Micronutrients as nutriceutical interventions in diabetes mellitus

Hyperglycemia portends chronic complications in insulin-dependent diabetes mellitus (IDDM) and substantial benefits are associated with "tight" glycemic control. Other interventions should either enhance glycemic control per se or add benefit to an established degree of glycemic control. Several micronutrients enhance insulin action and others offer promise in countering the untoward consequences of hyperglycemia. Supplements of micronutrients including the vitamins niacin (as niacinamide), C and E and the minerals zinc, chromium and vanadium have been studied. For the purpose of this review, the term "nutriceutic" refers to supplementation on the order of 2 to 10 times the RDA for which a benefit is linked to a mechanism of action. Benefits associated with "nutriceutic" supplementation are reported in small trials for vitamins C and E and these supplements are safe and affordable from food or tablet sources. A dietary strategy adding 200-600 mg of vitamin C and 100 IU of vitamin E to a healthy dietary pattern is worthy of consideration as an intervention for individuals with IDDM. Key teaching points: "Tight" glycemic control is effective in decreasing the complications of diabetes mellitus. Niacinamide is under clinical trial for efficacy in delaying or preventing the onset of type I diabetes. Several micronutrients enhance insulin action and others effectively counter the pathologic consequences of hyperglycemia. Vitamins C and E offer promise for diminishing protein glycoxidations.