Zinc, Chromium, Vitamin C, and Copper Combination Supplement for Prediabetes Progression

Study Overview
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Brief Summary
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Currently, the incidence of diabetes mellitus is increasing worldwide. People with prediabetes have higher risk to develop diabetes mellitus type 2. Several studies have proven that Zinc and Chromium are minerals that contribute to decreasing the level of blood glucose and insulin resistance. In addition, vitamin C also contributes in decreasing Fasting Blood Glucose (FBG) and Hemoglobin A1c (HbA1c). However, the eficacy of a combined zinc, chromium, vitamin C, and copper (ZCC) in decreasing blood glucose in prediabetic people has never been performed. The primary objective of this study is to investigate the effect of a combination of ZCC supplementation with standard healthy lifestyle counseling in improving glucose profile [Fasting Blood Glucose (FBG), 2-hour Oral Glucose Tolerance Test (OGTT), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)] from prediabetes to normal or reducing the risk of progression from prediabetes to Type 2-Diabetes Mellitus (T2DM) compared to placebo with standard healthy lifestyle intervention.

Detailed Description
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Diabetes is an important public health problem as the number of people with diabetes are increasing across the world and contributes to high mortality burden. Prediabetes is an intermediate stage between normal glucose tolerance and type 2 diabetes mellitus. Furthermore, people with prediabetes have higher risk to develop diabetes mellitus type 2. There are several objectives in this study, such as primary objective, secondary objectives, and exploratory objectives. Primary Objective: To investigate the effect of a combination of Zinc, Chromium, Vitamin C, and Copper supplementation (ZCC supplementation) with standard healthy lifestyle intervention in improving glucose profile [Fasting Blood Glucose (FBG), 2-hour Oral Glucose Tolerance Test (OGTT), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR)]) from prediabetes to normal (reducing the proportion of prediabetes and increasing the proportion to become normal) or reducing the risk of progression from prediabetes to Type 2-Diabetes Mellitus (T2DM) compared to placebo with standard healthy lifestyle intervention. Secondary Objectives: To investigate the level of Zinc and Chromium among the prediabetes, the safety of the ZCC supplementation, and the effect of a combination of Zinc, Chromium, Vitamin C, and Copper supplementation (ZCC supplementation) among prediabetic adults compared to the placebo supplementation on: Lipid profile [Low-Density Lipoprotein (LDL), High-Density Lipoprotein (HDL), Triglyceride]; Hemoglobin A1c (HbA1c); Dietary intake and physical activity Body weight and composition (body weight, Body Mass Index (BMI), body fat). Exploratory Objectives: To determine cost effectiveness of intervention on prediabetic adults comparing two different intervention models To determine the quality of life of prediabetes adults receiving a combination of zinc, chromium, vitamin C, and copper supplementation. Level of hs-crp; TNF-alpha and Vitamin C will be assessed later if needed (optional) Study Design: This study is a double-blind, randomized, placebo-controlled trial in the community setting, with two arms of intervention involving a total of 670 people. Study Duration: This study is a two-year study with 1 year of intervention for each subject.

Official Title
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A Combination of Zinc, Chromium, Vitamin C, and Copper Supplement for Prediabetes Progression: Randomized Controlled-Trial in Jakarta

Conditions
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PreDiabetes, Nutrition

Intervention / Treatment
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* Dietary Supplement: Zinc, Chromium, Vitamin C, and Copper Supplementation
* Behavioral: Standard healthy lifestyle intervention
* Other: Placebo


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adults aged between 35-65 years old; Being prediabetes as assessed by having fasting plasma glucose (FPG) level in the range of 100 mg/dL to 125 mg/dL; having 2-h values in the oral glucose tolerance (OGTT) level in the range of 140 mg/dL to 199 mg/dL; The study subjects will be recruited from household communities connected to any health care facilities such as primary health center, private clinics or private GP/specialist on the national health care system; The subjects are willing to sign informed consent; The subjects are willing to stay commitment during the study, at least 1 year; Having app-android mobile Exclusion Criteria: Pregnancy or lactation women; Transgender on hormonal injection; Bariatric surgery; Consuming other pills supplementation containing zinc and/or chromium, copper, vitamin C in regular basis; History of Inflammatory Bowel Disease (IBD), psychiatric disorders, chronic diseases (e.g., HIV, Cushing syndrome, CKD, acromegaly, hyperthyroidism, etc.); Not healthy (current status of the severely malnourished, acute problem of any severe disease, history of impaired hepatic, renal failure, heart failure, cancer, other catastrophic diseases. Currently using weight loss medication; Consuming pharmacology agents that might interfere the intervention (such as metformin, methylprednisolone, methyltestosterone, diuretics, complementary medicines); Subjects who are unable to read and understand the statements of consent form

Ages Eligible for Study
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Minimum Age: 35 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: There will be two arms of intervention: Arm 1: A combination of Zinc, Chromium, Vitamin C, and Copper (ZCC supplement) with standard healthy lifestyle intervention. Arm 2: A combination of placebo with standard healthy lifestyle intervention.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental Group<br>A combination of Zinc, Chromium, Vitamin C, and Copper (ZCC supplement) with standard healthy lifestyle intervention | Dietary Supplement: Zinc, Chromium, Vitamin C, and Copper Supplementation<br>* Combination of mineral and vitamin supplementation that consist of Zinc, Chromium, Vitamin C, and Copper<br>Behavioral: Standard healthy lifestyle intervention<br>* Standard healthy lifestyle intervention will follow the Guidelines on the Management and Prevention of Prediabetes by the Indonesian Ministry of Healthy and the Indonesian Diabetes Association.<br>|
| Placebo Comparator: Control group<br>Placebo with standard healthy lifestyle intervention | Behavioral: Standard healthy lifestyle intervention<br>* Standard healthy lifestyle intervention will follow the Guidelines on the Management and Prevention of Prediabetes by the Indonesian Ministry of Healthy and the Indonesian Diabetes Association.<br>Other: Placebo<br>* Placebo with inactive ingredients<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change of Fasting Blood Glucose (FBG) | To investigate the effect of ZCC supplementation with standard healthy lifestyle intervention in improving Fasting Blood Glucose compared to placebo with standard healthy lifestyle intervention | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change of Hemoglobin A1c (HbA1c) | To investigate the effect of ZCC supplementation with standard healthy lifestyle intervention in improving HbA1c compared to placebo with standard healthy lifestyle intervention | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change of 2 hour Oral Glucose Tolerance Test (2-hour OGTT) | To investigate the effect of ZCC supplementation with standard healthy lifestyle intervention in improving 2 hour OGTT compared to placebo with standard healthy lifestyle intervention | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) | To investigate the effect of ZCC supplementation with standard healthy lifestyle intervention in improving HOMA-IR compared to placebo with standard healthy lifestyle intervention | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Delay Onset of Type 2 Diabetes Mellitus (T2DM) Progression | Total participants who develop T2DM during study intervention as assessed by blood glucose | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change the Risk of T2DM Progression | Total participants whose blood glucose returned to normal during study intervention as assessed by blood glucose | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Lipid Profile (will be assessed by High Density Lipoprotein (HDL) in mg/dL, Low Density Lipoprotein (LDL) in mg/dL, Triglyceride (TG) in mg/dL, and total cholesterol in mg/dL)) | To investigate the effect of ZCC supplementation among prediabetes adults on lipid profile (HDL, LDL, TG and total cholesterol) | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change in Body Weight (kilogram) | To investigate the effect of ZCC supplementation among prediabetes adults on changing in body weight. | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change in Body Mass Index (BMI) (weight and height will be combined to report the BMI in kg/m^2) | To investigate the effect of ZCC supplementation among prediabetes adults on changing in BMI. | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change in Percentage of Fat Mass (using Body Impedance Analysis) | To investigate the effect of ZCC supplementation among prediabetes adults on changing in fat mass using Body Impedance Analysis. | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| Change in Dietary intake | To determine the differences in changes of dietary intake after receiving 12 months of ZCC or placebo supplementation with standard healthy lifestyle intervention. | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| The Difference of Zinc Level among prediabetes adults | To determine the difference of Zinc level in prediabetes adults. | Baseline (at the beginning of study) | 
| The Difference of Chromium Level among prediabetes adults | To determine the difference of Chromium level in prediabetes adults. | Baseline (at the beginning of study) | 
| Change in Physical Activity (assessed by IPAQ Questionnaire) | To determine the difference of physical activity in prediabetes adults using standardized questionnaire on control and intervention group. Moderate intensity activities have been established as between 3 and 6 METS (metabolic equivalent of task). One MET is the amount of energy used while sitting quietly. Physical activities will be rated using METs to indicate their intensity. Vigorous-intensity activity activities have been established as >6 METs. The higher the MET scores mean a better physical activity. | Baseline (at the beginning of study), Intervention Period (3 and 6 months), and 12 months | 
| The assessment on the Safety of the ZCC Supplementation for the respondents | To investigate the safety of the ZCC supplementation among prediabetes adults on the kidney function, liver function, and complete peripheral blood to assess whether the supplements have the specific effects for the respondents' organ function. | Baseline (at the beginning of study) and 12 months (end of the study) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Zinc, Chromium, Copper, Vitamin C