The authors did observe a significant inverse association between magnesium intake and the risk of Type 2 diabetes in both cohorts when comparing top vs. bottom quintiles of intake. The women and men in this study who had higher intakes of magnesium at baseline were also more likely to take multivitamins.

Diabetes and infection

Barringer et al. [9] reported a significant reduction in the incidence of infectious illness, and infection-related absenteeism from work among subjects who took a daily multivitamin supplement for 1 y, particularly among subjects with Type 2 diabetes. Infection incidence among diabetics was 93% among those in the placebo group compared to 17% in the multivitamin treated group. In subgroup analyses, it was determined that the beneficial effect of multivitamin supplementation was almost entirely observed in participants with Type 2 diabetes. The diabetic subjects in this study were also more likely to be deficient in one or more micronutrients at baseline.

Critical Thinking Questions:

Could a daily multivitamin supplement reduce the risk or delay the onset of Type 2 diabetes?

Can the micronutrients available in a standard multivitamin prevent the complications common among Type 2 diabetics?

Can the micronutrient needs of diabetics be met through diet alone?

Can a multivitamin enhance the effectiveness of therapies available to Type 2 diabetics?

Can a daily multivitamin regimen prevent the development of atherosclerosis or hypertension among diabetic patients?

What is the most appropriate combination of supplemental vitamins and minerals for diabetics?
What micronutrients are present/absent from commercially available multivitamin preparations that are specifically formulated for diabetics?

Professional Societies, Agencies, and Government Organizations:

American Diabetes Association (Position Statement):
Evidence-Based Nutrition Principles and Recommendations for the Treatment and Prevention of Diabetes and Related Complications
http://care.diabetesjournals.org/cgi/content/full/25/1/202#SEC11