Chromium supplementation in management of type 2 diabetes among patients attending Thika level 5 hospital, Kenya: a randomized placebo controlled study
Diabetes Mellitus is a condition with common elements of hyperglycaemia and glucose intolerance. It is the fourth leading cause of death in high-income countries and evidently epidemic in newly industrialized countries as well as economically developing nations such as Kenya. Type 2 Diabetes is characterized by insulin resistance and relative insulin deficiency. Studies have reported low serum chromium levels in Type 2 diabetics compared to non-diabetic population. Chromium has been reported to potentiate insulin action in muscle cells. Studies show contradictory findings on beneficial effects of chromium on; blood sugar (FBS and HbAlc), blood lipids (LDL, HDL, triglycerides and total cholesterol), adiposity measures (BMI, WC and W/H ratio), fat mass and lean body mass. Consequently similar studies have been recommended to investigate further the benefits of chromium with a view of coming up with conclusive evidence. The purpose of this study therefore was to investigate the contribution of chromium supplementation in the management of fasting blood sugar, HbAlc, LDL, HDL, triglycerides, BMI, W/H ratio and WC in Type 2 Diabetes mellitus patients in Thika level 5 Hospital, Kenya. This was a double blind randomized controlled trial with a sample size of 180 participants on hypoglycaemic drugs. The sample was randomized into two study groups at a ratio of 1:1 (control group and intervention group). Participants in the intervention group received chromium picolinate (500mcg/day) while the control group received placebo for a period of 4 months. Data was collected at baseline, monthly and end of month 4, using semi-structured questionnaires. Information collected included: demographic characteristics, medical history, physical activity and dietary patterns. Additionally, anthropometric measurements (weight, height and waist and hip circumferences) were taken. Blood samples were analysed for chromium levels, HbAlc, serum ferritin and serum lipids (LDL, HDL, total cholesterol and triglycerides). Descriptive statistics such as mean and standard deviation were used to analyze demographic, socioeconomic, blood sugar, blood lipids and anthropometry and nutrient adequacy from 24 hour recall; mode was used to describe the 7 day food frequencies. Principle component analysis was used to determine the wealth index/socioeconomic categories. T-test was used to determine differences in continuous data between the study groups and Chi-square test used to determine associations in categorized variables between the study groups. Wilcoxon test was used to determine differences in food frequencies between the study groups while GPAQ was used to analyze physical activity levels. Multiple regression was used to determine predictors of elevated HbAlc. On the whole, at baseline, the participants had high fasting blood sugar with low serum chromium levels. Chromium supplementation significantly reduced HbAlc (DID: intervention 1.44% versus control -0.79%; p=0.001) and LDL elevation (DID: intervention -0.09 mmol/l versus control -0.91 mmol/l; t-test; p=0.010). Chromium supplementation had no effect on BMI, WC and W/H ratio; no effect on chromium status (t-test; p=0.241), triglycerides (t-test; p=0.648) and HDL (t-test; p=0.648). The predictors for elevated (above 9%) HbAlc were age and fasting blood sugar; the higher the fasting blood sugar and the older the patients, the higher the likelihood of elevated HbAlc. Since chromium supplementation was effective in reducing HbAlc and LDL among Type 2 diabetics in this study; it is recommended that chromium is used in management of blood sugar in Type 2 Diabetes.