Nutritional Supplements for Diabetes Sold on the Internet

In This Article

Background

Diabetes is one of the most widespread chronic diseases. According to the World Health Organization (WHO), the number of people with diabetes rose from 220 million in 2009 to 346 million in 2011, 90% being diagnosed with diabetes Type 2 (T2D).^[1]

Diabetes, is a disease influenced by lifestyle changes, such as diet, and so target of complementary and alternative medicine, including nutritional supplements (NSs).^[2]

As defined by Food and Drug Administration (FDA),^[3] a NS is a product taken by mouth that contains a "dietary ingredient", which can be vitamin, mineral, herb, amino acid, enzyme or metabolite. NSs are generally offered both to prevent diabetes and support people with this disease.

NS use has gradually increased in both the United States (U.S.)^[4–6] and Europe.^[7] In the U.S. a programme called NHANES (National Health and Nutrition Examination Survey) has been developed to monitor the use of NSs in the population aged 1 year and older. Over the years, the age-adjusted prevalence of use of NS increased from 28% and 38% among adult males and females, respectively, in 1970–1974 to 44% and 53% in 2003–2006.^[6] In addition, a survey carried out in U.S. has shown that 73% of the U.S. adult population used one or more NSs in the year prior the interview and 4% of them reported an adverse event.^[5]

In the U.S. the use of NSs is higher in women, the elderly and people with healthier lifestyles and diets respect to other persons, but also in persons with chronic diseases such as diabetes mellitus.^[8,9] Another study found that the use of alternative medicine was significantly higher among people with diabetes.^[10] The European Community has commissioned the Health and Consumers Department to monitor the NSs market in Europe. Data from a recent report^[7] shows an increase in the use of NSs between 1997 and 2005, but with broad variations from country to country. Market growth in fact ranged from 20% in the United Kingdom (U.K.) to 219% in Poland.^[7]

In recent years, online sales have contributed to the growth in the use of NSs, and currently an estimated 4% of total NS sales were carried out on internet.^[11]

Considering the high prevalence of NS use and their easy access on the internet, the aim of the research was to investigate the type of information provided by websites selling NSs on the prevention and treatment of diabetes. The list of ingredients was also considered in order to analyse the existence of scientific evidence regarding their possible effects on diabetes.

Table 1. Characteristics of nutritional supplements sales websites included in the study
Company	URL*	Website location	Nutritional supplement	Health Professional contact suggested	FDA disclaimer†	Scientific references	Testimonials
Type II Free	https://www.typefreediabetes.com	USA-New York	Glucocin	No	No	No	No
Xtendlife	https://www.xtend-life.com	USA-Georgia	Diabet-Eze	Yes	No‡	Yes	Yes
ADW American Diabetes wholesale	https://www.americandiabeteswholesale.com	USA-Florida	Diachieve Sugar Defense	No	No	Yes	Yes
Green Turtle Bay Vitamin Company	https://www.energywave.com	USA-Winsconsin	Diabetiks	Yes	Yes	No	Yes
Native Remedies	https://www.nativeremedies.com	USA-Texas	Insulate Plus	No	No	Yes	Yes
Heart, Diabetes & Weight Loss	https://www.vagnini.com	USA-Texas	AGE Essential Defence	No	No	No	No
NutriVera Naturals	https://www.nutrivera.com	USA-Minnesota	Alpha Betic	Yes	Yes	No	No
Optimum Diabetics	https://www.optimumdiabetics.com	USA-Texas	Optimum Diabetics	Yes	Yes	No	Yes
Get Healthy Again	https://www.gethealthyagain.com	USA-Florida	Custom Elixir D	No	No	No	No
Nutrient Synergy, Inc.	https://www.nutrientsynergy.com	USA-Florida	Nepretin	Yes	No§	No	Yes

*latest access on 20th April 2012 †FDA disclaimer: "This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease" ‡the statement that the product is not a diabetes medication replacement is contained in the FAQ section. §the statement was not complete.

Table 2. Characteristics of references retrieved on the websites selling nutritional supplements
Nutritional supplement	Ingredient	N° of references	N° of relevant references*	Publication date of relevant references
Glucocin
	Biotin	19	2	1990
	Magnesium	26	2	1998
	Chromium	26	10	from 1987 to 2000
	Momordica c.	3	1	2007
	Gymnema s.	3	–	–
	Camellia s.	27	–	–
Diachieve
Sugar Defense	†	23	3	1997/1999/2000
Insulate Plus
	Chromium	2	1	1990
	Gymnema s.	1	–	–
	Vaccinium m.	2	1	1997

*studies carried out on humans and regarding diabetes, –The studies regarded the entire product and not the single ingredient

Table 3. Dosage recommended for nutritional supplements (NSs) offered by the companies online and dosage tested
Ingredient	N° of websites on which the dosage was specified/websites selling the relative NS	Dosage per day (mg) indicated in the website	Dosage tested (mg)	Reference
Alpha Lypoic Acid	1/6	600	300	Ansar et al., 2011 [14]
			600	de Oliveira, 2011 [15]
			600/1200/1800	Bartlett, 2008 [16]
			600/1200/1800	Lee, 2011 [17]
Gymnema sylvestre	1/6	2700	400	Leach, 2007 [18]
Magnesium	3/5	300 (2 websites)	365	Mooren, 2011[19]
Magnesium	3/5	768 (1 website)	291.6 – 745.2	Bartlett, 2008 [17]
Chromium	2/5	0.3	0.02 – 1	Bartlett, 2008 [16]
		0.66	0.04	Sharma, 2011[20]
			0.5	Kròl, 2011[21]
			0.5 – 1	Ali, 2011[22]
			1	Cefalu, 2010 [23]
Zinc	3/4	15	10	Shidfar et al., 2010 [24]
		54	30	Bartlett, 2008 [16]
		78	50	Hussain, 2006 [25]
Camellia sinensis	2/4	40	150 – 600	Neyestani, 2010 [26]
Camellia sinensis	2/4	1800	375 – 750	MacKenzie, 2007 [27]
Biotin	2/3	0.2	2	Albarracin, 2008 [28]
			2	Geohas, 2007 [29]
			5	Revilla-Monsalve, 2006 [30]
Momordica charantia	1/3	2700	1000	Ooi, 2010 [31]
Momordica charantia	1/3	2700	500–2000	Fuangchan, 2011[32]
Trigonella foenum-graecum	0/3	–	2800	Losso, 2009 [33]
Vaccinium myrtillus	1/3	100	–	–