Are Ayurvedic herbs for diabetes effective?

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Applied Evidence

Are Ayurvedic herbs for diabetes effective?

J Fam Pract. 2005 October;54(10):876-886

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References

1. Lad V. An introduction to Ayurveda. Altern Ther Health Med 1995;1:57-63.

2. Chopra A, Doiphode VV. Ayurvedic medicine. Core concept, therapeutic principles and current relevance. Med Clin North Am 2002;86:75-89.

3. Marles RJ, Farnsworth NR. Antidiabetic plants and their active constituents. Phytomedicine 1995;2:137-189.

4. Hardy M, Coulter I, Venuturupalli S, et al. Ayurvedic interventions for diabetes mellitus: a systematic review. Evidence Report/Technology Assessment No. 41. AHRQ Publication No. 01-E040; 2001.

5. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17:1-12.

6. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273:408-412.

7. Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet 1998;352:609-613.

8. Balk EM, Bonis PA, Moskowitz H, et al. Correlation of quality measures with estimates of treatment effect in meta-analyses of randomized controlled trials. JAMA 2002;287:2973-2982.

9. Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50:1088-1101.

10. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315:629-634.

11. Azad Khan A, Akhtar S, Mahtab H. Coccinia indica in the treatment of patients with diabetes mellitus. Bangladesh Med Res Counc Bull 1979;5:60-66.

12. Agrawal P, Rai V, Singh RB. Randomized placebo-controlled single-blind trial of holy basil leaves in patients with non-insulin-dependent diabetes mellitus. Int J Clin Pharmacol Ther 1996;34:406-409.

13. Chandola HM, Tripathi SN, Udupa KH. Hypoglycaemic response of c. tamala in patients of maturity onset (insulin independent) diabetes. J Res Ayurveda Sidda 1980;1:275-290.

14. Kamble SM, Jyotishi GS, Kamalakar PL, Vaidya SM. Efficacy of coccinia indica w. & a. in diabetes mellitus. J Res Ayurveda and Sidda 1996;17(1–2):77-84.

15. Kohli KR, Singh RH. A clinical trial of jambu (eugenia jambolana) in non-insulin dependant diabetes mellitus. J Res Ayurveda Sidda 1993;14(3–4):89-97.

16. Baskaran K, Kizar Ahamath B, Radha Shanmugasundaram K, Shanmugasundaram ER. Antidiabetic effect of a leaf extract from gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. J Ethnopharmacol 1990;30:295-300.

17. Shanmugasundaram E, Rajeswari G, Baskaran K, Rajesh Kumar BR, Radha Shanmugasundaram K, Kizar Ahmath B. Use of gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus. J Ethnopharmacol 1990;30:281-294.

18. Kuppurajan K, Seshadri C, Revathi R. Hypoglycaemic effect of coccinia indica in diabetes mellitus. Nagarjun 1986;29:1-4.

19. Kuppurajan K, Srivatsa A, Krishnaswami CV. Hypoglycemic and hypotriglyceridemic effects of methika churna (fenugreek). Antiseptic 1998;95:78-79.

20. Kumar N, Kumar A, Sharma ML. Clinical evaluation of single and herbo-mineral compound drugs in the management of madhumeha. J Res Ayurveda Sidda 1999;20(1–2):1-9.

21. Sharma RD, et al. Use of fenugreek seed powder in the management of non-insulin dependent diabetes mellitus. Nutr Res 1996;16:1331-1339.

22. Flexible dose open trial of Vijayasar in cases of newly-diagnosed non-insulin-dependent diabetes mellitus. Indian Council of Medical Research (ICMR), Collaborating Centres, New Delhi. Indian J Med Res 1998;108:24-29.

23. Goyal DK, Tiwari SK. Study on sadabahar (vinca rosea linn.) In madhumeha (diabetes mellitus). J Res Ayurveda Sidda 1999;20(1–2):93-100.

24. Chowdhary DP, Dua M, Bharti, Kishore P. Hypoglycaemic effect of a coded formulation: aysuh-82. J Res Ayurveda Sidda 1998;19(3–4):107-115.

25. Pandey VN, Rajagopalan SS, Chowdhary DP. An effective ayurvedic hypoglycemic formulation. J Res Ayurveda Sidda 1995;16(1–2):1-14.

26. Shankar R, Singhal R. Clinical studies of the effect of abraga (mica) chendooram in the treatment of diabetes mellitus (neerazhivu). J Res Ayurveda Sidda 1995;16(3–4):108-117.

27. Maji D, Singh AK. Clinical trial of D-400, a herbomineral preparation in diabetes mellitus. J Diabetic Assoc India 1995;35:1-4.

28. Sircar AR, Ahuja RC, Natu SM, Roy B, Sharma HM. Hypoglycemic, hypolipidemic and general beneficial effects of an herbal mixture MA-471. Alternat Ther Clin Pract 1996;3:26-31.

29. Shankar R, Sighal R. Clinical assessment of the effects of sandana (sandal) podi-a in the treatment of diabetes mellitus (neerazhiv). J Res Ayurveda Sidda 1994;15(3–4):89-97.

30. Sivaprakasam K, Rao KK, Yasodha R, Veluchamy G. Siddha remedy for diabetes mellitus. J Res Ayurveda Sidda 1984;5(1–4):25-32.

31. Kamble SM, Kamlakar PL, Vaidya S, Bambole VD. Influence of coccinia indica on certain enzymes in glycolytic and lipolytic pathway in human diabetes. Indian J Med Sci 1998;52:143-146.

32. Kapoor LD. CRC Handbook of Ayurvedic Medicinal Plants. Boca Raton, Fla: CRC Press; 1990.

33. Dash VB. Materia Medica of Indo-Tibetan Medicine. Delhi, India: MDIA Classics India; 1987;10-11.

34. Mishra L, Singh B, Dagenais S. Ayurveda: a historical perspective and principles of the traditional healthcare system in India. Altern Ther Health Med 2001;7:36-42.

Holy basil. Agrawal, Rai, and Singh (1996) reported the results of a randomized, placebo controlled crossover trial of the effects of a leaf extract of holy basil (Ocimum sanctum) on patients with type 2 diabetes.¹² Forty patients were recruited from community advertisements in Kanpur, India, and through visits to the offices of local dieticians. All subjects had a 5-day run-in period during which they all consumed a tea made from holy basil leaves. This was followed by an 8-week experimental period. The patients were randomly assigned to drink the holy basil leaf tea for 4 weeks followed by placebo leaves for 4 weeks, or the reverse (the placebo leaves first, followed by the holy basil leaf tea). The authors concluded that holy basil leaf powder caused significant reduction in the level of fasting blood sugar and postprandial blood sugar, and a moderate reduction in cholesterol. The Jadad score for this trial is 1. This study was identified from the Western literature search.

FAST TRACK

Herbs compared with placebo or diet, or used with hypoglycemic therapy showed statistically significant benefits in glucose control

Cinnamonum tamala. Chandola, Tripathi, and Udupa (1980) assessed the hypoglycemic effects of C tamala in type 2 diabetes patients.¹³ Thirty-two patients were recruited from the outpatient departments of the Institute of Medical Sciences, Varanasi, India, and received the intervention and 8 patients with type 2 diabetes served as controls. The socioeconomic characteristics of the patients were not noted, and the authors did not report if the 2 arms of patients were statistically equivalent on important prognostic variables at the start of the trial. The intervention consisted of leaves of C tamala (tejpatra) that were dried, pulverized, and filtered through a fine mesh, and given as 2 heaped teaspoons 4 times a day before meals and tea for a total of 1 month. All patients were advised to follow a 1800-calorie diet with restriction of sugar, potato, and rice. The control patients were only instructed to follow the above diet with no other medications. Fasting blood sugars were assessed in both arms of patients before the trial and at the end of 1 month. The authors reported the mean fasting blood sugar improved from 153 mg/dL to 113 mg/dL (P<.001) at the end of 1 month in patients treated with C tamala, while there was no improvement in control patients. The Jadad score for this study was 0. This study was identified from the Eastern literature search.

FAST TRACK

The single best-quality RCT reported beneficial results for Coccinia indica

Coccina indica. Kamble, Jyotishi, Kamalakar, et al (1996) studied the effect of fresh leaves of C indica on blood sugar levels and on hyperlipidemia in noninsulin-dependent diabetes mellitus (NIDDM, type 2) patients at an Ayurvedic clinic in Nagpur, India.14 Patients were classified into 4 arms: a healthy comparison arm (arm I, 15 patients); a NIDDM comparison arm (arm II, 30 patients); NIDDM patients treated with Coccinia (arm III, 25 patients); and a NIDDM arm treated with chlorpropamide (arm IV, 15 patients). Patients were given the Coccinia (decocted from fresh leaves, dried into a paste, and made into a 3-g tablet) twice a day for 12 weeks, although control group data only exist at 6 weeks. For patients in arm III, the study showed a statistically significant reduction in mean fasting blood sugar, from 160 to 118 mg/dL (P<.001) at 12 weeks, and a significant decrease in blood sugar levels after glucose tolerance tests: the 2-hour level dropped from 308 mg/dL to 142 mg/dL (P<.001). These results were roughly equivalent to those found in the chlorpropamide arm at 6 weeks, with any differences being not statistically significant. Additionally, after 12 weeks of treatment, the Coccinia treated patients showed significant within group reductions in levels of cholesterol (P<.001), phospholipid (P<.05), triglyceride (P<.001), and free fatty acid (P<.001) compared with untreated patients with diabetes. The Jadad score for this study was 0. This study was identified from the Eastern literature search.

Jamun beej. Kohli and Singh (1993) studied the effects of Jamun beej (Eugenia jambolana) on fasting blood sugar, glucose tolerance test, and symptomatic relief of symptoms associated with diabetes.¹⁵ Thirty patients identified from the outpatient unit of the Sunderlal Hospital in Varanasi, India, who had NIDDM confirmed by glucose tolerance test, were given E jambolana crushed into a fine powder at a dose of 4 g 3 times a day for 3 months. No dietary restrictions were included in the study. A second arm of 6 patients with confirmed NIDDM was given chlorpropamide (250 mg/d). No demographic information was provided on these patients. The authors reported a statistically significant reduction in mean fasting blood sugar of 51.86 mg/dL at 2 months (P<.001) but not at 3 months. The study also demonstrated a significant reduction in the response to the glucose tolerance test at both 2 months (P<.001) and at 3 months (P<.01), but comparisons with the patients receiving chlorpropamide were not statistically significant. The Jadad score total is 1. This study was identified from the Eastern literature search.