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Akhgarjand C, Moludi J, Ebrahimi-Mousavi S, Bagheri A, Bavani NG, Beigmohammadi MT, Malekahmadi M. The effect of chamomile consumption on glycemic markers in humans and animals: a systematic review and meta-analysis. J Diabetes Metab Disord 2024; 23:189-198. [PMID: 38932814 PMCID: PMC11196442 DOI: 10.1007/s40200-023-01345-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/04/2023] [Indexed: 06/28/2024]
Abstract
Purpose The use of natural and herbal products as alternative therapies, in conjunction with blood glucose-lowering medications, is on the rise for patients with diabetes. Our objective was to conduct a systematic review and comprehensive meta-analysis of both human and animal models to investigate the impact of chamomile consumption on glycemic control. Methods A systematic search was conducted on all published papers from January 1990 up to January 2022 via Scopus, PubMed/Medline, Google Scholar, and ISI Web of Science. Human and animal articles evaluating the effect of chamomile on serum glycemic markers were included. We used the random-effects model to establish the pooled effect size. The dose-dependent effect was also assessed. Results Overall, 4 clinical trials on human and 8 studies on animals met the inclusion criteria. With regard to RCTs, a favorable effect of chamomile consumption on serum fasting blood glucose (Standardized Mean Differences (SMD): -0.65, 95% CI: -1.00, -0.29, P < 0.001; I2 = 0%) and hemoglobin A1C (HbA1C) levels (SMD: -0.90, 95% CI: -1.39, -0.40, P < 0.001; I2 = 45.4%) was observed. Considering animal studies, consumption of chamomile extracts significantly reduced serum blood glucose (SMD: -4.37, 95% CI: -5.76, -2.98, P < 0.001; I2 = 61.2%). Moreover, each 100 mg/d increase in chamomile extract intervention resulted in a significantly declined blood glucose concentrations (MD: -54.35; 95% CI: -79.77, -28.93, P < 0.001; I2 = 94.8). Conclusion The current meta-analysis revealed that chamomile consumption could exert favorable effects on serum blood glucose and HbA1C. However, additional randomized controlled trials are needed to further confirm these findings. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01345-8.
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Affiliation(s)
- Camellia Akhgarjand
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalal Moludi
- School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sara Ebrahimi-Mousavi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Bagheri
- School of Nutrition Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Narges Ghorbani Bavani
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Taghi Beigmohammadi
- Department of Anesthesiology and Intensive Care, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Malekahmadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, P.O. Box 14155-6117, Iran
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Sooro MA, Thoahlane TS, Ramathebane MV, Mputsoe KA. A preliminary, quantitative study on the use of traditional and complementary medicine by cancer patients seen at the Senkatana oncology clinic, Maseru, Lesotho. BMC Complement Med Ther 2024; 24:136. [PMID: 38561693 PMCID: PMC10983638 DOI: 10.1186/s12906-024-04388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/03/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The use of traditional and complementary medicine (TCM) by cancer patients remains common in several countries especially in the Sub-Saharan Africa. However, the reasons for use are complex and change with time and geographic location, they may vary from therapy to therapy, and they are different from one individual to another. The use of TCM has been associated with active coping behaviour and a way through which patients take control of their own health. However, cancer patients do not disclose their use of TCM to the attending healthcare professionals and therefore the effects of these medicines on the patients may not be ascertained. AIM To investigate the use of traditional and complementary medicines among patients diagnosed with cancer. METHODS A cross-sectional, quantitative study was conducted at Senkatana Oncology clinic in May to June 2023. Cancer patients underwent standardized, quantitative interviews using structured questionnaires about their use of TCM. Descriptive statistics were used to analyse the data. Logistic regression analysis was also used to identify factors associated with satisfaction with the performance of TCM. RESULTS All interviewed patients (n = 50, 100%) reported to be using TCM. Patients consisted of 24 females (48%) and 26 males (52%) in the age range 14 to 82 years old. The majority of the study population was in the age group 35-44 years old. The most prevalent cancer among participating males was prostate cancer and among females was cervical cancer. Biological products use was the most prominent with the highest average percentage usage (14.7%). The majority of patients (66%, n = 33) indicated that they just wanted to try everything that could help. Patients (n = 47, 94%) further reported that they had been using complementary medicine during the same period as they were using conventional treatment so that both may work to help each other. Neither gender nor age predicted satisfaction with the performance of traditional and complementary medicine. CONCLUSIONS It is concluded that all interviewed cancer patients use TCM. Patients indicated that one of the reasons for using TCM was that they wanted to try everything that could help in their cancer care. Patients further reported that they did not inform their oncologist of their concurrent use of TCM because they had been advised not to use other medicines besides what they are given at the clinic.
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Affiliation(s)
- Mopa A Sooro
- Faculty of Health Sciences, Department of Pharmacy, National University of Lesotho, Roma, Lesotho.
| | - Thabo S Thoahlane
- Faculty of Health Sciences, Department of Pharmacy, National University of Lesotho, Roma, Lesotho
| | - Maseabata V Ramathebane
- Faculty of Health Sciences, Department of Pharmacy, National University of Lesotho, Roma, Lesotho
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Ghorat F, Mosavat SH, Hadigheh S, Kouhpayeh SA, Naghizadeh MM, Rashidi AA, Hashempur MH. Prevalence of Complementary and Alternative Medicine Use and Its Associated Factors among Iranian Diabetic Patients: A Cross-Sectional Study. CURRENT THERAPEUTIC RESEARCH 2024; 100:100746. [PMID: 38711867 PMCID: PMC11070824 DOI: 10.1016/j.curtheres.2024.100746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/14/2024] [Indexed: 05/08/2024]
Abstract
Objective This cross-sectional study aimed to assess the prevalence of complementary and alternative medicine (CAM) use and its associated factors among diabetic patients in Fasa, a city in southern Iran. Methods Data were collected from diabetic patients who visited the endocrinology clinics at Fasa University of Medical Sciences. A structured questionnaire was administered to gather information on CAM use, including the types of CAM modalities used, and reasons for use. The patient's demographic and clinical characteristics, such as age, gender, duration of diabetes, glycosylated hemoglobin (HbA1c) levels, and quality of life (QoL) were also recorded. Descriptive statistics were used to determine the prevalence of CAM use, while logistic regression analysis was employed to identify factors associated with CAM use. Results A total of 376 diabetic patients participated in the study, with more than 89% reporting CAM use within the past year. Herbal preparations were the most commonly used type of CAM, with a prevalence rate of 99.4%. Factors associated with CAM use included patients' psychological health, attitude towards the safety of CAM, belief in the synergistic effects of combining routine medications with CAM, and previous positive experiences with CAM. Conclusion The high prevalence of CAM use highlights the importance of considering it in diabetes management and the need for healthcare professionals' engagement in open discussions with patients about their CAM practices. Understanding the factors influencing CAM use can inform healthcare providers and policymakers in developing appropriate strategies for integrating CAM approaches into conventional diabetes care.
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Affiliation(s)
- Fereshteh Ghorat
- Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Seyed Hamdollah Mosavat
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samaneh Hadigheh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Seyed Amin Kouhpayeh
- Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | | | - Ali Akbar Rashidi
- Non-Communicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad Hashem Hashempur
- Research Center for Traditional Medicine and History of Medicine, Department of Persian Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Sachan K, Verma S, Arora K, Bharti U, Singh PK, Singh S. Traditional Herbal Medications Utilized in the Indian Medical System forthe Management of Diabetes: An Updated Review and Clinical Implications. Curr Diabetes Rev 2024; 20:e230124226017. [PMID: 38275040 DOI: 10.2174/0115733998273029231121094725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/05/2023] [Accepted: 10/13/2023] [Indexed: 01/27/2024]
Abstract
Phytomedicine, also called botanical medicine, is the practice of using plants to treat disease. Diabetes, for example, has been treated and prevented with herbal medication for a lot longer than Western medicine. Worldwide, diabetes has become a major health concern. The management of diabetes and hyperglycemia, two of the most common public health threats, is far from ideal. When hyperglycemia persists or is not under control, diabetes-related complications, like blindness, lower limb amputations, renal disease, and cardiovascular disease, play a significant role in the morbidity and mortality of the disease. Although chemicals and biochemical agents can assist in managing diabetes, there is currently no complete cure for the disease. Herbal remedies are one of many methods that can be used to treat and prevent diabetes and its subsequent problems. Numerous traditional treatments have been discovered for diabetes as a result of extensive research efforts. However, there are many factors to consider when deciding which herbs to use, such as the patient's financial status, the presence or absence of co-morbidities, and the accessibility, cost-effectiveness, and safety profile of the herbs. This article focuses on the use of herbal and natural remedies in the treatment and prevention of diabetes, the mechanisms by which these remedies lower blood glucose levels, and the specific herbal items now utilized in the management of diabetes.
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Affiliation(s)
- Kapil Sachan
- KIET School of Pharmacy, KIET Group of Institutions, Ghaziabad, Uttar Pradesh, India
| | - Suryakant Verma
- School of Pharmacy, Bharat Institute of Technology, Meerut, Uttar Pradesh, India
| | - Kunal Arora
- Faculty of Pharmacy, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Ujjwal Bharti
- ITS College of Pharmacy, Muradnagar, Ghaziabad, Uttar Pradesh, India
| | - Pranjal Kumar Singh
- SRM Modinagar College of Pharmacy, SRM Institute of Science and Technology, Delhi NCR Campus, Modinagar, Ghaziabad, Uttar Pradesh, India
| | - Smita Singh
- SRM Modinagar College of Pharmacy, SRM Institute of Science and Technology, Delhi NCR Campus, Modinagar, Ghaziabad, Uttar Pradesh, India
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Yaghmour KA, Abu Sadi R, Badroun F, Alali R, Almubarak F, Alabbad Z, Alharthi N, Samkari JA, Gaddoury MA. Complementary and Alternative Medicine Use Among Patients With Diabetes Mellitus in Saudi Arabia: A Community-Based Cross-Sectional Study. Cureus 2023; 15:e45792. [PMID: 37745747 PMCID: PMC10517425 DOI: 10.7759/cureus.45792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Global studies have observed a disparity in the use of complementary and alternative medicine (CAM) among diabetic patients. OBJECTIVES To estimate the prevalence, types, and correlates of CAM use among patients with diabetes mellitus (DM) in Saudi Arabia. METHODOLOGY A cross-sectional study was conducted among 1290 Saudis with type 2 DM aged ≥18 years. An electronic questionnaire was distributed through social media to collect data about patient demographics and DM-related characteristics, including age at DM diagnosis, DM duration, family history of DM, DM complications, DM medicine, and chronic diseases. The use of CAM and its type, cost, and duration; sources of CAM-related information; reason for using CAM; usefulness and side effects; CAM use in the future; and doctor consultation before CAM use were also evaluated. Among CAM non-users, the reason for not using CAM and future considerations of CAM were assessed. RESULTS A total of 1290 patients were included (27.4%) aged 18-29 years; 726 (56.3%) were women; 554 (42.9%) had a bachelor's degree in education; and 457 (35.4%) were unemployed. The prevalence of CAM use was 528 (40.9%). The most commonly used types were bitter apple 503 (95.3%), cinnamon 341 (64.6%), and ginger 290 (55.1%). The most frequent sources of CAM-related information were friends, families, and neighbors 259 (49.2%), while the most frequent justifications for use were the need for another DM treatment and faith in its advantages. Only 106 (20.1%) of the patients who used CAM disclosed adverse effects; 373 (51.8%) said they would use it again, and 66.1% said they would recommend it to other patients. Only 145 (27.5%) consulted a doctor before using CAM. CAM was more commonly used by patients who were older, women, married, and taking hypoglycemic drugs; whose most recent HbA1c level was 7-10%; and who had dyslipidemia, chronic disease, and a family history of DM. CONCLUSION The prevalence of CAM use is high among the Saudi population. Analyzing CAM use is essential in clinical interactions with Saudis with DM. The managing healthcare professionals must educate patients with DM on how to use CAM more effectively and safely.
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Affiliation(s)
| | - Raneem Abu Sadi
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Ftoon Badroun
- Medical Intern, King Abdulaziz University, Jeddah, SAU
| | - Rezan Alali
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Fatimah Almubarak
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Zainab Alabbad
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Noura Alharthi
- Medical Intern, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | - Jamil A Samkari
- Family and Community Medicine, King Abdulaziz University Faculty of Medicine, Rabigh, Jeddah, SAU
| | - Mahmoud A Gaddoury
- Community Medicine, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
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6
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Kumar S, Sharma SK, Mudgal SK, Gaur R, Agarwal R, Singh H, Kalra S. Comparative effectiveness of six herbs in the management of glycemic status of type 2 diabetes mellitus patients: A systematic review and network meta-analysis of randomized controlled trials. Diabetes Metab Syndr 2023; 17:102826. [PMID: 37451111 DOI: 10.1016/j.dsx.2023.102826] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/26/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND AIMS There are several herbal formulations for type 2 diabetes (T2D), but many of them have never been directly compared to establish the most effective methods. Therefore, the present systematic review and network meta-analysis aimed to compare and rank the effects of herbal formulations by combining direct and indirect evidence on the management of type 2 diabetes. METHODS From five electronic databases, relevant studies on the effectiveness of herbal formulations for glycemic status for people with type 2 diabetes were retrieved. Only randomized controlled trials that were published in English and looked at how herbal formulations affected adults' (>18-year-old) glycemic levels were included. A systematic review and network meta-analysis design with the random-effects model was used. RESULTS A total of 44 trials included 3130 participants on six herbs were included in the final analysis. Apple cider vinegar (ACV) (standardized mean difference (SMD) = -28.99), cinnamon (-9.73), curcumin (-13.15), and fenugreek (-19.64) significantly reduced fasting blood glucose (FBG) compared with placebo (all p < 0.05). Notably, only ACV (SMD = -2.10) and fenugreek seeds (0.84) were found significantly effective in reducing HbA1C. ACV was most effective herb to reduce FBG comparison with other herbs. CONCLUSIONS Several herbs could be considered as a valuable adjuvant therapy regarding glycemic control of type 2 diabetes patients. Health professionals should be encouraged to incorporate these herbs for the management of type 2 diabetes as part of their standard care.
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Affiliation(s)
- Subodh Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
| | - Suresh K Sharma
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
| | - Shiv Kumar Mudgal
- College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
| | - Rakhi Gaur
- College of Nursing, All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
| | - Rajat Agarwal
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
| | - Harminder Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, Haryana, India.
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Maleki V, Abbaszadeh S, Seyyed Shoura SM, Sohrabnavi A, Sepandi M, Taghdir M. Potential roles of ellagic acid on metabolic variables in diabetes mellitus: A systematic review. Clin Exp Pharmacol Physiol 2023; 50:121-131. [PMID: 36222179 DOI: 10.1111/1440-1681.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/17/2022] [Accepted: 10/07/2022] [Indexed: 01/05/2023]
Abstract
Diabetes mellitus is a widespread endocrine disorder globally. Due to its antioxidant and anti-inflammatory properties, ellagic acid has the potential to improve the metabolic effects of chronic non-communicable diseases. This systematic review summarizes current evidence about the potential effects of ellagic acid on metabolic variables in diabetes mellitus. A comprehensive systematic literature search was conducted in databases such as PubMed, Scopus, EMBASE, ProQuest and Google Scholar from inception until March 2022. All animal studies and clinical trials were eligible for inclusion. Studies using in vitro models or published in a non-English language were excluded. Of 1320 articles, 23 were selected for assessment, including 21 animal studies and two randomized controlled trial studies. Following ellagic acid administration, findings reported improvement in FBS, HbA1c, insulin (20, 8 and 12 studies, respectively), TG, TC, HDL-C (13, 10 and 5 studies, respectively), MDA, GSH, CAT, SOD (11, 6, 3 and 4 studies, respectively), and TNF-α and IL-6 (6 and 3 studies, respectively). In conclusion, ellagic acid may improve glycaemic indicators, dyslipidaemia, oxidative stress and inflammation in diabetes mellitus. However, further clinical trials are needed to explore the mechanisms more precisely and to observe the applied consequences.
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Affiliation(s)
- Vahid Maleki
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Nutrition and Food Hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Sepideh Abbaszadeh
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Nutrition and Food Hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Asma Sohrabnavi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojtaba Sepandi
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Taghdir
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Department of Nutrition and Food Hygiene, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Klammer C, Schindler K, Bugl R, Plazek D, Vötter M, Kirchner T, Martino C, Klammer-Martin J, Brix J, Dämon S, Hoppichler F, Kautzky-Willer A, Kruschitz R, Toplak H, Clodi M, Ludvik B. [Nutrition for diabetic patients (Update 2023)]. Wien Klin Wochenschr 2023; 135:62-77. [PMID: 37101026 PMCID: PMC10133079 DOI: 10.1007/s00508-023-02170-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 04/28/2023]
Abstract
All patients with diabetes require individual and personalized nutritional consultation with professionals. The patient's needs should be the primary focus of the dietary therapy, taking their lifestyle and the type of diabetes into consideration. With the recommendations to the patient's diet, there need to be specific metabolic goals to reduce the disease's progression and to avoid long term health effects. Therefore, practical guidelines such as portion size and meal planning tips should be the main focus.According to the latest national and international standards, patients suffering from diabetes should have access to nutrition consulting and nutritional training. During consultation they can be supported on- how to manage their health condition and choosing food and beverage to improve their health.These practical recommendations sum up the latest literature on nutritional aspects of diabetes treatment.
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Affiliation(s)
- Carmen Klammer
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
- ICMR - Institute of Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Österreich
| | - Karin Schindler
- Bundesministerium für Soziales, Gesundheit, Pflege und Konsumentenschutz, Wien, Österreich
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Rita Bugl
- Wiener Gesundheitsverband Klinik Ottakring, Wien, Österreich
| | | | | | - Tanja Kirchner
- Österreichische Gesundheitskasse Mein Peterhof Baden, Baden, Österreich
| | - Claudia Martino
- Österreichische Gesundheitskasse Mein Gesundheitszentrum Floridsdorf, Wien, Österreich
| | | | - Johanna Brix
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
| | - Sabine Dämon
- Special Institute for Preventive Cardiology and Nutrition, SIPCAN - Initiative für ein gesundes Leben, Elsbethen/Salzburg, Österreich
| | - Friedrich Hoppichler
- Special Institute for Preventive Cardiology and Nutrition, SIPCAN - Initiative für ein gesundes Leben, Elsbethen/Salzburg, Österreich
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Renate Kruschitz
- Abteilung für Innere Medizin, Krankenhaus der Elisabethinen, Klagenfurt, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Martin Clodi
- Abteilung für Innere Medizin, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich.
- ICMR - Institute of Cardiovascular and Metabolic Research, Johannes Kepler Universität Linz, Altenberger Straße 69, 4040, Linz, Österreich.
| | - Bernhard Ludvik
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Klinik Landstraße, Wien, Österreich
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Boscaro V, Rivoira M, Sgorbini B, Bordano V, Dadone F, Gallicchio M, Pons A, Benetti E, Rosa AC. Evidence-Based Anti-Diabetic Properties of Plant from the Occitan Valleys of the Piedmont Alps. Pharmaceutics 2022; 14:2371. [PMID: 36365189 PMCID: PMC9693256 DOI: 10.3390/pharmaceutics14112371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/20/2022] [Accepted: 10/28/2022] [Indexed: 10/29/2023] Open
Abstract
Data on urban and rural diabetes prevalence ratios show a significantly lower presence of diabetes in rural areas. Several bioactive compounds of plant origin are known to exert anti-diabetic properties. Interestingly, most of them naturally occur in different plants present in mountainous areas and are linked to traditions of herbal use. This review will aim to evaluate the last 10 years of evidence-based data on the potential anti-diabetic properties of 9 plants used in the Piedmont Alps (North-Western Italy) and identified through an ethnobotanical approach, based on the Occitan language minority of the Cuneo province (Sambucus nigra L., Achillea millefolium L., Cornus mas L., Vaccinium myrtillus L., Fragaria vesca L., Rosa canina L., Rubus idaeus L., Rubus fruticosus/ulmifolius L., Urtica dioica L.), where there is a long history of herbal remedies. The mechanism underlying the anti-hyperglycemic effects and the clinical evidence available are discussed. Overall, this review points to the possible use of these plants as preventive or add-on therapy in treating diabetes. However, studies of a single variety grown in the geographical area, with strict standardization and titration of all the active ingredients, are warranted before applying the WHO strategy 2014-2023.
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Affiliation(s)
- Valentina Boscaro
- Dipartimento di Scienza e Tecnologia del Farmaco, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Matteo Rivoira
- Dipartimento di Studi Umanistici, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy
- Atlante Linguistico Italiano (ALI), Via Sant’Ottavio 20, 10124 Turin, Italy
| | - Barbara Sgorbini
- Dipartimento di Scienza e Tecnologia del Farmaco, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Valentina Bordano
- Dipartimento di Scienza e Tecnologia del Farmaco, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Francesca Dadone
- Dipartimento di Scienza e Tecnologia del Farmaco, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Margherita Gallicchio
- Dipartimento di Scienza e Tecnologia del Farmaco, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Aline Pons
- Dipartimento di Studi Umanistici, University of Turin, Via Sant’Ottavio 20, 10124 Turin, Italy
| | - Elisa Benetti
- Dipartimento di Scienza e Tecnologia del Farmaco, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
| | - Arianna Carolina Rosa
- Dipartimento di Scienza e Tecnologia del Farmaco, University of Turin, Via Pietro Giuria 9, 10125 Turin, Italy
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Traditional Medicine Use among Type 2 Diabetes Patients in KZN. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/7334080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background. Traditional medicine (TM) is widely used in both developing and developed countries to assist in the attempt to curtail the prevalence and increase in diabetes mellitus. Approximately 53% of South Africans use TM to prevent and treat their diseases. There is no conclusive evidence regarding the safety and effectiveness of TM versus prescribed medicine. The most common therapies used by diabetics in Africa include herbal treatments, nutritional products, spiritual healing, and relaxation techniques. Therefore, this study aimed to evaluate the use of TM in patients with T2DM who are on chronic therapy and living in KwaZulu-Natal. Method. This cross-sectional study was conducted at a district hospital, in which purposive sampling was used to recruit participants and data were collected using a structured questionnaire. Information collected included demographic data, information pertaining to home remedies/TM, and self-care practices employed by participants while using TM. Data were analyzed using Pearson’s chi-squared test, t-test, and multivariate logistic regressions to determine predictors of TM usage. Results. Only 92 (27%) of 340 participants reported using TM, with Indians being the most frequent users (58.24%). Approximately, 83.72% (n = 72) used TM in conjunction with prescribed medication. Most participants (56.32%) acquired TM knowledge from family. The most frequently used TM was lemon and honey, Aloe vera, bitter gourd, green tea, and cinnamon. Traditional medicine use among African participants was 0.56 times (OR = 0.56, 95% CI = 0.34, 0.93) lower than Indian participants. There were no significant predictors for TM usage among the variables tested. Conclusion. A low prevalence rate of TM usage in T2DM patients was found. A significant correlation was noted between ethnicity and TM use. Large-scale studies are required to determine the additive and synergistic effects of TM in health care. Consideration should also be given to integrating TM into mainstream health care.
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Perception of Individuals with Diabetes about Efficacy and Safety of Complementary and Alternative Medicines (CAM) in the Jazan Region, Saudi Arabia. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2104056. [PMID: 35571737 PMCID: PMC9098292 DOI: 10.1155/2022/2104056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022]
Abstract
Background CAM is widely accepted for the management of diabetes, and CAM users from many countries showed positive perception towards its use. However, little is known about the perception of individuals with diabetes in Saudi Arabia. Objectives This study was aimed to assess the perception of the individuals with diabetes of Jazan region in Saudi Arabia towards CAM. Methods An online, anonymous cross-sectional survey was designed and conducted between September 5 and December 31, 2021. Data were collected using 19-item self-report survey from the individuals with diabetes of the Jazan region. Results A total of 359 validated responses were received. Approximately, 34% of the participants reported using CAM with modern medicine to control diabetes. Most of the participants reported that CAM is affordable, accessible, acceptable, and effective. Of the study sample, 28% reported using herbal medicine to control diabetes. Significantly, higher percentages of CAM users reported media (42% vs 27%) and friends/family (31% vs 27%) as the primary sources of information about CAM as compared to non-CAM users. Individuals who used CAM for diabetes showed significantly more positive perception (β = 2.386; p=0.001) than those who did not use CAM in the adjusted analysis. Similarly, students had a significantly higher positive perception towards CAM (β = 4.121; p=0.013) compared to employed individuals. Conclusion A quarter of the sample of individuals with diabetes used herbal medicine to control diabetes. Individuals who ever used CAM for diabetes showed positive perception towards CAM. However, there is a need of healthcare workers to be involved in educating the individuals with diabetes and the general public in order to use CAM more effectively and safely.
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Bredemolic acid restores glucose utilization and attenuates oxidative stress in palmitic acid-induced insulin-resistant C2C12 cells. Endocr Regul 2022; 56:126-133. [PMID: 35489052 DOI: 10.2478/enr-2022-0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective. Due to insulin resistance and oxidative stress that are associated with type 2 diabetes mellitus (T2DM), T2DM has become a prevalent metabolic disorder that presents various side effects. However, alternative antidiabetic treatment has commonly been used in treating diabetes mellitus in diabetic patients. In our previous studies, bredemolic acid has been reported as an antidiabetic agent that improves glucose uptake, ameliorates insulin resistance, and oxidative stress in the liver, heart, kidney, and skeletal muscle of prediabetic rats. However, these effects have not been validated in vitro. Therefore, this study was aimed to investigate the effects of bredemolic acid on insulin-mediated glucose utilization, lipid peroxidation, and the total antioxidant capacity (TOAC) in palmitic acid-induced insulin-resistant C2C12 skeletal muscle cells in vitro. Methods. Insulin resistance was induced in the skeletal muscle cells after 4 h of exposure to palmitic acid (0.5 mmol/l). Different cell groups were incubated in culture media DMEM supplemented with fetal calf serum (10%), penicillin/streptomycin (1%), and L-glutamine (1%) and then treated with either insulin (4 µg/ml) or bredemolic acid (12.5 mmol/l) or with both. Thereafter, the cells were seeded in 24- or 96-well plates for determination of the cell viability, glucose utilization, glycogen formation, and antioxidant capacity. Results. The results showed that bredemolic acid significantly improved TOAC and promoted glucose utilization via attenuation of lipid peroxidation and increased glycogen formation in the insulin-resistant cells, respectively. Conclusion. This study showed that bredemolic acid restored the insulin resistance through improved glucose utilization, glycogen formation, and TOAC in the skeletal muscle cells.
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Shrimant Kumar S, Santhi Sree M, Manjusha M, Reddy MM, B R, Kishore B, G RS, Mohapatra JJ. Efficacy of Residential, Group-Based, Intensive Holistic Lifestyle Intervention Among Type-2 Diabetes Patients - A Single Group Pre- And Post-intervention Study. Cureus 2022; 14:e22253. [PMID: 35350487 PMCID: PMC8933147 DOI: 10.7759/cureus.22253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/11/2022] Open
Abstract
Background The present study assessed the efficacy of the residential, group-based, intensive holistic lifestyle intervention on glycaemic control. Materials and methods A one-group pre and post-intervention study was conducted among 145 people with diabetes for a period of one year from February 2019 to January 2020. The study population underwent "Brahma Kumaris Raja Yoga lifestyle" intervention. Outcome variables were changes in HbA1c levels and anthropometric parameters (like weight, BMI, etc.). Paired t-test was used to compare normally distributed numeric variables. Results The mean age was 52.39±5.79 years, with a male-female ratio close to 1:1. Mean HbA1c at baseline was 9.06±2.1%. The mean weight and BMI were 71.03±12.84 kg and 28.28±4.83kg/m2, respectively. Mean HbA1c value had shown a reduction of 1.60% (95%CI 1.17 to 1.90, p <0.001) at three months and 1.58% (95% CI 1.13-1.87, p<0.001) reduction at a six-month follow-up. Between the third and sixth months, there was no significant change in the HbA1c value. Mean weight reduced by 0.79 kg (95% CI 0.08-1.08, p=0.023) at six-month follow-up and mean BMI decreased by 0.31 units from baseline to three months (95% CI 0.05-0.56, p=0.017). A statistically significant reduction was observed in waist circumference at the third month (MD=1.61 95% CI =0.95 to 2.28, P<0.001) and sixth month (MD=1.53, 95% CI 0.82-2.25, p<0.001) follow-up. Conclusion This residential, group-based, intensive holistic lifestyle intervention showed a significant decrease in HbA1c levels and anthropometric parameters at three- and six-months follow-up, thereby improving the overall health and wellbeing of people with diabetes.
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14
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Hekmat-Ardakani A, Morshed-Behbahani B, Rahimi-Ardabili H, Ayati MH, Namazi N. The effects of dietary supplements and natural products targeting glucose levels: an overview. Crit Rev Food Sci Nutr 2022; 63:6138-6167. [PMID: 35081820 DOI: 10.1080/10408398.2022.2028716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Identifying effective dietary supplements and medicinal herbs has attracted the attention of clinicians and researchers to complement the standard treatment in controlling diabetes mellitus. In the present overview, we aimed to collect studies with the highest level of evidence to shed light on detecting the most effective dietary supplements and medicinal herbs for controlling glycemic status. For the current overview, four electronic databases, including PubMed, Scopus, Web of Science, and Cochrane Library, were systematically searched from inception to 31 December 2020 and then updated until 1 October 2021 to obtain eligible meta-analyses on either dietary supplements or medicinal herbs and their effects on glycemic status. Fasting blood sugar (FBS) and Hemoglobin A1C (HbA1C) were considered as primary outcomes. Finally, ninety-one meta-analyses on dietary supplements (n = 55) and herbs (n = 36) were included. Evidence showed positive effects of chromium, zinc, propolis, aloe vera, milk thistle, fenugreek, cinnamon, ginger, and nettle on FBS and/or HbA1C. However, mostly the heterogeneity (I2) was high. Other supplements and herbs also showed no reduction in glucose levels or their effects were small. Although some dietary supplements and medicinal herbs showed a significant reduction in FBS and/or HbA1C, mostly their effects from the clinical point of view were not remarkable. In addition, due to high heterogeneity, publication bias, and a limited number of included studies in most cases further clinical trials are needed for making decision on anti-diabetic supplement efficacy.
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Affiliation(s)
| | - Bahar Morshed-Behbahani
- Midwifery Department, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hania Rahimi-Ardabili
- School of Population Health, UNSW, Sydney, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Sydney, Australia
| | - Mohammad Hossein Ayati
- School of Persian Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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15
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Cummings KC, Keshock M, Ganesh R, Sigmund A, Kashiwagi D, Devarajan J, Grant PJ, Urman RD, Mauck KF. Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clin Proc 2021; 96:1342-1355. [PMID: 33741131 DOI: 10.1016/j.mayocp.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023]
Abstract
The widespread use of complementary products poses a challenge to clinicians in the perioperative period and may increase perioperative risk. Because dietary supplements are regulated differently from traditional pharmaceuticals and guidance is often lacking, the Society for Perioperative Assessment and Quality Improvement convened a group of experts to review available literature and create a set of consensus recommendations for the perioperative management of these supplements. Using a modified Delphi method, the authors developed recommendations for perioperative management of 83 dietary supplements. We have made our recommendations to discontinue or continue a dietary supplement based on the principle that without a demonstrated benefit, or with a demonstrated lack of harm, there is little downside in temporarily discontinuing an herbal supplement before surgery. Discussion with patients in the preoperative visit is a crucial time to educate patients as well as gather vital information. Patients should be specifically asked about use of dietary supplements and cannabinoids, as many will not volunteer this information. The preoperative clinic visit provides the best opportunity to educate patients about the perioperative management of various supplements as this visit is typically scheduled at least 2 weeks before the planned procedure.
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Affiliation(s)
- Kenneth C Cummings
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH.
| | - Maureen Keshock
- Department of Regional Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH
| | - Ravindra Ganesh
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Deanne Kashiwagi
- Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jagan Devarajan
- Department of Regional Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH
| | - Paul J Grant
- Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Richard D Urman
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Ahmad R, AlLehaibi LH, AlSuwaidan HN, Alghiryafi AF, Almubarak LS, AlKhalifah KN, AlMubarak HJ, Alkhathami MA. Evaluation of clinical trials for natural products used in diabetes: An evidence-based systemic literature review. Medicine (Baltimore) 2021; 100:e25641. [PMID: 33879744 PMCID: PMC8078398 DOI: 10.1097/md.0000000000025641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 03/22/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND RELEVANCE A plethora of literature is available regarding the clinical trials for natural products however; no information is available for critical assessments of the quality of these clinical trials. AIM OF STUDY This is a first time report to critically evaluate the efficacy, safety and large scale applications of up-to-date clinical trials for diabetes, based on the three scales of Jadad, Delphi, and Cochrane. METHODOLOGY An in-depth and extensive literature review was performed using various databases, journals, and books. The keywords searched included, "clinical trials," "clinical trial in diabetes," "diabetes," "natural products in diabetes," "ethnopharmacological relevance of natural products in diabetes," etc. RESULTS Based on eligibility criteria, 16 plants with 74 clinical trials were found and evaluated. Major drawbacks observed were; "non-randomization and blindness of the studies," "non-blindness of patients/healthcare/outcome assessors," "lack of patient compliance and co-intervention reports," "missing information regarding drop-out/withdrawal procedures," and "inappropriate baseline characteristics." Principal component analysis and Pearson correlation revealed four components with %variability; PC1: 23.12, PC2: 15.83, PC3: 13.11, and PC4: 11.38 (P ≤ .000). According to descriptive statistics, "non-blinding of outcome assessors" was the major drawback (82%) whereas, "not mentioning the timing of outcome assessment" was observed lowest (6.8%). An in-house quality grading (scale 0-24) classified these clinical trials as; poor (67.6%), acceptable (19.9%), and good quality trials (13.5%). CONCLUSION Proper measures in terms of more strict regulations with pharmacovigilance of plants are utmost needed in order to achieve quality compliance of clinical trials.
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Affiliation(s)
- Rizwan Ahmad
- Natural Products and Alternative Medicines, College of Clinical Pharmacy, Imam Abdul Rahman Bin Faisal University, Kingdom of Saudi Arabia
| | | | - Hind Nasser AlSuwaidan
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Ali Fuad Alghiryafi
- College of Clinical Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Lyla Shafiq Almubarak
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Khawlah Nezar AlKhalifah
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Hawra Jassim AlMubarak
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| | - Majed Ali Alkhathami
- First Health Cluster in Eastern Province, Dammam Medical Complex, Dammam, Saudi Arabia
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Chávez-Castillo M, Nuñez V, Rojas M, Ortega Á, Durán P, Pirela D, Marquina M, Cano C, Chacín M, Velasco M, Rojas-Quintero J, Bermúdez V. Exploring Phytotherapeutic Alternatives for Obesity, Insulin Resistance and Diabetes Mellitus. Curr Pharm Des 2021; 26:4430-4443. [PMID: 32611293 DOI: 10.2174/1381612826666200701205132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022]
Abstract
At present, the pathologic spectrum of obesity-insulin resistance (IR)-diabetes mellitus (DM) represents not only a pressing matter in public health but also a paramount object of study in biomedical research, as they constitute major risk factors for cardiovascular disease (CVD), and other chronic non-communicable diseases (NCD). Phytotherapy, the use of medicinal herbs (MH) with treatment purposes, offers a wide array of opportunities for innovation in the management of these disorders; mainly as pharmacological research on small molecules accumulates. Several MH has displayed varied mechanisms of action relevant to the pathogenesis of obesity, IR and DM, including immunological and endocrine modulation, reduction of inflammation and oxidative stress (OS), regulation of appetite, thermogenesis and energy homeostasis, sensitisation to insulin function and potentiation of insulin release, among many others. However, the clinical correlates of these molecular phenomena remain relatively uncertain, with only a handful of MH boasting convincing clinical evidence in this regard. This review comprises an exploration of currently available preclinical and clinical research on the role of MH in the management of obesity, IR, and DM.
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Affiliation(s)
- Mervin Chávez-Castillo
- Psychiatric Hospital of Maracaibo, Maracaibo, Venezuela,Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Victoria Nuñez
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Milagros Rojas
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Ángel Ortega
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Pablo Durán
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Daniela Pirela
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - María Marquina
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Clímaco Cano
- Endocrine and Metabolic Diseases Research Center, School of Medicine, University of Zulia, Maracaibo, Venezuela
| | - Maricarmen Chacín
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla, Colombia
| | - Manuel Velasco
- Clinical Pharmacology Unit, José María Vargas School of Medicine, Central University of Venezuela, Caracas-Venezuela
| | - Joselyn Rojas-Quintero
- Pulmonary and Critical Care Medicine Department, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Valmore Bermúdez
- Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla, Colombia
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18
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Lin CH, Chiu HE, Wu SY, Tseng ST, Wu TC, Hung YC, Hsu CY, Chen HJ, Hsu SF, Kuo CE, Hu WL. Chinese Herbal Products for Non-Motor Symptoms of Parkinson's Disease in Taiwan: A Population-Based Study. Front Pharmacol 2021; 11:615657. [PMID: 33584294 PMCID: PMC7873047 DOI: 10.3389/fphar.2020.615657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/23/2020] [Indexed: 11/20/2022] Open
Abstract
Objective: Combinations of Chinese herbal products (CHPs) are widely used for Parkinson’s disease (PD) in Taiwan. Thereby, we investigated the use of CHPs in patients with PD. Methods: This study was a population-based cohort study that analyzed the data of patients with PD from the National Health Insurance Research Database. A total of 9,117 patients were selected from a random sample of one million individuals included in this database. We used multiple logistic regression models to estimate the adjusted odds ratios of the demographic factors and analyzed the formula and single CHPs commonly used for PD. Results: Traditional Chinese medicine users were more commonly female, younger, of white-collar status, and residents of Central Taiwan. Chaihu-Jia-Longgu-Muli-Tang was the most commonly used formula, followed by Ma-Zi-Ren-Wan and then Shao-Yao-Gan-Cao-Tang. The most commonly used single herb was Uncaria tomentosa (Willd. ex Schult.) DC., followed by Gastrodia elata Blume and then Radix et Rhizoma Rhei (Rheum palmatum L., Rheum tanguticum Maxim. ex Balf., and Rheum officinale Baill.). Chaihu-Jia-Longgu-Muli-Tang and U. tomentosa (Willd. ex Schult.) DC. have shown neuroprotective effects in previous studies, and they have been used for managing non-motor symptoms of PD. Conclusion: Chaihu-Jia-Longgu-Muli-Tang and U. tomentosa (Willd. ex Schult.) DC. are the most commonly used CHPs for PD in Taiwan. Our results revealed the preferences in medication prescriptions for PD. Further studies are warranted to determine the effectiveness of these CHPs for ameliorating the various symptoms of PD, their adverse effects, and the mechanisms underlying their associated neuroprotective effects.
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Affiliation(s)
- Chien-Hung Lin
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsienhsueh Elley Chiu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Szu-Ying Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan.,Department of Sports Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Ting Tseng
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Chan Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Chung Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Hsuan-Ju Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Sheng-Feng Hsu
- Graduate Institute of Acupuncture Science, China Medical University, Taichung, Taiwan.,Department of Chinese Medicine, China Medical University Hospital, Taipei, Taiwan
| | - Chun-En Kuo
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan.,Fooyin University College of Nursing, Kaohsiung, Taiwan
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19
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Tabrizi R, Nowrouzi-Sohrabi P, Hessami K, Rezaei S, Jalali M, Savardashtaki A, Shahabi S, Kolahi AA, Sahebkar A, Safiri S. Effects of Ginkgo biloba intake on cardiometabolic parameters in patients with type 2 diabetes mellitus: A systematic review and meta-analysis of clinical trials. Phytother Res 2020; 35:246-255. [PMID: 33090588 DOI: 10.1002/ptr.6822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/06/2020] [Accepted: 07/02/2020] [Indexed: 01/09/2023]
Abstract
Ginkgo biloba (GKB) may have a beneficial effect on cardiometabolic parameters in type 2 diabetes mellitus (T2DM), but the data is inconsistent. Therefore, the current systematic review and meta-analysis of clinical trials was conducted to assess the influence of GKB on cardiometabolic parameters in T2DM. Several online databases such as PubMed, Embase, Scopus, Web of Sciences, Google Scholar and Cochrane Library were systematically searched from inception up to September 2, 2019. Heterogeneity across included studies was assessed using the Cochran's Q statistic and I2 index. To pool weighted mean differences (WMDs) and the corresponding 95% confidence intervals (CIs) as summary effect size, we selected fixed or random-effects model according to the result of heterogeneity. Seven studies comprising 768 subjects were included in the present meta-analysis which resulted in a significant effect of GKB on hemoglobin A1c (HbA1c) (WMD = 0.26, 95% CI = [0.02, 0.50], p = .034) and serum HDL-cholesterol levels (WMD = 1.99, 95% CI = [0.19, 3.79], p = .030) with no significant publication bias. GKB can significantly modulate HbA1c and HDL-cholesterol levels. However, due to uncertainties related to the limited number of studies, it is too early to conclude whether GKB has any potential effects on the cardiometabolic factors in patients with T2DM or not.
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Affiliation(s)
- Reza Tabrizi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Nowrouzi-Sohrabi
- Department of Biochemistry, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamran Hessami
- Maternal-Fetal Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahla Rezaei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Jalali
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- Nutrition Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Savardashtaki
- Department of Medical Biotechnology, Faculty of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Shahabi
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Halal Research Center of IRI, FDA, Tehran, Iran
| | - Saeid Safiri
- Department of Persian Medicine, School of Traditional Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Rahat Breath and Sleep Research Center and School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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20
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Wang Y, Harrington PDB, Chen P. Metabolomic profiling and comparison of major cinnamon species using UHPLC-HRMS. Anal Bioanal Chem 2020; 412:7669-7681. [PMID: 32875369 DOI: 10.1007/s00216-020-02904-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023]
Abstract
The metabolomic profiles of four major species of cinnamon (Cinnamomum verum, C. burmannii, C. loureiroi, and C. cassia) were investigated by ultra-high-performance liquid chromatography-high-resolution mass spectrometry (UHPLC-HRMS). Thirty-six metabolites were tentatively characterized, belonging to various compound groups such as phenolic glycosides, flavan-3-ols, phenolic acids, terpenes, alkaloids, and aldehydes. Principal component analysis (PCA) and partial least squares-discriminant analysis (PLS-DA) on the HRMS data matrix resulted in a clear separation of the four cinnamon species. Coumarin, cinnamaldehyde, methoxycinnamaldehyde, cinnamoyl-methoxyphenyl acetate, proanthocyanidins, and other components varied among the four species. Such variations were used to develop a step-by-step strategy for differentiating the four cinnamon species based on their levels of pre-selected components. This study suggests a significant variation in the phytochemical compositions of different cinnamon species, which have a direct influence on cinnamon's health benefit potentials. Graphical Abstract.
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Affiliation(s)
- Yifei Wang
- Methods and Application of Food Composition Laboratory, U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, Beltsville, MD, 20705, USA
- Department of Chemistry & Biochemistry, College of Arts and Sciences, Ohio University, Athens, OH, 45701, USA
| | - Peter de B Harrington
- Department of Chemistry & Biochemistry, College of Arts and Sciences, Ohio University, Athens, OH, 45701, USA
| | - Pei Chen
- Methods and Application of Food Composition Laboratory, U.S. Department of Agriculture, Agricultural Research Service, Beltsville Human Nutrition Research Center, Beltsville, MD, 20705, USA.
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Tran N, Pham B, Le L. Bioactive Compounds in Anti-Diabetic Plants: From Herbal Medicine to Modern Drug Discovery. BIOLOGY 2020; 9:E252. [PMID: 32872226 PMCID: PMC7563488 DOI: 10.3390/biology9090252] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022]
Abstract
Natural products, including organisms (plants, animals, or microorganisms) have been shown to possess health benefits for animals and humans. According to the estimation of the World Health Organization, in developing countries, 80% of the population has still depended on traditional medicines or folk medicines which are mostly prepared from the plant for prevention or treatment diseases. Traditional medicine from plant extracts has proved to be more affordable, clinically effective and relatively less adverse effects than modern drugs. Literature shows that the attention on the application of phytochemical constituents of medicinal plants in the pharmaceutical industry has increased significantly. Plant-derived secondary metabolites are small molecules or macromolecules biosynthesized in plants including steroids, alkaloids, phenolic, lignans, carbohydrates and glycosides, etc. that possess a diversity of biological properties beneficial to humans, such as their antiallergic, anticancer, antimicrobial, anti-inflammatory, antidiabetic and antioxidant activities Diabetes mellitus is a chronic disease result of metabolic disorders in pancreas β-cells that have hyperglycemia. Hyperglycemia can be caused by a deficiency of insulin production by pancreatic (Type 1 diabetes mellitus) or insufficiency of insulin production in the face of insulin resistance (Type 2 diabetes mellitus). The current medications of diabetes mellitus focus on controlling and lowering blood glucose levels in the vessel to a normal level. However, most modern drugs have many side effects causing some serious medical problems during a period of treating. Therefore, traditional medicines have been used for a long time and play an important role as alternative medicines. Moreover, during the past few years, some of the new bioactive drugs isolated from plants showed antidiabetic activity with more efficacy than oral hypoglycemic agents used in clinical therapy. Traditional medicine performed a good clinical practice and is showing a bright future in the therapy of diabetes mellitus. World Health Organization has pointed out this prevention of diabetes and its complications is not only a major challenge for the future, but essential if health for all is to be attained. Therefore, this paper briefly reviews active compounds, and pharmacological effects of some popular plants which have been widely used in diabetic treatment. Morphological data from V-herb database of each species was also included for plant identification.
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Affiliation(s)
- Ngan Tran
- School of Biotechnology, International University—Vietnam National University, Ho Chi Minh City 721400, Vietnam;
| | - Bao Pham
- Information Science Faculty, Saigon University, Ho Chi Minh City 711000, Vietnam;
| | - Ly Le
- School of Biotechnology, International University—Vietnam National University, Ho Chi Minh City 721400, Vietnam;
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Alqathama A, Alluhiabi G, Baghdadi H, Aljahani L, Khan O, Jabal S, Makkawi S, Alhomoud F. Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship? BMC Complement Med Ther 2020; 20:65. [PMID: 32111222 PMCID: PMC7076897 DOI: 10.1186/s12906-020-2854-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/12/2020] [Indexed: 12/24/2022] Open
Abstract
Background Diabetes mellitus (DM) is a major public health problem and one of the most challenging diseases worldwide. According to the World Health Organization (WHO), the Kingdom of Saudi Arabia (KSA) has the second highest rate of diabetes in the Middle East and seventh highest globally. Some diabetic patients may prefer to use alternative approaches such as herbal remedies to control their blood glucose level and this study aims to assess the prevalence of herbal usage and to evaluate users’ and doctors’ knowledge, attitudes and beliefs about herbal medicine as well as the patient/doctor relationship in this regard. Method A cross-sectional survey was conducted in several hospitals and medical centres in Makkah, KSA, between January and March 2019. Around 289 type II diabetic patients and 105 doctors were interviewed. Results We found that 68% of the participants were frequent consumers of herbal remedies, especially cinnamon, ginger and fenugreek. Patients’ knowledge of herbal usage was mainly gleaned from family and friends as well as social media, and we found that many (71.4%) did not bother to consult or inform their doctors about their choice to self-medicate with herbs. Patients had no concerns regarding the efficacy and safety of herbal usage use in diabetes, as around half of the participants believe that herbal medicine is effective (54%) and safe (46%) for treating symptoms of diabetes. Two-thirds of the doctors (66%) routinely ask patients whether they use herbs for their condition. Although 25% of the doctors took a positive view of herbal medicine in relation to diabetes, others expressed concerns with the rise in herb use and want to see more attention paid to safety aspects. Conclusion The study concludes that herbal remedies are commonly used by diabetic patients and that a gap exists in the relationship between patients and doctors concerning the disclosure of herbal remedy use and views on its safety.
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Affiliation(s)
- Aljawharah Alqathama
- Department of Pharmacognosy, Pharmacy College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia.
| | - Ghadeer Alluhiabi
- Department of Pharmacognosy, Pharmacy College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Halah Baghdadi
- Department of Pharmacognosy, Pharmacy College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Lujain Aljahani
- Department of Pharmacognosy, Pharmacy College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Ola Khan
- Department of Pharmacognosy, Pharmacy College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Sara Jabal
- Department of Pharmacognosy, Pharmacy College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Shorooq Makkawi
- Department of Pharmacognosy, Pharmacy College, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
| | - Farah Alhomoud
- Department of Clinical Pharmacy and Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Chamomile (Matricaria recutita L.) and diabetes mellitus, current knowledge and the way forward: A systematic review. Complement Ther Med 2020; 48:102284. [PMID: 31987240 DOI: 10.1016/j.ctim.2019.102284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022] Open
Abstract
Chamomile, as a rich source of phenolic compounds and terpenoids, seems to be an effective approach in the management of chronic conditions such as diabetes mellitus. The aim of this systematic review was to evaluate evidence from animal and human studies of the effects of chamomile on metabolic risk markers and complications of diabetes mellitus. The literature search was conducted in PubMed, SCOPUS, Embase, ProQuest and Google Scholar electronic and were considered the articles published on April 2019. Original studies that investigated the effect of chamomile in diabetes mellitus which met the inclusion criteria were eligible. After screening 208 citations, 15 studies were included. The results of these studies demonstrated a significant effect of chamomile administration on metabolic profiles. All 12 studies that examined the impact of chamomile supplementation on glycemic control indicated this feature. Four of the five studies appraising the impact of chamomile on lipid profiles showed that it improved dyslipidemia. Six studies showed that chamomile markedly decreased oxidative stress particularly malondialdehyde. Altogether, four chamomile studies evaluating diabetes complications, including renal and hepatic profiles, found significant decreases compared to controls. These findings extend the novel functions of chamomile in the improvement of glycemic and lipid profiles and oxidative stress indicators in diabetes mellitus and related complications. In-depth studies focusing on underlying mechanisms are warranted to make useful conclusions.
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Ramamoorthi R, Gahreman D, Skinner T, Moss S. The effect of yoga practice on glycemic control and other health parameters in the prediabetic state: A systematic review and meta-analysis. PLoS One 2019; 14:e0221067. [PMID: 31618207 PMCID: PMC6795440 DOI: 10.1371/journal.pone.0221067] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/29/2019] [Indexed: 12/15/2022] Open
Abstract
A systematic review and meta-analysis was conducted to investigate the effects of yoga on glycemic control, lipid profiles, body composition and blood pressure in people in the pre-diabetic state. Studies on the effectiveness of yoga on population groups under high risk for diabetes, called prediabetic or suffering from metabolic syndromes were extracted from a thorough search of PubMed, Scopus, Cochrane Library, EBSCO and IndMED databases. Both Randomised Controlled Trial (RCT) and non-RCT studies were included in the systematic review and meta-analysis. Studies published between Jan 2002 and Dec 2018 were included. Studies were considered for evaluation if they investigated a yoga intervention to prevent T2DM, against a control group, while also reporting glycemic control and other health parameters of T2DM management. Summary effect sizes and 95% confidence intervals (CI) were calculated using the Comprehensive Meta-Analysis software in addition to publication bias. Of the 46,500 identified studies, 14 studies with 834 participants of whom were 50% women, were found to be eligible for inclusion in our systematic review. Our quantitative synthesis included 12 randomized control trials and 2 non-randomized control trials, with the follow-up period ranging from 4 to 52 weeks. Compared to controls, yoga intervention improved fasting blood glucose (FBG) [Standard Mean Difference (SMD -0.064 mg/dL (95% CI -0.201 to 0.074)]; low density lipoprotein (LDL) [SMD-0.090 mg/dL (95% CI -0.270 to 0.090)]; triglycerides [SMD -0.148 mg/dL (95% CI -0.285 to -0.012)]; total cholesterol [SMD -0.058 mg/dL (95% CI -0.220 to 0.104)] and systolic blood pressure [SMD -0.058 mm Hg (95% CI -0.168 to 0.053)]. This meta-analysis uncovered clinically improved effects of yoga intervention on glycemic control, lipid profiles and other parameters of T2DM management in prediabetic population. These results suggest that yoga intervention may be considered as a comprehensive and alternative approach to preventing T2DM. Further adequately powered, well designed RCTs are needed to support our findings and investigate the long-term effects of yoga in T2DM patients.
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Affiliation(s)
- Ramya Ramamoorthi
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Daniel Gahreman
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Timothy Skinner
- Københavns Universitet, Institut for Psykologi, Center for Sundhed og Samfund, Københavns Universitet, København K, Denmark
| | - Simon Moss
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
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Abdelmageed Marzook E, El-Bayoumy AS, Marzook FA. Preclinical evaluation of carnosine and Costus as hematological protective agents against gamma radiation. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1080/16878507.2019.1649931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Kodumuri PK, Thomas C, Jetti R, Pandey AK. Fenugreek seed extract ameliorates cognitive deficits in streptozotocin-induced diabetic rats. J Basic Clin Physiol Pharmacol 2019; 30:jbcpp-2018-0140. [PMID: 31326961 DOI: 10.1515/jbcpp-2018-0140] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 02/25/2019] [Indexed: 02/06/2023]
Abstract
Background Natural medicinal plants have been the focus of current research for developing neuroprotective agents to be used in the diabetes-linked cognitive dysfunction. Trigonella foenum-graecum seeds (known as fenugreek, methi in Hindi), is a well-known traditional medicinal herb and possesses anti-diabetic, anti-oxidant, and anti-inflammatory properties. Purpose This study was undertaken to explore the ameliorative effects of T. foenum-graecum seed extract on diabetes-induced cognitive dysfunction. Methods Experimental diabetes was induced by administering a single dose of streptozotocin (60 mg/kg) through intraperitoneal dose. Cognitive function was assessed using a T-maze and the Morris water maze. Lipid peroxidation levels and oxidative stress in the hippocampus was measured. Quantification of hippocampal CA1 and CA3 regions was done using cresyl violet stain. Results Diabetic rats demonstrated learning and memory impairment, which was evident from poor performance in behavioral tasks, i.e. T-maze and Morris water maze tasks. Learning and memory impairment in diabetic animals is associated with increased blood glucose levels, increased oxidative stress in the hippocampus and decreased number of neurons in the CA1 and CA3 regions of the hippocampus. The diabetic rats administered with T. foenum-graecum showed improved performance in behavioral tasks, and these changes were associated with decreased blood glucose levels, decreased oxidative stress in the hippocampus, and decreased neuronal loss from the CA1 and CA3 regions of the hippocampus. Conclusion In conclusion, administration of T. foenum-graecum seed extract ameliorates diabetes-linked cognitive dysfunction in rats by decreasing blood glucose levels, reducing lipid peroxidation and oxidative stress in the hippocampus, and preventing neuronal loss from the hippocampus.
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Affiliation(s)
- Praveen K Kodumuri
- Tomo Riba Institute of Health and Medical Sciences, Physiology, Old Assembly Complex,Naharlagun, India.,Department of Physiology, Varun Arjun Medical College and Rohilkand Hospital, Banthra, Shahjahanpur (Uttar Pradesh), India
| | - Christofer Thomas
- Department of Physiology, Sapthagiri Institute of Medical Science and Research Center, Bangalore, India
| | - Raghu Jetti
- Department of Basic Medical Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Anil Kumar Pandey
- ESIC Medical College, Physiology, Faridabad, India.,Department of Physiology, ESIC Medical College and Hospital, Faridabad, Haryana, India, Phone: + 91-7042918222
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[Nutrition for diabetic patients (Update 2019)]. Wien Klin Wochenschr 2019; 131:54-60. [PMID: 30980170 DOI: 10.1007/s00508-019-1470-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Evidence demonstrates that medical diabetes treatment has to be accompanied by lifestyle modifications. Structured nutrition interventions and increased physical activity will help patients to normalise, respectively maintain their body weight.The main target of a medical nutrition therapy aims at achieving normal or nearly normal blood glucose levels, prevention of delay of diabetes associated complications.
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Wound healing properties, antimicrobial and antioxidant activities of Salvia kronenburgii Rech. f. and Salvia euphratica Montbret, Aucher & Rech. f. var. euphratica on excision and incision wound models in diabetic rats. Biomed Pharmacother 2019; 111:1260-1276. [DOI: 10.1016/j.biopha.2019.01.038] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/05/2019] [Accepted: 01/09/2019] [Indexed: 01/27/2023] Open
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Ramamoorthi R, Gahreman D, Moss S, Skinner T. The effectiveness of yoga to prevent diabetes mellitus type 2: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14019. [PMID: 30653107 PMCID: PMC6370061 DOI: 10.1097/md.0000000000014019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is becoming a leading problem worldwide. Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached pandemic levels. Despite the significant incidence, there are limited reliable data resources and comprehensive systematic review and meta-analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM. OBJECTIVE The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM. METHODS The articles enrolled in the study will be retrieved from the online databases between 2002 and the date the searches are executed. The searches will be repeated just before the final analyses and further relevant studies for inclusion. We will conduct a bibliographic search in databases: Medline/PubMed, Scopus, Cochrane Library, EBSCO, and IndMED using keywords including prediabetes state, high risk for diabetes, metabolic syndrome, and yoga. A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies. This study protocol was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols 2015 guidelines. There will be no language restrictions. ETHICS AND DISSEMINATION The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee. We published an outline of the protocol in the International Prospective Register of Systematic Reviews (PROSPERO) in 2018. We plan to disseminate the findings of this systematic review and meta-analysis through publication in a peer-reviewed journal and presentation at relevant conference proceedings. In addition, we believe the results of the systematic review will have implications for policy and practice. We will prepare policymaker summary using a validated format, disseminate through social media and email discussion groups. REVIEW REGISTRATION NUMBER PROSPERO registration number CRD 42018106657.
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Affiliation(s)
- Ramya Ramamoorthi
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Daniel Gahreman
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Simon Moss
- College of Health and Human Sciences, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Timothy Skinner
- Københavns Universitet, Institut for Psykologi, Center for Sundhed og Samfund, Københavns Universitet, Øster Farimagsgade, København, Denmark
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Antihyperglycemic and Antilipidemic Effects of the Ethanol Extract Mixture of Ligularia fischeri and Momordica charantia in Type II Diabetes-Mimicking Mice. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:3468040. [PMID: 30386403 PMCID: PMC6189690 DOI: 10.1155/2018/3468040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/24/2018] [Accepted: 09/06/2018] [Indexed: 11/18/2022]
Abstract
The extract of the Momordica charantia fruit (MCE) is recognized as an alternative treatment for diabetes. The extract of Ligularia fischeri leaves (LFE) is traditionally used as a folk medicine for treating inflammatory diseases in Korea as well. In this study, we investigated the synergistic effect of MCE combined with LFE on antihyperglycemic and antihyperlipidemic potentials. Based on the α-glucosidase inhibitory effect and promotion of adipocyte differentiation in the 3T3-L1 cell line, the MLM was prepared with MCE:LFE (8:2 weight:weight). MLM showed the synergistic effects in the promotion of the glucose uptake rate, suppression of dipeptidyl peptidase-4 (DPP-4) mRNA expression, upregulation of an insulin receptor substrate and glucose transporter type-4 expression, and an increase in insulin-associated signaling in C2C12 cells. In addition, the efficacy of peroxisome proliferator-activated receptor-γ agonism and glucose uptake rate by MLM supplementation was significantly enhanced in vitro. Then, the antihyperglycemic and antihyperlipidemic effects of MCE, LFE, and MLM at the dose of 50, 100, and 200 mg/kg/day (n = 6 per each group) were determined in streptozotocin (STZ)-insulted mice fed an atherogenic diet (ATH) for 4 weeks. In addition, MLM (50, 100, and 200 mg/kg/day, n = 5 per each group) was supplemented in ATH-fed db/db mice for 10 weeks. Compared with MCE or LFE alone, MLM supplementation led to a more significant reduction of glucose levels in both STZ/ATH and db/db/ATH mice as well as lowered lipid profiles in STZ/ATH mice. In addition, the stimulation of islet of Langerhans regeneration was more pronounced by MLM supplementation in both mice models. In conclusion, antihyperglycemic and antihyperlipidemic effects were strengthened by the combined extracts of L. fischeri and M. charantia (MLM) in diabetes-mimicking mice.
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Rugerio-Escalona C, Ordaz-Pichardo C, Becerra-Martinez E, Cruz-López MDC, López-y-López VE, Mendieta-Moctezuma A, Maldonado-Mendoza IE, Jiménez-Montejo FE. "Diabetes and Metabolism Disorders Medicinal Plants: A Glance at the Past and a Look to the Future 2018": Antihyperglycemic Activity of Hamelia patens Jacq. Extracts. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:7926452. [PMID: 30224932 PMCID: PMC6129850 DOI: 10.1155/2018/7926452] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/21/2018] [Accepted: 07/31/2018] [Indexed: 12/15/2022]
Abstract
Diabetes is one the world's most widespread diseases, affecting over 327 million people and causing about 300,000 deaths annually. Despite great advances in prevention and therapy, existing treatments for this disorder have serious side effects. Plants used in traditional medicine represent a valuable source in the search for new medicinal compounds. Hamelia patens Jacq. has been used for treating diabetes and, so far, no reports have been made on the in vivo antihyperglycemic activity of this plant. The present study on H. patens aimed to test the antihyperglycemic effect of repeated administrations of the crude and fractional methanolic extracts (CME and FME, respectively) on rats with hyperglycemia induced by streptozotocin. After 10 administrations (20 days), each extract had lowered blood glucose to a normal level. The extracts produced effects similar to metformin. Of the five compounds identified by chromatographic analysis of the extracts, epicatechin and chlorogenic acid demonstrated antihyperglycemic effect. The antioxidant activity of the extracts was evidenced by their IC50 values (51.7 and 50.7 μg/mL, respectively). The LD50≥2000 mg/Kg suggests low toxicity for both CME and FME. Thus, considering that the antihyperglycemic and antioxidant effects of metformin and extracts from H. patens were comparable, the latter may be efficacious for treating diabetes.
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Affiliation(s)
- Catalina Rugerio-Escalona
- Centro de Investigación en Biotecnología Aplicada del Instituto Politécnico Nacional, Tlaxcala, Mexico
| | - Cynthia Ordaz-Pichardo
- Escuela Nacional de Medicina y Homeopatía del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Elvia Becerra-Martinez
- Centro de Nanociencias y Micro y Nanotecnología del Instituto Politécnico Nacional, Ciudad de México, Mexico
| | | | - Victor E. López-y-López
- Centro de Investigación en Biotecnología Aplicada del Instituto Politécnico Nacional, Tlaxcala, Mexico
| | - Aarón Mendieta-Moctezuma
- Centro de Investigación en Biotecnología Aplicada del Instituto Politécnico Nacional, Tlaxcala, Mexico
| | - Ignacio E. Maldonado-Mendoza
- Centro Interdisciplinario de Investigación para el Desarrollo Integral Regional, Unidad Sinaloa del Instituto Politécnico Nacional, Sinaloa, Mexico
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Zarvasi A, Jaberi AA, Bonabi TN, Tashakori M. Effect of self-acupressure on fasting blood sugar (FBS) and insulin level in type 2 diabetes patients: a randomized clinical trial. Electron Physician 2018; 10:7155-7163. [PMID: 30214697 PMCID: PMC6122868 DOI: 10.19082/7155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022] Open
Abstract
Background Uncontrolled symptoms of diabetes can lead to irreparable damage to vital organs. Despite the global trend towards the use of complementary alternative therapies, few studies have evaluated the effectiveness of self-acupressure in diabetes patients. Objective The aim of this study was to determine the effect of self-acupressure on FBS and insulin level in type 2 diabetes patients. Methods This randomized clinical trial was performed from September 2016 to February 2017. A total of 60 diabetic patients were selected from diabetes clinic in Rafsanjan in Iran, according to inclusion and exclusion criteria and then assigned to 2 groups (30 in acupressure and 30 in control) randomly by the minimization method. The intervention group received acupressure at ST-36, LIV-3, KD-3 and SP-6 points bilaterally for five minutes for each point in 10 seconds pressure and 2 seconds rest periods. Subjects in the control group received no intervention. The FBS and insulin levels were measured before and after the intervention for both groups. The data were analyzed by SPSS version 16 by the Chi-square test, independent-samples t-test, and paired-samples t-test. A level of 0.05 was considered significant for examining the hypotheses. Results There were no significant differences between the acupressure and control group regarding age, sex and level of education. The insulin level significantly increased after treatment in the acupressure group (p=0.001). There were no significant differences between the levels of insulin in study or control groups. Serum FBS level decreased significantly after intervention in the acupressure group compared to the control group (p=0.02). Conclusion Self-acupressure as a complementary alternative medicine can be a helpful complementary method in reducing FBS and increasing insulin levels in type 2 diabetic patients. Trial registration This trial was registered at the Iranian Registry of Clinical Trials with clinical trial registration number: IRCT2016122131459N1. Funding This study was financially sported by Deputy of Research and Technology of Rafsanjan University of Medical Sciences (Ref: 20.519).
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Affiliation(s)
- Asieh Zarvasi
- M.Sc. Student of Medical Surgical Nursing, Department of Medical Surgical Nursing, Students Research Commitments, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Ansari Jaberi
- M.Sc. of Psychiatric and Mental Health Nursing, Department of Psychiatric and Mental Health Nursing, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tayebeh Negahban Bonabi
- Ph.D. of Community Health Nursing, Department of Community Health Nursing, Social Determinants of Health Research Center, Faculty of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mahnaz Tashakori
- Ph.D. of Medical Biotechnology, Department of Laboratory Medicine, Faculty of Paramedical, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Experimental evaluation of a polyherbal formulation (Tetraherbs): antidiabetic efficacy in rats. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s00580-018-2755-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Candar A, Demirci H, Baran AK, Akpınar Y. The association between quality of life and complementary and alternative medicine use in patients with diabetes mellitus. Complement Ther Clin Pract 2018; 31:1-6. [DOI: 10.1016/j.ctcp.2018.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/11/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
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Butala MA, Kukkupuni SK, Venkatasubramanian P, Vishnuprasad CN. An Ayurvedic Anti-Diabetic Formulation Made from Curcuma longa
L. and Emblica officinalis
L. Inhibits α-Amylase, α-Glucosidase, and Starch Digestion, In Vitro. STARCH-STARKE 2018. [DOI: 10.1002/star.201700182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Megha A. Butala
- School of Integrative Health Sciences; Institute of Trans-Disciplinary Health Sciences and Technology (TDU); Yelahanka 560064 Bangalore India
| | - Subrahmanya K. Kukkupuni
- School of Integrative Health Sciences; Institute of Trans-Disciplinary Health Sciences and Technology (TDU); Yelahanka 560064 Bangalore India
| | - Padma Venkatasubramanian
- School of Integrative Health Sciences; Institute of Trans-Disciplinary Health Sciences and Technology (TDU); Yelahanka 560064 Bangalore India
| | - Chethala N. Vishnuprasad
- School of Integrative Health Sciences; Institute of Trans-Disciplinary Health Sciences and Technology (TDU); Yelahanka 560064 Bangalore India
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36
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Kim SK, Jung J, Jung JH, Lee BW, Kang SS, Roh GS, Hahm JR. Antidiabetic Effects of Vigna nakashimae Extract in Humans: A Preliminary Study. J Altern Complement Med 2017; 24:249-253. [PMID: 28976210 DOI: 10.1089/acm.2017.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vigna nakashimae (VN) extract has been shown to have antidiabetic and antiobesity effects in various animal studies; however, to our knowledge, no data on such effects exist in humans. METHODS We performed a randomized placebo-controlled study to investigate the antidiabetic effects of VN extract treatment for 12 weeks in humans. A total of 18 Korean patients with type 2 diabetes were enrolled in this study and were allocated randomly to either the VN extract group (1 g thrice daily) or control group (placebo tablets) for 12 weeks. We investigated blood glucose levels, body weight, lipid profiles, and adverse events after 12 weeks of treatment. Fifteen subjects were included in the final analysis. RESULTS There was no difference in age, sex, fasting glucose levels, or lipid profiles between the VN extract and control groups at baseline. However, the baseline glycosylated hemoglobin (HbA1c) levels of the control group were lower than those of the VN extract group. After treatment with VN extract for 12 weeks, the body weight and lipid profile of the VN extract group remained unchanged; however, the HbA1C levels decreased by 0.36% ± 0.33% (p = 0.027). In contrast, the HbA1C levels of the control group did not change after 12 weeks (p = 0.228). During the 12-week treatment with VN extract, no serious adverse events were reported. CONCLUSION Our data indicate that VN extract has implications for glucose lowering in type 2 diabetic patients.
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Affiliation(s)
- Soo Kyoung Kim
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea.,2 Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Jaehoon Jung
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea.,2 Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Jung Hwa Jung
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea.,2 Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Byong Won Lee
- 3 Department of Functional Crop, National Institute of Crop Science , RDA, Miryang, Korea
| | - Sang Soo Kang
- 2 Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea.,4 Department of Anatomy and Neurobiology, Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Gu Seob Roh
- 2 Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea.,4 Department of Anatomy and Neurobiology, Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Korea
| | - Jong Ryeal Hahm
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea.,2 Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Korea
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37
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Protein extract from the fruit pulp of Momordica charantia potentiate glucose uptake by up-regulating GLUT4 and AMPK. J Funct Foods 2017. [DOI: 10.1016/j.jff.2017.08.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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38
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Farzaei F, Morovati MR, Farjadmand F, Farzaei MH. A Mechanistic Review on Medicinal Plants Used for Diabetes Mellitus in Traditional Persian Medicine. J Evid Based Complementary Altern Med 2017; 22:944-955. [PMID: 29228789 PMCID: PMC5871259 DOI: 10.1177/2156587216686461] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/23/2016] [Accepted: 11/21/2016] [Indexed: 12/16/2022] Open
Abstract
Diabetes mellitus is the most common endocrine disorder and a major cause of morbidity and mortality. Traditional medicines worldwide suggest a wide range of natural remedies for the prevention and treatment of chronic disorders, including diabetes mellitus. This mechanistic review aims to highlight the significance of medicinal plants traditionally used as dietary supplements in Persian medicine in adjunct with restricted conventional drugs for the prevention and treatment of diabetes mellitus. Mounting evidence suggests that these natural agents perform their protective and therapeutic effect on diabetes mellitus via several cellular mechanisms, including regeneration of pancreatic β cell, limitation of glycogen degradation and gluconeogenesis, anti-inflammatory, immunoregulatory, antiapoptosis, antioxidative stress, as well as modulation of intracellular signaling transduction pathways. In conclusion, traditional medicinal plants used in Persian medicine can be considered as dietary supplements with therapeutic potential for diabetes mellitus and maybe potential sources of new orally active agent(s).
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Affiliation(s)
- Fatemeh Farzaei
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Universal Scientific Education and Research Network (USERN), Kermanshah, Iran
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Abstract
OPINION STATEMENT Diabetes mellitus (DM) and its associated complications are becoming increasingly prevalent. Gastrointestinal symptoms associated with diabetes is known as diabetic enteropathy (DE) and may manifest as either diarrhea, fecal incontinence, constipation, dyspepsia, nausea, and vomiting or a combination of symptoms. The long-held belief that vagal autonomic neuropathy is the primary cause of DE has recently been challenged by newer theories of disease development. Specifically, hyperglycemia and the resulting oxidative stress on neural networks, including the nitrergic neurons and interstitial cells of Cajal (ICC), are now believed to play a central role in the development of DE. DE occurs in the majority of patients with diabetes; however, tools for early diagnosis and targeted therapy to counter the detrimental and potentially irreversible effects on the small bowel are lacking. Delay in diagnosis is further compounded by the fact that DE symptoms overlap with those of gastroparesis or can be confused with side effects from diabetes medications. Still, early recognition of the presence of DE is essential to mitigating symptoms and preventing further progression of complications including dysmotility and malabsorption. Current diagnostic modalities include manometry, wireless motility capsule (SmartPill™), and scintigraphy; however, these are not regularly utilized in clinical practice due to limited availability. Several medications are available for symptom relief in DE patients including rifaximin for small intestinal bacterial overgrowth (SIBO) and somatostatin analogues for diarrhea. While rodent models on stem cell therapy and alteration of the microbiome are promising, there is still a great need for further research on the pathologic underpinnings and development of novel treatment modalities for DE.
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Affiliation(s)
- Jonathan Gotfried
- Temple University Digestive Disease Center, Temple University Hospital, Philadelphia, PA, USA
| | - Stephen Priest
- Temple University Lewis Katz School of Medicine at Temple University & Temple University Health System, Philadelphia, PA, USA
| | - Ron Schey
- Temple University Digestive Disease Center, Temple University Hospital, Philadelphia, PA, USA. .,Temple University Lewis Katz School of Medicine at Temple University & Temple University Health System, Philadelphia, PA, USA.
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40
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Putthapiban P, Sukhumthammarat W, Sriphrapradang C. Concealed use of herbal and dietary supplements among Thai patients with type 2 diabetes mellitus. J Diabetes Metab Disord 2017; 16:36. [PMID: 28852643 PMCID: PMC5569552 DOI: 10.1186/s40200-017-0317-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/16/2017] [Indexed: 12/29/2022]
Abstract
Background Diabetes mellitus (DM) has been one of the most common chronic diseases that create great impacts on both morbidities and mortalities. Many patients who suffering from this disease seek for complementary and alternative medicine. The aim of this study was to determine the prevalence and related factors of herbal and dietary supplement (HDS) use in patients with DM type 2 at a single university hospital in Thailand. Methods A cross-sectional study was performed in 200 type 2 DM patients via face-to-face structured interviews using developed questionnaires comprised of demographic data, diabetes-specific information, details on HDS use, and medical adherence. Results From the endocrinology clinic, 61% of total patients reported HDS exposure and 28% were currently consuming. More than two-thirds of HDS users did not notify their physicians, mainly because of a lack of doctor concern; 73% of cases had no awareness of potential drug-herb interaction. The use of drumstick tree, turmeric and bitter gourd and holy mushroom were most frequently reported. The main reasons for HDS use were friend and relative suggestions and social media. Comparisons of demographic characteristics, medical adherence, and hemoglobin A1c among these non-HDS users, as well as current and former users, were not statistically significantly different. Conclusions This study revealed a great number of DM patients interested in HDS use. The use of HDS for glycemic control is an emerging public health concern given the potential adverse effects, drug interactions and benefits associated with its use. Health care professionals should aware of HDS use and hence incorporate this aspect into the clinical practice. Electronic supplementary material The online version of this article (doi:10.1186/s40200-017-0317-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Prapaipan Putthapiban
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road Bangkok, Bangkok, 10400 Thailand.,Faculty of Science, Mahidol University, Bangkok, 10400 Thailand
| | - Weera Sukhumthammarat
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road Bangkok, Bangkok, 10400 Thailand.,Faculty of Dentistry, Mahidol University, Bangkok, 10400 Thailand
| | - Chutintorn Sriphrapradang
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road Bangkok, Bangkok, 10400 Thailand
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41
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Necyk C, Zubach-Cassano L. Natural Health Products and Diabetes: A Practical Review. Can J Diabetes 2017; 41:642-647. [PMID: 28826695 DOI: 10.1016/j.jcjd.2017.06.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 11/30/2022]
Abstract
The prevalence of natural health product (NHP) use in Canada is extensive. Patients with chronic diseases, including diabetes, use NHPs at a higher rate than the general population. Many NHPs exert hypoglycemic effects, among other effects relevant to diabetes management. To provide a practical, clinical review of NHPs with such effects targeted to pharmacists, a literature search was performed to collect data on the efficacy and safety profiles of 10 commonly used NHPs that exert antidiabetic properties. The following NHPs are included in this clinical review: alpha-lipoic acid, chromium, magnesium, bitter melon, cinnamon, fenugreek, gymnema, milk thistle, Reishi mushroom and white mulberry. Given the potential of NHPs to additively cause hypoglycemia when used concurrently with conventional medications, pharmacists should be up to date with current evidence around NHPs that may affect diabetes care to prevent adverse reactions and interactions. In addition, effective and respectful communication with patients around NHP use and collaboration with various health-care providers are essential in the patient care process.
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Affiliation(s)
- Candace Necyk
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
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42
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Sridhar SB, Shariff A, Al Halabi N, Sarmini R, Harb LA. Assessment of Perception, Experience, and Information-seeking Behavior of the Public of Ras Al-Khaimah, United Arab Emirates, Toward Usage and Safety of Complementary and Alternative Medicine. J Pharm Bioallied Sci 2017; 9:48-55. [PMID: 28584493 PMCID: PMC5450470 DOI: 10.4103/jpbs.jpbs_337_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AIMS AND OBJECTIVES This study was conducted to identify the different types of complementary and alternative medicine (CAM) used, reasons for the use of CAM, and the perceptions, experience, and information seeking-behavior toward usage and safety of CAM by the general public of Ras Al-Khaimah, UAE. MATERIALS AND METHODS This was a prospective cross-sectional study. A validated, self-administered, or interviewer-assisted survey questionnaire was used to collect the data. Data from 403 respondents satisfying inclusion criteria were collected and were analyzed using the Statistical Package for the Social Sciences version 24.0. RESULTS A majority of the respondents (218 [54.1%]) were females. The most commonly (210 [52.1%]) used CAM among the study respondents was herbal medicine. A total of 91 (22.6%) of the survey respondents mentioned that they receive conventional medications along with their CAM. Majority (213 [52.9%]) of the survey respondents opted for CAM to prevent illness. Good number (208 [51.6%]) of the survey respondents mentioned that CAM usage was beneficial in improving their health condition, and they (216 [53.6%]) do believe it as safe and effective. However, a small group (26 [6%]) of respondents reported side effects or complications with the use of CAM. CONCLUSION Widespread use of CAM for different medical problems was evident in our study. Although majority of the CAM users believe it as safe and effective, CAM usage should be discussed with the health-care providers to understand the safety issues involved in the use of majority of CAM.
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Affiliation(s)
- Sathvik Belagodu Sridhar
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Atiqulla Shariff
- Department of Clinical Pharmacy and Pharmacology, RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Nour Al Halabi
- RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Rand Sarmini
- RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
| | - Lubab Arkan Harb
- RAK College of Pharmaceutical Sciences, RAK Medical and Health Sciences University, Ras Al-Khaimah, UAE
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43
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A review of the evidence for alternative and complementary medical approaches in the prevention of atherosclerotic cardiovascular disease and diabetes. Cardiovasc Endocrinol 2017; 6:39-43. [PMID: 31646118 DOI: 10.1097/xce.0000000000000118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 01/19/2017] [Indexed: 11/25/2022] Open
Abstract
The use of complementary and alternative medicine approaches has increased in the recent years. It has been utilized in both the treatment and prevention of many chronic diseases, especially in the management of hypertension, diabetes, and hyperlipidemia. Lifestyle modifications play a fundamental role in alternative and complementary medicine. Regular exercise, maintenance of optimal weight, and a healthful diet play vital roles in maintaining ideal health. Specifically, the Dietary Approaches to Stop Hypertension and Mediterranean diets have been established as having beneficial effects on blood pressure and cholesterol and even cardiovascular outcomes. Still, additional supplements including fish oil, CoQ10, and red yeast rice (among others) have shown promising beneficial effects. Unfortunately, many of the beneficial claims of natural products are not scientifically proven, lack reproducibility, and/or yield conflicting results. Until more concrete evidence can be produced, it is important for physicians and patients alike to familiarize themselves with these natural products and increase their awareness of any potential adverse effects.
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44
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Kesavadev J, Saboo B, Sadikot S, Das AK, Joshi S, Chawla R, Thacker H, Shankar A, Ramachandran L, Kalra S. Unproven Therapies for Diabetes and Their Implications. Adv Ther 2017; 34:60-77. [PMID: 27864668 PMCID: PMC5216071 DOI: 10.1007/s12325-016-0439-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 12/11/2022]
Abstract
Diabetes is a chronic disease and is one of the leading causes of morbidity and mortality worldwide. Being an ancient disease, many individuals follow complementary and alternative medicinal (CAM) therapies for either the cure or prevention of the disease. The popularity of these practices among the general public is in no way a testimony to their safety and efficacy. Due to the possibility of undesirable interactions with conventional medicines, it is imperative that patients are asked about CAM use during patient assessment. Patient- and physician-targeted awareness programs on various aspects of CAM use must be initiated to create a better understanding of evidence-based use of these practices. In addition, there should be guidelines in place based on clinical trial outcomes, and stricter regulations need to be enforced on CAM practices to ensure their safety and effectiveness.
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Affiliation(s)
| | - Banshi Saboo
- Dia Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Shaukat Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology, Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Hemant Thacker
- Department of Endocrinology, Bhatia Hospital, Mumbai, India
| | - Arun Shankar
- Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharati Hospital, Karnal, Haryana, India
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45
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Sheikhrabori A, Dehghan M, Ghaedi F, Khademi GR. Complementary and Alternative Medicine Usage and Its Determinant Factors Among Diabetic Patients: An Iranian Case. J Evid Based Complementary Altern Med 2016; 22:449-454. [PMID: 27821612 PMCID: PMC5871159 DOI: 10.1177/2156587216675079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Although modern treatments have achieved much progress in blood sugar control in recent decades, evidences indicate that complementary and alternative treatments are very common in diabetic patients. The present study aims to investigate application of complementary and traditional medicines among diabetic patients in Iran in 2016. This was a cross-sectional study done on 294 diabetic patients who were referred to the diabetes clinic and were chosen using convenient sampling. Data were gathered using a demographic characteristics form and a researcher-made questionnaire (for studying application and satisfaction of using some of the complementary and alternative medicines). A total of 88.4% of diabetic patients have used at least one complementary and alternative treatment in the past year. The most common treatment was medicinal plants, which were used by 84.9% of the participants. Sixty-nine percent of the patients were satisfied with using complementary and traditional treatments. This study showed that diabetic patients are very interested in using complementary and alternative medicine.
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Affiliation(s)
- Akbar Sheikhrabori
- 1 School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mahlagha Dehghan
- 2 Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Fateme Ghaedi
- 3 School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholam Reza Khademi
- 4 Department of Prehospital Emergency, Kerman University of Medical Sciences, Kerman, Iran
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46
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Fattahi A, Niyazi F, Shahbazi B, Farzaei MH, Bahrami G. Antidiabetic Mechanisms of Rosa canina Fruits: An In Vitro Evaluation. J Evid Based Complementary Altern Med 2016; 22:127-133. [PMID: 27352916 DOI: 10.1177/2156587216655263] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 04/13/2016] [Accepted: 04/24/2016] [Indexed: 11/15/2022] Open
Abstract
Rosa canina fruits have been used traditionally for the treatment of diabetes mellitus and its complications. The aim of current study was to evaluate the in vitro mechanism of action of R canina in managing diabetes mellitus. Cell proliferation and cytotoxicity assay were performed on pancreatic β-cells, βTC6. The protective activity of the extract on streptozotocin-induced death in βTC6 cells was studied. The effect of R canina on the metabolism of glucose in HepG2, a hepatocellular carcinoma cell line, was evaluated. The effect of the extract on glucose diffusion across the dialysis membrane, which is a comfortable model for assessing cellular glucose absorption, was evaluated. The results obtained from current study confirmed that R canina extract can act as a growth factor for pancreatic β-cell line providing a novel mechanism for the observed antidiabetic effect of this natural agent. Further preclinical studies are necessary to evaluate the perfect mechanism of action of R canina in diabetes mellitus.
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Affiliation(s)
- Ali Fattahi
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Fatemeh Niyazi
- Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Shahbazi
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Gholamreza Bahrami
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran .,Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
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47
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Schindler K, Brix J, Dämon S, Hoppichler F, Kruschitz R, Toplak H, Ludvik B. [Nutrition for diabetic patients]. Wien Klin Wochenschr 2016; 128 Suppl 2:S131-6. [PMID: 27052240 DOI: 10.1007/s00508-015-0926-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Evidence demonstrates that medical diabetes treatment has to be accompanied by lifestyle modifications. Structured nutrition interventions and increased physical activity will help patients to normalise, respectively maintain their body weight. The main target of a diabetes therapy is aimed at achieving normal or nearly normal blood glucose levels. Reaching this goal may be facilitated by the following nutritional patterns: Using mainly carbohydrates from vegetables, whole grains, legumes and fruits, Restriction of mono- and disaccharides are often important factors in normalising body weight and blood glucose, Reduction of dietary fat could be indicated. However, the primary goal is the limitation of saturated fatty acids which to high percentage are consumed with animal products. There is not sufficient evidence to recommend a dietary protein consumption of more than 20% of energy intake. Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements. Natural food sources should be preferred.
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Affiliation(s)
- Karin Schindler
- Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich.
| | - Johanna Brix
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | | | - Friedrich Hoppichler
- Abteilung für Innere Medizin, Krankenhaus der Barmherzigen Brüder Salzburg, Salzburg, Österreich.,SIPCAN Institut, Salzburg, Österreich
| | - Renate Kruschitz
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
| | - Hermann Toplak
- Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Bernhard Ludvik
- Medizinische Abteilung mit Diabetologie, Endokrinologie und Nephrologie, Krankenanstalt Rudolfstiftung, Wien, Österreich
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48
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Crawford P, Thai C, Obholz J, Schievenin J, True M, Shah SA, Hallgren J, Clark J, Sharon D. Assessment of the effeCt of lIfestyle iNtervention plus water-soluble ciNnAMon extract On loweriNg blood glucose in pre-diabetics, a randomized, double-blind, multicenter, placebo controlled trial: study protocol for a randomized controlled trial. Trials 2016; 17:9. [PMID: 26732017 PMCID: PMC4702386 DOI: 10.1186/s13063-015-1138-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/21/2015] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The World Health Organization predicts that by 2030 diabetes will be the seventh leading cause of death in the world. Multiple studies have tried to determine if cinnamon is an effective treatment for diabetes. Cinnamon extract is an insulin sensitizer, protects mesangial cells, decreases inflammatory markers, and lowers glucose, lipids, and blood pressure in patients with type 2 diabetes, so we developed a protocol to study whether ingestion of water-soluble cinnamon extract prevents progression from pre-diabetes to diabetes. METHODS/DESIGN This is a randomized, double-blind, placebo-controlled trial comparing cinnamon extract versus placebo in subjects with pre-diabetes who have committed to participate in a lifestyle change program. The trial will be conducted at five sites and will include 428 subjects who take cinnamon extract or placebo for 1 year. Follow-up for these subjects will be for a total of 2 years (nine study visits). The primary outcomes to be assessed are 1) conversion of patients from pre-diabetes to diabetes and 2) impact of water-soluble cinnamon extract on hepatic transaminases, renal function, and QT interval on electrocardiogram. Secondary outcomes include changes in HbA1c, lipids, waist circumference, weight, blood pressure, and fasting plasma glucose. The trial protocol has been approved by the Institutional Review Board of the US Air Force 59th Medical Wing, Wilford Hall Ambulatory Surgical Center (Protocol FWH20110035H). Investigator-sponsored Investigational New Drug status (114078) was granted by the US Food and Drug Administration. DISCUSSION This study will provide high-quality evidence of the efficacy of water-soluble cinnamon extract in conjunction with lifestyle intervention for preventing patients with pre-diabetes from converting to diabetes. Additionally, it will provide important safety information about water-soluble cinnamon extract. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01301521 , 18 February 2011.
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Affiliation(s)
- Paul Crawford
- Nellis Family Medicine Residency, 4700 Las Vegas Blvd N, Las Vegas, NV, 89191, USA.
| | - Chuong Thai
- Eglin AFB Family Medicine Residency, 307 Boatner Rd, Suite 114, Eglin AFB, FL, 32542, USA.
| | - Joshua Obholz
- Eglin AFB Family Medicine Residency, 307 Boatner Rd, Suite 114, Eglin AFB, FL, 32542, USA.
| | - Jeffrey Schievenin
- Eglin AFB Family Medicine Residency, 307 Boatner Rd, Suite 114, Eglin AFB, FL, 32542, USA.
| | - Mark True
- Air Force Endocrinology Fellowship, Brooke Army Medical Center, 3551 Roger Brooke Dr, JBSA - Fort Sam Houston, TX, 78234, USA.
| | - Sachin A Shah
- Pharmacy Practice, University of the Pacific, Vacaville, CA, USA.
| | - John Hallgren
- 55MDOS, 2501 Capehart Road, Offutt AFB, NE, 68113, USA.
| | - Jill Clark
- Nellis Clinical Investigation Program, 4700 Las Vegas Blvd N, Las Vegas, NV, 89191, USA.
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Moravej H, Salehi A, Shamsedini A, Kolouri S, Karamizadeh Z. Complementary and Alternative Medicine to Treat Diabetes Mellitus Type 1 in Southern Iran. IRANIAN JOURNAL OF MEDICAL SCIENCES 2016; 41:71-2. [PMID: 26722150 PMCID: PMC4691275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Hossein Moravej
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Hossein Moravej, MD; Department of Pediatrics, Nemazee Hospital, Shiraz, Iran Tel: +98 917 1058371 Fax: +98 71 36474298
| | - Alireza Salehi
- Research center for Traditional Medicine and history of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Shamsedini
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sepideh Kolouri
- Research center for Traditional Medicine and history of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohreh Karamizadeh
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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