The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus

Vitamin Interventions to Prevent the Onset or Complications of Diabetes

John J. Cunningham, Ph.D., FACN

ABSTRACT

Hyperglycemia resulting from pancreatic beta cell destruction (insulin-dependent , IDDM) or defective insulin receptor function (non insulin-dependent, NIDDM) causes the degenerative complications of diabetes mellitus. Intervention strategies include primary prevention and alterations of glucose metabolism. Tight" (euglycemic) glucose control is accomplished by customizing the insulin regimen, diet and lifestyle and is well documented to be effective in delaying the onset of complications. Niacinamide has been tested at a pharmacologic dose in at-risk siblings of IDDMS, such as in the CanENDIT and DENIS trials. The results to date will be reviewed. Vitamin C is an ëaldose reductase inhibitor" in the sorbitol pathway with a potential for efficacy. Vitamins C and E offer protection against the oxidatative glycation of proteins that may also contribute to the delay of clinical complications.

References

The Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. N Engl J Med 329:977-986, 1993.

Cunningham JJ. Micronutrients as nutriceutical interventions in diabetes mellitus.

Journal of the American College of Nutrition8;17:7-10, 1998.

Niacinamide

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Sharma A, Kharb S, Chugh SN, Kakkar R, Singh G. Effect of glycemic control and vitamin E supplementation on total glutathione content in non-insulin-dependent diabetes mellitus. Ann Nutr Metab 44:11-13, 2000

Vitamin E

Bursell S-E, Clermont A, Aiello LP, Aiello L, et al. High-dose vitami E supplementation normalizes retinal blood flow and creatinine clearance in patients with type 1 diabetes. Diabetes Care 22:1245- 1251, 1999.

Jain SK, McVie R, Jaramillo JJ, Palmer M, Smith T: Effect of modest vitamin E supplementation on glycated hemoglobin and triglyceride levels and red cell indices in type I diabetic patients. J Am Coll Nutr 15:458-461, 1996.

Vitamin C

Cunningham JJ, Mearkle PL, Brown RG: Vitamin C: an aldose reductase inhibitor that normalizes erythrocyte sorbitol in insulin-dependent diabetes mellitus. J Am Coll Nutr 13:344-350, 1994.

Cunningham JJ: The glucose/insulin system and vitamin C: implications in insulin-dependent diabetes mellitus. J Am Coll Nutr 17:105-108, 1998.