Efficacy of herbal supplements (Cinnamon) in Diabetes mellitus treatment

1. Introduction
Worldwide estimated population of diabetes mellitus patients was 2.8 % in 2000 and it will
reach to 4.4% in 2030 if not controlled. The number of people suffering from the disease of
diabetes mellitus is projected to increase from 171 million in 2000 to 366 million in 2030.1

In controlling the risk factors associated with diabetes mellitus, life style modification specially
changing dietary habits are very useful. Evidences of glycemic control by regulating the
glycemic metabolism have earned herbal medicines the respect of supplementary medicines for
the management of diabetes mellitus.2

Since ancient times for the treatment of a range of diseases herbal medicines have been used.
In world health a key role have been played by medicinal plants. Despite of the advancement
in modern medicines in recent times, provision of healthcare is still shared by the plants. It is
believed that out of all the modern medicines about 25% involve plants directly or
indirectly.3’4’5’6

In developing and some developed countries like United States, Germany, France and Italy
herbal preparation with proper legislation are commonly used. However plant products are
known as dietary supplements in many countries like Unites States. In developing countries,
about 65-80% of the population depends on plants for primary healthcare due to lack of modern
medicines accessibility and poverty.7

2. Define a pharmacological concern/problem as it relates to out of hospital care.

The concept of herbal medicines being safe from side effects is being wrongly portrayed. To
assure quality safety and efficacy of herbal medicines, an insufficient data is available. Some
of the constituents of the plants are believed to be toxic besides having therapeutic constituents.

Multiple clinical trials shows the occurrence of side effects by using herbal agents though they
are less frequent as compared to synthetic medicines.8’9’10
For herbal medicines two kinds of side effects have been reported. The first one is thought to
be related to toxicity (predictable), over dosage and interaction with conventional medicines as
occurred for synthetic medicines too. On this basis occurrence of several allergic reactions is
reported upon herbal medicine usage. The second kind of side effects are related to preparation
and manufacturing issues like wrong plant indentation, poor manufacturing practices,
contamination, adulteration, wrong dosage and lack of standardization.11’12’13

Meta-analysis of vast literature of well controlled double blinded trials involving herbal
medicines provide the several discrepancies in using herbal medicines as follows;
 Using different dosage of herbal medicines
 Improper selection of patients and their randomization in trials
 Lessen number of participants in the trials for them to give statistical significant results
 Absence of quality control and standardization mechanisms for herbal medicines usage
 Varied treatment duration using herbal medicines

On the ground of these difficulties, to explore the efficacy and safety of herbal medicines further
detailed and proper organized investigation is needed to be done.

3. Summarize the background research related to the concern/problem.

Explored facts of a study showed that the amount (dosage) of herbal medicines to be used, their
dosage and treatment pattern for different age groups, detailed description about the duration
of the treatment need to be further investigated as positive effects of herbal medicines as in
controlling glycemic level in diabetic patients were not confirmed as inconsistently portrayed
in the previous literature.

A randomized control trail involving 204 type 2 diabetic patients conducted to explore the
effects of cinnamon as supplementary medicine in treating type 2 diabetes mellitus showed no
measure of glycemic control in the patients, which emphasizes the need of further detailed
investigation in using herbal medicines in diabetic patients.14

A mixed information regarding the effect of cinnamon on glycemic and lipid profile have been
reported in the various studies. After three months of cinnamon supplementation reversed
effects of increase glucose level (plasma) and no significant change in HbA1c was reported by
Blevins et al.15 A further study by Altschuler et al. demonstrated no beneficial effects in type1
diabetic adults upon cinnamon supplementation.16

No evident proves of efficacy in terms of health benefits of cinnamon supplementation in type

2 diabetic patients were reported in a study. The results of that study showed that on account of
cinnamon supplementation (cinnamomum cassia) that was given 1.5g/day depicted no
betterment in improving FBG (Fasting blood glucose), oral glucose tolerance and type 2
diabetic patients with post-menopausal phase.17

In Pakistan a clinical trial to evaluate the type 2 diabetic patients in light of cinnamon efficacy
put a strong emphasizes to evaluate this in western diabetic patients with likely varied baseline
characteristics like diet, glucose level, weight, height and prescribed medication.18

Conflicted results about the hypoglycemic effects of cinnamon have been reported due to the
challenges of varied trial features like heterogenous trial participation, poor design of the trial
and different points for impact estimation in different trials. This put focus on proper
investigation (i.e. long term and well-designed trials) to establish the safety and efficacy of
herbal medicine usage in treating diabetic patients.19

To evaluate the meaningful effects (i.e. fasting blood glucose) of cinnamon supplement in adult
type 2 diabetic patients a meta-analysis was conducted. The conclusion from the extensive
literature search showed the modest beneficial effects in terms of FPG and HbA1c, of herbal
medication in treating diabetic patients and recommended further studies to establish their use
in routine practice by healthcare professionals.20

4. Describe the impact this concern/problem has on providers/patients in an out of

hospital environment.

As conflicted information is available on the efficacy of herbal medicines in the treatment of

type 2 diabetes mellitus so it is difficult for healthcare professionals and dietitian nutritionists
to ensure safe and effective use of herbal medicines in treating type 2 diabetic patients. So
until larger and more organized studies and evidences are available, it is recommended to
follow the recommended diet, lifestyle changes and hypoglycemic drugs.
References

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2
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15
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supplements have a role in glycemic control in type 2 diabetes? A narrative review. Journal of
the Academy of Nutrition and Dietetics. 2016 Nov 1;116(11):1794-802.