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ABSTRACT

BackgrOlmd: Diabetes mellitus is the fourth leading cause of death in Taiwan (2002). We had focused on the needs of people with type 2 diabetes- the rapidly increasing prevalence of which should be a major concern for health- care providers. Traditional Chinese medicine, used in Taiwan for centuries, was used for many diseases, including type 2 diabetes mellitus. Because the morbidity and mortality remained terrible in the modem treating model, the benefits of Chinese formulas in preventing and delaying the development and progression of diabetic complications had been well expected. We used three Chinese medicine formulas (DMl, DM2 and DM3) to the type 2 diabetic outpatients in this study.

Objective: The purpose of this study was to investigate the effects and side effects of Chinese medicine formulas on type 2 diabetic outpatients with laboratory 'examinations.

Methods: All of the diabetic patients took a formula of Chinese medicine, concentrated powder 20 g/day, divided by four times for 16 weeks in this study.

DM1 was used for dryness and heat of lung and stomach, marked by extreme thirst and excessive drinking, dry mouth and tongue, red tongue with yellow- dry coating and rapid- strong pulse.

DM2 was used for deficiency of kidney- yin, marked by polyuria, extreme thirst and excessive drinking, dizziness, waist- soreness, soreness and numbness of extremities, blurred vision, red tongue with little coating, deep and thready pulse.

· DM3 was used for deficiency of qi and yin, marked by polyuria, extreme thirst and excessive drinking, fatigue, red tongue with little and white coating, deep and thin pulse.

Results: 31 type 2 diabetic outpatients 16-76 years old participated in the study. The mean age of the patients was S2.7±11.2 (17-76) years. The mean BMI was 24.2±3.6 (Kg/m2). The mean duration of diabetes was 6.4±6.1 years.

Before treatment, the mean glycosylated Ale (HbA le normal 4.4-6.4%) of group DM1 was 9.22±2.80% (week 0). After treatment 16 weeks, the mean HbA le was 7.43±1.88%. There was a significant decreasing trend in HbA le after treatment 16 weeks (p< O.OS). Before treatment, the mean HbA le of all patients was 8.73±2.63% (week 0). After treatment 12 and 16 weeks, the mean HbAle was 7.31±1.61% and 7.2S±1.63% respectively. There were significant decreasing trends in HbA le After treatment 12 and 16 weeks (p< O.OS).

Before treatment, the mean fasting plasma glucose (FPG normal 70-110 mg/dl) of group DM2 was 18S.2±91.9 mg/dl (week 0). After treatment 14 and 16 weeks, the mean was 13 O. 6±10.1 mg/ dl and 122.3± 13.0 mg/ dl respectively. There, were significant decreasing trends in FPG after treatment 14 and 16 weeks (p< O.OS). Before treatment, the

mean fasting plasma glucose of all patients was 193.3±86.1 mg/dl (week 0). After treatment 10, 12, 14 and 16 weeks, the mean was lS9.1±S0.4

mg/dl, lS8.1±S1.3 mg/dl, 14S.3±34.1 mg/dl, 14S,3±49.0 mg/dl

respectively. There were significant decreasing trends in FPG after treatment 10 weeks (p< O.OS).

The plasma LDL and VLDL were in the normal range in the 16 weeks period. Before treatment, the mean cholesterol (normal 140- 200 mg/dl) of group DM2 was 207.4±61.7 mgldl (week 0). After treatment 16 weeks, the mean was 164.5±23.9 mg/dl. There was a significant decreasing trend in cholesterol after treatment 16 weeks (p< 0.05).

Before treatment, the mean triglyceride (normal 50-150 mgldl) of group DM2 was 216.7±201.4 mg/dl (week 0). After treatment 12 and 16 weeks, the mean was 99.0±53.5 mgldl and 53.0±6.2 mg/dl respectively. There were significant decreasing trends in TG after treatment 12 and 16 weeks (p< 0.05).

The renal function tests and the liver function tests of all patients were not elevated in the 16-week treating period.

Conclusion: There were several beneficial effects of traditional Chinese medicine observed. There was better decreased in HbA_1c in the group DMl. There were better decreased in FPG, cholesterol and TO in the group DM2. There were no elevated liver function tests and renal function tests in the 16- week treating period. We will design a randomized, placebo- controlled study and collected more patients in the future to detennine the effects and side effects of Chinese medicine.

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r

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k}j§" ~~;f~~(Cholesterol, Triglyceride' HDL ' LDL ' VLDL) , "*-~

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t, • •

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--a ,#'I:±. 0 J

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7i

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(Cholesterol),

-=

g§ti:hili

~l:l( TG)' HDL, LDL 'VLDL'

J3t:x:j]

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t(GOT' GPT,

r

GT)' Jf}jt:x:j]~EA~~( BUN, Creatinine)'

bf<Jit

Jf<-

iffi..

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(Urine Routine

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ffl

tf

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(Gearent Strips for Urinalysis);f~~ ,

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ffJ

CLINITEK 50 '

t~,~ HbA1C

80 ;f~ftt:.1Jfr : Wf 3 {; ft-~ k

.:?tA K3E (BD vacutainer)

!-:.( Tosoh HPLC 7f i(~,~jt ,'Normal range: 4.4--6.4 % 0

~~tJfu.*,t(FPG) ,

f&i!

2

+

8~k:f~( PPG) , GOT, GPT ,BUN Creatinine' Uric acid ( UA) 'Cholesterol 'TG 'HDL, LDL, VLDL

FPG ' colorimetric test. Normal Range: 70--110mg/dl 0

PPG ' colorimetric test. Normal Range: < 120 mg/dl 0

GOT, multiple'- point rate test. Normal Range: 5--40 UIL 0

GPT ' multiple- point rate test. Normal Range: 10--50 UIL 0

r

GT ' multiple- point rate test. Normal Range: 6--70 mg/dl 0

BUN ' colorimetric test. Normal Range: 6--22 mg/dl 0

Creatinine' single- slide two- point rate test. Normal Range: 0.5--1.4 mgldl 0

Uric Acid' colorimetric test. Normal Range: 2.5--7.5 mg/dl 0

Cholesterol, colorimetric test. Normal Range: 140--200 mg/dl 0

TG ' colorimetric test. Nonnal Range: 50--150 mg/dl 0

HDL ' colorimetric test. Normal Range: 36--90 mg/dl 0

LDL ' colorimetric test. Nonnal Range: 100--500 mg/dl 0

VLDL ' colorimetric test. Normal,Range: 0--180 mg/dl 0

BMI Normal Range:.!f 20.9 ± 3.0; ~ 23.4 ±3.4 0

ltJ3ij.$

Normal Range:.!f 24.1 ± 6.1 ; ~ 19.6 ± 6.1 0

Mi#*

tf

m-a-:k

20

Jt '

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If '

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Jt

it

4 ' -'f-.t~ J,ij ;fJI 1.tr 6.4 ± 6. 1

1t-

0

DM1 itftJL,t,* '~~~~~~1G.nu..e.-t (HbA_{IC )} fAit1.tr 9.22±2.80

% ,~~§ 4, 8, 12 &. 16 .£JtA it ' i/',t1G.nu.. e. -t fA 1i. ft-

)]IJ

1.tr 8.56±2.33

%

'

7.94±2.53

%

'7.25±1.70

%

&. 7.43±1.88

%

'-i±.

~~~ 16 .£JtJHt1f it

flUft;H

Ls0;t

l

(p

<

0.05) 0

DM2 itftJL ,t,* ' i~ ~ ~ ~~1G.nu.. e. -t (HbA_IC ) fA 1i.1.tr 8.36 ±2.44

%

'-i±.i~~

4 ' 8 ' 12 &. 16 .£JtJHt ' ft-

)]IJ

1.tr 8.88±2.02

%

'7.36±2.11

% '6.94±1.54

%

&. 7.17±0.32

%

'1fTFffA;t!"*, 18 ~*itfljjit-tt

1:. fA

;t

A

(p>0.05) 0

DM3 i1i1L~*' i~~Jitr~~1G.nu..e.-t (HbA_IC ) fA1i.1.tr 7.95±3.75 % 'i~§it 4, 8, 12 &. 16l1.JtAitft-)]'J1.tr 5.8 % (;;1f-~JLti;J;t),

7.95±3.18

%

'7.35±2.33

%

&. 6.55±2.19

%,

;JfTFffA~~ ,

1

8 ~*

l!f'j fit -tt

L

fA

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~ (p>0.05) 0

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fA1A1.tr 8.73±2.63

%

'i~§4'8'12 &. 16l1.JtAit'~~1G.nu..e.T(HbAlc)

ag1t7t)JIJ~ 8.55±2.20 % '7.76±2.33 % '7.31±1.61 % &. 7.25±1.63

% '~~ffi-qt 12 jjf~~ 16

.£JIA:1fltfIHJt,tt LE9;ta

(p<0.05)'

Jt-*z

5 0

DMI i~JJi,t,*

'

-it.~~~~;J ~~tk*J!E9it1A~ 198.7±76.5 mg/dl '

1±.~~ffi- 2,4, 6, 8, 10, 12, 14 &. 16 ~Zqt

'

~ak*J!E9W.7t)JIJ~

182.7±70.6 mgldl' 173.1±62.8 mg/dl' 170.2±57.8 mg/dl' 179.3±60.7 mg/dl' 172.3±58.2 mg/dl' 177.3±60.0 mg/dl' 159.3±39.4 mgldl &. 156.9 ±59.6mg/dl' :1fTrrtE9~~' 18~~ltfIHJt,tt

LE9:t:l

(p>0.05) 0

DM2 .i1~Jl.,t,*

'

-it.;i1~~;J ~~tk*J!E91A~ 185.2±91.9 mg/dl '

-it.

~~ ~ 2 ' 4 ' 6 ' 8 ' 10 ' 12 ' 14 &. 16 i1!Z

qt '

~~

k

*J!

EI-J

w.

7t )Jlj

~

172.2±80.7 mg/dl' 171.3±37.7 mg/dl' 171.9±43.l mg/dl' 162.6±61.6 mgldl' 155.7±43.3 mg/dl ' 139.6±21.5 mgldl ' 130.6±10.l mg/dl &. 122.3 ±13.0 mg/dl '

-it.

;i1~qt 14 ~&.16 ~~

ltflj

jJt,tt

L

E9

1:

a

(p < 0.05) 0

DM3

ltfJl.,t,* '

-it.;~~~;j ~~k*J!~w.~ 210±169.7 mg/dl '

-it.

~~~ 2,4" 6,8, 10, 12, 14 &. 16 ~qt

'

~~k*J!E~W.

7t )Jlj

~ 97 mg/dl

(R:1f-fJl.tttt),

164.5±96.7 mgldl' 129.5±23.3 mg/dl' 150.5±71.4

mg/dl' 117 mg/dl(

R:1f-fJltttt),

117.5±20.5 mg/dl' 118.5±19.1 mg/dl

& 139.5±34.6 mg/dl '

:1f T

~EI-J ~~ ,

18

~ ~i!

flj

jJt,

tt

L

E9

~ ~

M~ DM1 'DM2 &.. DM3

-=-#Ji%tt,

~'h~~~~ ~Jltk..*~ss1Ki?; 193.3

±86.1 mg/dl ' )~~qt 2 ' 4 ' 6 ' 8 ' 10 ' 12 ' 14 &.. 16 ~ , ~JJtk..*J!sS

11)}JiIJ i?; 174.5±74.7 mg/dl ' 171.7±55.1 mg/dl ' 166±50.9 mg/dl ' 170.6 ±59.5 mg/dl ' 159.1±50.4 mg/dl ' 158.1±51.3 mg/dl' 145.3±34.1 mg/dl

.&. 145.3±49.0 mg/dl ' 4~~~it 10 ~.:t.it~itfIHJt.tt

J:..SS:t-l

(p< 0.05)'

Jt*

60

DM1 i!#Ji/~,*

'

m.qt-=-/J'8:tk..*~ss1K4)~~#ri?; 304.4±132.2 mg/dl' 4)~~ 4, 8 &.. 12

il!it, )}

JiIJ i?; 258.4±128.9 mg/dl' 313.8±117.4 mg/dl &.. 254 mg/dl (R ~ -

mitAt) ,

~

T

~

SS

~ ~

, 1

9

>1.13

it f'HJt.

tt

J:..

SS:t

~ (p>0.05) 0

DM2 i!#Ji/~*

'

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'

)}Jilj i?; 186.5±66.1 mg/dl ' 178.7±63.4 mg/dl &.. 167 mg/dl

(R:t-#Jiti·tt) ,

:tTftss~~

, 1

9

*itfo.Jt.tt J:..

as:t~ (p>0.05) 0

DM3

i!#Ji

I~'*'

m.it..::../j, 8:tk..*~sstt1A1±.>~~

m

i?; 437 mg/dl( R

1f -

#Ji ti;}t) ,

~11 ~ 8 &.. 12 ~

qt ' )}

Jilj i?; 312 mg/ efl &.. 176 mg/ dl '

Jit

1fT~SS~~'~ffi.k~'#~~~~~o

DM1 'DM2 &.. DM3 ==

#Ji%tt

'm.qt"::"/J'8:tSSk..*~tt1K1±)11if.M i.!, 277.1±124.2 mg/dl' ~11~ 4'8'&' 12 ~1t' 5J--JiIJi?; 234.4±114.1 mg/dl'

269.2±109.2 mg/dl &. 199±47.8 mg/dl' -tE~ii1,f-1£ 12 ~1tf'J

ft.fttt

J:..a0:t

~ (p<0.05) ,

Jt*

7 0

DM1 'DM2 &. DM3 ::: fiLa0 LDL &. VLDL )ii1,f-%J&. 16il!a0)ii

1§.-:rtFj M ' piT;ff t~jt ~t,

-tE

if-

't

1M.

z

p\J 0

DM1 i!~iL,~*

'

-tE)ii1,f-~:J ~g ~ ~f (cholesterol) ttm~ 235.5±44.3 mg/dl'

-tE

)ii~ 4, 8, 12 &. 16 i!!1£ a0 ~g ~ r!if'ii 7} J)IJ ~ 215.2±34.8 mg/dl'

221.0±45.5 mg/dl " 224.9±34.0 mg/dl &. 222.0±46.6 mg/dl ' ;ff T Ff-a0~

~ , 18

*1tf'Hft

tt

_{J:.. Ei0 :t} ~ 0

DM2 i!j..Ei,~*

'

~§.~ ffiftt1K)ii~~~ ~ 207.4±61.7 mg/dl ' -tE~ii~

4, 8" 12&.16il!1£, 7}JJ'J~ 195.9±69.6 mg/dl' 198.2±42.8 mg/dl"

204.2±54.4 mg/dl &. 164.5±23.9 mg/dl ' -tE)ii~ 16 il!1£ ' ~g ~ ~ttm fi-JT f~ , ;ff

1tf'Hfttt

J:..S0:t ~ ,

Jt-tt

9 0

DM3 1!fiL,~,* ' )ii~ ~~ Ag ~ PJilttm~ 217.5±24.7 mg/dl ' ~ii1,f- 4 "

8, 12 &. 16 ~1£ ' 7}JJ'J~ 208.0±32.5mg/dl" 198.0±58.0mg/dl' 210.5 ±36.1 mg/dl &. 178.5±43.1mg/dl ' ;ff T f~a0 ~

*

'

18

*1tf'Hfttt

J:.. a0

DMI "DM2 &. DM3 -=-fiL%tt ' )ii~m~g~r!ifEi01i~ 221.6± 52.7mg/dl '

-tE

)ii1ff 4 " 8 " 12 &. 16 ~1£ ' 7}J)'J ~ 207.3±49.5 mg/dl ' 210.1±44.6 mg/dl ' 216.6±39.9mg/dl &. 202.2±47.5 mg/dl ' ;ffTFf-S0:it!

#,~*~~~~~~tA'~*9 o

DM1 ~~,~* ' 1±. ~f;~JiJj M w

ttPJt*

'*"

~AE!. ~ ffif (cholesterol)

it1A~ I~'* ' ~f;~m ~ 244.2±40.9 mg/dl ' 1±.~f;~ 4 ' 8 ' 12.&. 16

iJ!

it '

5t

J}lj ~ 220.3±30.7mg/dl ' 226.5±43.4 mg/dl ' 224.9±34.0 mg!dl .&. 222.0±46. 6 mg!dl ' :1f T ~ ~ ~# ' 18 _{* i tfll} ~_{ttJ:.. €I-J :t A}

0

DM2 ~ #lL~* ' 1±. ~f; ~JiJj M

W

tl:l JJt~

'*"

ff.J ~E!.l!l fJi¥-tt

1A

€I-J I~' ~ , ~t11,f.

m

~ 259.3±57.9 mg/dl '

1£

~&1! 4 ' 8 ' 12 .&. 16 ~it '

5t

lJlJ ~ 237 ±49.2 mg/dl ' 238.8±41.5 mg/dl ' 236.0±46.0 mg/dl.&. 183±18.4 mg/dl '

~k1!16~~'mOOQ.~€l-JT~':1f~~~~~€I-J:tA o

D~~~~*'1±.k~~Mwtl:lm*#ff.Jg~Q.~€I-J~~'

~t1~%rAE!.~ffiftt~~235 mg/dl ' ~f;~ 4, 8, 12.&. 16 ~it ' -J}lJll~ 231 mg/dl' 239 mg/dl ' 236 mg/dl.&. 209 mg/dl ' JIJ~#-1Y~3!if* 0

DM1 ' DM2.&. DM3 -=-"f.li%tt ' ~f;~ ~;dB ~ ~€I-J~~ 248.3±44.7 mg/dl ' 1±.~f;~ 4 ' 8 ' 12.&. 16 ~1t ' )1-lJIJ ~ 225.6±35.2 mg/dl ' 226.4

±40.3 mg/dl ' 228.3±33.9 mg/dl.&. 215±43.2 mg/dl ' 1±.~f;~1t 4 ~.&. 16 ~ , AE!. @ ~.1A€I-J T f~ , :1f itfl]i:JtttJ:.. €I-J

;t

A '

~* 10 0

DM1 ~f.JL~,* ' 1±. if; ~ ~;J

-=--

fJit

i:hIh

fJi~

(TO)

It

1A

~ 164.l ± 1 00.1

mg/dl ' 1±. if; ~ 4 ' 8 ' 12 .&. 16

iJ!

it ' )j-lJlJ ~ 146.4±83.9 mg/dl ' 141.6

±61.2 mg/dl ' 139.8±55.1 mg/dl.&. 142.8±53.3 mg/dl ' 1fT ~€I-J~~ ,

1§.

*-

it~IJ ,~ft tt J:. E!-J ;t" 0 DM2 i!JJi,~~ ,:= i!itthrei!i~ (TG) tttt~t7-~M~ 216.7±201.4 mg/dl ' -if~t7-~ 4, 8, 12 a 16 ~1t

'

)}53IJ~ 205.1±232.2 mg/dl' 149.1 ±162.4 mg/dl ' 99.0±53.5 mg/dl a 53.0±6.2 mg/dl ' -if ~t7-~ 12 ~a 16 ~.'~.*~R(TG).~~T~'~it~~#J:.~;tA o DM3 1!~Ji,~~ , ~t7-~m:= i!it*~rerB§ (TG) tt1t~ 271.0±25.5 mg/dl ' ~t7-1f 4, 8, 12 a 16 i~Ht

' )}

53 I

J

~ 339.0 mg/dl(R ~- fo,Jiit~t) , 227.0±90.5 mg/dl ' 223.5±85.6 mg/dl a 237.5±94.0 mg/dl ' ~T ~E!-J ~ 8 ~

, 1

~it~'HftttJ:. ~~;t A 0

DMI 'DM2 a DM3 ~ft,Ji%tt, ~~thre~~(TG) ~t7-~~~ ~~tt~ 195.4 ± 154.7 mg/ dl ' -if ~t7-1! 4 ' 8 ' 12 a 16

:il!

1t ' )}

53 IJ~ 1 77.7 ± 159.7 mg/ dl ' 152.0±111.3 mg/dl ' 135.5±65.4 mg/dl a 137.1±75.1 mg/dl ' -if ~t7-1! 12 ~aI6~.'~~*~D (TG)~T~'~it~~#J:.~~A'~

*

11 0 DMl1!~'-if~~MMtilim~.*~~(TG) .#~~*,

ft.

TG

4~t7-~ ~~ E!-Jtt~ 233.1±87.7 mg/dl '

4it7-~

.

4 ' 8 ' 12 a 16

~

1t '

)i-53IJ~ 191.6±91.8 mg/dl ' 193.3±34.7 mg/dl' 186±23.8 mg/dl a 179±37.5 mg/dl ' ~T~~~~ , 18 i¥J*-it~'l#fttt J:.a~;tA ₀

mg/dl ' 1±~f:;1! 4, 8

a

12

il!Lit '

1t-)]IJ J.$.; 362.3±289.7 mg/dl' 263±268.8 mg/dl

a

128.7±62.2 mg/dl' 1±~f:;lj 12 ~it 'TG T[If-itf'l,~ft.tt

J:..f!Jit

1±

~f:;lf- 4, 8 ' 12

a

16 ~

it '

1t-)]IJ J.$.; 399 mg/dl ' 227±90.5 mg/dl ' 223.5 ±85.6 mg/dl

a

237.5±94.0 mg/d.l ' 1fT[If-EI)~-;}

, 1

8

.i.itf'Hft.tt

J:..EI)

a~mJ.$.; 275.8±166.1 mg/d.l ' ~f:;~it 4 ' 8 ' 12

a

16 ~ , 1t-)]IJJ.$.; 260.8± 186.7 mg/dl' 218.5±129.8 mg/d.l' 176.3±57.7 mg/dl

a

195.7±56.8

*-

12 0

4, 8, 12

a

16 ~itEl)1K1t-}j'JJ.$.; 48.0±12.6 mg/dl' 48.1±13.8 mg/dl'_{. ,} 44.8±7.0 mg/dl

a

50.6±17.5 mg/dl '

.i.itf'Uft.tt

J::.EI);t~ 0

8, 12

a

16 ~it

'

)}}jIJJ.$.; 53.6fI6.7 mg/d1' 50.9±19.1 mg/dI' 45.6±5.0 mg/<Jl

a

48.5±4.1 mg/dl '

.i.itf'Hft.tt J::.

sg;t

~ 0

8 ' 12 &. 16

.11!

qi.

' 1J-)7IJ ib 41 ±2. 8 mg/dl ' 88.5 ± 7 0.0 mg/ dl ' 41.5 ±6.4

mg!dl

a

37.5±2.1 mg/dl ' .i-:!tfIUJtttJ:.Er~;t~ 0

DMI ' DM2 &. DM3 -=-~Ji%tt ' ~~~%r HDL E01Aib 48.4±1l.6

mgldl ' 4~~1! 4 ' 8 ' 12 &. 16 .11!qi. ' 1J-)7IJ ib 49.5±13.9 mg/dl' 52.7±

24.1 mg/dl ' 44.6±6.1 mg/dl &. 48.4±14.4 mg/dl ' .i-:!tf1J ftJttt J:. a0 ;t ~ ,

Ji;ft 13 0

DMl11m,~1t' BUN 4~~~~;J it1tib 15.8±5.8 mg/dl' 4~~~ 4, 8, 12 .&. 16 .11!

qi.

' 1J- )7IJ ib 13.3±4.2 mg/dl' 13. 7±3.3 mg/dl' 15.1 ±4.5 mg/dl

a

15.4±4.3 mg/dl ' .i-:!tfIJJJttt J:. a0 ;t

a

0

DM211~lL~1t ' BUN tt1A~~~mib 19.4±6.5 mg/dl ' 4~~~ 4 '

8, 12 &. 16

.11!

qt, 1J-)7IJ ib 18.0±5.1 mg/dl' 18.3±4.4 mg/dl' 20.6±5.0 mg/dl

a

20.3±5.3 mg/dl ' .i-:!tfIHJttt J:. a0;t ~ 0

DM311#JL~1t, BUN ~~~~;Jtt1Aib 12.3 mg/dl(;;~-.~JLtkAt),

~~~ 4, 8, 12 .&. 16 i~Ai. a0it1A1J-~IJ ib 12.1±2.5 mg/dl' 13.5±5.5 mg/dl'

13.8±3.7 mg!dl .&. 13.5±2.9 mg/dl ' .i-:!tfIJ .~Jttt J:.E8;t ~ 0

DMI ,DM2 .&. DM3 -=-#JL%tt ' BUN ~~~#rE01t~ 17.4±6.3

mg/dl ' ;{£~~1Ji: 4 ' 8 ' 12 .&. 16 .11!ii. ' 1J-)7IJ ib 14.9±4.9 mg/dl ' 15.5±4.4

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4. Amos AF, Mc Carty, Zimmetp Pl. The rising global burden of diabetes and its complications. Estimates and projections to the year 2010, Diabet Med, 7: 85,1997.

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10.1tj1irJt1~t±:i-' *j-frk#iF;1~il+-fflt, ~)ffLteJi&/2'-~' pp. 217- 222 ' 1998 0

11. Anderson RA. Nutritional factors influencing the glucose/ insulin system: chromium. J Am Colle Nutri, 16: 404- 410, 1997.

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