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The effect of ginseng (the genus panax) on glycemic control: a systematic review and meta-analysis of randomized controlled clinical trials.

Abstract

IMPORTANCE

Despite the widespread use of ginseng in the management of diabetes, supporting evidence of its anti-hyperglycemic efficacy is limited, necessitating the need for evidence-based recommendations for the potential inclusion of ginseng in diabetes management.

OBJECTIVE

To elucidate the effect of ginseng on glycemic control in a systematic review and meta-analysis of randomized controlled trials in people with and without diabetes.

DATA SOURCES

MEDLINE, EMBASE, CINAHL and the Cochrane Library (through July 3, 2013).

STUDY SELECTION

Randomized controlled trials ≥30 days assessing the glycemic effects of ginseng in people with and without diabetes.

DATA EXTRACTION

Relevant data were extracted by 2 independent reviewers. Discrepancies were resolved by consensus. The Heyland Methodological Quality Score and the Cochrane risk of bias tool were used to assess study quality and risk of bias respectively.

DATA SYNTHESIS

Sixteen trials were included, in which 16 fasting blood glucose (n = 770), 10 fasting plasma insulin (n = 349), 9 glycated hemoglobin (n = 264), and 7 homeostasis model assessment of insulin resistance (n = 305) comparisons were reported. Ginseng significantly reduced fasting blood glucose compared to control (MD =  -0.31 mmol/L [95% CI: -0.59 to -0.03], P = 0.03). Although there was no significant effect on fasting plasma insulin, glycated hemoglobin, or homeostasis model assessment of insulin resistance, a priori subgroup analyses did show significant reductions in glycated hemoglobin in parallel compared to crossover trials (MD = 0.22% [95%CI: 0.06 to 0.37], P = 0.01).

LIMITATIONS

Most trials were of short duration (67% trials<12wks), and included participants with a relatively good glycemic control (median HbA1c non-diabetes = 5.4% [2 trials]; median HbA1c diabetes = 7.1% [7 trials]).

CONCLUSIONS

Ginseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. In order to address the uncertainty in our effect estimates and provide better assessments of ginseng's anti-diabetic efficacy, larger and longer randomized controlled trials using standardized ginseng preparations are warranted.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01841229.

Links

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  • Authors+Show Affiliations

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Departments of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Clinical Epidemiology, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.

    ,

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.

    Risk Factor Modification Centre, St. Michael's Hospital, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

    Source

    PloS one 9:9 2014 pg e107391

    MeSH

    Blood Glucose
    Diabetes Mellitus, Type 1
    Diabetes Mellitus, Type 2
    Fasting
    Glycated Hemoglobin A
    Herbal Medicine
    Homeostasis
    Humans
    Insulin
    Insulin Resistance
    Middle Aged
    Panax
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    25265315

    Citation

    Shishtar, Esra', et al. "The Effect of Ginseng (the Genus Panax) On Glycemic Control: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials." PloS One, vol. 9, no. 9, 2014, pp. e107391.
    Shishtar E, Sievenpiper JL, Djedovic V, et al. The effect of ginseng (the genus panax) on glycemic control: a systematic review and meta-analysis of randomized controlled clinical trials. PLoS ONE. 2014;9(9):e107391.
    Shishtar, E., Sievenpiper, J. L., Djedovic, V., Cozma, A. I., Ha, V., Jayalath, V. H., ... Vuksan, V. (2014). The effect of ginseng (the genus panax) on glycemic control: a systematic review and meta-analysis of randomized controlled clinical trials. PloS One, 9(9), pp. e107391. doi:10.1371/journal.pone.0107391.
    Shishtar E, et al. The Effect of Ginseng (the Genus Panax) On Glycemic Control: a Systematic Review and Meta-analysis of Randomized Controlled Clinical Trials. PLoS ONE. 2014;9(9):e107391. PubMed PMID: 25265315.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The effect of ginseng (the genus panax) on glycemic control: a systematic review and meta-analysis of randomized controlled clinical trials. AU - Shishtar,Esra', AU - Sievenpiper,John L, AU - Djedovic,Vladimir, AU - Cozma,Adrian I, AU - Ha,Vanessa, AU - Jayalath,Viranda H, AU - Jenkins,David J A, AU - Meija,Sonia Blanco, AU - de Souza,Russell J, AU - Jovanovski,Elena, AU - Vuksan,Vladimir, Y1 - 2014/09/29/ PY - 2013/12/28/received PY - 2014/06/05/accepted PY - 2014/9/30/entrez PY - 2014/9/30/pubmed PY - 2015/6/16/medline SP - e107391 EP - e107391 JF - PloS one JO - PLoS ONE VL - 9 IS - 9 N2 - IMPORTANCE: Despite the widespread use of ginseng in the management of diabetes, supporting evidence of its anti-hyperglycemic efficacy is limited, necessitating the need for evidence-based recommendations for the potential inclusion of ginseng in diabetes management. OBJECTIVE: To elucidate the effect of ginseng on glycemic control in a systematic review and meta-analysis of randomized controlled trials in people with and without diabetes. DATA SOURCES: MEDLINE, EMBASE, CINAHL and the Cochrane Library (through July 3, 2013). STUDY SELECTION: Randomized controlled trials ≥30 days assessing the glycemic effects of ginseng in people with and without diabetes. DATA EXTRACTION: Relevant data were extracted by 2 independent reviewers. Discrepancies were resolved by consensus. The Heyland Methodological Quality Score and the Cochrane risk of bias tool were used to assess study quality and risk of bias respectively. DATA SYNTHESIS: Sixteen trials were included, in which 16 fasting blood glucose (n = 770), 10 fasting plasma insulin (n = 349), 9 glycated hemoglobin (n = 264), and 7 homeostasis model assessment of insulin resistance (n = 305) comparisons were reported. Ginseng significantly reduced fasting blood glucose compared to control (MD =  -0.31 mmol/L [95% CI: -0.59 to -0.03], P = 0.03). Although there was no significant effect on fasting plasma insulin, glycated hemoglobin, or homeostasis model assessment of insulin resistance, a priori subgroup analyses did show significant reductions in glycated hemoglobin in parallel compared to crossover trials (MD = 0.22% [95%CI: 0.06 to 0.37], P = 0.01). LIMITATIONS: Most trials were of short duration (67% trials<12wks), and included participants with a relatively good glycemic control (median HbA1c non-diabetes = 5.4% [2 trials]; median HbA1c diabetes = 7.1% [7 trials]). CONCLUSIONS: Ginseng modestly yet significantly improved fasting blood glucose in people with and without diabetes. In order to address the uncertainty in our effect estimates and provide better assessments of ginseng's anti-diabetic efficacy, larger and longer randomized controlled trials using standardized ginseng preparations are warranted. TRIAL REGISTRATION: ClinicalTrials.gov NCT01841229. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/25265315/full_citation L2 - http://dx.plos.org/10.1371/journal.pone.0107391 DB - PRIME DP - Unbound Medicine ER -