Evaluation of Chromium Picolinate for Blood Glucose Control in Critically Ill PatientsChristopher Stone, Richard Lane, Jared Briones AdventHealth ApopkaBackground: Glycemic control is a cornerstone in the management of critically ill patients in the intensive care unit (ICU), as both hyper- and hypo-glycemia are associated with increased morbidity and mortality. Dysglycemia in critical illness is multifactorial, resulting from stress‑mediated neuroendocrine activation, inflammatory cytokine release, multiorgan dysfunction, and rapidly changing nutrition requirements. In recognition of adverse outcomes associated with dysglycemia, current ADA guidelines recommend targeting blood glucose levels between 140-180 mg/dL in critical illness. Chromium is a trace mineral involved in macronutrient metabolism, with studies in the outpatient setting indicating potential benefits for insulin sensitivity and glycemic control. Despite these findings, evidence supporting chromium supplementation in critically ill populations remains absent. This study aims to evaluate the effects of chromium picolinate on blood glucose management of critically ill subjects.
Methods: This was a retrospective chart review conducted within the AdventHealth Central Florida Division hospital system. Subjects were included if they were admitted from January 1st, 2022, to December 31st, 2025, age greater than 18 years, admitted to the ICU, diagnosed with type 2 diabetes mellitus or had an A1c of 6.5% or greater, and received continuous infusion insulin. Subjects were excluded if they were diagnosed with type 1 diabetes mellitus, received renal replacement therapy, or had documented chromium use prior to admission. The primary outcome was improved glycemic control, defined as a reduction in total daily insulin requirements of at least 15 units. Secondary outcomes included 30-day all-cause mortality, time to target glucose range (<180 mg/dL), hospital length of stay, ICU length of stay, and rate of adverse drug events.
Results: A total of 90 subjects were included, 45 in each group. Improved glycemic control occurred in 31% (14/45) of the chromium group compared to 13% (6/45) in the control (p-value=0.043). Analyzing the secondary outcomes, hours to target blood glucose range (<180 mg/dL) was 14 and 4 (p-value= 0.035) for the chromium and non-chromium groups respectively. There were no differences between additional outcomes including 30-day mortality, 30-day all cause readmission, hospital length of stay, ICU length of stay, and adverse drug events. Chromium was associated with decreased insulin utilization of 17.8 units compared to an increase of 22.4 units in the non-chromium group by day 3 of treatment (p-value< 0.001).
Conclusion: In critically ill patients with hyperglycemia, chromium picolinate supplementation was associated with a significant reduction in insulin utilization. No differences in adverse event rate were observed between the intervention and control group. These results indicate that chromium supplementation in critically ill patients may improve glycemic control. Limitations include the retrospective study design, lack of chromium level evaluation and the ability to identify an appropriate comparator. Further prospective studies are recommended to further explore the potential benefits of chromium on glycemic control in the critically ill.
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