OBJECTIVE -Chromium picolinate (CrPic) supplementation has been suggested to improve glycemia, but there are conflicting reports on efficacy. We sought to determine the effect of CrPic on insulin sensitivity, glycemic control, and body composition in subjects with type 2 diabetes.RESEARCH DESIGN AND METHODS -Thirty-seven subjects with type 2 diabetes were evaluated. After baseline, subjects were placed on a sulfonylurea (glipizide gastrointestinal therapeutic system 5 mg/day) with placebo for 3 months. Subjects were then randomized in a double-blind fashion to receive either the sulfonylurea plus placebo (n ϭ 12) or the sulfonylurea plus 1,000 g Cr as CrPic (n ϭ 17) for 6 months. Body composition, insulin sensitivity, and glycemic control were determined at baseline, end of the 3-month single-blind placebo phase, and end of study.RESULTS -Subjects randomized to sulfonylurea/placebo, as opposed to those randomized to sulfonylurea/CrPic, had a significant increase in body weight (2.2 kg, P Ͻ 0.001 vs. 0.9 kg, P ϭ 0.11), percent body fat (1.17%, P Ͻ 0.001 vs. 0.12%, P ϭ 0.7), and total abdominal fat (32.5 cm 2 , P Ͻ 0.05 vs. 12.2 cm 2 , P Ͻ 0.10) from baseline. Subjects randomized to sulfonylurea/CrPic had significant improvements in insulin sensitivity corrected for fat-free mass (28.8, P Ͻ 0.05 vs. 15.9, P ϭ 0.4), GHb (Ϫ1.16%, P Ͻ 0.005 vs. Ϫ0.4%, P ϭ 0.3), and free fatty acids (Ϫ0.2 mmol/l, P Ͻ 0.001 vs. Ϫ0.12 mmol/l, P Ͻ 0.03) as opposed to sulfonylurea/placebo.CONCLUSIONS -This study demonstrates that CrPic supplementation in subjects with type 2 diabetes who are taking sulfonylurea agents significantly improves insulin sensitivity and glucose control. Further, CrPic supplementation significantly attenuated body weight gain and visceral fat accumulation compared with the placebo group. Diabetes Care 29:1826 -1832, 2006T he primary strategy to improve metabolic control in patients with type 2 diabetes consists of lifestyle modification combined with pharmacologic intervention (1). However, alternative strategies, e.g., nutritional supplementation with over-the-counter agents, are extensively practiced by a large number of patients and are frequently undertaken without first informing the medical provider. According to the Food and Drug Administration, there are more than 29,000 different nutritional supplements available to consumers, and Americans spend over 12 billion dollars per year on these supplements (2,3). Unfortunately, considerable controversy exists regarding use of dietary supplements in subjects with diabetes because efficacy data for many of the supplements consist of only uncontrolled studies and anecdotal reports. As such, there is a paucity of data in humans in regard to the effect of most commercially available supplements to improve metabolic abnormalities.One supplement that has attracted considerable clinical interest is chromium (4). However, routine use of chromium in subjects with diabetes is not currently recommended, and the most recent 2006 Clinical Practice Recommendations from the A...

Objectives Administration of eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), omega-3 fatty acids in fish oil, has been associated with improved patient outcomes in acute lung injury (ALI) when studied in a commercial enteral formula. However, fish oil has not been tested independently in ALI. We therefore sought to determine if enteral fish oil alone would reduce pulmonary and systemic inflammation in patients with ALI. Design Phase II randomized controlled trial. Setting Four North American medical centers. Patients Mechanically ventilated patients with ALI ≥ 18 years of age. Interventions Subjects were randomized to receive enteral fish oil (9.75g EPA and 6.75g DHA daily) or saline placebo for up to 14 days. Measurements and Main Results Bronchoalveolar lavage fluid (BALF) and blood were collected at baseline (day 0), day 4±1, and day 8±1. The primary endpoint was BALF interleukin (IL)-8 levels. Forty-one participants received fish oil and 49 received placebo. Enteral fish oil administration was associated with increased serum EPA concentration (p<0.0001). However, there was no significant difference in the change in BALF IL-8 from baseline to day 4 (p=0.37) or day 8 (p=0.55) between treatment arms. There were no appreciable improvements in other BALF or plasma biomarkers in the fish oil group compared to the control group. Similarly, organ failure score, ventilator-free days, ICU-free days, and 60-day mortality did not differ between the groups. Conclusions Fish oil did not reduce biomarkers of pulmonary or systemic inflammation in patients with ALI, and the results do not support the conduct of a larger clinical trial in this population with this agent. This experimental approach is feasible for proof of concept studies evaluating new treatments for ALI.