Health for life

A small study from the Netherlands has failed to find blood sugar benefit from chromium supplementation. The study appears in last months issue of Diabetes Care.

Chromium had previously been shown to improve insulin sensitivity, but subsequent studies have been inconclusive.

This 6-month, double-blind, randomized trial tested treatment amounts of 500 or 1000 micrograms/day of chromium picolinate in 46 people with type 2 diabetes. Participants taking chromium had no change in A1C, weight, blood pressure, or lipid profile.

Although benefit was not seen in this study population - whose participants were obese (average BMI 34) with poorly controlled blood sugar (A1C > 8%) who took large amounts of insulin (more than 50 units/day) - it does not rule out benefit in populations with better glucose control.

________
For the study:
Chromium Treatment Has No Effect in Patients With Poorly Controlled, Insulin-Treated Type 2 Diabetes in an Obese Western Population

What did that study show?

In yesterdays post on the role of telephonic disease management for obesity, the Disease Management Care Blog pointed out that POWER was a landmark study that demonstrated that remote lifestyle counseling performed as well as traditional face-to-face counseling.

A New England Journal of Medicine editorial accompanying the POWER article points out that there may have been an additional factor that explained the results: patient attendance at the in-person counseling sessions dropped off precipitously as the trial progressed (an average of only 2 out of 24 scheduled visits after the seventh month), while the telephonic approach achieved 16 out of 18 scheduled contacts.

The DMCB agrees and suggests this is an additional virtue of remote telephonic disease management.  While in-person counseling may have more of an individual impact, it does little good if  patients no-show.  In contrast, "high volume" telephonic counseling may have more of a population-based effect, because a lower intensity intervention has greater absolute impact if its delivered to more persons.

NIH scientist Susan Yanovskis editorial falls short on capitalizing on that insight.  While it grudgingly points out that POWER shows "PCPs can deliver safe and effective weight-loss interventions in primary care settings," it neglects to mention the two important implications of POWER:

1) non-physician team members acting collaboration with PCPs are an important resource in the national battle against obesity and

2) offering a variety of communication channels increases reach and gives more patients new and effective options to access anti-obesity programs.