This summer has brought a significant uptick in creatine’s visibility in the popular and social media — searches for “is creatine good” were up by 76% on TikTok alone over the past month — and it has sent increased traffic to all other major platforms, too.

With physicians and nutritionists on television advocating for its widespread use, including in this segment from the “Today” show, it’s likely that more patients with diabetes will show up asking about its safety and efficacy. What does the scholarly research say about creatine with respect to how it could help or hurt these patients?

Creatine’s Behavior in Patients With Diabetes

First, a little background on creatine monohydrate. Since the 1970s, more than 680 peer-reviewed studies have been published on this supplement, making it one of the most investigated of its kind on the market. Most commonly used by athletes, the performance benefits of the supplement are primarily threefold, as detailed in this study: It enhances rapid energy release and recovery, increases the appearance of muscle size by drawing water into cells and augmenting their volume, and enables extended skeletal muscle performance and fatigue resistance over limited periods of time.

“Creatine, when used appropriately, can improve your max power. It can help with muscle growth in certain individuals; it typically does not have as significant of an impact when you’re doing more endurance-based sports,” said Karan Rai, MD, a sports medicine physician with OSF HealthCare, headquartered in Peoria, Illinois. “If you’re a weekend warrior or CrossFit athlete trying to get a little extra boost while practicing appropriate hydration and dietary intake, I think creatine has benefits.”

One of the functional behaviors of creatine is in helping the phosphagen system quickly make more adenosine triphosphate, the main fuel used by the cells. As the cells’ quick-start generator, the phosphagen system is extremely important for body parts that need a lot of energy fast. Diabetes, whether type 1 or type 2, isn’t just about high blood sugar. It also gradually damages muscles, makes the mitochondria — the powerhouses of the cells — work poorly, and reduces patients’ ability to be physically active.

The potential to turn that process around in patients with diabetes is one benefit of creatine that has been examined, including in this study, along with the supplement’s metabolic benefits.

“Creatine is generally considered safe. However, care should still be exercised with diabetic patients. Type 1 and 2 diabetics may find some benefits with creatine supplementation,” said Jerome Burke, Jr, MD, PhD, a medical toxicologist and physician-scientist who is the program director for research and reporting at the FDA’s Center for Drug Evaluation and Research in Silver Spring, Maryland. “With that said, more research is needed to confirm the full benefits of creatine.”

Differing Functions for People With Type 1 and Type 2 Diabetes

The effects of creatine use with type 2 diabetes have been fairly widely studied. In this disease, creatine supplementation appears to augment muscle glucose uptake, particularly when combined with regular aerobic or resistance exercise. This 2001 study that appeared in Diabetes, the official publication of the American Diabetes Association, showed that “...1) oral creatine supplementation can offset the decline of muscle GLUT4 protein content in skeletal musculature during disuse atrophy, and 2) oral creatine supplementation increases GLUT4 content during subsequent rehabilitation training.”

More recently, this 2022 review of three randomized clinical trials, originally published in Current Diabetes Reviews, declared that creatine was “a hypoglycemic intervention for patients with type 2 diabetes, without major adverse events reported,” although the authors did call for more trials of the same type on this subject.

“For type 2 diabetics, where the body is insulin resistant, creatine has been shown to enhance skeletal glucose uptake and improve glucose metabolism. This increases the muscles’ ability to store and use glucose, which may lower blood glucose levels,” Burke said. “Some studies have suggested that there might be a direct correlation with insulin sensitivity, which makes the body more responsive to insulin over time.”

The efficacy of creatine supplementation in type 1 diabetes is an area with limited dedicated research, especially when compared to type 2 diabetes. While creatine has shown some promise in the area of maintaining muscle quality for those with type 1 diabetes, overall, its direct applicability to this condition is less clear due to the differences in the mechanism of type 1 diabetes in the body. Burke said that individuals with type 1 may still find the supplement useful for its ancillary benefits.

“Creatine might assist with muscle strength and energy for high-intensity exercise but may not affect blood sugar control. For those engaging in high-intensity training, creatine use would provide other benefits,” Burke said, noting that patients with diabetes engaging in vigorous exercise should monitor their glucose closely.

Stay Hydrated, and Pay Attention to Kidney Function

When taking creatine, there are standard safety tips to keep in mind, and these apply to people with diabetes just as they do for everyone else who uses this supplement. Burke advises all users to consult with their medical doctor to develop a plan before starting creatine supplements, which he says is especially important for patients with diabetes, to ensure that adding this supplement aligns with their diabetes management goals.

“It’s important to remember to stay hydrated and monitor glucose levels when taking creatine,” he adds. Also, as noted previously, it’s possible that creatine could alter insulin sensitivity over time, underscoring the importance of careful monitoring. 

The standard dose of creatine is 3-5 g/d, as reported in this study, among many others. Creatine most commonly comes in powdered form and can be mixed with water, juice, or a sports drink; individuals should follow the instructions on the label of the particular supplement they choose and monitor their sugar intake.

“High dosage could affect kidney function, which can result in nephritis or chronic kidney disease,” Burke cautioned. “While current evidence doesn’t show significant harm in healthy individuals, measurements of glomerular filtration rate in the kidneys may be compromised with supplemental creatine.”

Creatine: It’s a bit of a mixed bag, but especially given that exercise is an important component of managing both type 1 and type 2 diabetes, use of this popular supplement is likely to come up with an increasing number of patients. Incorporating it into a healthy routine that includes appropriate hydration and keeping a close eye on glucose could make this supplement worth exploring as an adjunct therapy for many individuals with diabetes.