Evaluation of Chromium Picolinate Supplementation and Insulin Requirements in Critically Ill Adults With Type 2 Diabetes Mellitus.

BACKGROUND

Chromium picolinate has been studied as an adjunct to improve glycemic indices in ambulatory type 2 diabetes mellitus, but its role in critically ill patients is unknown.

OBJECTIVE

To evaluate whether chromium picolinate supplementation was associated with reduced insulin requirements without worsening glycemic control in critically ill adults with type 2 diabetes mellitus.

METHODS

We conducted a single-center retrospective pre-post cohort study of adult intensive care unit patients with type 2 diabetes mellitus or hemoglobin A1c ≥6.5% who received insulin and at least 4 consecutive chromium picolinate doses between July 2022 and January 2023. Patients served as their own controls during 24-hour pre- and post-chromium periods. The primary outcome was change in total daily insulin dose. Secondary outcomes included proportion of measured glucose values within 140 to 180 mg/dL, acute kidney injury, hypoglycemia, and exploratory Sequential Organ Failure Assessment-2 change.

RESULTS

Among 91 screened patients, 45 met the inclusion criteria. Median total daily insulin dose decreased from 76.3 U/d (interquartile range [IQR], 40.1-96.9) before chromium to 40.0 U/d (IQR, 20.5-65.6) after chromium; the Hodges-Lehmann paired difference was -23.0 U/d (95% CI, -33.25 to -14.25; P < .0001). Proportion of measured glucose values within target did not differ significantly. No post-intervention hypoglycemia was observed, and 2 patients met the study-defined acute kidney injury criterion. Interpretation is limited by the retrospective design and absence of a concurrent control group.

CONCLUSIONS

Chromium picolinate supplementation was associated with lower insulin requirements without worsening glycemic control. These hypothesis-generating findings require confirmation in prospective controlled studies.