Sweetening the Market for Diabetes Control

With Americans’ growing penchant for packing on pounds, it’s no surprise that obesity-related diabetes is on the rise too: Nearly 21 million men, women, and children suffer from diabetes today, and their numbers are expected to swell to more than 48 million by 2050, according to the Centers for Disease Control and Prevention (CDC; Atlanta).

“Diabetes is the greatest public health crisis of the first quarter of the 21st century,” says Larry Deeb, MD, president of medicine and science at the American Diabetes Association (ADA: Alexandria, VA). “Currently, 1 in 10 healthcare dollars-and 1 in 4 Medicare dollars-is spent on diabetes and its complications.”

RESEARCH RESULTS

Despite the dire predictions, researchers are optimistic about continuing progress in understanding and treating diabetes-as long as funding holds out.

Diabetes is a chronic condition that results when the body doesn’t make insulin (a hormone that helps glucose enter cells) or doesn’t respond appropriately to insulin. When that happens, glucose accumulates in the blood instead of moving into cells, where it is needed for energy and growth. The most common form of diabetes is type 2, or adult-onset diabetes, which occurs when the body isn’t able to use insulin made by the pancreas; obesity is a major risk factor for type 2. Type 1, or juvenile diabetes, which occurs when the body is unable to make insulin, is usually diagnosed in children and teens.

One of the latest breakthroughs in diabetes research happened in February, when scientists announced that they had identified the most important genes associated with the risk of developing type 2 diabetes. In a study published online in the February 11, 2007 issue of Nature, researchers from Imperial College (London), McGill University (Montreal), and elsewhere reported that they had identified four points on individuals’ genetic maps that correlate to the risk of developing type 2 diabetes. Furthermore, one of these genetic mutations could help explain the causes of type 2 diabetes, which may lead to new treatments, said the researchers.

While the current news is promising, some diabetes experts are concerned about the level of funding for future research in President George Bush’s proposed fiscal year 2008 budget. The budget proposal would add less than 1% to funding for the National Institutes of Health’s (NIH; Bethesda, MD) National Institute of Diabetes & Digestive & Kidney Disease and would hold funding at $62.8 million for CDC’s Division of Diabetes Translation. ADA, in fact, has urged Congress to boost NIH diabetes research funding by 8% and add $20.8 million for the CDC’s diabetes prevention division.

CHROMIUM PICOLINATE

Maintaining a healthy body weight, exercising, and eating a low-fat diet are the most important ways to help stave off diabetes, but a growing body of research offers evidence that some dietary supplements also can have a beneficial effect.

Supplemental chromium, which comes in three forms-chromium picolinate, chromium chloride, and chromium nicotinate-is in the forefront of a number of diabetes-related studies these days. In fact, a peer-reviewed analysis published in the December 2006 issue of Diabetes Technology & Therapeutics suggests that chromium picolinate is effective in improving glycemic control and normalizing lipid levels in type 2 diabetes. “The main messages are that all forms of chromium are not equivalent, and that higher doses of chromium picolinate are required for people with type 2 diabetes,” says research chemist C. Leigh Broadhurst, PhD, lead author of the publication. “Separating out chromium picolinate, which yields highly consistent results in research studies, compared with other chromium supplements shows that at doses between 200 and 1000 µg, it is a superior nutritional adjunct to diabetes treatments.”

Another study, published in Diabetes Care in August 2006, found that people who took a common oral diabetes medication along with 1000 mg of chromium picolinate daily had better insulin sensitivity and glucose control than when they used medication alone.

While chromium picolinate has been the subject of much research, scientists have also been looking at the effectiveness of ingredients that have been merged with chromium picolinate. For instance, Nutrition 21 (Purchase, NY), which sells Chromax chromium picolinate, also markets Diachrome, a combination of chromium picolinate and biotin designed to help improve glucose metabolism.

“We screened a number of nutrients, combining them with chromium picolinate, to see if any of them could enhance its beneficial effect,” says Jim Komorowski, MS, vice president of technical services and scientific affairs at Nutrition 21. “We found that biotin had a significant effect in improving glucose metabolism. Since diabetes is caused in part by nutrition and dietary habits, people with diabetes are looking to improve their diet. One way is by taking supplements with important nutrients like chromium and biotin.”

A recent placebo controlled, double-blind, randomized single-center study suggested that Diachrome safely improves blood glucose levels and cholesterol metabolism in those with type 2 diabetes. The 30-day study, also reported in the December 2006 issue of Diabetes Technology & Therapeutics, examined 36 overweight or obese poorly controlled patients with type 2 diabetes who were already receiving oral diabetes drugs. A 400-patient, 90-day randomized placebo-controlled study to investigate the effects of chromium picolinate and biotin on other risk factors in type 2 diabetes is scheduled to be published next year.

Komorowski says he also expects to see more research on chromium picolinate released this year, adding that several other long-term studies will continue over the next couple of years. One study at the University of Wyoming (Laramie, WY), slated to end in June 2008, is testing novel synthetic chromium–amino acid complexes on animal and cellular models of type 2 diabetes to find newer, safer, effective, and inexpensive chromium complexes to prevent and treat type 2 diabetes. And the NIH’s National Center for Complementary and Alternative Medicine (NCCAM) is sponsoring a Yale University (New Haven, CT) study on the effects of chromium on high blood glucose levels in people with impaired glucose tolerance, often a precursor to type 2 diabetes.

CHROMIUM NICOTINATE

Niacin-bound chromium, or chromium nicotinate, has also drawn new research support for improving lipid profiles and glucose tolerance. A new study at Ohio State University (Columbus, OH) suggests that InterHealth Nutraceuticals Inc.’s (Benecia, CA) ChromeMate, an oxygen-coordinated niacin-bound form of supplemental chromium, may affect fat metabolism and muscle activity at the genetic level.

Researchers for the study, which was published in the November 2006 issue of Physiological Genomics, wanted to see what effect ChromeMate has on risk factors for metabolic syndrome, including inefficient insulin action and abdominal obesity. The study was conducted with Leprdb mice, which are born obese and diabetic, and researchers probed the effects of ChromeMate compared with a placebo on the subcutaneous fat tissue (fat tissue under the second layer of skin) using gene microarray analysis. They found that ChromeMate activated the expression of four genes that provide the signal for fat precursor cells to produce muscle instead of fat cells, and de-activated genes that encode for CIDEA and UCP1, key components in brown fat tissue thermogenesis.

“We are very pleased with these findings,” says Debasis Bagchi, PhD, senior vice president for research and development at InterHealth. “The down-regulation of CIDEA and UCP1 is particularly heartening, because of their specific role related to obesity and because brown fat is the most difficult type of fat for people to lose.” In fact, CIDEA is considered a “candidate” gene for obesity, and mice that don’t have the gene are resistant to diet-induced obesity and diabetes. “ChromeMate is supported by an extremely large body of research that substantiates its efficacy in dealing with core symptoms of metabolic syndrome,” adds Evelyn Scalora, product manager for InterHealth.

CINNAMON

Cinnamon is hot in the consumer press right now as a diabetes support ingredient, boding well for its future as a supplement, says Tim Romero, president of Integrity Nutraceuticals International (Sarasota, FL), which markets Cinnulin PF, a proprietary cinnamon extract. “There’s some good research going on about cinnamon extract, and the mass media has actually picked up on the story,” Romero says. “It’s definitely a growing market as people are becoming more aware of the health benefits of cinnamon. We are continuing to support the research because we feel there’s a lot more to be discovered.”

A new study presented at the American College of Nutrition’s (Clearwater, FL) annual meeting in October 2006 suggests that Cinnulin may provide protective antioxidant effects in reducing oxidative stress associated with metabolic syndrome, in addition to improving blood glucose control and enhancing body composition. Twenty-four people with impaired fasting glucose received either a placebo or 250 mg of Cinnulin PF for 12 weeks. The Cinnulin PF group saw a major increase in two measures that determine antioxidant activity and a decrease in malondialdehyde, showing heart health protection.

“The results are extremely positive,” says collaborator Richard Anderson, PhD, research chemist at USDA, adding that the active compounds found in cinnamon extract may help reduce the risk of diabetes and heart disease by providing protection from harmful oxidation.

And in January, Sweet Success Enterprises Inc. (San Antonio, TX) tapped into the growing consumer awareness of cinnamon’s benefits by launching diabetic-friendly GlucaSafe, a beverage made with Cinnulin, pomegranate, and green and white teas. “Given the substantial size of the diabetic market, we anticipate that interest in this great-tasting and functional product will be high among consumers with diabetes,” says Sweet Success chairman and CEO William Gallagher.

PYCNOGENOL

Branching out into diabetes support with more than 35 years of health benefit research behind it, Pycnogenol is a French maritime pine tree extract patented by Horphag Research (Geneva) and distributed in North America by Natural Health Science (Hoboken, NJ). The most recent Pycnogenol research, scheduled to be published in Diabetes Research and Clinical Practice, suggests that the extract is more potent in suppressing carbohydrate absorption in diabetes than synthetic prescription alpha-glucosidase inhibitors.

Conducted by German researchers, the study investigated the interaction of Pycnogenol with the enzyme alpha-glucosidase, which breaks down food carbohydrates. Pycnogenol delayed the uptake of glucose 190 times more than prescription medications, say the researchers. “Recent findings more and more point to a favorable effect of Pycnogenol not only for diabetes, but also prediabetes and metabolic syndrome,” says Frank Schonlau, PhD, director of scientific communications at Horphag.

MAGNESIUM

Because diabetics tend to have low magnesium levels, some researchers have focused on boosting intake of the mineral as a possible way to improve glucose control. In the October 2006 issue of Diabetic Medicine, an analysis of nine magnesium studies concluded that magnesium supplements may be effective in reducing plasma fasting glucose levels in people with type 2 diabetes. Results from other studies have been contradictory, and NIH has recommended additional research to explore the association among blood magnesium levels, dietary magnesium intake, and type 2 diabetes.

Magnesium is just one of the ingredients in Trace Minerals Research’s (Salt Lake City) Insulin Health X-Factors, which also contains vitamins, minerals, and other ingredients like chromium and alpha lipoic acid.

“Alpha lipoic acid is a phenomenal antioxidant that helps with regulation of blood sugar and protects against diabetic neuropathy,” says Chris Meletis, director of science and research for Trace Minerals.

Although more research is needed, some small studies have shown possible benefits from alpha lipoic acid in glucose uptake in muscle, sensitivity of the body to insulin, and diabetic neuropathy, according to NCCAM.

Another ingredient that may offer benefits for prediabetics is Cargill’s (Minneapolis) Xtend isomaltulose, a slowly digestible sugar that won the Health Ingredients Europe 2006 Gold Award for best innovation in health ingredients.

“Our research gives a good initial indication that Xtend isomaltulose triggers the body’s satiety-regulating mechanisms,” says Fred Brouns, PhD, manager of nutritional science in Europe for Cargill. “In addition, isomaltulose, through its low blood glucose and insulin response, helps the body to burn more fat as a source of energy, compared with when consuming normal sugar.” A growing body of evidence suggests that low glycemic and insulemic properties may aid prediabetics, says Brouns, so isomaltulose may help food and beverage manufacturers provide useful products for these consumers.

ONE STEP CLOSER

The diabetes epidemic has reached the crisis stage. But as researchers continue to learn more about the disease and communicate its risks and prevention strategies, the future is looking a little brighter. One of the latest efforts to publicize the problem took place on March 27, dubbed “American Diabetes Alert Day” by ADA. Health experts marked the occasion by urging people who are overweight, physically inactive, and over 45 years of age to take the American Diabetes Risk Test to determine if they need to take action.

“Today is a day for Americans to take charge of their health,” ADA’s Deeb said on March 27. “But there is hope. Early detection and treatment can help prevent type 2 diabetes or serious complications associated with diabetes. By taking the American Diabetes Risk Test, people can be one step closer to having the information they need to live a healthier life.”