Do complementary agents lower HbA1c when used with standard type 2 diabetes therapy?

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Do complementary agents lower HbA1c when used with standard type 2 diabetes therapy?

J Fam Pract. 2014 June;63(6):336-338

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References

1. Balk ME, Tatsioni A, Lichtenstein AH, et al. Effect of chromium supplementation on glucose metabolism and lipids: a systematic review of randomized controlled trials. Diabetes Care. 2007;30:2154-2163.

2. Akilen R, Tsiami A, Devendra D, et al. Cinnamon in glycaemic control: Systematic review and meta analysis. Clin Nutr. 2012;31:609-615.

3. Ludvik B, Hanefeld M, Pacini G. Improved metabolic control by Ipomoea batatas (Caiapo) is associated with increased adiponectin and decreased fibrinogen levels in type 2 diabetic subjects. Diabetes Obes Metab. 2008;10:586-592.

4. Ludvik, B, Neuffer, B, Pacini G. Efficacy of Ipomoea batatas (Caiapo) on diabetes control in type 2 diabetic subjects treated with diet. Diabetes Care. 2004;27:436-440.

5. Lu FR, Shen L, Qin Y, et al. Clinical observation on trigonella foenum-graecum L. total saponins in combination with sulfonylureas in the treatment of type 2 diabetes mellitus. Chin J Integr Med. 2008;14:56-60.

6. Huseini HF, Larijani B, Heshmat R, et al. The efficacy of Silybummarianum (L.) Gaertn. (silymarin) in the treatment of type II diabetes: a randomized, double-blind, placebo-controlled clinical trial. Phytother Res. 2006;20:1036-1039.

7. Hussain SA. Silymarin as an adjunct to glibenclamide therapy improves long-term and postprandial glycemic control and body mass index in type 2 diabetes. J Med Food. 2007;10:543-547.

8. Asp ML, Collene AL, Norris LE, et al. Time-dependent effects of safflower oil to improve glycemia, inflammation and blood lipids in obese, post-menopausal women with type 2 diabetes: a randomized,double-masked, crossover study. Clin Nutr. 2011;30:443-449.

9. American Diabetes Association; Bantle JP, Wylie-Rosett J, Albright AL, et al. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2008;31 suppl 1:S61-S78.

10. Diabetes UK Nutrition Working Group, Dyson PA, Kelly T, Deakin T, et al. Evidence-Based Nutrition Guidelines for the Prevention and Management of Diabetes. Diabetes UK Web site. Available at: www.diabetes.org.uk/Documents/Reports/nutritional-guidelines-2013-amendment-0413.pdf. Accessed October 2, 2013.

What about caiapo, fenugreek, milk thistle, and safflower oil?

Two small, moderate-quality RCTs of caiapo (sweet potato skin extract) in diet-controlled patients with diabetes demonstrated small but possibly clinically significant reductions in HbA1c between the intervention and control groups.^3,4

TABLE
Effect of complementary or alternative agents on HbA1c in type 2 diabetes

CAA*	Dose/day	Concurrent diabetes therapy	Study type	Study size	Study duration	Difference in HbA1c (in HbA1c units)	95% CI or P value
Chromium¹	1.28-1000 mcg	Not given	Meta-analysis of 13 RCTs	381	3 wk-8 mo	-0.6^†	-0.9 to -0.2
Cinnamon²	1-3 g	Various oral hypoglycemic agents‡	Meta-analysis of 5 RCTs	315	1.5-4 mo	-0.09 (WMD)^†	-0.14 to -0.04
Caiapo³	4 g	Diet only	RCT	61	5 mo	-0.21 (caiapo)^§ +0.25 (placebo)^§	P=.08 P=.0001
Caiapo⁴	4 g	Diet only	RCT	61	3 mo	-0.53 (caiapo)^§ +0.06 (placebo)^§	P<.001 P=.23
Trigonella foenum-graecum (fenugreek)⁵	6.84 g	Sulfonylurea	RCT	69	3 mo	-1.46 (fenugreek)^§ -0.41 (placebo)^§	P<.05 P<.05
Silybum marianum (milk thistle)⁶	200 mg	Metformin and sulfonylurea	RCT	51	4 mo	-1.0 (milk thistle)^§ +1.2 (placebo)^§	P<.001 P<.0001
Silybum marianum (milk thistle)⁷	200 mg	Sulfonylurea	RCT	38	4 mo	-1.5 (milk thistle)^§ -0.5 (placebo)^§	P<.05 P=NS
Safflower oil vs conjugated linoleic acid⁸	8 g	Various oral hypoglycemic agents^‡	DBRCD	35	4 mo	-0.6 (safflower oil)^§ +0.1 (conjugated linoleic acid)^§	P=.0007 P=NS

^{CAA, complementary or alternative agents; CI, confidence interval; DBRCD, double-blind, randomized, crossover design; HbA1c, glycosylated hemoglobin A1c; NS, not significant; RCT, randomized controlled trial; WMD, weighted mean difference.
*All CAAs were compared against placebo, with the exception of safflower oil, which was compared against conjugated linoleic acid supplementation.
† Change in HbA1c means at study endpoint; the difference in HbA1c in intervention vs placebo groups.
‡ Oral hypoglycemic agents included a-glucosidase inhibitors, biguanides, glinides, glitazones, sulfonylureas, and thiazolidinediones.
§ Change in HbA1c means at study endpoint; the change in HbA1c from baseline.}

Evidence-based answers from the Family Physicians Inquiries Network

Do complementary agents lower HbA1c when used with standard type 2 diabetes therapy?

References

What about caiapo, fenugreek, milk thistle, and safflower oil?

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