الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Type 2 diabetes mellitus (T2DM) is still a widespread public health concern around the globe, and that is because of the associated morbidities and high mortality rates mostly in the countries of low or middle-income. Because of the great deal of clinical disability that may be precipitated by diabetes and the prevalence that is rising around the world, it is insistent to denote the risk factors for T2DM that can be modified such as aspects of the lifestyle and also the hypoglycemic medications to attenuate and slowdown the advance of complications.
In recent decades, interventions to attain a better control of the diabetic parameters and reduce the risk of complications as cardiovascular diseases using supplements that are of natural origin has been of great interest to the public and their effectiveness and safety has been evaluated.
One of the trace elements that has a great role in glucose metabolism and lipid homeostasis inside the body is chromium. The biologically active form is Trivalent chromium.
There are several formulations for CRIII that are present in the market and used in supplementation, the most common are chromium chloride, chromium nicotinate, and chromium picolinate. It has been suggested that chromium deficiency can lead to insulin resistance and diabetes.
Recently a crucial part of the Diabetes management and care plan is diabetes self-management education (DSME). Over the time Diabetes education has been promoted as a well established intervention and has changed from just an approach that improves the knowledge and compliance of the patients to a Strategy focused on empowerment and self-management.
The purpose of this research was to evaluate the impact of chromium picolinate supplements and nutrition education program on diabetic patients regarding anthropometrics, diabetic profile , lipid profile and clinical findings after 12 weeks of intervention.
One hundred and fifty diabetic subjects were entailed in the study, they were sorted into three groups of 50 patients, group I received 200 ucgm of chromium picolinate daily for 3 months, group II followed a nutrition education program for 3 months and group III combined both interventions for 12 weeks.
The following variables were gathered at the beginning of the study and after 12 weeks:
• A 24-hour recall for average three days has been taken from each patient in order to collect data on the consumption of various food and drinks and calculating their average total energy intake and macronutrients.
• Anthropometrics as:
- Weight
- Height
- Waist circumference
- Body mass index (BMI)
- Estimation of body composition (fat mass and lean body mass (LBM))
• Laboratory investigation: which included:
- Fasting blood glucose.
- Glycated hemoglobin (HbA1C).
- Fasting blood insulin and HOMA- IR
- Lipid profile (triglycerides, LDL and HDL cholesterol)
- Renal function tests (urea, creatinine)
• Clinical Assessment as blood pressure and pulse rate.
6.2. Conclusions
It could be concluded from the results that:
• The impact of chromium supplementation and nutrition education on the anthropometric measurements of patients didn’t show a specific effect due to any of them, the patients that followed a nutrition education program only without any supplementation for diabetes showed the most mean weight loss and greatest body fat reduction which gives an idea that chromium supplements don’t have a specific role in weight reduction…..however most of the patients of the three groups showed improvement in their weight and body mass index.
• The Daily supplementation with chromium renders a significant improvement in the values of several markers in individuals with T2DM, like reductions in the values of fasting blood glucose, glycated hemoglobin, fasting insulin and HOMA IR. Therefore chromium supplements can be regarded as a promising therapeutic policy that might Assist and enhance control plans for diabetic patients.
• No significant adverse effects were reported during the study period. Because chromium supplements were well tolerated thus this benefit-to-risk ratio gives grounds for the practitioners to include Cr supplementation in the management plans for patients, also no renal toxicity was noted with the dose supplied.
• Dietary guidance seemed to have a favourable impact on nutritional intake.
• Chromium picolinate supplementation did not have a special effect on the body composition analysis ( either reduction in body fat or increase in muscle mass) as similar results were noticed in the patients who followed a nutrition education program on the body fat composition….also the effect on muscle mass was contrary to the expected from the literature as it was alleged that chromium supplements preserve lean body mass during the process of weight loss.
• In T2DM patients, chromium supplementation may improve their lipid profile significantly. However, the lipid-lowering effects of chromium supplementation were minor and may not be clinically meaningful.
• Educating patients on DSME must be prioritized. A modification in the diet and incorporation of regular physical activity and exercise is the key to starting a healthy lifestyle and controlling diabetes.
6.3. Recommendations
from the results of this study, the following can be recommended:
• It is advised that healthcare providers encourage patients with T2DM to continue using their prescribed hypoglycemic agents and to make appropriate dietary and physical activity changes to their lifestyle.
• Chromium picolinate can have an adjuvent role in the gylcemic control for type 2 diabetic pateints as it proved to improve the diabetic profile for patients.
• More extensive research is needed to assess the role of chromium supplements as an adjuvant therapy treatment for diabetes. Several doses and supplements should be tested.
• Chromium supplementation should be prescribed by the clinical nutritionist for patients diagnosed with insulin resistance or with recent onset of type 2 diabetes after ruling out any renal insufficiency
• Specially tailored meal planning is mandatory for diabetic patients as lifestyle as well as dietary modifications posses a great impact on the diabetic profile
• Diabetes self-management education appears to have a significant influence on glycemic outcomes. Diabetes self-management education can profit from technological advancement and digitalization. Digital alternatives show promising results and great potential for improving the efficacy of diabetes self-management education further and providing ongoing support. The implementation of diabetes self-management education into routine clinical care frequently remains a challenge.
• As DSME increases the competence and skills of people with diabetes in their treatment, it would also be expected to reduce disease burden and improve psycho-social outcomes thus DSME can be an important pillar in the management of diabetes.
• Further studies in varying doses of CrP on population with same characteristics are recommended to find out the best and safe dose of CrP on human subjects
• The measurements of lipoprotein A, which especially is atherosclerogenic and typically elevated in T2DM was not pooled in the present study. Further adequately powered studies based on this outcome are needed.