Diabetes is a serious disease. It is the seventh leading cause of death in the United States. It can be managed with exercise, diet, insulin, and other drugs to control blood sugar levels.
Coenzyme Q10 for Prevention and Adjunct Treatment of Type-2 Diabetes
In a 2017 article in the British Journal of Diabetes, Dr. David Mantle, a Fellow of the Royal Society of Chemistry and of the Royal College of Pathologists, makes the following points about the use of Coenzyme Q10 molecules are fat-soluble molecules that are both bsynthesized in the body and ingested in the diet and in supplements. Coenzyme Q10 is synthesized in the body in the same biological pathway as cholesterol. Bio-synthesis of Coenzyme Q10 begins to decline once humans reach their adult years. The reduced production of Coenzyme Q10 cannot be compensated in any practical... Read more about this term supplements to prevent and treat type-2 diabetes:
- CoQ10 depletion has been implicated in the pathogenesis of diabetes.
- Coenzyme Q10 plays important roles in both mitochondrial Bio-energetics is both the process and the study of the flow and transformation of energy in living beings. Coenzyme Q10 has both a bio-energetics function and an antioxidant function in the body.... Read more about this term and in Antioxidants are substances that protect the cells and lipoproteins against the harmful effects of free radicals. They are substances that prevent the oxidation of other molecules and compounds. There are two broad categories of antioxidants: enzymatic and non-enzymatic. Non-enzymatic antioxidants are substances like Coenzyme Q10, vitamin C, vitamin E, glutathione, and various carotenoids. Prominent enzymatic antioxidants include catalase, glutathione peroxidase,... Read more about this term protection against oxidative stress.
- Supplementation with Coenzyme Q10 can significantly improve glycemic control.
- Supplementation with Coenzyme Q10 can improve vascular dysfunction.
- Supplementation with Coenzyme Q10 may be of particular importance in type-2 diabetics who have been prescribed Statins are a class of medications that effectively block the body’s synthesis of cholesterol. In so doing, statins also block the body’s synthesis of Coenzyme Q10.... Read more about this term.
- Supplementation with Coenzyme Q10 may be of particular importance for patients with fatty liver disease.
- Supplementation with Coenzyme Q10 is well tolerated, with no The outcome of a clinical trial is thought to have statistical significance, or to be statistically significant, if the outcome is likely not caused by chance at a given statistical significance level, typically at the 0.05 level. Statistically significant outcomes may or may not be clinically significant. ... Read more about this term adverse effects reported in long-term use.
- The importance of the formulation of the Coenzyme Q10 supplement with respect to product quality and bio-availability cannot be over-emphasized.
Three Different Forms of Coenzyme Q10 Supplements
Coenzyme Q10 occurs in the body in three closely related chemical forms:
- the oxidized form (Ubiquinone, the oxidized form of Coenzyme Q10, expressed as Q10 or CoQ10, is absolutely essential for the mitochondrial ATP energy production process. Ubiquinone is the form of Coenzyme Q10 that the body synthesizes, and ubiquinone is the form of Coenzyme Q10 that has been extensively tested for safety, absorption, and efficacy in clinical trials.... Read more about this term)
- the partially reduced and very unstable and transitory form (semiquinone)
- the reduced form(ubiquinol)
Dr. Mantle refutes the claim of some supplement manufacturers that ubiquinol is the more important bio-active form of Coenzyme Q10. This is incorrect because Coenzyme Q10 is continually inter-converted between the oxidized and reduced forms within the cells. Accordingly, the ubiquinone and ubiquinol CoQ10 forms have equal metabolic importance [Mantle 2017].
Dr. Mantle also disputes the claim of some manufacturers that Coenzyme Q10 can be made more water soluble. Any alteration of the molecular structure changes the CoQ10 molecules so that they are no longer Coenzyme Q10 [Mantle 2017].
Effect of Coenzyme Q10 on Blood Glucose
In his 2017 article, Dr. Mantle summarizes the clinical studies showing that CoQ10 supplementation is associated with reductions in fasting plasma glucose and in HbA1c levels.
N.B. HbA1c levels give an overall picture of what the average blood sugar level has been for a period of weeks or months.
In a 2018 meta-analysis of the study results from 13 RCTs, Zhang et al confirmed that Coenzyme Q10 supplementation may assist glycemic control [Zhang 2018].
Effect of Coenzyme Q10 on Vascular Dysfunction
Dr. Mantle  explains that type-2 diabetes is characterized by an increased risk of damage to blood vessels throughout the body. Elevated blood glucose levels in type-2 diabetics cause the attachment of a sugar of the blood vessel wall proteins, resulting in endothelial cell dysfunction and in changes in red blood cell aggregation and adhesion characteristics. The damage to blood vessels is related to oxidative stress and systemic Inflammation is an immune system response to an injury to cells or tissues. It is the body’s attempt to defend against invaders such as bacteria andviruses and to mend the damage done by invaders. Typically, inflammation manifests itself in the form of fever and swelling, in the swarming of white blood cells and the release of cytokines to fight against... Read more about this term.
The increased oxidative stress is associated with reduced plasma CoQ10 concentrations. Dr. Mantle summarizes studies that CoQ10 supplementation significantly improves endothelial cell dysfunction [Mantle 2017].
He then summarizes the two Randomized controlled trials are studies in which patients or healthy volunteers are assigned at random (purely by chance) to receive one or more clinical interventions. One or more of the interventions is the active treatment being tested. Another of the interventions is the control against which the active treatment is being tested. The control is, typically, the standard practice or... Read more about this term of supplementation with the ubiquinone form of Coenzyme Q10:
- The Q-SYMBIO study in which The Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... Read more about this term patients were administered Coenzyme Q10 (3 x 100 mg/day) or matching placebos for 2 years in addition to their conventional The Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately. In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... Read more about this term medicine. The outcome of the study was 1) improved heart function and 2) heart disease mortality reduced by 43% in the heart failure patients, of whom 10% had type-2 diabetes [Mortensen 2014].
- The KISEL-10 study in which senior citizens living at home (not institutionalized) were administered Coenzyme Q10 (2 x 100 mg/day) in combination with 200 mcg/day Selenium (symbol Se, atomic number 34) is a trace element that is an essential nutrient and an essential component of some of the most important antioxidants in the body, in particular the selenoproteins glutathione peroxidase, thioredoxin reductase, and selenoprotein P. Selenium is involved in the optimal functioning of the immune system. Professor Alehagen has pointed out that there exists a... Read more about this term or matching placebos for 4 years. The outcome was improved heart function as seen on echocardiograms and heart disease mortality reduced by 53% in elderly subjects, of whom 20% had diabetes [Alehagen 2013].
N.B. The study participants in the Q-Symbio is the abbreviated name for the two-year multi-center, randomized, double-blind, placebo-controlled study of Coenzyme Q10 supplements as an adjunct treatment of chronic heart failure patients. The name reflects the focus of the study on the SYMptoms, BIomarker status (BNP), and long-term Outcomes (hospitalizations and mortality) of the supplementation. The data from the Q-Symbio study show that long-term supplementation with... Read more about this term had an average age of 63 years. The study participants in the The KiSel-10 study was a four-year randomized, double-blind, placebo-controlled study of 443 Swedish citizens aged 70 to 88 who received either a combined daily supplementation of high-selenium yeast and Coenzyme Q10 or matching placebos. The elderly Swedish citizens who received the active treatment of selenium and Coenzyme Q10 had significantly reduced risk of death from heart disease, significantly better heart... Read more about this term had an average age of 78 years. In both cases, the study participants — people well over the age of 40 years — benefited from supplementation with the ubiquinone form of Coenzyme Q10.
In a double-blind crossover study, researchers showed that a well-formulated ubiquinone CoQ10 supplement gave a significantly better absorption and bio-availability than a ubiquinol product did [Lopez-Lluch 2019].
Coenzyme Q10 and Statins and Diabetes
Dr. Mantle makes two important points about statin medications in his British Journal of Diabetes article [Mantle 2017]:
- In patients on statin medications, there is a recognized increased risk of developing type-2 diabetes.
- Statin medications inhibit not only the bio-synthesis of Cholesterol is one of the major fat-soluble compounds that is found in animal plasma membranes. It is necessary for life and is found throughout the body. It is carried from the liver to the tissues where it is needed by lipoproteins of which it is a component. Much of the cholesterol is transported in Low density lipoproteins (LDL). High levels... Read more about this term; they also inhibit the bio-synthesis of Coenzyme Q10. And type-2 diabetes patients need Coenzyme Q10 to protect against the risk of Atherosclerosis is the thickening of the artery walls brought about by the build-up of plaque (plaque is made up of cholesterol and other fatty substances and waste products and calcium and fibrin) and the subsequent slowing of the flow of blood through the clogged arteries. More research is needed into the role of Coenzyme Q10 in the prevention and adjunct... Read more about this term and heart failure.
Coenzyme Q10 and Liver Disease
Dr. Mantle connects the dots linking non-alcoholic fatty liver disease (NAFLD) to a need for CoQ10 supplementation [Mantle 2017]:
- The liver is a major site of CoQ10 bio-synthesis.
- NAFLD compromises metabolic function in the liver.
- Reduction in the CoQ10 bio-synthesis in the liver is likely to have a deleterious effect on heart function.
- Heart disease is one of the major causes of death in NAFLD patients.
- NAFLD is associated with increased incidence of heart failure, arrhythmias, valve dysfunction, and atherosclerosis.
Conclusion: Coenzyme Q10 and Type-2 Diabetes
- CoQ10 administration benefits glycemic control and vascular function.
- CoQ10 administration benefits patients prescribed statin medications and patients with fatty liver disease.
- CoQ10 is safe, well-tolerated, and affordable. It has no serious adverse effects. It cannot be over-dosed.
- The formulation (the choice of the carrier oils and the heating/cooling process) of the CoQ10 supplement is of high importance, far more important than the form of the CoQ10 supplement (ubiquinone or ubiquinol).
- Claims that a CoQ10 supplement has been made water-soluble and claims that the ubiquinol form is better absorbed by older people are undocumented or poorly documented marketing claims.
It is best to seek out a Coenzyme Q10 supplement with documented absorption and efficacy. There is too much variability in CoQ10 products to take a chance on one that is not proven.
Alehagen U, Johansson P, Björnstedt, M, Rosén A & Dahlström U. (2013). Cardiovascular mortality and N-terminal-proBNP reduced after combined selenium and coenzyme Q10 supplementation: a 5-year prospective randomized A double-blind study is a study in which neither the investigators nor the study participants know which participants are receiving the active treatment and which participants are receiving the control treatment until the study has been completed and the seal on the code has been broken.... Read more about this term, placebo-controlled trial among elderly Swedish citizens. International Journal of Cardiology; 167(5): 1860-1866.
Lopez-Lluch G, Del Pozo-Cruz J, Sanchez-Cuesta A & Navas P. (2019). Bioavailability of CoQ10 supplements depends on carrier lipids and solubilisation. Nutrition; 57: 133-140.
Mantle D. (2017). Coenzyme Q10 supplementation for diabetes and its complications: an overview. The British Journal of Diabetes; 17:1–4.
Mohr D, Bowry VW & Stocker R. (1992). Dietary supplementation with Coenzyme Q10 results in increased levels of ubiquinol-10 within circulating Lipoproteins are particles comprised of protein and lipids, with a core of triglycerides and cholesterol esters and an outer layer of phospholipids. Lipoproteins transport lipids through the bloodstream. LDL-lipoproteins carry cholesterol from the liver to the body tissues. HDL- lipoproteins carry cholesterol back to the liver from the body tissues. LDL-lipoproteins also bind and transport Coenzyme Q10 molecules, predominately in... Read more about this term and increased resistance of human low-density lipoprotein to the initiation of Oxidation is the chemical reaction of a substance with oxygen. Peroxidation is the extreme form of oxidation that results from free radicals’ stealing electrons from lipids, either in the cell membranes or in the lipoproteins. The final product of lipid peroxidation is highly reactive malondialdehyde, a bio-marker for oxidative stress and damage.... Read more about this term. Biochimica et Biophysica Acta; 1126(3): 247-254.
Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D & Littarru, GP. (2014). The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC. Heart Failure; 2(6): 641-649.
Zhang SY, Yang KL, Zeng LT & Wu XH. (2018). Effectiveness of Coenzyme Q10 supplementation for type 2 Diabetes is a metabolic disease characterized by high blood sugar levels. Diabetes is caused by the body’s failure to produce sufficient insulin (type 1 diabetes) or by the body’s failure to respond to the available insulin (type 2 diabetes). The high blood sugar levels that are characteristic of diabetes are associated with increased risk of heart attack, stroke, and coronary... Read more about this term: a systematic review and meta-analysis. Int J Endocrinol; 2018: 6484839.
The information presented in this review article is not intended as medical advice and should not be used as such.
16 April 2020