The use of vitamin and mineral supplements is common in the United States, with about 50% of the adults routinely consuming these dietary supplements (DS). However, little is known about the use of these products in patients with diabetes.

Using data from the National Health and Nutrition Examination Survey (NHANES), researchers described the prevalence and trends of DS use among U.S. adults with diabetes between 1999 and 2014. The NHANES is an annual, cross-sectional, stratified, multistage, national survey that combines interviews and physical examinations to assess the health and nutritional status of adults and children in the U.S.  Data on the use of any supplement product, multivitamins/multiminerals (MVMM) (i.e., products with >10 vitamins and/or minerals), individual vitamins, minerals, and non-MVMMs (NMVMMs) were collected over eight continuous 2-year waves. 

Participants were excluded from data analysis if they were pregnant, younger than age 20 years, lacked physical examination data, or did not have diabetes.  Diabetes was defined as a previous diagnosis of diabetes, a hemoglobin A1c of >6.5%, a fasting plasma glucose of >126 mg/dL , any plasma glucose that was >200 mg/dL, a 2-hour plasma glucose of 200 mg/dL, or by the use of insulin. 

Participants were queried as to their use of any DS within the past 30 days. In total, 6,668 patients with diabetes were included in the analysis. Older adults aged >65 years accounted for 62% of the weighted percentage for any DS use followed by those aged 40 to 64 years, a group that had a weighted percentage of DS use of 51%; the group with the lowest use of DS was those aged 20 to 39 years, accounting for only 30% of the weighted percentage. 

Researchers found that during the study period, 54% of persons with diabetes utilized a DS. Those most likely to consume a DS were older persons (aged >65 years), females, non-Hispanic whites, those who had achieved a higher educational level, those with a longer duration of diabetes and those with an additional comorbidity, such as cancer, chronic kidney disease, cardiovascular disease, and chronic obstructive pulmonary disease. 

When the prevalence and trends in the use of any DS, MVMN, any vitamin or any mineral were compared from 1999 to 2000 (the first wave) to 2013 to 2014 (the second wave), researchers found that there was an increase from 52% to 58%; this trend was not statistically significant. However, if MVMM combinations were excluded, the trend became statistically significant and rose from 17% to 26%. There was a statistically significant decrease in MVMM from 36% to 32% between the first and second wave. The use of any vitamin significantly increased from 47% to 52%, whereas the use of any mineral remained flat, ranging from 47% from 1999 to 2000 to 51% from 2013 to 2014. 

Among individual vitamins, minerals, or common MVMM components, there was a statistically significant increase in vitamin D use from 34% to 43%. Interestingly, lycopene, an antioxidant found in tomatoes, jumped from 2.4% to 21% among men after favorable reports of its effects on prostate cancer. Choline use remained low. After an initial increase from 1999 to 2006, the use of vitamin A decreased in 2007. Supplements whose use statistically decreased over time included vitamin B (except for vitamin B 12) and vitamin E.  

The most common minerals (i.e., prevalence was >24%) used by persons with diabetes included calcium followed by magnesium, copper, chromium selenium, manganese, and zinc, all of which remained fairly consistent, except for zinc. Use of boron, iodine, iron, magnesium, molybdenum phosphorus, potassium vanadium, and zinc decreased over time. Additional trends in MVMM use were noted based on age, gender, race, and educational attainment. 

Although the use of NMVMMs accounted for about 5% of DS, there was an 18-fold increase in omega-3-fatty acid–containing supplements. Fish oil/ eicosapentaenoic acid/docosahexaenoic acid/docosapentaenoic acid supplements were the most commonly used NVMM supplements in the second wave, demonstrating a 10-fold increase in use. Increases were also observed in the use of omega-6, omega-9, amino acids, methylsulfonyl-methane, and probiotics but not in bilberry, garlic, ginkgo bilboa, ginseng, grape seed, para-aminobenzoic acid, quercetin, and soy.

It is important for pharmacists to understand the pattern of use of DS among patients with diabetes so that they can dispel misinformation and assist in proper product selection. 

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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