Systematic Review of Herbs and Dietary Supplements for Glycemic Control in Diabetes
- Gloria Y. Yeh, MD, MPH12,
- David M. Eisenberg, MD1,
- Ted J. Kaptchuk, OMD1 and
- Russell S. Phillips, MD12
- 1Division for Research and Education in Complementary and Integrative Medical Therapies, Harvard Medical School, Boston, Massachusetts
- 2Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
OBJECTIVE—To conduct a systematic review of the published literature on the efficacy and safety of herbal therapies and vitamin/mineral supplements for glucose control in patients with diabetes.
RESEARCH DESIGN AND METHODS—We conducted an electronic literature search of MEDLINE, OLDMEDLINE, Cochrane Library Database, and HealthSTAR, from database inception to May 2002, in addition to performing hand searches and consulting with experts in the field. Available clinical studies published in the English language that used human participants and examined glycemic control were included. Data were extracted in a standardized manner, and two independent investigators assessed methodological quality of randomized controlled trials using the Jadad scale.
RESULTS—A total of 108 trials examining 36 herbs (single or in combination) and 9 vitamin/mineral supplements, involving 4,565 patients with diabetes or impaired glucose tolerance, met the inclusion criteria and were analyzed. There were 58 controlled clinical trials involving individuals with diabetes or impaired glucose tolerance (42 randomized and 16 nonrandomized trials). Most studies involved patients with type 2 diabetes. Heterogeneity and the small number of studies per supplement precluded formal meta-analyses. Of these 58 trials, the direction of the evidence for improved glucose control was positive in 76% (44 of 58). Very few adverse effects were reported.
CONCLUSIONS—There is still insufficient evidence to draw definitive conclusions about the efficacy of individual herbs and supplements for diabetes; however, they appear to be generally safe. The available data suggest that several supplements may warrant further study. The best evidence for efficacy from adequately designed randomized controlled trials (RCTs) is available for Coccinia indica and American ginseng. Chromium has been the most widely studied supplement. Other supplements with positive preliminary results include Gymnema sylvestre, Aloe vera, vanadium, Momordica charantia, and nopal.
- CAM, complementary and alternative medicine
- GTT, glucose tolerance test
- RCT, randomized controlled trial
- TCM, Traditional Chinese medicine
Address correspondence and reprint requests to Gloria Y. Yeh, MD, Harvard Osher Institute, 401 Park Dr., Ste. 22A, Boston, MA 02215. E-mail:.
Received for publication 30 October 2002 and accepted in revised form 13 January 2003.
Additional information for this article can be found in an online appendix at http://care.diabetesjournals.org.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
- DIABETES CARE