Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
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Index Copernicus  – 161.11; MEiN – 140 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2014, vol. 23, nr 6, November-December, p. 939–946

Publication type: original article

Language: English

Dietary Supplementation During Diabetes Therapy and the Potential Risk of Interactions

Katarzyna Zabłocka-Słowińska1,A,B,C,D, Ewelina Dzielska1,B,C,D, Iwona Gryszkin2,B, Halina Grajeta1,E,F

1 Department of Food Science and Nutrition, Wroclaw Medical University, Poland

2 Nutrition and Dietetics Clinic, North Public Health Care Institution, Wrocław, Poland


Background. The classification of dietary supplements as foodstuffs promotes widespread access to them and increases the possibility of patients using them without being monitored. Unreasonable or excessive consumption of these preparations poses risks to type-2 diabetes mellitus (T2DM) patients (among others) because it may induce disturbances in glycemic control. The aim of this study was to assess the frequency of dietary supplementation among patients using anti-diabetic drugs and such patients’ nutrient intake in order to evaluate the potential risk of interactions.
Material and Methods. The study participants were 150 diabetic patients who were asked about the type of pharmacotherapy and dietary supplementation they used. The intake of minerals, vitamins, dietary fiber and long-chain polyunsaturated fatty acids (LC-PUFAs) from the patients’ diets were also assessed, using the 24-h dietary recall method.
Results. The highest percentage of patients taking individual anti-diabetic drugs used supplements containing magnesium and herbs. They also often took antioxidant vitamins, B-group vitamins and omega-3 fatty acids. In the majority of patients (both those using supplements and those not), the dietary recall showed insufficient intake of potassium, calcium and magnesium, as well as of vitamin E, folic acid, vitamin D and LC-PUFAs. In addition, their diets provided high median amounts of iron, copper, vitamin A and β-carotene.
Conclusion. The level of dietary supplementation and the ill-balanced diets reported by the majority of the recruited T2DM patients indicate a high possible risk of interactions with the anti-diabetic drugs. Therefore, patients should always consult their physicians regarding dietary supplementation, and medically trained staff should routinely assess dietary intake to avoid hazardous changes in the activity of drugs.

Key words

dietary supplements, nutrients, anti-diabetic drugs, interactions.

References (32)

  1. Yoshimura Y, Kamada C, Takahashi K, Kaimoto T, Satoshi I, Ohashi Y, Araki A, Umegaki H, Sakurai T, Ito H: The Japanese Elderly Diabetes Intervention Trial Study Group: Relations of nutritional intake to age, sex and body mass index in Japanese elderly patients with type 2 diabetes: the Japanese Elderly Diabetes Intervention Trial. Geriatr Gerontol Int 2012, 12, 29–40.
  2. Ahn H J, Min KW, Cho YO: Assessment of vitamin B6 status in Korean patients with newly diagnosed type 2 diabetes. Nutr Res Pract 2011, 5, 34–39.
  3. Oh HM, Yoon JY, Cho SH, Yoon JS: Vitamin A and vitamin E status of diabetic patients and normal adults in Korea. Korean J Nutr 2009, 42, 318–326.
  4. Bleich SN, Wang YC: Consumption of sugar-sweetened beverages among adults with type 2 diabetes. Diabetes care 2011, 34, 551–555.
  5. Chaudhary DP, Sharma R, Bansal DD: Implications of magnesium deficiency in type 2 diabetes: a review. Biol Trace Elem Res 2010, 134, 119–129.
  6. Walker AF: Potential micronutrient deficiency lacks recognition in diabetes. Br J Gen Pract 2007, 57, 3–4.
  7. Ustawa o bezpieczeństwie żywności i żywienia z dnia 29 czerwca 2010 r. Dz. U. 2010 r. Nr 136, poz. 914 z późn. zm.
  8. Suliburska J, Bogdański P: Ocena sposobu żywienia, stanu odżywienia oraz ryzyka występowania interakcji leków z żywnością u pacjentów z cukrzycą typu 2. Farm Współ 2011, 4, 3–8.
  9. Jarosz M: Normy żywienia dla populacji polskiej – nowelizacja. Wyd. IŻŻ, Warszawa 2012.
  10. European Food Safety Authority (EFSA) Panel on Dietetic Products, Nutrition and Allergies: Scientific opinion on dietary reference value for manganese. EFSA Journal 2013, 11, 3419–3444.
  11. Mudra M, Ercan-Fang N, Zhong L, Furne J, Levitt M: Influence of mulberry leaf extract on the blood glucose and breath hydrogen response to ingestion of 75 g sucrose by type 2 diabetic and control subjects. Diabetes Care 2007, 30, 1272–1274.
  12. Sheng X, Zhang Y, Gong Z, Huang C, Zang YQ: Improved insulin resistance and lipid metabolism by cinnamon extract through activation of peroxisome proliferator – activated receptors. PPAR Res 2008, 1–9.
  13. Horvath EM, Tackett L, McCarthy AM, Raman P, Brozinick JT, Elmendorf JS: Antidiabetogenic effects of chromium mitigate hyperinsulinemia – induced cellular insulin resistance via correction of plasma membrane cholesterol imbalance. Mol Endocrinol 2008, 22, 937–950.
  14. Layam A, Reddy CLK: Antidiabetic property of spirulina. Diabet Croat 2006, 35, 29–33.
  15. Guerrero-Romero F, Rodgiguez-Moran M: Complementary therapies for diabetes: the case for chromium, magnesium and antioxidants. Arch Med Res 2005, 36, 250–257.
  16. Wälti MK, Zimmermann MB, Spinas GA, Hurrell RF: Low plasma magnesium in type 2 diabetes. Swiss Med Wkly 2003, 133, 289–292.
  17. Dong J, Xun P, He K, Qin L: Magnesium intake and risk of type 2 diabetes. Diabetes Care 2011, 34, 2116–2122.
  18. Rabinowitz H, Friedensohn A, Leibovitz A, Gabay G, Rocas C, Habot B: Effect of chromium supplementation on blood glucose and lipid levels in type 2 diabetes mellitus elderly patients. Int. J Vitam Nutr Res 2004, 74, 178–182.
  19. Martin J, Wang ZQ, Zhang XH, Wachtel D, Volaufova J, Matthews DE, Cefalu, WT: Chromium picolinate supplementation attenuates body weight gain and increases insulin sensitivity in subjects with type 2 diabetes. Diabetes Care 2006, 29, 1826–1832.
  20. Broadhurst CL, Domenico P: Clinical studies on chromium picolinate supplementation in diabetes mellitus – a review. Diab Technol Ther 2006, 8, 677–687.
  21. Chen G, Zhang Y, Lu D, Li N, Ross AC: Retinoids synergize with insulin to induce hepatic Gck expression. Biochem J 2009, 419, 645–653.
  22. Shinde SN, Dhadke VN, Suryakar AN: Evaluation of oxidative stress in type 2 diabetes mellitus and follow-up along with vitamin E supplementation. Ind J Clin Biochem 2011, 26, 74–77.
  23. Martini LA, Catania AS, Ferreira SRG: Role of vitamins and minerals in prevention and management of type 2 diabetes mellitus. Nutr Rev 2010, 68, 341–354.
  24. Liu KW, Dai DLK., Ho W, Lau E, Woo J: Metformin – associated vitamin B12 deficiency in the elderly. Asian J Gerontol Geriatr 2011, 6, 82–87.
  25. Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V: Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000, 23, 1227–1231.
  26. Pittas AG, Lau J, Hu FB, Dawson-Hughes B: The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007, 92, 2017–2029.
  27. Flash P, Rossmeisl M, Bryhn M, Kopecky J: Cellular and molecular effects of n-3 polyunsaturated fatty acids on adipose tissue biology and metabolism. Clin Sci 2009, 116, 1–16.
  28. Singer P, Shapiro H, Theilla M, Anbar R, Singer J, Cohen J: Anti-inflammatory properties of omega-3 fatty acids in critical illness: novel mechanisms and an integrative perspective. Int Care Med 2008, 34, 1580–1592.
  29. Martín de Santa Olalla L, Sánchez Muniz FJ, Vaquero MP: n-3 fatty acids in glucose metabolism and insulin sensitivity. Nutr Hospital 2009, 24, 113–127.
  30. Sankar D, Ali A, Sambandam G, Rao R: Sesame oil exhibits synergistic effect with anti-diabetic medication in patients with type 2 diabetes mellitus. Clin Nutr 2011, 30, 351–358.
  31. Holstein A, Beil W: Oral antidiabetic drug metabolism: pharmacogenomics and drug interactions. Expert Opin Drug Metab Toxicol 2009, 5, 225–241.
  32. Cramer JA: A systematic review of adherence with medication for diabetes. Diabetes Care 2004, 27, 1218–1224.