(299) Chromium Active Replacement in Diabetes in the Intensive Care Unit: CARD-ICU Study

Introduction: Chromium is a critical micronutrient for glucose homeostasis and insulin sensitivity. It enhances insulin sensitivity by activating pathways involved in glucose transporter 4 translocations, increasing glucose transport. Patients with type 2 diabetes mellitus (T2DM) often have low chromium levels due to altered excretion. While outpatient chromium supplementation is studied, its effect on critically ill patients is unknown. This study aims to evaluate the efficacy and safety of chromium picolinate in reducing the total daily dose (TDD) of insulin in critically ill T2DM patients.

Methods: This single-site retrospective quasi-experimental pre-post study was conducted between July 2022 and January 2023 in three ICUs. Patients served as their own control in “pre-chromium” and “post-chromium” phases after four doses of chromium. Included were ICU patients ≥18 years old with T2DM or HbA1c ≥ 6.5%. Exclusions: end-stage renal disease on renal replacement therapy, type 1 diabetes mellitus, anemia, thyroid disorders, liver impairment, active cancer, pregnancy, previous chromium use, or diet changes. Primary outcome: reduction in TDD of insulin. Secondary outcomes: time blood glucose within 140-180 mg/dL, and rate of acute kidney injury (AKI).

An estimated 45 patients were required for 80% power with α = 0.05 for a significant TDD reduction of 15 units (σ = 25 units). Shapiro-Wilk test assessed normality. Outcomes were analyzed with Wilcoxon signed-rank test and multivariate logistic regression for confounders. Descriptive statistics analyzed baseline characteristics. Safety outcomes used Fisher’s Exact test. IBM SPSS 29.0 conducted all analyses.

Results: Ninety-one patients were screened, 45 met inclusion criteria. TDD of insulin significantly lowered post-intervention (Median = 40 units, IQR = 20.5-65.6) compared to pre-intervention (Median = 76.3 units, IQR = 40.1-96.9), with p< 0.001. Blood glucose target time was not significantly different (p=0.297). Two patients (4.4%) experienced AKI.

Conclusions: Chromium supplementation was associated with reduced TDD of insulin in critically ill T2DM patients, suggesting its potential as an effective and safe adjuvant therapy. Further prospective studies are necessary to confirm these findings and to better understand the role of chromium in this population.