Le diabète, facteur de dénutrition et de carences en micronutriments ?

Depending on the case, diabetes is cause and/or consequence of the nutritional deficit. In every case studied in this article, the nutritional deficit increases the risk of micro- and macrovascular complications. Elderly diabetic patients are more often undernourished than the nondiabetic patients and this undernutrition influences the frequency and the prognosis of the foot ulcers who are more often infected, heal more slowly and lead more often to amputations. Vitamin D, zinc, magnesium and chromium are involved in the regulation of insulin secretion and in the insulin signaling pathway so contributing to influence insulin sensitivity. During type 2 or type 1 diabetes, the circulating rates of these micro nutrients are significantly lower than in the absence of diabetes without there is yet a real deficiency. Vitamin B12 deficiency is also more frequent in diabetic population than in no diabetics and its frequency increases in case of treatment by metformin because of an effect of this one on its absorption. Deficiencies in vitamin D, zinc and magnesium increase the cardiovascular risk of diabetic patients because of their effect on oxidative stress and on the endothelial dysfunction. The circulating rates of these various nutrients are significantly lowered in the case of cardiovascular complications during diabetes. International studies are in favour of association between these deficits and the arisen of microvascular complications with specificity according to the type of deficit and the type of complication. Whatever is the considered deficit, in spite of these epidemiological data, the available interventional studies are insufficient and do not show that to supplement specifically these deficits can modify significantly the evolution and the prognostic of the diabetes.