Effect of Coenzyme Q10 Supplementation on Diabetes Biomarkers: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials

A P4 Medicine Perspective of Gut Microbiota and Prediabetes: Systems Analysis and Personalized Intervention

Type 2 diabetes (T2D) accounts for approximately 90% of diabetes worldwide and has become a global public health problem. Generally, individuals go to hospitals and get healthcare only when they have obvious T2D symptoms. While the underlying cause and mechanism of the disease are usually not well understood, treatment is for the symptoms, but not for the disease cause, and patients often continue to progress with more symptoms. Prediabetes is the early stage of diabetes and provides a good time window for intervention and prevention. However, with few symptoms, prediabetes is usually ignored without any treatment. Obviously, it is far from ideal to rely on the traditional medical system for diabetes healthcare. As a result, the medical system must be transformed from a reactive approach to a proactive approach. Root cause analysis and personalized intervention should be conducted for patients with prediabetes. Based on systems medicine, also known as P4 medicine, with a predictive, preventive, personalized, and participatory approach, new medical system is expected to significantly promote the prevention and treatment of chronic diseases such as prediabetes and diabetes. Many studies have shown that the occurrence and development of diabetes is closely related to gut microbiota. However, the relationship between diabetes and gut microbiota has not been fully elucidated. This review describes the research on the relationship between gut microbiota and diabetes and some exploratory trials on the interventions of prediabetes based on P4 medicine model. Furthermore, we also discussed how these findings might influence the diagnosis, prevention and treatment of diabetes in the future, thereby to improve the wellness of human beings.

Coenzyme Q10 Supplementation Improves Adipokine Levels and Alleviates Inflammation and Lipid Peroxidation in Conditions of Metabolic Syndrome: A Meta-Analysis of Randomized Controlled Trials

Evidence from randomized controlled trials (RCTs) suggests that coenzyme Q₁₀ (CoQ₁₀) can regulate adipokine levels to impact inflammation and oxidative stress in conditions of metabolic syndrome. Here, prominent electronic databases such as MEDLINE, Cochrane Library, and EMBASE were searched for eligible RCTs reporting on any correlation between adipokine levels and modulation of inflammation and oxidative stress in individuals with metabolic syndrome taking CoQ₁₀. The risk of bias was assessed using the modified Black and Downs checklist, while the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to evaluate the quality of evidence. Results from the current meta-analysis, involving 318 participants, showed that CoQ₁₀ supplementation in individuals with metabolic syndrome increased adiponectin levels when compared to those on placebo (SMD: 1.44 [95% CI: -0.13, 3.00]; I² = 96%, p < 0.00001). Moreover, CoQ₁₀ supplementation significantly lowered inflammation markers in individuals with metabolic syndrome in comparison to those on placebo (SMD: -0.31 [95% CI: -0.54, -0.08]; I² = 51%, p = 0.07). Such benefits with CoQ₁₀ supplementation were related to its ameliorative effects on lipid peroxidation by reducing malondialdehyde levels, concomitant to improving glucose control and liver function. The overall findings suggest that optimal regulation of adipokine function is crucial for the beneficial effects of CoQ₁₀ in improving metabolic health.

The impact of coenzyme Q10 on metabolic and cardiovascular disease profiles in diabetic patients: A systematic review and meta-analysis of randomized controlled trials

AIMS

Coenzyme Q10 (CoQ10) is well known for its beneficial effects in cardiovascular disease (CVD); however, reported evidence has not been precisely synthesized to better inform on its impact in protecting against cardiovascular-related complications in diabetic patients.

MATERIALS AND METHODOLOGY

The current meta-analysis included randomized controlled trials published in the past 5 years reporting on the effect of CoQ10 on metabolic and CVD-related risk profiles in individuals with diabetes or metabolic syndrome. We searched electronic databases such as MEDLINE, Cochrane Library, Scopus and EMBASE for eligible studies. In addition to assessing the risk of bias and quality of evidence, the random and fixed-effect models were used to calculate the standardized mean difference and 95% confidence intervals for metabolic parameters and CVD outcomes.

RESULTS

Overall, 12 studies met the inclusion criteria, enrolling a total of 650 patients. Although CoQ10 supplementation did not statistically affect all metabolic profiles measured, it significantly reduced CVD-risk-related indexes such as total cholesterol and low-density lipoprotein (LDL) levels in diabetic patients when compared to those on placebo [SMD = 0.13, 95% CI (0.03; 0.23), Chi2 = 43.62 and I 2 = 29%, P = .07].

CONCLUSIONS

The overall results demonstrated that supplementation with CoQ10 shows an enhanced potential to lower CVD risk in diabetic patients by reducing total cholesterol and LDL. Moreover, the beneficial effects of CoQ10 in lowering the CVD risk are associated with its ameliorative properties against oxidative stress and improving endothelial health.

The Paradox of Coenzyme Q10 in Aging

Coenzyme Q (CoQ) is an essential endogenously synthesized molecule that links different metabolic pathways to mitochondrial energy production thanks to its location in the mitochondrial inner membrane and its redox capacity, which also provide it with the capability to work as an antioxidant. Although defects in CoQ biosynthesis in human and mouse models cause CoQ deficiency syndrome, some animals models with particular defects in the CoQ biosynthetic pathway have shown an increase in life span, a fact that has been attributed to the concept of mitohormesis. Paradoxically, CoQ levels decline in some tissues in human and rodents during aging and coenzyme Q₁₀ (CoQ₁₀) supplementation has shown benefits as an anti-aging agent, especially under certain conditions associated with increased oxidative stress. Also, CoQ₁₀ has shown therapeutic benefits in aging-related disorders, particularly in cardiovascular and metabolic diseases. Thus, we discuss the paradox of health benefits due to a defect in the CoQ biosynthetic pathway or exogenous supplementation of CoQ₁₀.

Coenzyme Q10 Supplementation in Aging and Disease

Coenzyme Q (CoQ) is an essential component of the mitochondrial electron transport chain and an antioxidant in plasma membranes and lipoproteins. It is endogenously produced in all cells by a highly regulated pathway that involves a mitochondrial multiprotein complex. Defects in either the structural and/or regulatory components of CoQ complex or in non-CoQ biosynthetic mitochondrial proteins can result in a decrease in CoQ concentration and/or an increase in oxidative stress. Besides CoQ₁₀ deficiency syndrome and aging, there are chronic diseases in which lower levels of CoQ₁₀ are detected in tissues and organs providing the hypothesis that CoQ₁₀ supplementation could alleviate aging symptoms and/or retard the onset of these diseases. Here, we review the current knowledge of CoQ₁₀ biosynthesis and primary CoQ₁₀ deficiency syndrome, and have collected published results from clinical trials based on CoQ₁₀ supplementation. There is evidence that supplementation positively affects mitochondrial deficiency syndrome and the symptoms of aging based mainly on improvements in bioenergetics. Cardiovascular disease and inflammation are alleviated by the antioxidant effect of CoQ₁₀. There is a need for further studies and clinical trials involving a greater number of participants undergoing longer treatments in order to assess the benefits of CoQ₁₀ treatment in metabolic syndrome and diabetes, neurodegenerative disorders, kidney diseases, and human fertility.

Effects of coenzyme Q10 on cardiovascular and metabolic biomarkers in overweight and obese patients with type 2 diabetes mellitus: a pooled analysis

BACKGROUND

The potential effects of coenzyme Q10 (CoQ₁₀) supplementation in overweight/obese patients with type 2 diabetes mellitus are not fully established. In this article, we aimed to perform a pooled analysis to investigate the effects of CoQ₁₀ intervention on cardiovascular disease (CVD) risk factors in overweight/obese patients with type 2 diabetes mellitus (T2DM).

METHODS

MEDLINE, Embase, and Cochrane databases were searched for randomized controlled trials that evaluated the changes in CVD risk factors among overweight and obese patients with T2DM following CoQ₁₀ supplementation. Two investigators independently assessed articles for inclusion, extracted data, and assessed risk of bias. Major endpoints were synthesized as weighted mean differences (WMDs) with 95% CIs. Subgroup analyses were performed to check the consistency of effect sizes across groups. Publication bias and sensitivity analysis were also performed.

RESULTS

Fourteen eligible trials with 693 overweight/obese diabetic subjects were included for pooling. CoQ₁₀ interventions significantly reduced fasting blood glucose (FBG; -0.59 mmol/L; 95% CI, -1.05 to -0.12; P=0.01), hemoglobin A1c (HbA1c; -0.28%; 95% CI-0.53 to -0.03; P=0.03), and triglyceride (TG) levels (0.17 mmol/L; 95% CI, -0.32 to -0.03; P=0.02). Subgroup analysis also showed that low-dose consumption of CoQ₁₀ (<200 mg/d) effectively reduces the values of FBG, HbA1c, fasting blood insulin, homeostatic model assessment of insulin resistance, and TG. CoQ₁₀ treatment was well tolerated, and no drug-related adverse reactions were reported.

CONCLUSION

Our findings provide substantial evidence that daily CoQ₁₀ supplementation has beneficial effects on glucose control and lipid management in overweight and obese patients with T2DM.

Effectiveness of Coenzyme Q10 Supplementation for Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis

OBJECTIVE

To evaluate the effectiveness and safety of coenzyme Q10 for patients with type 2 diabetes mellitus (T2DM).

METHODS

Data from randomized controlled trials were obtained to assess the effects of coenzyme Q10 versus placebo or western medicine on patients with T2DM. The study's registration number is CRD42018088474. The primary outcomes included glycosylated hemoglobin, fasting blood glucose, and fasting insulin.

RESULT

Thirteen trials involving 765 patients were included. Compared with the control group, coenzyme Q10 may decrease the HbA1c (WMD -0.29; 95% CI -0.54, -0.03; P = 0.03) and the fasting blood glucose (WMD -11.21; 95% CI -18.99, -3.43; P = 0.005). For fasting insulin, there is also not strong evidence that confirms which one is better because there was no statistical difference (WMD -0.48; 95% CI -2.54, 1.57; P = 0.65).

CONCLUSION

Based on current evidence, coenzyme Q10 may assist glycemic control, decrease TG, and improve HDL-C in patients with T2DM.