Nutritional Supplements for Diabetes Sold on the Internet

Business or Health Promotion?

Loredana Covolo; Michela Capelli; Elisabetta Ceretti; Donatella Feretti; Luigi Caimi; Umberto Gelatti


BMC Public Health. 2013;13(777) 

In This Article


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.