Effect of Fenugreek on Hyperglycemia: A Systematic Review and Meta-Analysis

T. Evaluation of polyherbal synergy against diabetes: in-vitro analysis

AIMS

To evaluate the anti-diabetic properties of a polyherbal formulation consisting of Curcuma longa, Emblica officinalis, and Trigonella foenum-graecum through in-vitro assays, and investigate its synergistic effects on glucose metabolism, lipid metabolism, and insulin function.

MATERIALS AND METHODS

The polyherbal extract was prepared using methanol, water, and methanol-water as solvents. In-vitro antioxidant (DPPH, Phosphomolybdenum) and anti-diabetic (α-amylase, α-glucosidase inhibition, yeast glucose uptake, and inhibitory glucose diffusion) assays were conducted. L6 rat skeletal muscle cells were used for MTT assay and glucose uptake.

RESULTS

The methanol extract showed the highest antioxidant and anti-diabetic activities compared to aqueous and hydroalcoholic extracts. The IC50 values in DPPH and α-amylase inhibition assays were close to standard drugs, while the MTT assay demonstrated moderate cytotoxicity, confirming the extract's safety. Glucose uptake increased significantly, particularly in L6 cells treated with the methanolic extract.

CONCLUSION

The polyherbal formulation exhibited potent anti-diabetic properties, particularly the methanolic extract, showing significant glucose regulation and insulin function improvement. This formulation holds promise as a natural treatment for diabetes.

Daily fenugreek intake does not attenuate abdominal aortic aneurysm growth in rats

Objective: Abdominal aortic aneurysm (AAA) is a permanent local dilation of the abdominal aorta developed by chronic local inflammation and elastin degradation. Trigonella foenum-graecum (fenugreek) has been reported to have anti-inflammatory properties. We hypothesized that fenugreek supplementation can inhibit AAA growth. Materials and methods: AAA was induced in male Sprague-Dawley rats by intraluminal porcine pancreatic elastase infusion. The treatment by oral gavage was initiated post-operatively on day 1 and was administered daily (750 mg/kg/daily or 1500 mg/kg/daily or distilled water) for 27 days. AAA expansion was monitored weekly by ultrasound measurements in a blinded-to-treatment fashion; rats were euthanized 28 days after surgery. AAA cross-sections were examined histologically, where treatment allocation were blinded. Results: AAA developed in all three groups, yet there was no measured difference (p=0.104) in the maximal inner anterior-posterior abdominal aortic diameter on day 28 post-surgery between the control group (110% ± 70%, n=11), the low-dose fenugreek treatment group (LDF, 105% ± 68%, n=11), and the high-dose fenugreek treatment group (HDF, 153% ± 96%, n=13). Additionally, assessments of elastin structure in the AAA wall using Miller's stain revealed disorganized and ruptured fibers, but no significant differences in the severity of damage or elastin content among the groups were noted. No significant differences were observed in the presence of infiltrating neutrophils (as indicated by myeloperoxidase-positive cells), macrophage infiltration (% CD68-positive area), or area of vascular smooth muscle cells (a-SMA stained cells), or media thickness across control low-dose, and high-dose treatment groups. Conclusions: Daily fenugreek administrations did not halt AAA progression in either low-dose (750 mg/kg/daily) or high-dose (1500 mg/kg/daily) groups when compared to controls. These results did not show any beneficial effects of fenugreek supplementation in the aneurysm wall, and therefore, we can not recommend fenugreek supplementation as a treatment for patients with growing AAAs.

Trigonella foenum-graecum L. ameliorates metabolism-associated fatty liver disease in type 2 diabetic mice: a multi-omics mechanism analysis

ETHNOPHARMACOLOGICAL RELEVANCE

Trigonella foenum-graecum L. (HLB), a widely recognized traditional Chinese medicine, has been historically used for the treatment of diabetes mellitus and its complications. However, the efficacy and mechanism of HLB in the treatment of type 2 diabetes mellitus (T2DM) combined with metabolic-associated fatty liver disease (MAFLD) remain poorly understood.

AIM OF THE STUDY

To investigate the therapeutic effects of HLB on T2DM combined with MAFLD in mice and elucidate its underlying mechanisms.

MATERIALS AND METHODS

The indices of glucose and lipid metabolism, along with oxidative stress markers, were measured using commercially available assay kits. Histopathological analyses of liver and colon tissues were conducted. Additionally, the mRNA expression levels of genes related to fatty acid metabolism, inflammatory factors, and intestinal tight junction proteins were quantified using reverse transcription polymerase chain reaction (RT-PCR). Microbiome, metabolomic, and transcriptomic analyses were employed to evaluate gut microbiota composition, metabolic profiles, and liver differential genes, respectively.

RESULTS

After a 4-week treatment period, HLB effectively ameliorated abnormalities of glucose-lipid metabolism, hepatic oxidative stress, and inflammatory responses. Furthermore, HLB modulated hepatic function and intestinal damage. Through comprehensive multi-omics analysis, the observed improvements were attributed to the remodeling of the gut microbiota and its metabolic alterations, including an increased abundance of beneficial bacteria, regulation of bile acid metabolism.

CONCLUSIONS

These findings not only provide a theoretical foundation for the broader application of HLB in traditional Chinese medicine but also offer novel insights into the potential pharmacological mechanisms underlying HLB's efficacy in T2DM and MAFLD treatment.

Fenfuro®-mediated arrest in the formation of protein-methyl glyoxal adducts: a new dimension in the anti-hyperglycemic potential of a novel fenugreek seed extract

The fenugreek plant (Trigonella foenum-graecum) is traditionally known for its anti-diabetic properties owing to its high content of furostanolic saponins, which can synergistically treat many human ailments. Non-enzymatic protein glycation leading to the formation of Advanced Glycation End products (AGE) is a common pathophysiology observed in diabetic or prediabetic individuals, which can initiate the development of neurodegenerative disorders. A potent cellular source of glycation is Methyl Glyoxal, a highly reactive dicarbonyl formed as a glycolytic byproduct. We demonstrate the in vitro glycation arresting potential of Fenfuro®, a novel patented formulation of Fenugreek seed extract with clinically proven anti-diabetic properties, in Methyl-Glyoxal (MGO) adducts of three abundant amyloidogenic cellular proteins, alpha-synuclein, Serum albumin, and Lysozyme. A 0.25% w/v Fenfuro® was able to effectively arrest glycation by more than 50% in all three proteins, as evidenced by AGE fluorescence. Glycation-induced amyloid formation was also arrested by more than 36%, 14% and 15% for BSA, Alpha-synuclein and Lysozyme respectively. An increase in MW by attachment of MGO was also partially prevented by Fenfuro® as confirmed by SDS-PAGE analysis. Glycation resulted in enhanced aggregation of the three proteins as revealed by Native PAGE and Dynamic Light Scattering. However, in the presence of Fenfuro®, aggregation was arrested substantially, and the normal size distribution was restored. The results cumulatively indicated the lesser explored potential of direct inhibition of glycation by fenugreek seed in addition to its proven role in alleviating insulin resistance. Fenfuro® boosts its therapeutic potential as an effective phytotherapeutic to arrest Type 2 diabetes.

Efficacy and safety of stem cell therapy in patients with dilated cardiomyopathy: an umbrella review of systematic reviews

BACKGROUND

Stem cell therapy (SCT) has emerged as a potential therapeutic avenue, with various cell types being explored for their efficacy in treating dilated cardiomyopathy (DCM). However, the safety and efficacy of these therapies have been the subject of numerous systematic reviews. This umbrella review aims to consolidate the existing evidence on stem cell interventions for DCM, providing a comprehensive overview of the current research landscape.

METHODS

This review was conducted following the JBI and PRISMA guidelines. Systematic reviews and meta-analyses of randomized controlled trials (RCTs) evaluating the safety and efficacy of SCT for DCM were included. Outcomes such as 6-minute walk test (6-MWT), left ventricular end-diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACE), New York Heart Association (NYHA), and quality of life (QoL), among others, were considered. A literature search was executed across databases like PubMed, Embase, Web of Science, and Cochrane Database up to 7 October 2023. The quality of the included reviews was assessed using the JBI Checklist for Systematic Reviews and Research Syntheses. Data synthesis was carried out in both narrative and tabular formats, with the GRADE criteria guiding the determination of evidence certainty.

RESULTS

Nine systematic reviews met the inclusion criteria. LVEF found to be significantly improved with SCT. LVEDD and LVEDV assessments yielded mixed results, with some reviews observing significant changes. Left ventricular end-systolic volume showed consistent reductions across multiple studies. B-type natriuretic peptide concentrations post-interventions were explored in several studies, with mixed findings. Health-related quality of life (HRQL) showed varied results, with some studies noting improvements and others finding no significant differences. NYHA classifications and 6-MWT results indicated potential benefits from stem cell treatments. SCT was observed to be generally safe. The certainty of evidence was low or very low for most of outcomes.

CONCLUSION

SCT showed has shown promise in treating DCM, with many studies highlighting its safety and potential benefits. Nonetheless, the existing data has its limitations due to biases in the RCTs studies. To truly establish the benefits of SCT for DCM, future high-quality RCTS, are crucial.

Therapeutic effect of fenugreek supplementation on type 2 diabetes mellitus: A systematic review and meta-analysis of clinical trials

Introduction

Numerous clinical trials have investigated the effects of fenugreek, a traditional herbal medicine, on type 2 diabetes mellitus (T2DM). However, the results from these studies have been inconsistent. Therefore, we aimed to perform a meta-analysis on the effects of fenugreek supplementation on weight, body mass index (BMI), lipid profile, and glycemic indices in patients with T2DM.

Methods

We searched PubMed, Scopus, Embase, ISI Web of Science, and Cochrane Library databases to identify clinical trial studies until October 2023. The data were analyzed using a random-effects model and presented as the weighted mean difference (WMD) along with the associated 95 % confidence interval (CI).

Results

A total of 19 studies were included in the meta-analysis. The results indicated a significant impact of fenugreek supplementation on lowering fasting plasma glucose (FPG) (WMD: 20.32 mg/dl; 95 % CI: 26.65 to -13.99), hemoglobin A1C (HbA1c) (WMD: 0.54 %; 95 % CI: 0.80 to -0.28), homeostatic model assessment of insulin resistance (HOMA-IR) (WMD: 0.36; 95 % CI: 0.67 to -0.05), total cholesterol (TC) (WMD: 33.10 mg/dL; 95 % CI: 64.31 to -1.88), low-density lipoprotein cholesterol (LDL-C) (WMD: 29.14 mg/dL; 95 % CI: 55.45 to -2.83), BMI (WMD: 0.73 kg/m2; 95 % CI: 1.40 to -0.07), and increasing the high-density lipoprotein cholesterol (HDL-C) (WMD: 5.68 mg/dL; 95 % CI: 3.51 to 7.85). However, the effect on fasting insulin, triglycerides, and weight was not significant.

Conclusions

Fenugreek supplementation has been shown to improve FPG, HbA1C, HOMA-IR, TC, LDL-C, HDL-C, and BMI in patients with T2DM. The overall results suggest that fenugreek may have protective and therapeutic effects on T2DM parameters.

Prevalence of mental health disorders in knee osteoarthritis patients: a systematic review and meta-analysis

Background

Knee osteoarthritis (OA) is a prevalent degenerative disease affecting synovial joints, predominantly the knee, leading to various complications, including mental health conditions like depression and anxiety. This systematic review aimed to determine the prevalence of depression and anxiety in knee OA patients.

Methods

A comprehensive literature search was conducted in various databases till September 15, 2023. Studies focusing on the prevalence of mental health issues in patients with knee OA were included, excluding narrative reviews, protocols, unpublished reports, editorials, case reports, abstracts, and commentaries. All statistical analyses were performed in R version 4.2.3.

Results

This review included a total of 14 studies involving middle-aged to elderly adult patients with knee OA, with ages ranging from 45 to 75 years. Among these, 13 studies involving 3390 adult patients with an average age of 59.75 years reported a pooled prevalence of depression of 30% (95% confidence interval: 18-43), demonstrating a substantial heterogeneity (I 2=98%). Additionally, anxiety was identified with a combined prevalence of 27% (95% confidence interval: 24-30) based on three studies that included 1407 older adult patients with an average age of 62.1 years. These studies displayed minimal heterogeneity (I 2=7%).

Conclusion

The findings show a significant prevalence of depression among adult patients with knee OA and anxiety among older adults with knee OA, emphasizing the need for integrated healthcare approaches that address both orthopedic and mental health conditions. More comprehensive research is essential to deepen our understanding of the connection between mental illnesses and knee OA and to develop effective preventive and treatment strategies.

Potential Benefit of Spices for Glycemic Control

The prevalence of hyperglycemia is increasing worldwide in large part due to the escalating prevalence of obesity. It can occur along with other disorders and diseases, contributing to escalating health costs and accumulating disabilities. Besides dietary approaches and availability of antidiabetic medications, other complementary approaches and adjunct therapies using biologically active botanical phytochemicals have received growing attention for managing type 2 diabetes mellitus. Spices are one source of these bioactive plant constituents, and considerable preclinical studies have investigated their possible health benefits. There also are an increasing number of human clinical trials assessing the ability of spices and their individual plant constituents to improve glucose homeostasis in those with type 2 diabetes mellitus and other dysglycemic conditions. This narrative review provides a summary of the human studies evaluating the effects of select spices on glucose homeostasis and highlights areas for future research.

The Role of Fenugreek in the Management of Type 2 Diabetes

The number of people diagnosed with type 2 diabetes is on the increase worldwide. Of growing concern, the prevalence of type 2 diabetes in children and youths is increasing rapidly and mirrors the increasing burden of childhood obesity. There are many risk factors associated with the condition; some are due to lifestyle, but many are beyond our control, such as genetics. There is an urgent need to develop better therapeutics for the prevention and management of this complex condition since current medications often cause unwanted side effects, and poorly managed diabetes can result in the onset of related comorbidities. Naturally derived compounds have gained momentum for preventing and managing several complex conditions, including type 2 diabetes. Here, we provide an update on the benefits and limitations of fenugreek and its components as a therapeutic for type 2 diabetes, including its bioavailability and interaction with the microbiome.

A randomized double blind placebo controlled trial to assess the safety and efficacy of a patented fenugreek (Trigonella foenum-graecum) seed extract in Type 2 diabetics

Background

Fenugreek plant (Trigonella foenum-graecum) constitutes a traditionally acclaimed herbal remedy for many human ailments including diabetes, obesity, neurodegenerative diseases, and reproductive disorders. It is also used as an effective anti-oxidative, anti-inflammatory, antibacterial, and anti-fungal agent. The seed of the plant is especially enriched in several bioactive molecules including polyphenols, saponins, alkaloids, and flavonoids and has demonstrated potential to act as an antidiabetic phytotherapeutic. A novel patented formulation (Fenfuro®) was developed in our laboratory from the fenugreek seeds which contained >45% furostanolic saponins (HPLC).

Objective

A placebo-controlled clinical compliance study was designed to assess the effects of complementing Fenfuro® on a randomized group of human volunteers on antidiabetic therapy (Metformin and sulphonylurea) in controlling the glycemic index along with simultaneous safety assessment.

Study methodology and trial design

In a randomized double-blind, placebo-controlled trial, 42 individuals (21 male and 21 female volunteers) in the treatment group (out of 57 enrolled) and 39 individuals (17 male and 22 female volunteers) in the placebo group (out of 47 enrolled), all on antidiabetic therapy with Metformin/Metformin with sulphonyl urea within the age group of 18-65 years were administered either 1,000 mg (500 mg × 2) (Fenfuro®) capsules or placebo over a period of 12 consecutive weeks. Fasting and postprandial glucose along with glycated hemoglobin were determined as primary outcomes to assess the antidiabetic potential of the formulation. Moreover, in order to evaluate the safety of the formulation, C-peptide and Thyroid Stimulating Hormone (TSH) levels as well as immunohematological parameters were assessed between the treatment and placebo groups at the completion of the study.

Results

After 12 weeks of administration, both fasting as well as postprandial serum glucose levels decreased by 38 and 44% respectively in the treatment group. Simultaneously, a significant reduction in glycated hemoglobin by about 34.7% was also noted. The formulation did not have any adverse effect on the study subjects as there was no significant change in C- peptide level and TSH level; liver, kidney, and cardiovascular function was also found to be normal as assessed by serum levels of key immunohematological parameters. No adverse events were reported.

Conclusion

This clinical compliance study re-instated and established the safety and efficacy of Fenfuro® as an effective phytotherapeutic to treat hyperglycemia.

COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis

BACKGROUND

The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization.

OBJECTIVE

This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions.

METHODS

We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative.

RESULTS

Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses.

CONCLUSIONS

This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies.

TRIAL REGISTRATION

PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr.

A Scoping Review of the Clinical Evidence for the Health Benefits of Culinary Doses of Herbs and Spices for the Prevention and Treatment of Metabolic Syndrome

Metabolic syndrome (MetS) is a growing global health problem. Evidence suggests that diets rich in phytochemical-containing herbs and spices can contribute to reducing the risk of chronic diseases. This review assesses the scope of evidence supporting the use of herbs and spices in the diet for the prevention or treatment of MetS and its associated health conditions. A search of the PubMed, Scopus and Google Scholar databases was carried out to assess the available clinical evidence for culinary doses of commonly used herbs and spices. Trials that were measuring health factors related to metabolic disorders in healthy individuals, or the health of individuals with MetS or associated diseases, were included. Out of a total of 1738 papers identified, there were 142 relevant studies on black pepper, chilli, cardamom, cinnamon, coriander, cumin, fennel, fenugreek, garlic, ginger, nigella seed, rosemary, sage and turmeric. No relevant research was found for cloves, mint, oregano, parsley or thyme. Cinnamon, fenugreek and ginger were the herbs/spices with the most published trials on them and that showed promise for glycaemic control. Cardamom appears to have potential to reduce inflammatory markers, and cinnamon, ginger and turmeric to reduce blood lipids. Patients with type 2 diabetes were the population most likely to be included in studies, but the preventative benefits of herbs/spices in healthy populations were also investigated, particularly for chilli, ginger and cinnamon. There is evidence for the beneficial effect of culinary doses of many common herbs/spices in the prevention and treatment of MetS and associated disorders.