Journal of Trace Elements in Medicine and Biology 25 (2011) 149–153

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Journal of Trace Elements in Medicine and Biology

journal homepage: www.elsevier.de/jtemb

CLINICAL STUDIES

Beneficial effect of chromium supplementation on glucose, HbA1 C and lipid

variables in individuals with newly onset type-2 diabetes
Shilpi Sharma a , Rajendra Prasad Agrawal b,∗ , Maya Choudhary a , Shreyans Jain b ,
Shekhar Goyal b , Vivek Agarwal b
a
College of Home Science, MPUA&T, Udaipur, Rajasthan, India
b
Diabetes Care & Research Centre, S.P. Medical College, Bikaner, Rajasthan, India

a r t i c l e i n f o a b s t r a c t

Article history: Project: Chromium is an essential nutrient involved in normal carbohydrate and lipid metabolism. It
Received 8 July 2010 influences glucose metabolism by potentiating the action as taking part in insulin signal amplification
Accepted 30 March 2011 mechanism. A placebo-controlled single blind, prospective study was carried out to investigate the effect
of chromium supplementation on blood glucose, HbA1 C and lipid profile in newly onset patients with
Keywords: type-2 diabetes.
Chromium
Procedure: Total 40 newly onset type-2 diabetics were selected and after 1 month stabilization further
Type 2 diabetes
randomly divided into two groups viz. study group and placebo group. The study group received 9 g
Glycaemic control
brewer’s yeast (42 ␮g Cr) daily and the other placebo group received yeast devoid of chromium for 3
months. Subjects were instructed not to change their normal eating and living habits. Fasting blood
glucose, HbA1 C and lipid profile were analyzed at beginning and completion of the study.
Results: Results revealed that fasting blood glucose level significantly reduced in the subjects consum-
ing yeast supplemented with chromium (197.65 ± 6.68 to 103.68 ± 6.64 mg/dL; p < 0.001). HbA1 C values
improved significantly from 9.51 ± 0.26% to 6.86 ± 0.28%; p < 0.001 indicating better glycaemic control. In
experimental group total cholesterol, TG and LDL levels were also significantly reduced from 199.66 ± 3.11
to 189.26 ± 3.01 mg/dL; p < 0.02, 144.94 ± 8.31 to 126.01 ± 8.26; p < 0.05 and 119.19 ± 1.71 to 99.58 ± 1.10;
p < 0.001 respectively.
Conclusions: These data demonstrate beneficial effect of chromium supplementation on glycaemic control
and lipid variables in subjects with newly onset type-2 diabetes.
© 2011 Elsevier GmbH. All rights reserved.

Introduction
Trivalent chromium is considered as an essential element
for insulin function and glucose disposal in mammalian nutri-
tion. Even 50 years ago the element chromium was proposed
to be an essential element for mammals with a role in main-
taining proper carbohydrate and lipid metabolism [1]. Chromium
is one of the most studied supplements and a majority of the
trials found a positive effect of chromium on fasting plasma glu-
cose [2]. There is growing evidence that chromium may facilitate
insulin signaling and chromium supplementation therefore may
improve systemic insulin sensitivity [3]. Spectroscopic and crystal-
lographic investigations carried out to understand molecular basis
of chromium insulin interaction emphasized role of chromium in
glucose metabolism [4].
∗ Corresponding author at: 2, Adarsh Colony, Bikaner - 334003, Rajasthan, India.
Tel.: +91 151 2202431; fax: +91 151 2202131.
E-mail address: drrpagrawal@yahoo.co.in (R.P. Agrawal).
Trivalent chromium, the form found in food and dietary supple-
ment is believed to be safe [5]. The DRI (daily reference intake) of
chromium for adult is between 20 and 35 ␮g/day depending on age
and gender. In general, oral intake of chromium has a low level of
toxicity partially due to its very poor absorption [6].
Acute and sub acute syndromes of chromium deficiency have
been reported in patients receiving total parenteral nutrition [7,8].
Such a chromium deficit was proposed as a contributing factor
in some cases of maturity-onset diabetes and atherosclerotic dis-
ease [9,10]. Considerable variations are seen in concentration of
chromium of different food groups. Therefore, chromium intakes
cannot be predicted from databases. Chromium repletion after
experimental dietary depletion improved glycaemic status [11].
Much smaller quantities of chromium are required in vivo to restore
normal glucose level. In the presence of Cr, in a biologically active
form, much lower levels of insulin are required, however, Cr is con-
sidered as a nutrient despite a therapeutic agent and therefore
seems beneficial for those whose problems are due to subopti-
mal intake of Cr [12]. Results from the trials support the view that
chromium supplementation in patients with type 1, type 2, gesta-

0946-672X/$ – see front matter © 2011 Elsevier GmbH. All rights reserved.
doi:10.1016/j.jtemb.2011.03.003
150 S. Sharma et al. / Journal of Trace Elements in Medicine and Biology 25 (2011) 149–153

Table 1
Baseline characteristics of study groups.

Variables Control Experimental t p

Mean ± SE CV Mean ± SE CV

BMI (kg/m2 ) 26.12 ± 0.87 16.28 25.09 ± 1.92 37.38 0.49 <0.6
W/H ratio 0.92 ± 0.01 05.43 0.93 ± 0.01 05.43 1.00 <0.4

BP (mmHg) Systolic 138.5 ± 4.65 16.41 161.5 ± 5 15.13 3.37 <0.05

Diastolic 87.5 ± 2.46 13.73 91.5 ± 3.47 18.53 0.94 <0.4

Mean blood glucose (mg/dL) 226.17 ± 18.36 39.69 197.65 ± 6.68 16.53 1.43 <0.2
HbA1 c (%) 9.30 ± 0.22 11.51 9.51 ± 0.26 15.40 0.61 <0.6

Lipid profile (mg/dL) Cholesterol 189.19 ± 2.11 05.45 199.66 ± 3.11 07.61 2.79 <0.02
Triglyceride 128.99 ± 3.60 13.65 144.94 ± 8.31 28.03 1.76 <0.1
HDL 51.65 ± 0.94 08.89 48.91 ± 1.93 19.30 1.28 <0.4
LDL 121.34 ± 2.05 08.25 119.19 ± 1.71 07.01 0.81 <0.5
VLDL 28.31 ± 0.73 12.61 30.29 ± 1.59 25.68 1.13 <0.4

tional or steroid-induced diabetes can improve both glucose and Table 2

Mean ± SE values of nutrient intake by diabetic patients.
insulin metabolism [13]. On the other hand some studies denied
importance of Cr in treatment of type 2 diabetes [14,15]. Nutrient Prior After
This present investigation was undertaken to measure the effect Energy (kcal) 2004.50 ± 30.10 2014.63 ± 29.59
of a chromium-rich brewer’s yeast on glucose tolerance, HbA1 C and Protein (g) 68.8 ± 0.86 67.90 ± 1.1
lipid levels of newly onset type 2 diabetes so that role of Cr sup- Total fat (g) 50.20 ± 1.19 50.28 ± 1.13
plementation could be figured out with reference to glycaemia in Visible 25.98 ± 0.63 25.18 ± 0.60
Invisible 24.21 ± 0.73 25.10 ± 0.67
man.
Carbohydrates (g) 330.47 ± 7.12 326.07 ± 4.65
Fiber (g) 12.41 ± 0.38 13.36 ± 0.42
Calcium (mg) 651.91 ± 7.42 624.75 ± 13.99
Iron (mg) 27.56 ± 0.47 27.63 ± 0.49
Thiamin (mg) 1.34 ± 0.13 1.15 ± 0.02
Riboflavin (mg) 1.14 ± 0.02 1.42 ± 0.02
Materials and methods Niacin (mg) 15.42 ± 0.24 14.91 ± 0.30
Carotene (␮g) 2268.51 ± 98.44 2479.91 ± 43.59
From the out patient of diabetic clinic of PBM Hospital, Bikaner Vitamin C (mg) 67.80 ± 1.90 66.96 ± 1.70
40 newly onset type 2 diabetic subjects were randomly selected a
No significant differences between the groups for any of the nutrient variables.
ranging from 35 to 67 years. As this was a single blind study sub-
jects were blinded. Medical and dietary records were screened to
exclude diabetic persons with a history of liver, kidney, intestinal Results
disorders or gout and those presently taking brewer’s yeast or other
nutrient supplements containing chromium. Baseline characteristics of both the groups were well matched
Approval from institutional ethical committee was also except for systolic blood pressure and cholesterol (Table 1). The
obtained prior to the study. After explaining the procedure and values of total calorie, fat, carbohydrate, protein, micronutrient
theme of the study, informed written consent was taken before intake before and after the study have been shown in Table 2.
hand. The subjects were randomly assigned into one of the two The magnitude of the effect of organic chromium supplementa-
supplementation groups: brewer’s yeast and placebo. Twenty sub- tion on fasting blood glucose and glycosylated hemoglobin has
jects received 9 g brewer’s yeast capsules (Twin Laboratory Inc. been also compared in placebo and study group in Table 3. After
American Fork, OTAH, U.S.A.). Another 20 subjects received placebo supplementation with chromium rich yeast, the mean fasting
capsules similar in colour and texture with that of yeast cap- blood glucose level of the subjects showed a significant decrease
sules. The brewer’s yeast content was 9 g (42 ␮g Cr) of yeast from 197.65 ± 6.68 mg/dL to 103.68 ± 6.64 mg/dL (p < 0.001). The
powder filled in 9 gelatinized capsules. Patients were asked to mean glycosylated hemoglobin of the experimental group also
take 9 capsules in a day, 3 capsules after each meal i.e. break- reduced significantly from the value of 9.51 ± 0.26% to 6.86 ± 0.28%
fast, lunch and dinner with either milk or water for 3 months (p < 0.001) (Table 3 and Fig. 1).
daily. Each subject received 1-month supply of capsules at a
visit.
Anthropometric and biochemical data were recorded. Body 10
mass index (BMI) and waist hip ratio were calculated using stan- 9
p<0.001
dard methods. Blood glucose estimation was done before breakfast 8
and twice in a week by glucometer provided to the patients. At the 7
HbA1c %

beginning and completion of the study lipid profile was analyzed 6

by using complete chemistry autoanalyzer (Ark Diagnostic Pvt. Ltd., Before
5
After
Andheri (E), Mumbai) and glycosylated hemoglobin (HbA1c) by 4
employing ion exchange chromatography technique (Roche, Basel, 3
Switzerland). 2
Statistical analysis of data was performed using arithmetic 1
mean, standard error and least square analysis. The least square
0
analysis was carried out by using SPSS version 10.0. To find out sta- Control Experimental
tistical difference between means within the group, student paired
‘t’ test was performed. Fig. 1. Comparison of HbA1 c in experimental and control groups.
 S. Sharma et al. / Journal of Trace Elements in Medicine and Biology 25 (2011) 149–153 151

<0.001**
<0.001**

<0.001**
<0.02*

<0.02*
<0.05*
<0.8
<0.4

<0.8

<0.5

<0.4
p
0

0.31

2.73
0.44

7.16

2.41
2.12
0.81
9.66
1.17
10.01
1.00

Lipid Profile (mg/dl)

t
-5
Cholesterol
6.79 Triglyceride
5.43

18.42
15.67

31.32
19.97

7.77

9.82
32.05

5.40
24.40
CV

-10 HDL
p<0.05 LDL
VLDL
141.5 ± 5.33
89.5 ± 2.87

103.68 ± 6.64

8.26

1.58
24.46 ± 0.34

6.86 ± 0.28

3.01

1.02
1.10
0.92 ± 0.01

-15
Mean ± SE

±
±
±
±
±
189.26
126.01
50.69
99.58
27.66
After

-20

p<0.05 p<0.001

-25
37.38
5.43

15.13
18.59

16.52
16.40

7.61
28.03
19.30
7.01
25.69
CV

Fig. 2. Changes in lipid profile in experimental group.

25.09 ± 1.92

91.5 ± 3.47

197.65 ± 6.68

3.11
8.31
1.93
1.71
1.59
9.51 ± 0.26
0.93 ± 0.01
Experimental

The effect of chromium intervention on lipid profile is shown

161.5 ± 5
Mean ± SE

in Table 3 and Fig. 2. In the yeast group, a significant decline in

±
±
±
±
±
199.66
144.94
48.91
119.19
30.29

cholesterol for 10 mg/dL was observed. The similar trend emerged
Before

for triglyceride and LDL levels. Mean triglyceride and LDL levels
reduced significantly from 144.94 ± 8.31 to 126.01 ± 8.26 mg/dL
and 119.19 ± 1.71 to 99.58 ± 1.10 mg/dL respectively. The mean
<.04

<.04
<.06

<.04
<.01

<.08
<.09
<.06
<.04
<.02

HDL values increased from 48.91 ± 1.93 to 50.69 ± 1.02 mg/dL at the
–
p

completion of the study. Reduction was also observed in VLDL level

in chromium group from 30.29 ± 1.59 to 27.66 ± 1.58 mg/dL, how-
.98

1.13
.53

.44
.12
.51
1.12
1.46
1.05
2.03

ever, changes in HDL and VLDL were not statistically significant.

–
t

In placebo group none of these parameters changed significantly

during study period except for LDL and VLDL.
33.12
5.43

19.81
15.67

11.57
8.45

22.69
11.57

38.59
11.41
39.20
CV

Discussion and conclusion

130.5 ± 5.29
89.5 ± 2.87

246.31 ± 5.81

3.98
8.78
3.06

0.63
0.92 ± 0.01

8.71 ± 0.20
28.17 ± 191

8.6

In present study, beneficial effect of chromium supplementation

Mean ± SE

±
±
±
±
±

was observed regarding fasting blood glucose and HbA1 C. Systolic

185.26
129.33
49.64
111.23
26.98

blood pressure also improved significantly while the same trend

After

was observed for lipid profile as it reflected in improved values of

cholesterol, triglyceride and LDL.
Average individual becomes chromium deficit with age.
Chromium deficiency is strongly associated with many aspects of
16.27
5.43

16.41
13.73

39.69
11.51

5.45
13.65
8.89
8.25
12.61

metabolic syndrome including insulin resistance and type 2 dia-

CV

betes. Cr supplementation alone and combination of Cr together

with vitamin C and E were found very effective for improvement of
226.17 ± 18.36

glucose metabolism in type 2 diabetes [16]. Oral Cr (D-phe) treat-

138.5 ± 4.65
87.5 ± 2.46

2.11
26.12 ± 0.87

9.30 ± 0.22

3.60
0.94
2.05
0.73
0.92 ± 0.01

ment was reported to reduce glucose intolerance, insulin resistance

Mean ± SE

±
±
±
±
±
Comparative effect of chromium on different parameters.

and hepatic ER stress in obese, insulin resistant mice [17]. In one

Control

189.19
128.99
51.65
121.34
28.31
Before

previously conducted study Cr yeast decreased the fasting blood

glucose and LDL level in streptozotocin induced diabetic rats [18].
These results are in accordance with the outcomes of the present
study. Cr yeast supplementation was considered to have poten-
Triglyceride
Cholesterol
Diastolic

tial to improve carbohydrate and lipid metabolism amongst human

Systolic

VLDL

patients featuring type 2 diabetes mellitus [19]. In vitro study find-

HDL
LDL

ings showed that chromium picolinate (Cr pic) may improve insulin
Mean blood glucose (mg/dL)

sensitivity by enhancing intracellular insulin receptor. Treatment

with Cr pic for 10 weeks significantly ameliorated changes in
metabolic risk factors including favourable changes in histopathol-
Lipid profile (mg/dL)

ogy of the liver, kidney and pancreas suggesting its potential role in
the management of diabetes [20]. Intake of milk powder contain-
BMI (kg/m2 )

BP (mmHg)

p < 0.001.

ing 400 ␮g/day of chromium for 16 weeks in subjects with type 2

W/H ratio

HbA1 c (%)

p < 0.05.
Variables

diabetes mellitus resulted in lowering of FPG, fasting insulin and

Table 3

improvement of metabolic control in male patients [21]. Research

*

**

advocated that supplementation of well controlled type 2 diabetes

152 S. Sharma et al. / Journal of Trace Elements in Medicine and Biology 25 (2011) 149–153
with Cr enriched yeast is safe and can result in improvements in
blood glucose variables and oxidation stress [22]. Brewer’s yeast
chromium supplementation provided better control of glucose and
lipid variables while decreasing drug dosage in type 2 diabetes
patients [23]. Chromium appeared to be a safe supplement and
asserted to have a role as adjunctive therapy when chemistry and
pharmacology, efficiency and safety of trivalent chromium in treat-
ment of type 2 diabetes was evaluated [24].
Several researchers indicated towards the similar outcomes
regarding potential of Cr supplementation in type 2 diabetic
patients [25,26] while some have made its role in diabetes debat-
able. Few studies disclaimed beneficial effect of Cr supplementation
in diabetes [14,15,27]. In a double blind randomized placebo
controlled trial in Chinese population with type 2 diabetes, sup-
plementation with 1000 ␮g of Cr led to a fall in HbA1 C by 2% [28]
while with 400 ␮g of Cr no improvement was observed in another
study by the same researcher [15]. An earlier researcher found
similar observations previously concluding that beneficial effects
of chromium in individuals with diabetes were observed at levels
higher than the upper limit of the estimated safe and adequate daily
dietary intake [29]. In a study, six different commercial trivalent
chromium compounds were compared for their metabolic effects
[30]. Only three enhanced insulin sensitivity (NBC, chelavite and
picolinate), however all tested compounds seemed safe. In a recent
study, 1000 ␮g/day dose of Cr Pic could not change the insulin
sensitivity index statistically but increased acute insulin response
to glucose [31]. The variations observed in various studies were
attributed to duration of study, form of Cr used, the extent of obesity
and glucose intolerance of the subjects [32].
The effect of chromium in in vitro, and probably in in vivo,
depends on the presence of endogenous or exogenous insulin. No
effect has been demonstrated in in vitro systems that did not either
depend on or contain insulin [33]. Chromium deficiency causes an
impaired response to added insulin in rat epididymal fat tissue and
when glucose uptake or glucose oxidation or utilization for lipid
synthesis was measured, the dose–effect curve was flat. This sug-
gests cell transport, the first step of the sugar metabolism, as a major
site of action for chromium. Overall, chromium has been postulated
to act by one or more of the following ways; (A) increase in the
number of insulin receptors, (B) increased binding of insulin to its
receptor and (C) increased activation of the receptor in the pres-
ence of insulin [34]. Thus chromium is one of the “master” nutrient
for controlling blood sugar in diabetic population, may be respon-
sible to reduce myocellular lipids and enhance insulin sensitivity in
subjects with type 2 diabetes. It suggested that modulation of lipid
metabolism by Cr in peripheral tissues may represent a novel mech-
anism of action [35]. In previous chromium supplemented study, it
was demonstrated that in rats chromium enhances the movement
of glucose into tissues at the same time chromium deficiency causes
impaired glucose uptake and insulin resistance [36]. These can be
restored to normal by repletion of chromium. Other studies report
that plasma glucose of genetically diabetic mice improves after
GTF supplementation [37,38]. Rats fed with a hypercholesterolemic
diet for 35 days were protected from hypercholesterolemia when
supplemented with chromium [39].
A significant improvement in blood glucose level of diabetic
subjects was observed after chromium rich yeast supplementation
for 3 months in present study. On the other hand, no change was
observed in placebo group in this respect. The findings of a study
manifested that mean levels of plasma chromium were approxi-
mately 33% lower and urine values almost 100% higher in 93 type 2
diabetes patients compared to a group of healthy control subjects
[40]. These investigators also noted that in the early years of onset
of type 2 diabetes, plasma chromium values were inversely corre-
lated with plasma glucose. Several investigators reported a marked
improvement in glucose disposal or insulin output in men after
chromium supplementation. A correlation was reported between
decreased serum cholesterol level and improved glucose tolerance
in 27 normal and hyperglycemic women, aged 40–75 years sup-
plemented with a chromium rich brewer’s yeast extract [41]. In
another study 24 volunteers with mean age 78, including 8 mildly
type 2 diabetes subjects, who were randomly allocated to one of the
two groups and were fed (daily for 8 weeks) 9 g of either brewer’s
yeast or chromium poor torula yeast, a significant improvement
was observed in the experimental group [42]. These observations
along with the results of the present study suggested that in in
vitro studies chromium must be supplied in the form of complex
with certain ligands, which may enhance its absorption, activity
and tissue retention.
The present study documents significant improvement in
triglycerides and LDL in yeast supplemented group. Other work-
ers also reported improvement in serum triglyceride and total
lipid levels as a result of chromium supplementation [43,44]. A
study was conducted on 14 diabetic patients and found that 30 g of
brewer’s yeast (50 ␮g of chromium for 8 weeks daily) was highly
effective in reducing cholesterol and triglyceride levels as well as
increased high-density lipoprotein cholesterol [45]. Similarly the
effect of brewer’s yeast supplementation on human serum lipids
was assessed [46]. A group of 19 hyperlipidemic adults consumed
10 g chromium rich brewer’s yeast (48 ␮g daily) for 8 weeks. The
total circulating serum cholesterol decreased by a modest amount
in this group after supplementation. These findings indicate that
chromium rich brewer’s yeast is active in in vitro system and
improves the blood lipid concentrations when given in physiolog-
ical active form.
In summary, the addition of organic chromium supplements
result in improved glycemic control. The reduction in HbA1 C and
mean blood glucose reflect the ability of chromium to maintain
euglycemia. Moreover, the decrease in triglyceride and LDL suggest
additional benefits in terms of reducing the risk of complication in
patients with newly onset type-2 diabetics.
Thus, this study has demonstrated that chromium supplementa-
tion is an effective regimen for newly onset type-2 diabetic patients
and may provide possible positive effect on other coronary risk
factors associated.
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