Abstract
Aims: To rank the effectiveness of medicinal plants for glycaemic control in Type 2 Diabetes (T2DM). Methods: MEDLINE, EMBASE, CINAHL and Cochrane Central were searched in October 2020. We included meta-analyses of randomised controlled clinical trials measuring the effectiveness of medicinal plants on HbA1c and/or Fasting Plasma Glucose (FPG) in patients with T2DM. Results: Twenty five meta-analyses reported the effects of 18 plant-based remedies. Aloe vera leaf gel, Psyllium fibre and Fenugreek seeds had the largest effects on HbA1c: mean difference –0.99% [95% CI−1.75, −0.23], −0.97% [95% CI −1.94, −0.01] and −0.85% [95% CI −1.49, −0.22] respectively. Four other remedies reduced HbA1c by at least 0.5%: Nigella sativa, Astragalus membranaceus, and the traditional Chinese formulae Jinqi Jiangtang and Gegen Qinlian. No serious adverse effects were reported. Several other herbal medicines significantly reduced FPG. Tea and tea extracts (Camellia sinensis) were ineffective. However, in some trials duration of follow-up was insufficient to measure the full effect on HbA1c (<8 weeks). Many herbal remedies had not been evaluated in a meta-analysis. Conclusion: Several medicinal plants appear to be as effective as conventional antidiabetic treatments for reducing HbA1c. Rigorous trials with at least 3 months’ follow-up are needed to ascertain the effects of promising plant-based preparations on diabetes.
Highlights
Type 2 Diabetes Mellitus (T2DM) is a major, growing health problem
It is clear that tea and tea extracts are ineffective
Practical information on safe plant-based preparations with hypoglycaemic effects should be made widely available to clinicians and patients with diabetes
Summary
Type 2 Diabetes Mellitus (T2DM) is a major, growing health problem. Over 90% of these have T2DM and over 1 million deaths per year are attributable to diabetes (Khan et al, 2020). The costs are huge: the USA alone spends $294 billion per year on management of diabetes in the population aged 20–79 (International Diabetes Federation, 2019). Initial treatment of diabetes involves lifestyle modifications including changes to the diet and increasing physical activity, but dietary advice does not usually extend to herbs and phytomedicines. Individualised dietary advice is recommended alongside a personalised management plan that aims to reduce and maintain HbA1c to below 6.5% (National Institute for Health and Care Excellence, 2020). Pharmacotherapy is initiated if patients fail to maintain HbA1c levels below this threshold
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