Ethnopharmacological Uses and Public Knowledge Regarding Cinnamomum zeylanicum in Khobar, Saudi Arabia

Efficacy of Young Cinnamomum zeylanicum Blume Bark on Hyperglycemia and PTPase Activity in Type 2 Diabetes

Diabetes is a major public health concern and natural easy-going remedies are being searched. Since Cinnamomum zeylanicum Blume has a low coumarin concentration and possible insulin-enhancing properties, it is preferred over all other cinnamon species. Although similar research has been done on humans, there have been very few studies on this particular species, and none among South Asians. Moreover, no human trial that properly described their intervening agent (C. zeylanicum) and checked its efficacy at the molecular level along with clinical variables was conducted. Therefore, the current research aimed to explore the effects of C. zeylanicum on the glycemic index, lipid profile, and expression of the protein tyrosine phosphatase 1 B (PTP1B) enzyme in the peripheral blood mononuclear cells (PBMC) in type 2 diabetes. We examined the presence of bioactive compounds in young C. zeylanicum bark (Alba grade) from native Sri Lanka using gas chromatography-mass spectrometry, high-performance thin-layer chromatography, and thin-layer chromatography before introducing it in the clinical study where trans-Cinnamaldehyde was found to be a major chemical constituent (>60%). Then, from January 2020 to March 2022, a randomized double-blinded placebo-controlled trial was carried out in the Diabetic Clinic at AIIMS Rishikesh. A total of 154 diabetic patients were enrolled and were taken either cinnamon or placebo capsules (1.5 g/day) for 120 days on an empty stomach with warm water along with their conventional treatment. Reduction in fasting blood glucose levels in the cinnamon group was found -35.50% (95% CI, -173 to 58.4), whereas in the placebo group change was 5.00% (95% CI, -165 to 224). For glycosylated hemoglobin, it differed -0.85% (95% CI, -8.2 to 1.6) in the cinnamon group compared to the placebo where it was found 0.15% (95% CI, -6.1 to 5.5). PTP1B expression in PBMC was determined from pre- and post-trial blood samples using the Western Blot, and significant inhibition was also observed (p=0.039). The study result depicts, C. zeylanicum is emerging as a beneficial plant for type 2 diabetes in Northern India and could be used as an adjunctive treatment rather than as a standalone managerial remedy.

Evaluation of clinical trials for natural products used in diabetes: An evidence-based systemic literature review

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.