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NEW YORK (Reuters Health) – The use of antidepressant medication is strongly associated with the risk of developing diabetes, according to findings published in the March issue of Diabetes Care.

Dr. Richard R. Rubin, of Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues point out that among diabetics, the risk of depression is 50 to 100% greater than in the general population. Furthermore, depression in diabetic patients is associated with higher complication and mortality rates and higher health care costs.

In 3187 participants in the randomized Diabetes Prevention Program (DPP) study, Dr. Rubin’s team sought to determine whether depression symptoms or antidepressant use were associated with progression to type 2 diabetes, and whether the associations varied depending on the treatment arm: standard lifestyle recommendations plus 850 mg metformin twice daily (MET arm), standard lifestyle recommendations plus placebo (PLB arm), or an intensive lifestyle modification program (ILS arm).

The mean follow-up was 3.2 years.

At baseline, 10.3% of subjects had Beck Depression Inventory (BDI) scores indicating at least mild depression (11 or higher), and 5.7% were taking antidepressants. Intermittent antidepressant use was reported for 7.2% of total person-years during the DPP, and continuous antidepressant use was reported for 3.2% of total person-years.

No association was observed between elevated BDI scores at baseline or during the study and diabetes risk in any treatment arm when other factors associated with the risk of developing diabetes were controlled for.

“Baseline antidepressant use, on the other hand, was strongly associated with diabetes risk” in both the PLB and ILS arms (hazard ratios [HR] 2.25 and 3.48, respectively), according to the report.

Compared with no use, continuous antidepressant use during the study was also associated with diabetes risk in the PLB (HR 2.60) and ILS (HR 3.39) arms. Intermittent antidepressant use during the study was associated with diabetes risk in the ILS arm (HR 2.07). No association was found between antidepressant use and development of diabetes among participants in the MET arm.

“If antidepressants prove to be an independent diabetes risk factor, clinicians will need to consider this when prescribing depression treatment in patients at high risk for diabetes,” Dr. Rubin said in an interview with Reuters Health. “One possibility is to consider psychological treatment to avoid potential iatrogenic effects of antidepressants (although limited resources may often make this unfeasible),” he explained. “In one study of depressed patients with diabetes who had high A1c levels, cognitive behavioral therapy counseling was associated with improved glycemic control; this suggests a potential benefit for patients at high risk for developing diabetes.”

“This paper was based on data from the DPP, with average participant follow-up of 3.2 years,” Dr. Rubin notes. “We have continued to follow these participants and now have an additional 5 years of data,” he said. “We will soon analyze the longer term data to see if the associations we found during the DPP are sustained.”

From Shaklee.com:

Nutritional Supplementation

Additional information (Precautions) is available by clicking on the underlined supplement.

Chromium
The way that chromium affects blood sugar was first discovered in animal studies in the 1950’s. In the 1970’s, it was discovered that chromium is important in special intravenous (IV) feeding solutions called total parenteral nutrition (TPN solutions). It was discovered that when chromium was missing from the TPN solution, after several months, blood sugar increased in patients. Chromium was added and blood sugar in TPN patients returned to normal. Various studies support that chromium has a positive effect on blood glucose.

It is thought that chromium helps insulin by moving glucose and other nutrients into the cells of the body. This helps to maintain muscle mass during times when the diet does not provide enough calories. Chromium also stabilizes the body’s metabolism. Chromium can lower cholesterol and triglycerides. Chromium may also decrease hunger and limit food cravings. Insulin is involved in the regulation of the center in the brain the makes one feel full and stop eating. Insulin is also important in the development of a brain chemical linked to the craving for carbohydrates.

Most Americans are at risk for low chromium because of a diet rich in refined sugars. Individuals who eat diets high in refined sugars tend to eliminate 300 percent more chromium in their urine than those whose diets are low in refined sugars. Individuals who live in countries with high levels of chromium that comes from diets rich in unrefined grains have a lower rate of diabetes and atherosclerosis (hardening of the arteries). People who exercise regularly eliminate two to six times the normal amount of chromium in their urine on days of exercise. Many athletes make this problem worse by using high-carbohydrate supplements. The elderly also are at risk for low chromium due to not enough chromium in the diet and poor absorption. Women can have a drop in chromium levels during the third trimester (seventh, eighth, and ninth months) of pregnancy.

There is a disagreement among healthcare professionals over what is the best chromium to use. Chromium is only active in certain forms. The most important of these forms is glucose tolerance factor (GTF). Dr. Walter Mertz of the United States Department of Agriculture did research with GTF chromium. He found that chromium was a crucial part of the process where insulin attaches to cells. GTF chromium is safe and usually does not cause side effects.

Chromium picolinate is another popular form of chromium that is used to regulate blood sugar levels. Even though chromium picolinate is considered safe, a recent study in lab animals at Dartmouth College and The George Washington Medical Center reported that certain doses of chromium picolinate caused damage to chromosomes. More information is needed about this supplement because other studies have reported that it is safe and effective.

For diabetics, adding chromium or other blood sugar regulating agents to their diet should be done slowly, especially if they are on other medication to control their diabetes. With lifestyle and dietary changes, only a small dose of chromium may be needed.

Magnesium
Magnesium is involved in the breakdown of glucose in the body and release of insulin. Low magnesium may make diabetes worse in some people.  Hypomagnesemia (low magnesium in the blood) happens in about 25 percent of diabetic patients. Many Americans are below the RDA (Recommended Dietary Allowance) for magnesium. Many experts feel that the RDA for magnesium needs to be increased.

Magnesium is eliminated from the body by the kidneys. Individuals with kidney disease should consult a healthcare professional before using a magnesium supplement. Too much magnesium may cause diarrhea.

Vanadium
Vanadium is a trace mineral that is very important for plant nutrition, but what it does for human nutrition is not clear. It works with enzymes in the body. High amounts of vanadium are found in the kidneys, liver, and bone. Fat cells temporarily store vanadium for quick release into the body. Supplementing with vanadyl sulfate and other forms of vanadium has been reported to improve diabetes.

Animal studies have reported that when vanadium was given to diabetic rats, their increased blood glucose returned to normal. Other studies have reported that vanadyl sulfate not only lowers blood glucose in diabetic animals, but also decreases cholesterol and triglycerides. In one study in diabetic rats, researchers found that vanadium may protect the pancreatic beta cells.

Human studies are encouraging. Type 2 diabetics given oral vanadyl sulfate had a nearly 20 percent drop in fasting blood glucose in one study.  Minor gastrointestinal upset was the only reported side effect. In another study, supplementation with vanadyl sulfate daily for three weeks resulted in improved insulin action.

Vanadium pentoxide and vanadyl sulfate are active forms of vanadium that are easily absorbed by the body. Vanadium appears to be safe even at high doses. Doses should be increased gradually, especially if it is given with GTF chromium.

Alpha-Lipoic Acid (ALA)
Alpha-lipoic acid (ALA) is an antioxidant made by the body. ALA is also known as alpha-lipoate or thiotic acid. Lipoates are small water and fat-soluble molecules that are easily absorbed from the gastrointestinal tract. It is also used in heart disease and for AIDS patients. Alpha-lipoic acid affects insulin and blood sugar in type 2 diabetics.  ALA may be effective in the treatment of diabetic neuropathy. In a recent study, about 97 percent of diabetic patients treated with ALA daily for three weeks reported an improvement in their neuropathy symptoms.There are no known toxicities with ALA. It is important to monitor blood glucose closely in diabetics supplementing their diet with ALA.

Zinc
Zinc deficiency is found in patients with problems in blood glucose control. In clinical studies, diabetic animals and humans with zinc deficiencies improved when supplemented with zinc. Zinc helps to regulate insulin production by the pancreas and glucose use by muscle and fat cells. Very high doses of zinc may cause diarrhea, dizziness, lethargy, vomiting, and loss of muscle coordination.

Cyclo (His-Pro)
Cyclo hispro may be a useful agent in improving blood sugar regulation in individuals with hypoglycemia, diabetes, and impaired glucose tolerance (IGT). It has been reported that individuals with diabetes have problems with absorbing zinc from the intestines, causing low zinc levels in the blood. Both animal and human studies report that cyclo hispro may affect the absorption of zinc from the intestines. This extract also contains high levels of zinc. For the diabetic patient, zinc is important for wound healing, proper functioning of the immune system, and for the skin. There are no reported side effects with the use of cyclo hispro.

In a recent clinical study, cyclo hispro was given to 22 male subjects with type 2 diabetes. After three months, the treatment group reportedly decreased fasting blood glucose levels and fasting plasma insulin levels. In addition, the treatment group had slight decreases in cholesterol and LDL and increased plasma zinc concentrations. The results of the study demonstrated the benefit of the use of cyclo hispro extract with zinc in type 2 diabetics.

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