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With the exceptions of folate for prevention of birth defects and calcium for
prevention of bone disease, currently there is no evidence of benefit from
vitamin or mineral supplementation in diabetic patients without underlying
deficiencies. Given the recent revelations about antioxidant vitamins, it is
prudent to refrain from using vitamin E, vitamin C, or vitamin A in excess of
the Dietary Reference Intakes.
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of supplementation. If serum levels of
in the gut.2,3 However, it is conceivable 25-hydroxy vitamin D are not nor- Vitamin A, Carotenoids, and
that the latter compensatory mecha- malized at that time, then work up Retinoids
nism may not be sufficient to prevent Vitamin A is essential for normal
from http://diabetesjournals.org/spectrum/article-pdf/22/4/214/503705/214.pdf
for malabsorption, particularly gluten
zinc deficiency in some people. enteropathy, should be considered. vision and for an effective function-
Small studies in older subjects with ing of the immune system.2,3 Because
CAM Therapies
diabetes have suggested some benefit Vanadium of its role in cell differentiation, it
in healing skin ulcerations with zinc Vanadium has a significant effect on may have a role in the emergence and
supplementation.2,3,13 Reliable labora- glucose metabolism. However, clinical propagation of neoplastic disease.
tory techniques to measure zinc status studies have failed to show evidence of A number of carotenoids, especially
are not clinically available, and clini- efficacy of vanadium salts in diabetes beta-carotenoids, are considered to be
cal trials with zinc supplementation and have found that there is potential pro-vitamins because of their ability
in diabetic subjects are very small and for toxicity.18 New organo-vanadium to convert to vitamin A in the liver.
have yielded inconsistent results. A compounds with higher potency and Retinoids derive from natural vitamin
recent observational study reported less toxicity are under investigation as A products and have some properties
a significant inverse association of a potential treatment of diabetes.18 similar to carotenoids.
dietary intakes and serum levels of There is no evidence that people
zinc and selenium with gestational Selenium with diabetes are at risk of vitamin A
diabetes.14 These observations merit Selenium is an important component deficiency, and therefore there is no
additional confirmatory studies. of selenoproteins, which are implicated reason to recommend vitamin A in
If one suspects zinc deficiency, in modulating oxidative stress and reg- amounts beyond the DRIs.2,3 Indeed,
especially in high-risk patients such ulating thyroid hormone activity.19 In excess vitamin A consumption may
five trials (four with high risk of bias),
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additional study.40 References
sensitivity. Unfortunately, the improve- T he d iscrepa nc y a mong t he
ment in insulin sensitivity after oral results of interventional trials with
1
Franz MJ, Bantle JP, Beebe CA, Brunzell
JD, Chiasson JL, Garg A, Holzmeister LA,
administration of LA is < 20% of the antioxidant vitamins and the known
from http://diabetesjournals.org/spectrum/article-pdf/22/4/214/503705/214.pdf
Hoogwerf B, Mayer-Davis E, Mooradian
improvement seen after intravenous increased oxidative load and its con- AD, Purnell JQ, Wheeler M: Evidence-based
administration.44 This limits the clini-
CAM Therapies
sequences in diabetes are unexpected nutrition principles and recommendations
cal utility of this compound. and cannot be readily explained at the for the treatment and prevention of diabetes
The antioxidant effects of LA and related complications. Diabetes Care
present time. 25:148–198, 2002
may also be helpful in slowing the
development of diabetic neuropa- CONCLUSIONS AND
2
Mooradian AD, Failla M, Hoogwerf B,
Maryniuk M, Wylie-Rosett J: Selected vita-
thy.44 Although the role of long-term RECOMMENDATIONS mins and minerals in diabetes. Diabetes Care
supplementation is less clear, there is People with poorly controlled diabetes 17:464–479, 1994
evidence to suggest that oral LA at a are susceptible to multiple micronu- 3
Mooradian AD: Micronutrients in diabe-
dose of 600–1,800 mg/daily may be trient deficiencies.1– 4 Some of these tes mellitus. In Drugs, Diet, and Disease.
beneficial in the treatment of diabetic micronutrients have potent antioxi- Vol. 2. Ioannides C, Flatt PR, Eds. Hemel
peripheral neuropathy and cardiovas- dant activity. It is not known whether Hempstead, U.K., Ellis Horwood, 1999, p.
the ingestion of antioxidant vitamins 183–200.
cular autonomic neuropathy.44
could delay or perhaps reverse the oxi- 4
Mooradian AD: Antioxidants and diabetes.
MICRONUTRIENTS AS dative damage. Nestle Nutr Workshop Ser Clin Perform
Programme 11:107–122, 2006
ANTIOXIDANTS People with diabetes should be
Several micronutrients have potent educated about the importance of
5
Hasanain B, Mooradian AD: Antioxidant
vitamins and their influence in diabetes mel-
antioxidant properties. These include acquiring daily vitamin and min- litus. Curr Diabetes Rep 2:448–456, 2002
carotenoids, vitamins E and C, sele-