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Estimating Concentrations of Chromium and Manganese in Diabetes Patients

Serum concentration levels of both chromium and manganese metals are altered in people with and without diabetes.

Diabetes mellitus continues to be one of the most common endocrine disorders worldwide. The increase in carbohydrates, lipids and proteins leads to hyperglycemia, ketonuria, and other metabolic abnormalities. it is not uncommon that diabetes leads to microvascular complications such as retinopathy, neuropathy among other disorders. In addition, it is also known that diabetes, if left untreated may lead to more complicated disease states like stroke, ischemic heart disease and other cardiovascular abnormalities. The two different types of diabetes come into existence due to variations in insulin production. With type 1 diabetes, there is little to no insulin produced and the body’s immune system destroys the insulin producing cells found in the pancreas. This decline in insulin levels requires type 1 diabetes patients to inject themselves with insulin several times a day, as well as manage their diet and exercise. Type 2 diabetes, a disease state caused by several factors like overproduction of hormones and obesity results in a decreased release of insulin. Insulin requires chromium to activate the insulin kinase receptor. Doing so increases insulin sensitivity, glucose utilization and B-cells sensitivity. Manganese is an essential trace metal that is required in all diets to help regulate blood glucose levels and promote cellular energy.

In the study titled “Insulin Sensitivity to Trace Metals (Chromium, Manganese) in Type 2 Diabetic Patients and Non-Diabetic Individuals,” researchers aimed to determine the relationship between the role of chromium and manganese in both people with diabetes and without. A cross-sectional comparative study was conducted from September 2014 to April 2015 at the Ayub Teaching Hospital and Women medical college. The study consisted of one hundred patients with type 2 diabetes and one hundred control patients without diabetes. The cases and controls were between the ages of 22 and 65 years where there were 69 males and 31 females with type 2 diabetes and 39 males and 61 females as controls. Patients were sorted into groups using a Non-probability convenient sampling technique. Any patient found to have secondary diabetes or other disease states affecting glucose levels were excluded from the study. Fasting and random blood samples were taken from each patient and divided into two parts: Estimation of blood glucose and HbA1c were measured using reagent kits. Remaining serum was left to clot and then further centrifuged to detect traces of chromium and manganese. A wet digestion method was used to estimate levels of chromium and manganese. The digestion mixture was made by combining sulphuric acid, nitric acid, and 63% per chloric acid in a ratio of 1:5:2. The solution was then filtered and obtained for analysis of trace metals. Finally, each individual’s weight and height were measured using a digital stadiometer.

Results indicated that fasting and random blood glucose levels were significantly higher in people with type 2 diabetes when compared with people without. There was also a decrease in both serum chromium and manganese levels in people with diabetes (p<0.001) versus those without. In addition, the mean value of BMI varied between both groups; people with diabetes had a mean value BMI of approximately 26.9 whereas people without showed a mean value BMI of 22.

Diabetes continues to be a metabolic disease, affecting individuals worldwide. It has a long-standing role in the development of hyperglycemia and other long-term vascular complications such as ischemic heart disease, stroke, and myocardial infarctions, as a result of insulin action. According to researchers, trace minerals play an important role in the activity of insulin in both diabetes patients and people without diabetes.

Manganese contributes to the activity of insulin by activating the hexokinase enzyme that causes an increase of glucose in the cells. A deficiency in this metal, therefore, may result in hypoglycemic episodes. The study showed that there were lower levels of chromium and manganese in individuals with diabetes when compared to people without diabetes. Researchers believe that this decline in metals warrants supplementation of chromium and manganese in diabetes patients.

Practice Pearls:

  • Diabetes is one of the leading causes of morbidity and mortality worldwide.
  • Both type 1 and type 2 diabetes vary in the production and activity of insulin.
  • Trace metals like chromium and manganese decline in people with diabetes compared to people without.

Hajra, Bibi, Shaukat Ali Orakzai, Uzma Faryal, Mukhtar Hassan, Shazia Rasheed, and Salim Wazir. “INSULIN SENSITIVITY TO TRACE METALS (CHROMIUM, MANGANESE) IN TYPE 2 DIABETIC PATIENTS AND NON DIABETIC INDIVIDUALS.” Journal of Ayub Medical College Abbottabad. N.p., n.d. Web. 19 July 2017.


Nuha Awad, Doctor of Pharmacy Candidate: Class of 2018; LECOM College of Pharmacy