Effectiveness and Safety of Gymnema sylvestre on Glycemic and Lipid Control in Type 2 Diabetes: a Systematic Review and Meta-analysis
Article Sidebar
Main Article Content
Abstract
Objective: To undertake a systematic review and meta-analysis of the effectiveness and safety of Gymnema sylvestre in glycemic and lipid control in patients with type 2 diabetes. Methods: The researchers searched published reports through the electronic databases including Pubmed, Embase, Scopus, CENTRAL, AMED, CINAHL, Web of science, www.clinicaltrials.gov and databases in Thailand from inception to July 2017. The researchers selected randomized or non-randomized trials with a control group on the effectiveness of Gymnema sylvestre in patients with type 2 diabetes. The study employed random effect model and reported Weighted Mean Difference (WMD) with confident interval 95% (95%CI). The primary outcome was FBG and the secondary was HbA1c. Results: The search identified 5 studies consistent to inclusion criteria. The studies determined the effects of Gymnema sylvestre as a supplemental therapy for 4-12 weeks in 215 type 2 diabetes. Four-fifth of the studies showed moderate quality as assessed using ROBINS-I. Meta-analysis showed that patients in Gymnema sylvestre tended to have a decrease in fasting blood sugar (FBS) for 2.86 mg/dl (95%CI; -18.15, 12.43) (I2 = 0.0%, P = 0.98) and in HbA1c 0.21% (95% CI; -0.84, 0.42) (I2= 0.0%, P = 0.46) when compared to placebo group. Gymnema sylvestre group had a significant reduction in total cholesterol for 28.26 (95%CI; -36.19, -20.34) (I2= 0.0%, P = 0.40) and in triglyceride for 21.03 mg/dl (95% CI; -27.93, -14.13) (I2 = 0.0%, P = 0.59). The adverse effects on liver and kidney found in Gymnema sylvestre group were not different from those in the control. Conclusion: The studies on the effects of Gymnema sylvestre on glycemic and lipid control in patients with type 2 diabetes with hyperlipidemia were scarce. Present evidence is not enough to support the use of Gymnema sylvestre for reducing FBS and HbA1c. However, it supports the use as a supplement for reducing total cholesterol and triglyceride in such group of patients. The use of Gymnema sylvestre is safe. However, additional studies with a large sample size and strong design are needed.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
2. Bureau of Non Communicable Disease, Department of Disease Control. Situation of diabetes mellitus disease [online]. 2014 [cited Oct 31, 2015]. Available from: thaincd.com/information-statistic/non-communic a ble-disease-data.php.
3. American Diabetes Association. Management of hyperglycemia in type 2 diabetes, 2015: A patient centered approach. Diabetes Care 2015;38:140–9.
4. Barnes PM, Bloom B and Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep 2008;12:1-23.
5. Authatanin W., Bumrerrach S and Nimsoontorn K. Situation of using herb for control blood glucose in diabetes patient [online]. 2013 [cited Nov 1, 2015]. Available from: home.kku.ac.th/chd/index.
6. Ríos JL, Francini F and Schinella GRl. Natural products for the treatment of type 2 diabetes mellitus. Planta Med J 2015; 81: 975-94.
7. Suksomboon N, Poolsup N, Boonkaew S and Suthisisang CC. Meta-analysis of the effect of herbal supplement on glycemic control in type 2 diabetes. Ethnopharmacol 2011;137: 1328-33.
8. Gupta SS. and Seth CB. Experimental studies on pituitary diabetes II: Comparison of blood sugar level in normal and anterior pituitary extract induced hyperglycemic rats treated with a few Ayurvedic remedies. Indian J Med Res 1962; 50: 708-14.
9. Bespinyowong R, Pongthananikorn S and Chiabcha- lard A. Efficacy and safety of Gymnema inodorum tea consumption in type 2 diabetic patients. Chula Med J 2013; 57:587-99.
10. Thakur GS, Sharma R, Sanodiya BS, Pandey M, Prasad GBSK and Bisen PS. Gymnema sylvestre: an alternative therapeutic agent for management of diabetes. JAPS 2012; 2: 1-6.
11. Higgins, JPT and Green S. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011): The Cochrane Collaboration; 2011 [online]. 2011[cited Aug 9, 2015] Available from: www.cochrane-handbook.org.
12. Moher D, Liberati A, Tetzlaff J and Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151: 264–8.
13. Gagnier J, Boon H, Rochon P, Moher D, Barnes J and Bombardier C. Reporting randomized, controlled trials of herbal interventions: an elaborated CON SORT statement. Ann Intern Med 2006;144: 364–67.
14. Jadad AR, Moore RA, Carroll D, Jenkinson JM, Reynolds DJ, et al. Assessing the quality of report of randomized clinical trials: is blinding necessary? Control Trials 1996; 17:1-12.
15. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D and et al. Cochrane Bias Methods Group; Cochrane Statistical Methods Group: The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011, 343:d5928.
16. Sterne JAC, Higgins JPT, Elbers RG, Reeves BC and the development group for ROBINSI. Risk of bias in non-randomized studies of interventions (ROBINS-I): detailed guidance, updated 12 October 2016 [cited Nov 10, 2017]. Available from www.riskof bias.info
17. Higgins JPT, Thompson SG, Deeks JJ and Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-60.
18. Kurian GA, V. Manjusha, Nair SS, Varghese T and Padikkala J. Short-term effect of G-400, polyherbal formulation in the management of hyperglycemia and hyperlipidemia conditions in patients with type 2 diabetes mellitus. J Nutr 2014;30:1158-64.
19. Baskaran K, Ahamath B K, Shanmugasundararam K R and Shanmugasundararam E.R.B. Antidiabetic effect of a leaf extract from Gymnema sylvesry in non-insulin dependent diabetes mellitus patients. Ethnopharmacol 1990;30:295-305.
20. Bandara T, Rokeya, Khan S, et al. Effects of leaves on glycemic and lipidemic status in type 2 diabetic subjects. Bangladesh J Pharmacol 2009;4: 92-5.
21. Kumar SN, Mani UV and Mani I. An Open Label Study on the Supplementation of Gymnema sylvestre in Type 2 Diabetics. J Diet Suppl 2010;7:273-82.
22. Li Y, Zheng M, Zhai X et all. Effect of Gymnema sylvestre, Citrullus colocynyhis And Arteminia ansin thium on blood glucose and lipid in diabetic human. Acta Pol Pharm 2015;72:981-5.
23. Izzo AA, Hoon-Kim S, Radhakrishnan R and Williamson EM. A Critical approach to evaluating clinical efficacy, adverse events and drug interactions of herbal remedies. Phytother Res, 2016; 30: 691-700.
24. Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboonc K, and Leelasettagoolc C. The effi- cacy of ginger for the prevention of postoperative nausea and vomiting: A meta-analysis. AJOG 2006; 194: 95-9.
25. Maenthaisonga R, Chaiyakunapruka R, Niruntra porn S and Kongkaewa C. The efficacy of aloe vera used for burn wound healing: A systematic review. Burns 2007; 33: 713-8.
26. Kongkaewa C and Chaiyakunapruk N. Efficacy of Clinacanthus nutans extracts in patients with herpes infection: Systematic review and meta-analysis of randomised clinical trials. Complement Ther Med 2010; 19: 47-53.
27. Dhippayom T, Kongkaew C, Chaiyakunapruk N, Dilokthornsakul P, Sruamsiri R, et al. Clinical effects of Thai herbal compress: a systematic review and meta-analysis. Evid Based Complement Alternat Med 2015; 2015:942378. doi: 10.1155/2015/942378.
28. Igwe EO and Charlton KE. A systematic review on the health effects of plums (Prunus domestica and Prunus salicina). Phytother Res 2016; 30:701-31.
29. Shergis JL, Wu L, Zhang AL, Guo X, Lu C and Xue CC. Herbal medicine for adults with asthma: A systematic review. J Asthma 2016; 53: 650-9.
30. Sawangjit R, Puttarak P, Saokaew S, Chaiyakuna- pruk N. Efficacy and safety of Cissus quadrangularis L. in clinical use: a systematic review and meta-analysis of randomized controlled trials. Phytother Res 2017;31:555-67. doi: 10.1002/ptr.5783.
31. Bhansali S, Shafiq N, Pandhi P, Singh AP, Singh I and et.al. Effect of a deacyl gymnemic acid on glucose homeostasis & metabolic parameters in a rat model of metabolic syndrome. Indian J Med Res 2013; 137:1174-9.
32. Feeman WE. Executive Summary of The third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285:2486-97.
33. Shigematsu N, Asano R, Shimosaka M and Okazaki M. Effect of administration with the extract of Gymnema sylvestre R. Br leaves on lipid metabolism in rats. Biol Pharm Bull 2001;24:713-7.
34. Nakamura Y, Tsumura Y, Tonogai Y and Shibata T. Fecal steroid excretion is increased in rats by oral administration of gymnemic acids contained in Gym nema sylvestre leaves. J Nutr 1999;129:1214–22.
35. Tiwari P, Mishra BN and Sangwan NS. Phytochemical and pharmacological properties of Gymne ma sylvestre: An Important Medicinal plant. BioMed J 2014; 2014: 830285. doi: 10.1155/2014/83 0285.
