Role of Fenugreek in the prevention of type 2 diabetes mellitus in prediabetes

Antidiabetic potential of fenugreek (Trigonella foenum-graecum): A magic herb for diabetes mellitus

Fenugreek (Trigonella foenum-graecum) is a widely grown dietary herb in Asia, and its seeds are traditionally used for several diseases, including diabetes. The seeds and leaves possess a variety of compounds that play an important role in regulating their hypoglycemic effect. However, so far, no extensive systematic review exists on its antidiabetic effect, highlighting the molecular mechanisms and isolated compounds. The purpose of this review is to summarize the preclinical and clinical antidiabetic properties of fenugreek and its isolated compounds by focusing on underlying mechanisms. PubMed, Google Scholar, Science Direct, and Scopus databases were searched to retrieve articles until June, 2024. Preclinical studies demonstrated that the antidiabetic effect of fenugreek was mostly associated with enhanced glucose transporter type-4 (GLUT4) translocation and hexokinase activity, decreased glucose-6-phosphatase and fructose-1,6-bisphosphatase activities, inhibited α-amylase and maltase activities, protected β cells, and increased insulin release. Furthermore, few studies have reported its role as a glucagon-like peptide-1 (GLP-1) modulator, 5'-AMP-activated kinase (AMPK) activator, and dipeptidyl peptidase-IV (DPP-IV) inhibitor. Further clinical trials showed that fenugreek seeds improved blood glucose levels, insulin resistance, insulin sensitivity, and lipid profiles. This study highlights significant evidence of the antidiabetic effect of fenugreek and its isolated compounds; therefore, it could be a potential therapy for diabetes.

The effect of Fenugreek seed dry extract supplement on glycemic indices, lipid profile, and prooxidant-antioxidant balance in patients with type 2 diabetes: A double-blind randomized clinical trial

Introduction

This study aims to determine the effects of fenugreek seed dry extract (FDE) on the glycemic indices, lipid profile, and prooxidant-antioxidant balance (PAB) in patients with type 2 diabetes (T2D).

Methods

A double-blind randomized clinical trial was carried out on 54 individuals with T2D. Participants were randomly assigned to a FDE group (received 3 tablets containing 335 mg of FDE daily for 8 weeks) or a placebo group (received tablets containing microcrystalline cellulose). Anthropometric indices, physical activity, diet, fasting blood sugar (FBS), serum insulin, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein (HDL-C), and PAB were assessed.

Results

An eight-week intake of 3 tablets containing 335 mg of FDE decreased serum insulin (P=0.016, P<0.001), HOMA-IR (P=0.009, P<0.001), TG (P<0.001, P=0.001), and PAB (P<0.001, P<0.001) compared to the baseline, in both placebo and intervention groups respectively. TC decreased significantly compared to the baseline in the placebo group (P=0.028), while HDL-C increased in the FDE group compared to the baseline (P<0.001) and placebo group (P=0.014).

Conclusion

In the present study even though changes of parameters were more in intervention group compared to the control group, we did not observe any significant differences between studied groups except for HDL-C. However, the effects might become apparent with a higher dosage, longer study duration, or a larger sample size compared to the placebo group. Further clinical trials are needed in this regard.

The Role of Fenugreek in the Management of Type 2 Diabetes

The number of people diagnosed with type 2 diabetes is on the increase worldwide. Of growing concern, the prevalence of type 2 diabetes in children and youths is increasing rapidly and mirrors the increasing burden of childhood obesity. There are many risk factors associated with the condition; some are due to lifestyle, but many are beyond our control, such as genetics. There is an urgent need to develop better therapeutics for the prevention and management of this complex condition since current medications often cause unwanted side effects, and poorly managed diabetes can result in the onset of related comorbidities. Naturally derived compounds have gained momentum for preventing and managing several complex conditions, including type 2 diabetes. Here, we provide an update on the benefits and limitations of fenugreek and its components as a therapeutic for type 2 diabetes, including its bioavailability and interaction with the microbiome.

A randomized double blind placebo controlled trial to assess the safety and efficacy of a patented fenugreek (Trigonella foenum-graecum) seed extract in Type 2 diabetics

Background

Fenugreek plant (Trigonella foenum-graecum) constitutes a traditionally acclaimed herbal remedy for many human ailments including diabetes, obesity, neurodegenerative diseases, and reproductive disorders. It is also used as an effective anti-oxidative, anti-inflammatory, antibacterial, and anti-fungal agent. The seed of the plant is especially enriched in several bioactive molecules including polyphenols, saponins, alkaloids, and flavonoids and has demonstrated potential to act as an antidiabetic phytotherapeutic. A novel patented formulation (Fenfuro®) was developed in our laboratory from the fenugreek seeds which contained >45% furostanolic saponins (HPLC).

Objective

A placebo-controlled clinical compliance study was designed to assess the effects of complementing Fenfuro® on a randomized group of human volunteers on antidiabetic therapy (Metformin and sulphonylurea) in controlling the glycemic index along with simultaneous safety assessment.

Study methodology and trial design

In a randomized double-blind, placebo-controlled trial, 42 individuals (21 male and 21 female volunteers) in the treatment group (out of 57 enrolled) and 39 individuals (17 male and 22 female volunteers) in the placebo group (out of 47 enrolled), all on antidiabetic therapy with Metformin/Metformin with sulphonyl urea within the age group of 18-65 years were administered either 1,000 mg (500 mg × 2) (Fenfuro®) capsules or placebo over a period of 12 consecutive weeks. Fasting and postprandial glucose along with glycated hemoglobin were determined as primary outcomes to assess the antidiabetic potential of the formulation. Moreover, in order to evaluate the safety of the formulation, C-peptide and Thyroid Stimulating Hormone (TSH) levels as well as immunohematological parameters were assessed between the treatment and placebo groups at the completion of the study.

Results

After 12 weeks of administration, both fasting as well as postprandial serum glucose levels decreased by 38 and 44% respectively in the treatment group. Simultaneously, a significant reduction in glycated hemoglobin by about 34.7% was also noted. The formulation did not have any adverse effect on the study subjects as there was no significant change in C- peptide level and TSH level; liver, kidney, and cardiovascular function was also found to be normal as assessed by serum levels of key immunohematological parameters. No adverse events were reported.

Conclusion

This clinical compliance study re-instated and established the safety and efficacy of Fenfuro® as an effective phytotherapeutic to treat hyperglycemia.

Enhancing glycaemic control and promoting cardiovascular health: the therapeutic potential of Trigonella foenumgraecum in diabetic patients - a systematic review and meta-analysis

Background

The antidiabetic potential of fenugreek has been highlighted in past literature, and various in-vitro and in-vivo studies have validated its glucose-lowering effects; however, very limited data are available on its effects on diabetic patients.

Objective

An updated systematic review and meta-analysis of randomized control trials that assessed patients who were administered fenugreek.

Methods

The PRISMA guidelines (Supplemental Digital Content 1, http://links.lww.com/MS9/A361) were followed when conducting this meta-analysis. PubMed, Scopus, Google Scholar and MEDLINE were searched from inception until June 2023, for randomized control trials that compared fenugreek with control in patients with type 2 diabetes mellitus (DM) and reported the following outcomes of interest: fasting blood glucose, glycated haemoglobin A1c (HbA1c) and postprandial glucose levels. The findings were presented as mean difference (MD) with 95% confidence intervals (CIs) and were pooled using a random effects model.

Results

Fenugreek significantly (P<0.001) reduced the fasting blood sugar (FBS), HbA1c levels and postprandial glucose levels in diabetic patients when compared to the control.

Conclusion

Among patients with type 2 DM, our comparisons demonstrated a reduction in FBS, HbA1c levels and postprandial glucose levels with the administration of fenugreek seed at 2-5 mg dose in powder form.

Fenugreek derived diosgenin as an emerging source for diabetic therapy

Diabetes is a chronic metabolic disease that endangers the entire body's tissues and organs. Diabetes impairs glucose and insulin regulation in the human body by causing pancreatic cell damage. Diabetes modifies pathways such as serine/threonine protein kinase (Akt) and Protein kinase C (PKC)/- glucose transporter 4 (GLUT4), peroxisome proliferator-activated receptor (PPAR) glucose absorption, and inhibits α-amylase and α-glucosidase, Sodium/glucose cotransporter 1 (SGLT-1), and Na+-K+-ATPase activity. Diabetes may also be caused by a decrease in the expression of sterol regulatory element binding protein 1 (SREBP-1) and its target genes, fatty acid synthase (FAS), stearoyl-CoA desaturase-1 (SCD-1), and acetyl-CoA carboxylase α (ACC), as well as a decrease in the levels of C/EBP homologous protein (CHOP), Caspase12, and Caspase3 proteins. Diabetes has long been linked to diseases of the cardiovascular, nervous, skeletal, reproductive, hepatic, ocular, and renal systems. Diosgenin, a steroidal compound derived from fenugreek, aids in the prevention of diabetes by altering cellular pathways in favor of healthy bodily functions. Diosgenin is a new nutraceutical on the market that claims to cure diabetes in particular. This article focuses on diosgenin extraction and purification, fenugreek bioactive compounds, pharmacological properties of diosgenin, mode of action of diosgenin to cure diabetes, and dosages.

A Placebo-Controlled, Double-Blind Clinical Investigation to Evaluate the Efficacy of a Patented Trigonella foenum-graecum Seed Extract "Fenfuro®" in Type 2 Diabetics

BACKGROUND

Trigonella foenum-graecum (Fenugreek) is an extensively researched phytotherapeutic for the management of Type 2 diabetes without any associated side effects. The major anti-diabetic bioactive constituents present in the plant are furostanolic saponins, which are more abundantly available in the seed of the plant. However, the bioavailability of these components depends on the method of extraction and hence formulation of the phytotherapeutic constitutes a critical step for its success.

OBJECTIVE

The present study reports the efficacy of a novel, patented fenugreek seed extract, Fenfuro®, containing significant amount of furostanolic saponins, in an open-labelled, two-armed, single centric study on a group of 204 patients with Type 2 diabetes mellitus over a period of twelve consecutive weeks.

RESULTS

Administration of Fenfuro® in the dosage of 500 mg twice daily along with metformin and/or sulfonylurea-based prescribed antidiabetic drug resulted in a reduction of post-prandial glucose by more than 33% along with significant reduction in fasting glucose, both of which were greater than what resulted for the patient group receiving only Metformin and/or Sulfonylurea therapy. Fenfuro® also resulted in reduction in mean baseline HOMA index from 4.27 to 3.765, indicating restoration of insulin sensitivity which was also supported by a significant decrease in serum insulin levels by >10% as well as slight reduction in the levels of C-peptide. However, in the case of the Metformin and/or Sulfonylurea group, insulin levels were found to increase by more than 14%, which clearly indicated that drug-induced suppression of glucose levels instead of restoration of glucose homeostasis. Administration of the formulation was also found to be free from any adverse side effects as there were no changes in hematological profile, liver function and renal function.

CONCLUSION

The study demonstrated the promising potential of this novel phytotherapeutic, Fenfuro®, in long-term holistic management of type-2 diabetes.

From Gut to Glucose: A Comprehensive Review on Functional Foods and Dietary Interventions for Diabetes Management

BACKGROUND

In the realm of diabetes research, considerable attention has been directed toward elucidating the intricate interplay between the gastrointestinal tract and glucose regulation. The gastrointestinal tract, once exclusively considered for its role in digestion and nutrient assimilation, is presently acknowledged as a multifaceted ecosystem with regulatory supremacy over metabolic homeostasis and glucose metabolism. Recent studies indicate that alterations in the composition and functionality of the gut microbiota could potentially influence the regulation of glucose levels and glucose homeostasis in the body. Dysbiosis, characterized by perturbations in the equilibrium of gut microbial constituents, has been irrevocably linked to an augmented risk of diabetes mellitus (DM). Moreover, research has revealed the potential influence of the gut microbiota on important factors, like inflammation and insulin sensitivity, which are key contributors to the onset and progression of diabetes. The key protagonists implicated in the regulation of glucose encompass the gut bacteria, gut barrier integrity, and the gut-brain axis. A viable approach to enhance glycemic control while concurrently mitigating the burden of comorbidities associated with diabetes resides in the strategic manipulation of the gut environment through adapted dietary practices.

OBJECTIVE

This review aimed to provide a deep understanding of the complex relationship between gut health, glucose metabolism, and diabetes treatment.

CONCLUSION

This study has presented an exhaustive overview of dietary therapies and functional foods that have undergone extensive research to explore their potential advantages in the management of diabetes. It looks into the role of gut health in glucose regulation, discusses the impact of different dietary elements on the course of diabetes, and evaluates how well functional foods can help with glycemic control. Furthermore, it investigates the mechanistic aspects of these therapies, including their influence on insulin sensitivity, β-cell activity, and inflammation. It deliberates on the limitations and potential prospects associated with integrating functional foods into personalized approaches to diabetes care.

An Overview of Pharmaceutical Care in Type II Diabetes Mellitus Patients: Current Position and Prospects

Diabetes mellitus is an ongoing disease that is related to a high mortality rate due to severe complications. Diabetes mellitus type 2 (DMT2) is a persistent metabolic deficiency and its prevalence has been increasing consistently worldwide. As a result, it is rapidly turning into a plague in some parts of the world, and the number of people affected is expected to double in the following decade due to an increase in the maturing populace, adding to the overall existing importance for medical service providers, particularly in the underdeveloped nations. Extensive diabetes care is an intricate task that takes a whole group of medical care experts, including drug specialists, to provide multidisciplinary care for the patients. The duty of drug experts has changed significantly in recent years, changing from conventional drug dispensing in the drug store to patient- centered clinical support services. Upgrading the medication treatment to accomplish better remedial results without causing drug-related issues has been considered the essential objective of treatment for diabetic patients. This review discusses the healthcare needs of patients with T2DM, the current evidence for the role of pharmacists in diabetes care, and insight into the upcoming role of pharmacists in its management. The advanced role of clinical pharmacists in diabetes control through drug treatment, diabetes care centers, and diabetes health counselor schooling, is also discussed in this review.

Application of natural compounds in the treatment and prevention of prediabetes

Prediabetes is an intermediate stage in the development of type 2 diabetes mellitus characterized by impaired fasting glucose and/or impaired glucose tolerance. Prediabetes generally has no obvious clinical symptoms, and most patients are found in health examinations or due to other diseases. Reactive hypoglycemia may indicate the possibility of early diabetes. Without effective preventive measures, prediabetes can progress to diabetes leading to serious public health problems. Therefore, early diagnosis and intervention are important. Many animal experiments and clinical trials have proven that natural compounds substantially improve glucose metabolism disorder. The active ingredients are mainly alkaloids, polysaccharides, saponins, terpenoids, flavonoids and polyphenols. Their mechanism of action mainly involves improved insulin sensitivity and insulin resistance, inhibited activity of alpha-glucosidase, antioxidant activity, anti-inflammatory, regulation of gut microbiota and activating of peroxisome proliferator-activated receptor-γ. This paper reviews the mechanisms of action of natural compounds on prediabetes and the status of related research.

A randomized, controlled, comparative, proof-of-concept study to evaluate the efficacy and safety of Nisha-Amalaki capsules in prediabetic patients for preventing progression to diabetes

BACKGROUND

Prediabetes is an intermediate state of hyperglycemia, which acts as a precursor to Diabetes mellitus if left untreated. Nisha (Curcuma longa) and Amalaki (Emblica officinalis) combination has been advocated as drugs of choice to treat the early manifestations of Diabetes mellitus.

OBJECTIVE

This prospective, randomized, single-blind, placebo-controlled, comparative study was planned to assess the efficacy and safety of Nisha-Amalaki capsules in preventing progression to Diabetes mellitus in prediabetic patients when administered for 6 months.

METHODS

The study was conducted on prediabetic participants randomized to receive either Nisha-Amalaki (500 mg) or placebo one capsule twice a day for six months. The effect of study medications on IDRS (Indian Diabetes Risk Score), BMI (Body Mass Index), blood sugar, serum insulin, HOMA-IR (Homeostasis Model Assessment-Estimated Insulin Resistance), HbA1c (glycated hemoglobin), oxidative markers, Ayurvedic symptoms and Quality of Life (QoL) scores was assessed at regular intervals.

RESULTS

58 of the 62 participants enrolled completed the study. Significant fall in IDRS score [p < 0.001], BMI [p < 0.001], fasting, and 2 h post-OGTT sugar, insulin, HbA1c, HOMA-IR, and oxidative stress markers [p < 0.001] was observed in patients receiving Nisha-Amalaki at 6 months. Ayurvedic symptoms and QoL scores also improved at 6 months in the treatment group.

CONCLUSION

Treatment with Nisha-Amalaki capsules improved all study parameters including insulin sensitivity at 6 months as compared to placebo in prediabetic patients. Thus Nisha-Amalaki should be considered as prophylactic therapy in prediabetics to delay progression to diabetes.

The Effect of Fenugreek in Type 2 Diabetes and Prediabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Fenugreek is a widely used herbal medicine as a complementary therapy for diabetes mellitus. Lots of clinical trials have proved its beneficial effect on glycemic control parameters and lipid profiles. Thus, we conducted a systematic review and meta-analysis to evaluate the effectiveness and safety of fenugreek as a treatment for type 2 diabetes mellitus. We searched PubMed, Embase, Cochrane, China Knowledge Resource Integrated Database (CNKI), Korean studies Information Service System (KISS), Research Information Sharing Service (RISS), and ScienceON to select RCTs which used fenugreek targeting hyperglycemia with a control group. We used either a random effect model or a fixed model in a meta-analysis of Fasting blood glucose (FBG), 2 h plasma glucose during a 75 g oral glucose tolerance test (OGTT) (2-hPG), homeostatic model assessment for insulin resistance (HOMA-IR), glycosylated hemoglobin (HbA1c)/total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), body mass index (BMI). After screening, a total of 10 studies (706 participants) remained. Fenugreek significantly reduced FBG, 2-hPG, and HbA1c, but it did not significantly decrease HOMA-IR. Moreover, it significantly improved TC, TG, and HDL-C, while there were no significant differences in LDL-C and BMI. Hepatic or renal toxicity was not observed, and there were no severe adverse events associated with fenugreek despite mild gastrointestinal side effects in some studies. In conclusion, fenugreek improves overall glycemic control parameters and lipid profile safely.

Role of Fenugreek, Cinnamon, Curcuma longa, Berberine and Momordica charantia in Type 2 Diabetes Mellitus Treatment: A Review

Type 2 diabetes mellitus (T2DM) is a complex disease that has become a major global health concern. Given the efficacy of antidiabetic drugs, pharmacological therapy is considered the first-line treatment of T2DM; however, due to their potential side effects and high costs, new and cost-effective treatments with minimal side effects are needed. Medicinal plants have been used for centuries as part of traditional medicine to treat T2DM. Among these, fenugreek, cinnamon, Curcuma longa, berberine, and Momordica charantia have demonstrated different degrees of hypoglycemic activity in clinical studies and animal models. Therefore, the aim of this review is to synthesize the mechanisms of action of five medicinal plants, as well as the experimental and clinical evidence of their hypoglycemic activity from the published literature.

The Effects of Fenugreek Seed Consumption on Blood Pressure: A Systematic Review and Meta-analysis of Randomized Controlled Trials

INTRODUCTION

Cardiovascular diseases (CVDs) are growing health issues worldwide. Hypertension (HTN) is one of the most common among CVDs in all populations. Fenugreek has recently been the center of multiple investigations.

AIM

In this systematic review and meta-analysis, we aimed at gathering and summing up the existing literature regarding the impact of fenugreek seed on systolic blood pressure (SBP) and diastolic blood pressure (DBP).

METHODS

All major databases (MEDLINE, Cochrane library, EMBASE, and Web of Science) were searched from inception up to 28 June 2022. Relevant randomized controlled trials (RCTs) meeting the inclusion criteria were included and the required data was extracted. The pooled effects were reported as weighted mean differences (WMDs). I-squared test was used to detect between-study heterogeneities. Subgroup analyses were conducted to find sources of heterogeneities. P-values < 0.05 were considered as statistically significant.

RESULTS

Six RCTs including a total of 373 participants were included in the final meta-analysis. Fenugreek seed supplementation significantly reduced SBP (WMD: 3.46 mmHg, 95% CI - 6.33, - 0.59, P=0.018), but not DBP (WMD: 3.19 mmHg; 95% CI, - 5.82 to 12.21, P=0.488). Subgroup analyses showed that fenugreek seed administered in dosages ≥ 15 g/day and durations ≤ 12 weeks significantly reduced SBP and DBP.

CONCLUSION

Supplementation with fenugreek seed, especially in dosages ≥ 15 g/day and durations ≤ 12 weeks, might play a role in reducing SBP, but not DBP. However, further investigations are warranted to ensure the clinical relevance of these findings.

Effect of Fenugreek on Hyperglycemia: A Systematic Review and Meta-Analysis

Fenugreek is used for medicinal purposes in various traditions. Some studies have demonstrated that the seeds of this plant may have an anti-diabetic effect by lowering fasting blood sugar levels and improving glucose tolerance. We conducted a systematic review of the hypoglycemic effects of fenugreek. An electronic literature search was carried out in the PubMed, Google Scholar, Scopus, and Cochrane Library databases through 18 November 2022 to find trials that assessed fasting blood glucose, postprandial blood glucose, and HbA1c changes in participants treated with fenugreek and in the control group. The mean difference with 95% confidence intervals (CI) was calculated to represent the analysis. Fourteen trials, consisting of 894 participants, were included in the meta-analysis. The results showed a reduction in fasting blood glucose levels (MD: 3.70, 95% CI of -27.02, 19.62; p = 0.76), postprandial blood glucose (MD: -10.61, 95% CI of -68.48, 47.26; p = 0.72), and HbA1c (MD: -0.88, 95% CI -1.49, -0.27; p = 0.00) with fenugreek consumption. While this review and included trials that found beneficial effects of fenugreek consumption on glycemic control, the quality and heterogeneity of studies remain a concern. Given the wider availability and lower cost of fenugreek, rigorous double-blinded randomized controlled trials should be conducted with fenugreek to understand its true potential as a diabetes control herbal agent.

Intervention for Prevention of Type 2 Diabetes Mellitus Among Prediabetes: A Review of the Literature

Introduction

In recent decades, the prevalence and incidence of type 2 diabetes mellitus (T2DM) have increased rapidly and represent a significant public health problem worldwide. Long-term T2DM is associated with microvascular complications such as retinopathy, nephropathy, and neuropathy. Prediabetes is a state of hyperglycemia with blood glucose levels higher than normal but lower than the diabetes threshold. Several studies have demonstrated the effectiveness of lifestyle interventions that resulted in a 40% to 70% reduction in diabetes mellitus in adults with prediabetes. These interventions focused on increased physical activity and dietary changes that were able to prevent or delay the onset of T2DM in prediabetes. However, most review studies focused on interventions to prevent T2DM in high-risk groups such as obesity. There was a limitation of reports related to prediabetes. Nevertheless, it remains a high-risk condition for the development of T2DM with a conversion rate of 5% to 10% per year. Therefore, the aim of this study was to review the current evidence on intervention studies aimed at reducing the incidence of type 2 diabetes in prediabetes.

Method

The researcher conducted a literature search of common online databases such as Medline, Google Scholar, and Cochrane Library between January 2011 and December 2021.

Result

The intervention for the prevention of T2DM in prediabetes consisted of a lifestyle intervention, a nutritional supplementation intervention, and a pharmacological intervention.

Conclusion

Several studies suggest that T2DM in prediabetes can be prevented by lifestyle modification and pharmacological interventions, or a combined intervention. However, further interventions may be needed to confirm this.

An Exploratory Study of the Safety and Efficacy of a Trigonella foenum-graecum Seed Extract in Early Glucose Dysregulation: A Double-Blind Randomized Placebo-Controlled Trial

Background: This was an exploratory study to assess the safety and efficacy of a specialized Trigonella foenum-graceum L. seed extract for supporting healthy blood glucose metabolism in a pre-diabetic cohort. Methods: Fifty-four participants were randomised to receive 500 mg/day of T. foenum-graecum seed extract or matching placebo daily for 12 weeks. Fasting blood glucose (FBG), post-prandial glucose (PPBG), HbA1c, fasting insulin (FI), post-prandial insulin (PPI) and C-peptide were assessed at baseline, week 6 and week 12. Lipid levels, liver enzymes and C-reactive protein (CRP), along with safety markers and tolerability were also assessed at baseline and week 12. Results: By week 12 there was a significant difference in FBG (p < 0.001), PPBG (p = 0.007) and triglycerides (p = 0.030) between treatment groups, with no changes in HbA1c (p = 0.41), FI (p = 0.12), PPI (p = 0.50) or C-peptide (p = 0.80). There was no difference in total cholesterol (p = 0.99), high-density lipoprotein (p = 0.35), low density lipoprotein (p = 0.60) or CRP (p = 0.79). There was no change in safety markers and the treatment was well tolerated. Conclusions: The results of the study indicated that T. foenum-graecum seed extract may influence blood glucose metabolism and larger studies are warranted to evaluate efficacy and potential mechanisms of action.

The role of selected nutraceuticals in management of prediabetes and diabetes: An updated review of the literature

Dysglycemia is a disease state preceding the onset of diabetes and includes impaired fasting glycemia and impaired glucose tolerance. This review aimed to collect and analyze the literature reporting the results of clinical trials evaluating the effects of selected nutraceuticals on glycemia in humans. The results of the analyzed trials, generally, showed the positive effects of the nutraceuticals studied alone or in association with other supplements on fasting plasma glucose and post-prandial plasma glucose as primary outcomes, and their efficacy in improving insulin resistance as a secondary outcome. Some evidences, obtained from clinical trials, suggest a role for some nutraceuticals, and in particular Berberis, Banaba, Curcumin, and Guar gum, in the management of prediabetes and diabetes. However, contradictory results were found on the hypoglycemic effects of Morus, Ilex paraguariensis, Omega-3, Allium cepa, and Trigonella faenum graecum, whereby rigorous long-term clinical trials are needed to confirm these data. More studies are also needed for Eugenia jambolana, as well as for Ascophyllum nodosum and Fucus vesiculosus which glucose-lowering effects were observed when administered in combination, but not alone. Further trials are also needed for quercetin.

Fenugreek Seed Galactomannan Aqueous and Extract Protects against Diabetic Nephropathy and Liver Damage by Targeting NF-κB and Keap1/Nrf2 Axis

This investigation was conducted to test the potential of the galactomannan (F-GAL) and aqueous extract (FS-AE) of the Fenugreek seed aqueous to prevent liver and kidney damage extracts in streptozotocin (STZ)-induced T1DM in rats. Non-diabetic and diabetic rats received the normal saline as a vehicle or were treated with FS-EA or F-GAL at a final concentration of 500 mg/kg/each. Treatments with both drugs reduced fasting hyperglycemia and improved serum and hepatic lipid profiles in the control and diabetic rats. Additionally, F-GAL and FS-AE attenuated the associated reduction in the mass and structure of the islets of Langerhans in diabetic rats and improved the structure of the kidneys and livers. In association, they also reduced the generation of reactive oxygen species (ROS), lipid peroxides, factor (TNF-α), interleukin-6 (IL-6), and nuclear levels of NF-κB p65, and improved serum levels of ALT, AST, albumin, and creatinine. However, both treatments increased hepatic and renal superoxide dismutase (SOD) in the livers and kidneys of both the control and diabetic-treated rats, which coincided with a significant increase in transcription, translation, and nuclear localization of Nrf2. In conclusion, FS-AE and F-GAL are effective therapeutic options that may afford a possible treatment for T1DM by attenuating pancreatic damage, hyperglycemia, hyperlipidemia, and hepatic and renal damage.

Non-pharmacological interventions for the prevention of type 2 diabetes in low-income and middle-income countries: a systematic review of randomised controlled trials

OBJECTIVE

Diabetes poses serious health threats and economic burdens to patients, especially in low-income and middle-income countries (LMICs). This systematic review searches for non-pharmacological interventions for the prevention of type-2 diabetes mellitus (T2DM) among patients who are non-diabetic and pre-diabetic from LMICs.

SETTINGS

LMICs.

PARTICIPANTS

Adult population aged over 18 years without having diabetes.

PRIMARY AND SECONDARY OUTCOMES

Primary outcome is to measure the change in the incidence of T2DM. The secondary outcome is to measure changes in glycated haemoglobin (HbA1c) level, weight/body mass index (BMI), fasting glucose level and 2-hour glucose from baseline of the included randomised controlled trials.

METHODS

This review has been conducted following the standard systematic review guidelines. A total of six electronic databases including MEDLINE, Embase, the Cochrane Library, Web of Science, ClinicalTrials.gov and International Clinical Trials Registry Platform were searched in February 2021 using a comprehensive search strategy.Two sets of independent reviewers performed screening, risk of bias (ROB) assessment using the Cochrane ROB tool and data extraction. Narrative coalescence of selected articles was demonstrated using tables. No meta-analysis was performed due to the lack of homogenous intervention strategies and study settings.

RESULT

A total of five studies were included for the review with a combined population of 1734 from three countries. Three of the studies showed a significant reduction in T2DM incidence after the intervention of physical training and dietary modifications. Four of the studies also demonstrated a significant reduction of different secondary outcomes like weight, BMI, fasting and 2-hour plasma glucose and HbA1c. All the studies demonstrated a low ROB in most of the bias assessment domains with some unclear results in allocation concealments.

CONCLUSIONS

Emphasising non-pharmacological interventions for T2DM prevention can improve health outcomes and lessen the economic burdens, which will be of paramount importance in LMICs.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42020191507.

Effect of Trigonella foenum-graecum L. seed extract on the reproductive system of male mice and possible mechanism of its action on spermatogenesis

Fenugreek seed exhibits antidiabetic, antineoplastic, hepatoprotective, antidepressant and immunomodulatory properties. Fenugreek also causes antifertility effects in rodents. However, the impact of fenugreek seed on male reproduction and the possible mode of its action are not properly evaluated. Herein, we examined the effect of aqueous seed extract of fenugreek (FSE) and the possible mechanism of its action on male reproductive health in mice. Parkes mice were orally administered FSE (600 mg/kg body weight/day) or distilled water for 28 and 56 days, respectively. Various sperm parameters, histopathology, serum testosterone level and fertility indices were assessed. Furthermore, steroidogenic enzymes activities, oxidative status and germ cell dynamics in the testis were evaluated. Toxicological endpoints were also assessed. Treatment with FSE caused degenerative changes in the testis histoarchitecture. The treatment also affected various sperm parameters and concentrations of sialic acid and fructose in the epididymis and seminal vesicle, respectively. Fenugreek treatment also had negative impact on oxidative status and germ cell dynamics in the testis; fertility indices were also affected in female mice impregnated by the extract-treated male mice, though libido of the treated male mice remained unaffected. Results show that treatment with FSE caused adverse effects on the male reproductive health and pregnancy outcome in Parkes mice.

Heterocyclic compounds as a magic bullet for diabetes mellitus: a review

Diabetes mellitus (DM) is a major metabolic disorder due to hyperglycemia, which is increasing all over the world. From the last two decades, the use of synthetic agents has risen due to their major involvement in curing of chronic diseases including DM. The core skeleton of drugs has been studied such as thiazolidinone, azole, chalcone, pyrrole and pyrimidine along with their derivatives. Diabetics assays have been performed in consideration of different enzymes such as α-glycosidase, α-amylase, and α-galactosidase against acarbose standard drug. The studied moieties were depicted in both models: in vivo as well as in vitro. Molecular docking of the studied compounds as antidiabetic molecules was performed with the help of Auto Dock and molecular operating environment (MOE) software. Amino acid residues Asp349, Arg312, Arg439, Asn241, Val303, Glu304, Phe158, His103, Lys422 and Thr207 that are present on the active sites of diabetic related enzymes showed interactions with ligand molecules. In this review data were organized for the synthesis of heterocyclic compounds through various routes along with their antidiabetic potential, and further studies such as pharmacokinetic and toxicology studies should be executed before going for clinical trials.

Diabetes mellitus (DM) is a major metabolic disorder due to hyperglycemia, which is increasing all over the world.

Ameliorative Effect of Trigonella Foenum Graecum L. on Lipid Profile, Liver Histology and LDL-Receptor Gene Expression in High Cholesterol-Fed Hamsters

Background

Trigonella foenum graecum L. (Fenugreek, FG) is used in many countries as a medicinal plant. Evidence has suggested the hypolipidemic effect of Fenugreek; however, its actual mechanism has not been determined yet.

Objectives

The purpose of our research was to investigate the effect of Fenugreek on lipid profile, liver histology and LDL receptor gene expression in male hamsters fed with high cholesterol diet.

Methods

These animals were given normal diet (ND), high cholesterol diet (HCD: 2% cholesterol and 0.5% cholic acid added to ND), HCD supplemented with 2g and 8g fenugreek per 100g ND (HCD+FG2 and HCD+FG8) respectively for four weeks. At the end of treatment, serum lipids, lipoproteins and liver enzymes were measured. Finally, LDL receptor (LDLR) gene expression was determined in the liver of the studied animals using Real Time-PCR method and liver histological changes were evaluated by H&E staining method.

Results

A significant reduction was observed in serum triglyceride (p<0.01), total cholesterol, low and very low density cholesterol, aspartate and alanine transaminases in HCD+FG8 group (p<0.05) compared with HCD group, while serum level of HDL-c (p<0.01) increased. In addition, LDLR gene expression in HCD+FG8 group increased 7.8 folds. The results confirm the protection effect of liver tissue in HCD+FG8 group against pathological changes. There was no significant change in LDLR gene expression in HCD+FG2 group. In conclusion, fenugreek ameliorated dyslipidemia by up-regulation of LDLR gene expression and can be used as a protective agent against hypercholesterolemia.

Therapeutic potential of targeting intestinal bitter taste receptors in diabetes associated with dyslipidemia

Intestinal release of incretin hormones after food intake promotes glucose-dependent insulin secretion and regulates glucose homeostasis. The impaired incretin effects observed in the pathophysiologic abnormality of type 2 diabetes have triggered the pharmacological development of incretin-based therapy through the activation of glucagon-like peptide-1 (GLP-1) receptor, including GLP-1 receptor agonists (GLP-1 RAs) and dipeptidyl peptidase 4 (DPP4) inhibitors. In the light of the mechanisms involved in the stimulation of GLP-1 secretion, it is a fundamental question to explore whether glucose and lipid homeostasis can be manipulated by the digestive system in response to nutrient ingestion and taste perception along the gastrointestinal tract. While glucose is a potent stimulant of GLP-1 secretion, emerging evidence highlights the importance of bitter tastants in the enteroendocrine secretion of gut hormones through activation of bitter taste receptors. This review summarizes bitter chemosensation in the intestines for GLP-1 secretion and metabolic regulation based on recent advances in biological research of bitter taste receptors and preclinical and clinical investigation of bitter medicinal plants, including bitter melon, hops strobile, and berberine-containing herbs (e.g. coptis rhizome and barberry root). Multiple mechanisms of action of relevant bitter phytochemicals are discussed with the consideration of pharmacokinetic studies. Current evidence suggests that specific agonists targeting bitter taste receptors, such as human TAS2R1 and TAS2R38, may provide both metabolic benefits and anti-inflammatory effects with the modulation of the enteroendocrine hormone secretion and bile acid turnover in metabolic syndrome individuals or diabetic patients with dyslipidemia-related comorbidities.

Low to no cost remedies for the management of diabetes mellitus; global health concern

Purpose

Diabetes mellitus (DM) is a chronic non-communicable endocrine and metabolic disease that is thought to be the fastest emerging health challenge of the twenty-first century. Presently, 90% of diabetic population is handicapped with T2-DM, and the majority of pre-diabetes on the way to T2-DM progression. By keeping in view, a review article has been compiled to highlight the significance of value aided effective, low-cost, safe, and useful remedies that could easily be accessible to the global community in order to moderate the possibility of DM and related complications.

Methods

Literature search for this review was carried out using scientific databases including PubMed, EBSCO, Scopus, Web of science, and google scholar. Whilst, value aided articles were selected on the basis of their therapeutic potential, safety profile and outreach.

Results

Escalating research data validated that herbal remedies and physical activities significantly prevents hyperglycemia, hyperlipidemia, and other complications in people with T2-DM.

Conclusion

Globally, nearly half-billion individuals are living with diabetes. Therefore, it is urged to embrace herbal remedies and physical mediation in our daily routine in order to tackle such devastating disorder.

A hairy-root transformation protocol for Trigonella foenum-graecum L. as a tool for metabolic engineering and specialised metabolite pathway elucidation

The development of genetic transformation methods is critical for enabling the thorough characterization of an organism and is a key step in exploiting any species as a platform for synthetic biology and metabolic engineering approaches. In this work we describe the development of an Agrobacterium rhizogenes-mediated hairy root transformation protocol for the crop and medicinal legume fenugreek (Trigonella foenum-graecum). Fenugreek has a rich and diverse content in bioactive specialised metabolites, notably diosgenin, which is a common precursor for synthetic human hormone production. This makes fenugreek a prime target for identification and engineering of specific biosynthetic pathways for the production of triterpene and steroidal saponins, phenolics, and galactomanans. Through this transformation protocol, we identified a suitable promoter for robust transgene expression in fenugreek. Finally, we establish the proof of principle for the utility of the fenugreek system for metabolic engineering programs, by heterologous expression of known triterpene saponin biosynthesis regulators from the related legume Medicago truncatula in fenugreek hairy roots.

Hypoglycemic and hypolipidemic activity of combined milk thistle and fenugreek seeds in alloxan-induced diabetic albino rats

BACKGROUND AND AIM

Despite the availability of antidiabetic drugs, they are not free from associated adverse side effects. This study aimed to evaluate the hypoglycemic and hypolipidemic effects of oral administration of seeds from two medicinal plants: (1) Milk thistle and (2) fenugreek.

MATERIALS AND METHODS

Plant seeds were washed in distilled water and ground with a coffee grinder. Alloxan was used to induce diabetes in 20 male albino rats. Diabetic rats were randomly divided into two groups: (1) Group 1 (n=10), diabetic rats fed with 0.5 g/kg milk thistle and 2 g/kg fenugreek seeds per day and (2) Group 2 (n=10), diabetic rats fed standard rodent food for 4 weeks.

RESULTS

Oral administration of milk thistle and fenugreek seeds for 2 weeks resulted in significant improvement in body weight, blood glucose, glycosylated hemoglobin (HbA1c), cholesterol, and triglyceride levels in alloxan-induced diabetic rats. After 4 weeks, this ameliorative effect was significantly elevated with respect to blood glucose (155.00±9.70 mg/dL vs. 427.50±5.70 mg/dL; p<0.001), HbA1c (5.5±0.19% vs. 13.65±1.77%; p<0.001), cholesterol (281.50±10.95 mg/dL vs. 334.30±6.80 mg/dL; p<0.001), triglyceride (239.60±6.87 mg/dL vs. 284.20±9.95 mg/dL; p<0.01), and body weight (265.30±8.10 g vs. 207.40±11.4 g; p<0.01) as compared with non-treated diabetic rats.

CONCLUSION

Milk thistle and fenugreek seeds possess hypoglycemic and hypolipidemic properties and could be used as natural compounds that are suitable as parent compounds for the development of new antidiabetic drugs.

Use of Dietary Supplements in Living Kidney Donors: A Critical Review

Dietary supplement use is high among US adults, with the intention by users to promote overall health and wellness. Kidney donors, who are selected based on their overall good health and wellness, can have high utilization rates of dietary supplements. We provide a framework for the evaluation of living kidney donors and use of dietary supplements. In this review, dietary supplements will include any orally administered dietary or complementary nutritional products, but excluding micronutrients (vitamins and minerals), food, and cannabis. Use of dietary supplements can influence metabolic parameters that mask future risk for chronic illness such as diabetes and hypertension. Dietary supplements can also alter bleeding risk, anesthesia and analgesic efficacy, and safety in a perioperative period. Finally, postdonation monitoring of kidney function and risk for supplement-related nephrotoxicity should be part of a kidney donor educational process. For practitioners evaluating a potential kidney donor, we provide a list of the most commonly used herbal supplements and the effects on evaluation in a predonation, perioperative donation, and postoperative donation phase. Finally, we provide recommendations for best practices for integration into a comprehensive care plan for kidney donors during all stages of evaluation. We recommend avoidance of dietary supplements in a kidney donor population, although there is a paucity of data that identifies true harm. Rather, associations, known mechanisms of action, and common sense suggest that we avoid use in this population.

Effect of fenugreek supplementation on blood lipids and body weight: A systematic review and meta-analysis of randomized controlled trials

ETHNOPHARMACOLOGICAL RELEVANCE

Fenugreek is a traditional herbal medicine that has been used for centuries to treat hyperglycemia, muscle spasms, gastritis, constipation, edema, and other metabolic disorders. Recently, lipid-lowering effects of fenugreek have been identified.

AIM OF THE STUDY

The aim of this systematic review and meta-analysis was to determine and clarify the impact of fenugreek supplementation on anthropometric indices and serum lipid levels.

MATERIALS AND METHODS

We searched PubMed, Scopus, ISI Web of Science, Cochrane Library, and Google Scholar from inception to June 2019 using relevant keywords. All randomized controlled trials (RCTs) investigating the effects of fenugreek on anthropometric indices and plasma lipids in adults were included. A random-effects model was used for quantitative data synthesis. A sensitivity analysis was conducted using the leave-one-out method.

RESULTS

A meta-analysis of 12 RCTs (14 arms) with 560 participants suggested a significant decrease in plasma concentrations of total cholesterol (WMD = -9.371 mg/dL; 95% CI: -15.419, -3.323, p = 0.002), triglycerides (WMD = -13.776 mg/dL; 95% CI: -26.636, -0.916, p = 0.036), and low density lipoprotein cholesterol (WMD = -6.590 mg/Dl; 95% CI: -13.042, -0.137, p = 0.045), as well as an increase in plasma high density lipoprotein cholesterol (WMD = 3.501 mg/dL; 95% CI: 1.309, 5.692, p = 0.002), while body weight (WMD = 0.223 kg; 95% CI: -0.509, 0.955, p = 0.551) and body mass index (WMD = 0.091 kg/m2; 95% CI: -0.244, 0.426, p = 0.596) were not altered.

CONCLUSION

Fenugreek supplementation improved lipid parameters in adults. However, to confirm these results, more studies, particularly among hyperlipidemic patients, are needed.

Biofortification of chromium in fenugreek seeds

BACKGROUND

Fenugreek and chromium are known to have anti-diabetic properties and this has been well demonstrated by multiple studies. Researches have been undertaken to study thebiofortification of chromium (Cr3+) in fenugreek. Some of the researchers have studied the biofortification from the soil irrigated with tannery waste water or from soil amended by tannery-sludge, with a view of enhancing the anti-diabetic effect of fenugreek plants. The present research work was also undertaken to increase the chromium content of fenugreek seeds, but through direct treatment of chromium picolinate solution to fenugreek seeds.

METHODS

Fenugreek seeds were procured and divided in four groups having three batches of 10 g seeds- treatment1, treatment2, control1 and control2. Control1 group was kept raw and was given no treatment and control2 group was germinated using double distilled water. Treatment1 and treatment2, on the other hand, were given treatment of 0.02 g and 0.04 g chromium picolinate solution, on first day and 0.01 g and 0.02 g chromium picolinate solution on second day, respectively. The germinated samples were then completely dried, powdered, digested with di-acid mixture and assayed using Inductively Coupled Plasma optical emission spectrometry method for chromium content. The treatment1 sample was selected for further nutritional analysis along with control1 and control2 group to compare the nutritional composition of raw, germinated and chromium treated fenugreek seed flour. Fifteen sprouts from treatment1 group (treatment1A group) and fifteen sprouts from control2 group (control3 group) were sown in earthen pots for the analysis of chromium content in seeds of new plants.

RESULTS

The fenugreek seeds treated with two different concentrations of chromium picolinate viz. treatment1 and treatment2 group attained 55 and 80 times higher chromium content as compared to control2 group, respectively. All the estimated minerals and bioactive compounds were significantly high (p ≤ 0.01) in germinated fenugreek seed flour and chromium treated fenugreek seed flour compared to raw fenugreek seed flour. Germinated fenugreek seed flour and chromium treated fenugreek seed flour were statistically comparable to each other in respect of all the parameters analysed. Hence, it was evident that enriching fenugreek seeds with chromium, did not affect the nutritional content of fenugreek seed by any mean. Also, there was no significant difference between the chromium content in seeds of control3 group and T1A group.

CONCLUSIONS

Treatment of fenugreek seeds with chromium solution seems to be an efficient and safe method for increasing their chromium concentration as compared to application of chromium to the soil for biofortification with minimal to no chance of chromium accumulation and inheritance in next generation plants. However, there is a need of more research to see how reliable these observations would be when different chromium salts and/or varied chromium concentration are used.

Nutraceutical Improves Glycemic Control, Insulin Sensitivity, and Oxidative Stress in Hyperglycemic Subjects: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

The aim of this research was to investigate the effects of nutraceuticals including bitter melon, fenugreek, cinnamon, alpha-lipoic acid, zinc, biotin, chromium, and cholecalciferol on glycemic control, insulin sensitivity, lipid profiles, oxidative stress, and inflammatory markers in hyperglycemia. The study design was a randomized, double-blind, placebo-controlled trial. Subjects with hyperglycemia were randomly divided into 2 groups. The treatment group ( n = 52) was given a nutraceutical and the control group ( n = 50) was provided with a placebo for 12 weeks. Fasting blood glucose (FBG), hemoglobin A1c (HbA1C), homeostatic model assessment of insulin resistance (HOMA-IR), lipid profiles, biomarkers of oxidative stress, and inflammation were assessed before and after the intervention at 6 weeks and 12 weeks. Nutraceutical supplementation demonstrated a statistically significant decrease in FBG (13.4% and 18.9%), HbA1C (6.5% and 11.3%), and HOMA-IR (28.9% and 35.2%) compared with the placebo. Moreover, low-density lipoprotein-cholesterol (LDL-C) level was significantly reduced in the nutraceutical group (7.1% and 9.3%). Furthermore, the nutraceutical significantly decreased oxidative stress markers, oxidized LDL-C (14.8% and 18.9%) and malondialdehyde (16.6% and 26.2%) compared with the placebo. In conclusion, this nutraceutical can improve glycemic control, insulin resistance, lipid profiles, and oxidative stress markers in hyperglycemic subjects. Therefore, it has the potential to decrease cardiovascular disease risk factors. Clinical trial registration: TCTR20180907001, www.clinicaltrials.in.th.

Impact of Active Antihyperglycemic Components as Herbal Therapy for Preventive Health Care Management of Diabetes

Diabetes is a metabolic hyperglycemic condition that progressively develops, effect small and large sensory fibers in the affected population. It has various complications as hypertension, coronary artery disease, stroke, blindness, kidney disease as well as peripheral neuropathy. Sulfonylureas, thiazolidinediones, metformin, biguanidine, acarbose and insulin are commonly used drugs for diabetic patients, but these all have certain side effects. Even metformin, that is known as the miracle drug for diabetes has been found to be associated with side effects, as during treatment it involves complications with eyes, kidneys, peripheral nerves, heart and vasculature. In the present article, we hypothesize recent discoveries with respect to active ingredients from Indian medicinal plants i.e., polypeptide-p (protein analogue act as artificial insulin), charantin (a steroidal saponin), momordicin (an alkaloid) and osmotin (ubiquitous plant protein and animal analogue of human adeponectin) possessing anti-hyperglycemic potential for diabetes type II. Therefore, plants as herbal therapy have preventive care of hyperglycemia accompanied with healthy lifestyle which can provide significant decline in the incidences of diabetes in future.

Advances on application of fenugreek seeds as functional foods: Pharmacology, clinical application, products, patents and market

Trigonella foenum-graecum L. (fenugreek) is one of the oldest applied medicinal herbs. Significant pharmacological and clinical evidence have highlighted the medicinal application of fenugreek. Explore the current knowledge regarding the bioactivity (animal aspects) and clinical application of fenugreek and its bioactive components, as well as the products, markets and patents related to fenugreek. This review highlights the phytochemicals, bioactivity (animal aspects) and clinical application of fenugreek from recent literatures and products, markets and patents from database. Until now, more than 100 phytochemicals have been isolated from fenugreek seeds, mainly including polysaccharides, saponins, alkaloids, phenolic acids, and flavonoids. Fenugreek extract and its bioactive compounds showed excellent antidiabetic activity and anti-obesity activity in animal and human study. Although the fenugreek seed has been used as TCM raw materials for a long time of period in China, China is lacking the research of fenugreek in both depth and width.

Ayurvedic polyherbal combination (PDBT) for prediabetes: A randomized double blind placebo controlled study

BACKGROUND

Increasing prevalence of type 2 diabetes mellitus (DM) has become alarming, burdening health care systems throughout the world. Prediabetes is an intermediate step before manifestation of full blown DM. Effective intervention at this step would help stop/slow progression to DM.

OBJECTIVE

This study aimed at use of a polyherbal combination (PDBT - constituted of Tinospora cordifolia, Pterocarpus marsupium, Gymnema sylvestre, Zingiber officinale and Momordica charantia) along with life style modification compared to a placebo in prevention of DM among prediabetic individuals.

MATERIALS AND METHODS

The study was a double blinded, placebo controlled randomized clinical trial. Participants were divided in to a group on PDBT and life style management (LSM) and second on placebo and LSM. Participants in the intervention group received 2 gm/day of PDBT. All participants received the intervention for a period of 6 months.

RESULTS

One hundred and fourteen participants were enrolled in the study, 57 each in intervention and control group. At the end of the study, 8 participants from the intervention group, compared to 15 participants in the control group had converted to DM. There was a 47% risk reduction in the intervention group. Participants in the intervention group showed statistically significant decrease in their blood glucose level (fasting and PP), HbA1c, fasting serum insulin and HOMA-IR values. There was no significant change in BMI. No adverse effects were reported by any participants.

CONCLUSION

PDBT along with LSM in prediabetic participants was associated with reduction in conversion to DM than placebo along with LSM without any adverse effects.

Polyherbal dietary supplementation for prediabetic adults: study protocol for a randomized controlled trial

Background

Prediabetes describes a state of hyperglycemia outside of normal limits that does not meet the criteria for diabetes diagnosis, is generally symptomless, and affects an estimated 38% of adults in the United States. Prediabetes typically precedes the diagnosis of type 2 diabetes, which accounts for increased morbidity and mortality. Although the use of dietary and herbal supplements is popular worldwide, and a variety of single herbal medicines have been examined for glycemic management, the potential of increasingly common polyherbal formulations to return glycemic parameters to normal ranges among adults with prediabetes remains largely unexplored. The purpose of this study is to evaluate the efficacy of a commercially available, polyherbal dietary supplement on glycemic and lipid parameters in prediabetic individuals.

Methods

In this multi-site, double-blinded, randomized controlled clinical trial, 40 participants with prediabetes will be randomized to either a daily oral polyherbal dietary supplement (GlucoSupreme™ Herbal; Designs for Health®, Suffield, CT, USA; containing cinnamon bark (Cinnamomum cassia), banaba leaf (Lagerstroemia speciosa standardized to 1% corosolic acid), kudzu root (Pueraria lobata standardized to 40% isoflavones), fenugreek seed (Trigonella foenum-graceum standardized to 60% saponins), gymnema leaf (Gymnema sylvestre standardized to 25% gymnemic acid), American ginseng root (Panax quinquefolius standardized to 5% ginsenosides), and berberine HCl derived from bark (Berberis aristata)) or placebo for 12 weeks. Short-, medium-, and comparatively long-term markers of glycemic control (blood glucose and fasting insulin, fructosamine, and glycated hemoglobin/A1c, respectively), and other glycemic parameters (GlycoMark, β-cell function, and insulin sensitivity/resistance) will be obtained. Lipid profile (total cholesterol, LDL, HDL, and triglycerides), inflammation (hs-CRP), progression to type 2 diabetes mellitus, as well as safety indices (ALT, AST) will be obtained. An intention-to-treat analysis will be used to assess changes in study outcomes.

Discussion

Treatment options for adults with prediabetes are currently limited. This study aims to evaluate the safety and efficacy of a commercially available dietary supplement in the popular, but as yet insufficiently studied, category of polyherbal formulas for the management of glycemic parameters and other biomarkers associated with prediabetes.

Trial registration

ClinicalTrials.gov, ID: NCT03388762. Retrospectively registered on 4 January 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-3032-6) contains supplementary material, which is available to authorized users.

Antidiabetic Effect of Fenugreek Seed Powder Solution (Trigonella foenum-graecum L.) on Hyperlipidemia in Diabetic Patients

BACKGROUND

Many drugs are commercially available for use in the management of diabetes. However, their side effects and high costs underscore the need for herbal alternative drugs. Trigonella foenum-graecum is one of the medicinal plants which are important in the management of diabetes mellitus. This study investigated the effect of Trigonella foenum-graecum seed powder solution on the lipid profile of newly diagnosed type II diabetic patients.

METHODS

A total of N = 114 newly diagnosed type II diabetic patients without any significant diabetes complication were selected. They were grouped into two groups: the treatment group (n = 57) consumed 25 g Trigonella foenum-graecum seed powder solution orally twice a day for one month and the second group is the control (n = 57) which receives metformin. Blood sample was collected from each participant by a medical technologist/technician before and after the study. Lipid profile was analyzed by using Mindray BS 200E fully automated clinical chemistry analyzer.

RESULT

By the end of the intervention period, the treatment group showed significantly lower total cholesterol level by 13.6% as compared with the baseline level (219.1 ± 35.51 vs. 189.29 ± 29.06, P < 0.001) and the control group (189.29 ± 29.06 vs. 208.2 ± 40.2, P < 0.001); triglyceride level also reduced by 23.53% compared with the baseline level (256.1 ± 15.4 vs. 195.8 ± 82.95, P < 0.001) and compared with the control group (195.8 ± 82.95 vs. 244.1 ± 96.9, P < 0.05); and low-density lipoprotein cholesterol level also reduced by 23.4% as compared to the baseline level (137.9 ± 26.9 vs. 105.6 ± 24.2, P < 0.001) and the control group (between groups) (105.6 ± 24.2 vs. 144.1 ± 23.3, P < 0.001), but the treatment group showed significantly increased high-density lipoprotein cholesterol level by 21.7% as compared to the baseline level, within group (37.8 ± 1.51 vs. 48.3 ± 11.9, P < 0.001), and the control group, between groups (48.3 ± 11.9 vs. 36.01 ± 9.5, P < 0.001). However, lipid profile levels in the control group were not significantly changed.

CONCLUSION

The present study showed that the administration of Trigonella foenum-graecum seed powder solution had pronounced effects in improving lipid metabolism in type II diabetic patients with no adverse effects. Therefore, Trigonella foenum-graecum seed may provide new alternatives for the clinical management of type II diabetes.

Toxicological evaluation of a saponin-rich standardized extract of fenugreek seeds (FenuSMART®): Acute, sub-chronic and genotoxicity studies

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Safety evaluation of a standardized extract of fenugreek seeds (FenuSMART).

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Acute and subchronic oral toxicity studies of FenuSMART on Wistar rats.

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Mutagenicity study of FenuSMART.

The present study investigated the safety of a saponin-rich standardized extract of fenugreek seeds (FenuSMART^®; FHE), that has been clinically shown to be effective in ameliorating the postmenopausal discomforts and establishing hormonal balance. The safety was assessed by oral acute (2500 mg/kg b. wt. for 14 days) and subchronic (250, 500 and 1000 mg/kg b. wt. for 90 days) toxicity studies on Wistar rats and mutagenicity studies employing Salmonella typhimurium strains. Administration of FHE did not produce any toxicologically significant changes in clinical/behavioral observations, ophthalmic examinations, body weight, organ weight, feed consumption, urinalysis, hematology and clinical biochemistry parameters when compared to the untreated control group of animals. Highest dose recovery group (1000 mg/kg b. wt.) of animals also showed no mortality or adverse events; with hematological and biochemical parameters at par with those of controls. Terminal autopsy revealed no alterations in relative organ weight or any treatment-related histopathology changes. FHE also showed no mutagenicity upon Ames test employing TA-98, TA-100 and TA-102 Salmonella typhimurium strains with or without metabolic activation. Based on the results of the study, the no observed-adverse-effect level (NOAEL) of FHE was determined as 1000 mg/kg b. wt./day, the highest dose tested.

Exploring the Therapeutic Ability of Fenugreek against Type 2 Diabetes and Breast Cancer Employing Molecular Docking and Molecular Dynamics Simulations

Fenugreek (Trigonella foenum-graecum) is used as a spice throughout the world. It is known for its medicinal properties such as antidiabetic, anticarcinogenic, and immunological activities. The present study shows the properties and the nutritional quality of fenugreek seed extract and focuses on screening of active compounds in drug designing for type 2 diabetes and breast cancer. Quantitative analysis was used to calculate the percentages of protein, carbohydrates moisture, fatty acid, galactomannan, oil, and amino acid. Phytochemical analysis revealed the presence of flavonoids, terpenoids, phenols, proteins, saponins, and tannins in fenugreek seed extracts. Molecular docking and molecular dynamics simulation-based computational drug discovery methods were employed to address the role of fenugreek seed constituents against type 2 diabetes and breast cancer. The computational results reveal that the compound galactomannan can be ascribed as potential drug candidate against breast cancer and type 2 diabetes rendered by higher molecular dock scores, stable molecular dynamics (MD) simulations results, and lower binding energy calculations.

Sufficient NADPH supply and pknG deletion improve 4-hydroxyisoleucine production in recombinant Corynebacterium glutamicum

Cofactor engineering is a common strategy to improve amino acid production. 4-hydroxyisoleucine (4-HIL), a nonproteinogenic amino acid, exhibits unique insulinotropic and insulin-sensitizing activities, therefore has potential medical value in treating diabetes. In our previous study, l-isoleucine (Ile) dioxygenase gene ido was overexpressed in an Ile-producing Corynebacterium glutamicum strain, and 4-HIL was de novo synthesized from glucose. In this study, to increase the NADPH supply, the endogenous NAD⁺ kinase gene ppnK and glucose-6-phosphate dehydrogenase gene zwf were co-expressed with ido. The resulting strain SL01 produced 81.12 ± 5.96 mM 4-HIL, 62% higher than the ido-mere expressing strain SN02. However, the strain SL02 co-expressing exogenous NADH kinase gene POS5 with ido grew slowly and its 4-HIL production decreased by 12%, perhaps due to the lower 2-oxoglutarate (OG) level and slightly weaker membrane permeability. To increase OG availability for 4-HIL conversion, the serine/threonine protein kinase G gene pknG was deleted and replaced by ido gene in SL02. The growth of the resulting strain SL04 was restored and 4-HIL production was improved to 84.14 ± 6.38 mM; meanwhile, the conversion ratio of Ile to 4-HIL reached up to 0.98 ± 0.01 mol/mol. Therefore, sufficient NADPH supply and OG availability may be benefit to 4-HIL de novo biosynthesis in recombinant C. glutamicum.

Insulin-Sensitizer Effects of Fenugreek Seeds in Parallel with Changes in Plasma MCH Levels in Healthy Volunteers

In developed, developing and low-income countries alike, type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases, the severity of which is substantially a consequence of multiple organ complications that occur due to long-term progression of the disease before diagnosis and treatment. Despite enormous investment into the characterization of the disease, its long-term management remains problematic, with those afflicted enduring significant degradation in quality-of-life. Current research efforts into the etiology and pathogenesis of T2DM, are focused on defining aberrations in cellular physiology that result in development of insulin resistance and strategies for increasing insulin sensitivity, along with downstream effects on T2DM pathogenesis. Ongoing use of plant-derived naturally occurring materials to delay the onset of the disease or alleviate symptoms is viewed by clinicians as particularly desirable due to well-established efficacy and minimal toxicity of such preparations, along with generally lower per-patient costs, in comparison to many modern pharmaceuticals. A particularly attractive candidate in this respect, is fenugreek, a plant that has been used as a flavouring in human diet through recorded history. The present study assessed the insulin-sensitizing effect of fenugreek seeds in a cohort of human volunteers, and tested a hypothesis that melanin-concentrating hormone (MCH) acts as a critical determinant of this effect. A test of the hypothesis was undertaken using a hyperinsulinemic euglycemic glucose clamp approach to assess insulin sensitivity in response to oral administration of a fenugreek seed preparation to healthy subjects. Outcomes of these evaluations demonstrated significant improvement in glucose tolerance, especially in patients with impaired glucose responses. Outcome data further suggested that fenugreek seed intake-mediated improvement in insulin sensitivity correlated with reduction in MCH levels.

Effects of medicinal food plants on impaired glucose tolerance: A systematic review of randomized controlled trials

BACKGROUND

The objective of this systematic review was to assess available scientific data on the efficacy and safety of medicinal food plants for the treatment of impaired glucose tolerance.

METHODS

We included randomized controlled trials (RCTs) with a minimum follow-up period of 6weeks. The diagnosis was determined by fasting plasma glucose values after two-hour oral glucose tolerance testing (OGTT). Two authors independently extracted data and evaluated bias. The Cochrane tool of risk of Bias Tool was used.

RESULTS

This review included ten trials. Most studies were highly biased as data were incomplete or reporting was selective. The two-hour fasting plasma glucose after the curcumin extract intervention showed statistical significance after 3, 6 and 9months: p<0.01. Also, glycosylated haemoglobin levels A1c (HbA1c) values after curcumin extract intervention showed statistical significance after 3, 6 and 9months: p<0.01. Insulin resistance (HOMA-IR) after curcumin extract intervention showed statistical significance after 6months and after 9months: p<0.05 and p<0.01.

CONCLUSIONS

Curcumin has shown the confident results to be effective for the treatment of impaired glucose tolerance. Fenugreek and flaxseed may also be effective, but due to low quality of these studies the results must be interpreted with caution.