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Review
. 2009 Jun;55(6):591-6.

Complementary and alternative medicine for the treatment of type 2 diabetes

Richard Nahas  1 , Matthew Moher
Affiliations
Review

Complementary and alternative medicine for the treatment of type 2 diabetes

Richard Nahas et al. Can Fam Physician. 2009 Jun.

Abstract
in English, French

Objective: To review clinical evidence supporting complementary and alternative medicine interventions for improving glycemic control in type 2 diabetes mellitus.

Quality of evidence: MEDLINE and EMBASE were searched from January 1966 to August 2008 using the term type 2 diabetes in combination with each of the following terms for specific therapies selected by the authors: cinnamon, fenugreek, gymnema, green tea, fibre, momordica, chromium, and vanadium. Only human clinical trials were selected for review.

Main message: Chromium reduced glycosylated hemoglobin (HbA(1c)) and fasting blood glucose (FBG) levels in a large meta-analysis. Gymnema sylvestre reduced HbA(1c) levels in 2 small open-label trials. Cinnamon improved FBG but its effects on HbA(1c) are unknown. Bitter melon had no effect in 2 small trials. Fibre had no consistent effect on HbA(1c) or FBG in 12 small trials. Green tea reduced FBG levels in 1 of 3 small trials. Fenugreek reduced FBG in 1 of 3 small trials. Vanadium reduced FBG in small, uncontrolled trials. There were no trials evaluating microvascular or macrovascular complications or other clinical end points.

Conclusion: Chromium, and possibly gymnema, appears to improve glycemic control. Fibre, green tea, and fenugreek have other benefits but there is little evidence that they substantially improve glycemic control. Further research on bitter melon and cinnamon is warranted. There is no complementary and alternative medicine research addressing microvascular or macrovascular clinical outcomes.

OBJECTIF: Faire le point sur les données cliniques en faveur d’interventions de médecine complémentaire et alternative pour améliorer le contrôle de la glycémie dans le diabète de type 2.

QUALITÉ DES PREUVES: On a consulté MEDLINE et EMBASE entre janvier 1966 et août 2008 à l’aide du terme type 2 diabetes en combinaison avec chacun des termes suivants pour des traitements spécifiques, choisis par les auteurs : cinnamon, fenugreek, gymnema, green tea, fibre, momordica, chromium et vanadium. Seuls les essais cliniques humains ont été retenus pour cette étude.

PRINCIPAL MESSAGE: Le chrome a réduit l’hémoglobine glycosylée (HbA1c) et la glycémie à jeun (GÀJ) dans une grande méta-analyse. Le gymnema sylvestre a réduit les niveaux d’ HbA1c dans 2 petits essais sans insu. La cannelle a amélioré la GÀJ, mais on ignore ses effets sur l’ HbA1c. La margose n’a eu aucun effet dans 2 petits essais. Les fibres ont eu des effets variables sur le HbA1c ou sur la GÀJ dans 12 petits essais. Le thé vert a abaissé la GÀJ dans 1 essai sur 3. Le fenugrec a diminué la GÀJ dans un essai sur 3. Le vanadium a réduit la GÀJ dans des petits essais non contrôlés. Aucun essai n’a évalué les complications micro ou macro-vasculaires, ou d’autres issues cliniques.

CONCLUSION: Le chrome et possiblement le gymnema sylvestre semblent améliorer le contrôle de la glycémie. Les fibres, le thé vert et le fenugrec ont d’autres effets bénéfiques, mais il y a peu de données indiquant qu’ils améliorent le contrôle de la glycémie. La margose et la cannelle mériteraient d’autres études. Il n’existe aucune recherche en médecine complémentaire et alternative sur les issues cliniques micro ou macro-vasculaires.

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