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

The Journal of Family Practice. 2014 June;63(6):336-338

June 1, 2014|Family Medicine

Monique M. Moona, MD;Richard Smits, MD;Joseph Kertesz, MA;Albert Meyer, MD;Leslie Mackler, MSLS

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.}

References

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