What supplementary medicines are required by diabetic patients in their routine prescription?

Supplementary Medicines Required by Diabetic Patients in Their Routine Prescription

There is no clear evidence that dietary supplementation with vitamins, minerals, herbs, or spices is required for diabetic patients who do not have underlying deficiencies, and such supplements are not generally recommended for glycemic control. 1

Vitamin B12 Supplementation

• Metformin, a common first-line medication for diabetes, is associated with vitamin B12 deficiency, suggesting that periodic testing of vitamin B12 levels should be considered in patients taking metformin, particularly in those with anemia or peripheral neuropathy 1
• Routine supplementation with vitamin B12 may be necessary for diabetic patients on long-term metformin therapy to prevent deficiency-related complications 1

Micronutrients and Supplements

• There is no clear evidence of benefit from herbal or nonherbal (vitamin or mineral) supplementation for people with diabetes without underlying deficiencies 1
• Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised due to lack of evidence of efficacy and concern related to long-term safety 1
• Specifically, b-carotene supplementation should be avoided as there is evidence of harm for certain individuals and it confers no benefit 1
• There is insufficient evidence to support the routine use of herbal supplements and micronutrients, such as cinnamon, curcumin, vitamin D, aloe vera, or chromium, to improve glycemia in people with diabetes 1

Special Population Considerations

• For special populations, including pregnant or lactating women, older adults, vegetarians, and people following very low-calorie or low-carbohydrate diets, a multivitamin may be necessary 1
• These recommendations should be based on individual nutritional needs rather than diabetes status alone 1

Cardiovascular Risk Reduction

• Aspirin therapy (75-162 mg/day) is recommended as a primary prevention strategy in those with type 1 or type 2 diabetes at increased cardiovascular risk (10-year risk >10%), which includes most men >50 years of age or women >60 years of age who have at least one additional major risk factor 1
• Aspirin should not be recommended for CVD prevention for adults with diabetes at low CVD risk (10-year CVD risk <5%) 1
• Eating foods rich in long-chain n-3 fatty acids, such as fatty fish (EPA and DHA) and nuts and seeds (ALA), is recommended to prevent or treat cardiovascular disease; however, evidence does not support a beneficial role for the routine use of n-3 dietary supplements 1

Medication Interactions and Precautions

• Diabetic patients should be cautious about potential drug interactions with their antidiabetic medications 2, 3
• Alcohol consumption may place people with diabetes at increased risk for hypoglycemia, especially if taking insulin or insulin secretagogues, and should be limited to moderate intake (no more than one drink per day for women and two drinks per day for men) 1
• Patients receiving insulin secretagogues or insulin may require lower doses when taking metformin to reduce the risk of hypoglycemia 2

Common Pitfalls and Caveats

• Avoid recommending supplements as a replacement for proper dietary management and medication adherence 1
• Be aware that certain medications can affect glycemic control, including thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blockers, and isoniazid 2
• Recognize that diabetic patients may be taking multiple medications that can interact with each other, requiring careful monitoring and adjustment 3
• Understand that while certain supplements may be marketed for "diabetes management," there is insufficient scientific evidence to support their routine use 1

In conclusion, while specific vitamin B12 supplementation may be needed for patients on metformin, and aspirin may be indicated for cardiovascular risk reduction in certain diabetic patients, there is no strong evidence supporting the routine use of other supplements for diabetic patients without documented deficiencies.