Effect of fenugreek (Trigonella foenum-graecum L.) intake on glycemia: a meta-analysis of clinical trials

Nithya Neelakantan, Madanagopal Narayanan, Russell J de Souza, Rob M van Dam, Nithya Neelakantan, Madanagopal Narayanan, Russell J de Souza, Rob M van Dam

Abstract

Background and aim: Fenugreek is a herb that is widely used in cooking and as a traditional medicine for diabetes in Asia. It has been shown to acutely lower postprandial glucose levels, but the long-term effect on glycemia remains uncertain. We systematically reviewed clinical trials of the effect of fenugreek intake on markers of glucose homeostasis.

Methods: PubMed, SCOPUS, the Cochrane Trials Registry, Web of Science, and BIOSIS were searched up to 29 Nov 2013 for trials of at least 1 week duration comparing intake of fenugreek seeds with a control intervention. Data on change in fasting blood glucose, 2 hour postload glucose, and HbA1c were pooled using random-effects models.

Results: A total of 10 trials were identified. Fenugreek significantly changed fasting blood glucose by -0.96 mmol/l (95% CI: -1.52, -0.40; I² = 80%; 10 trials), 2 hour postload glucose by -2.19 mmol/l (95% CI: -3.19, -1.19; I² = 71%; 7 trials) and HbA1c by -0.85% (95% CI: -1.49%, -0.22%; I² = 0%; 3 trials) as compared with control interventions. The considerable heterogeneity in study results was partly explained by diabetes status and dose: significant effects on fasting and 2 hr glucose were only found for studies that administered medium or high doses of fenugreek in persons with diabetes. Most of the trials were of low methodological quality.

Conclusions: Results from clinical trials support beneficial effects of fenugreek seeds on glycemic control in persons with diabetes. However, trials with higher methodology quality using a well characterized fenugreek preparation of sufficient dose are needed to provide more conclusive evidence.

Figures

Figure 1
Figure 1
Selection of trials for meta-analysis. (Search was conducted to identify articles up to 29 Nov 2013).
Figure 2
Figure 2
Forest plot of the effect of fenugreek on fasting blood glucose. The effects in individual trials are depicted as open squares with 95% confidence intervals (CIs). Pooled estimates with 95% CIs are depicted as open diamonds.
Figure 3
Figure 3
Forest plot of the effect of fenugreek on 2 hour postload glucose. The effects in individual trials are depicted as open squares with 95% confidence intervals (CIs). Pooled estimates with 95% CIs are depicted as open diamonds.

References

    1. International Diabetes Federation. 5. Brussels, Belgium: IDF Diabetes Atlas; 2011.
    1. Kirtikar KR, Basu BD. Indian medicinal plants. 3. Allahabad, India: Lalit Mohan Prakashan; 2000.
    1. Saxena A, Vikram NK. Role of selected Indian plants in management of type 2 diabetes: a review. J Altern Complement Med. 2004;10:369–378. doi: 10.1089/107555304323062365.
    1. Wang E, Wylie-Rosett J. Review of selected Chinese herbal medicines in the treatment of type 2 diabetes. Diabetes Educ. 2008;34:645–654. doi: 10.1177/0145721708320559.
    1. Smith-Spangler CM, Bhattacharya J, Goldhaber-Fiebert JD. Diabetes, its treatment, and catastrophic medical spending in 35 developing countries. Diabetes Care. 2012;35:319–326. doi: 10.2337/dc11-1770.
    1. Neeraja A, Rajyalakshmi P. Hypoglycemic effect of processed fenugreek seeds in humans. J Food Sci Technol. 1996;33:427–430.
    1. Raghuram TC, Sharma RD, Sivakumar B, Sahay BK. Effect of fenugreek seeds on intravenous glucose disposition in Non-insulin-dependent diabetic-patients. Phytother Res. 1994;8:83–86. doi: 10.1002/ptr.2650080206.
    1. Hannan JM, Ali L, Rokeya B, Khaleque J, Akhter M, Flatt PR, Abdel-Wahab YH. Soluble dietary fibre fraction of Trigonella foenum-graecum (fenugreek) seed improves glucose homeostasis in animal models of type 1 and type 2 diabetes by delaying carbohydrate digestion and absorption, and enhancing insulin action. Br J Nutr. 2007;97:514–521. doi: 10.1017/S0007114507657869.
    1. Lu F, Shen L, Qin Y, Gao L, Li H, Dai Y. Clinical observation on Trigonella Foenum-graecum L. total Saponins in combination with sulfonylureas in the treatment of type 2 diabetes mellitus. Chin J Integr Med. 2008;14:56–60. doi: 10.1007/s11655-007-9005-3.
    1. Sauvaire Y, Baissac Y, Leconte O, Petit P, Ribes G. Steroid saponins from fenugreek and some of their biological properties. Adv Exp Med Biol. 1996;405:37–46. doi: 10.1007/978-1-4613-0413-5_4.
    1. Moorthy R, Prabhu KM, Murthy PS. Anti-hyperglycemic compound (GII) from fenugreek (Trigonella foenum-graecum Linn) seeds, its purification and effect in diabetes mellitus. Indian J Exp Biol. 2010;48:1111–1118.
    1. Uemura T, Hirai S, Mizoguchi N, Goto T, Lee JY, Taketani K, Nakano Y, Shono J, Hoshino S, Tsuge N. et al.Diosgenin present in fenugreek improves glucose metabolism by promoting adipocyte differentiation and inhibiting inflammation in adipose tissues. Mol Nutr Food Res. 2010;54:1596–1608. doi: 10.1002/mnfr.200900609.
    1. Singh AB, Tamarkar AK, Narender T, Srivastava AK. Antihyperglycaemic effect of an unusual amino acid (4-hydroxyisoleucine) in C57BL/KsJ-db/db mice. Nat Prod Res. 2010;24:258–265. doi: 10.1080/14786410902836693.
    1. Sauvaire Y, Petit P, Broca C, Manteghetti M, Baissac Y, Fernandez-Alvarez J, Gross R, Roye M, Leconte A, Gomis R, Ribes G. 4-Hydroxyisoleucine: a novel amino acid potentiator of insulin secretion. Diabetes. 1998;47:206–210. doi: 10.2337/diab.47.2.206.
    1. Vijayakumar MV, Singh S, Chhipa RR, Bhat MK. The hypoglycaemic activity of fenugreek seed extract is mediated through the stimulation of an insulin signalling pathway. Br J Pharmacol. 2005;146:41–48. doi: 10.1038/sj.bjp.0706312.
    1. Broca C, Manteghetti M, Gross R, Baissac Y, Jacob M, Petit P, Sauvaire Y, Ribes G. 4-Hydroxyisoleucine: effects of synthetic and natural analogues on insulin secretion. Eur J Pharmacol. 2000;390:339–345. doi: 10.1016/S0014-2999(00)00030-3.
    1. Alamdari KA, Choobineh S, Jadidi JP. Antidiabetic effects of exercise and fenugreek supplementation in males with NIDDM. Medicina Dello Sport. 2009;62:315–324.
    1. Sharma RD. Effect of fenugreek seeds and leaves on blood-glucose and serum-insulin responses in human-subjects. Nutr Res. 1986;6:1353–1364. doi: 10.1016/S0271-5317(86)80020-3.
    1. Kassaian N, Azadbakht L, Forghani B, Amini M. Effect of fenugreek seeds on blood glucose and lipid profiles in type 2 diabetic patients. Int J Vitam Nutr Res. 2009;79:34–39. doi: 10.1024/0300-9831.79.1.34.
    1. Gopalpura PB, Jayanthi C, Dubey S. Effect of Trigonella foenum-graecum seeds on the glycemic index of food: a clinical evaluation. Int J Diab Dev Ctries. 2007;27:41–45. doi: 10.4103/0973-3930.37033.
    1. Madar Z, Abel R, Samish S, Arad J. Glucose-lowering effect of fenugreek in non-insulin dependent diabetics. Eur J Clin Nutr. 1988;42:51–54.
    1. Sharma RD, Raghuram TC. Hypoglycemic effect of fenugreek seeds in Non-insulin-dependent diabetic subjects. Nutr Res. 1990;10:731–739. doi: 10.1016/S0271-5317(05)80822-X.
    1. Gupta A, Gupta R, Lal B. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. J Assoc Physicians India. 2001;49:1057–1061.
    1. Mathern JR, Raatz SK, Thomas W, Slavin JL. Effect of fenugreek fiber on satiety, blood glucose and insulin response and energy intake in obese subjects. Phytother Res. 2009;23:1543–1548. doi: 10.1002/ptr.2795.
    1. Chevassus H, Molinier N, Costa F, Galtier F, Renard E, Petit P. A fenugreek seed extract selectively reduces spontaneous fat consumption in healthy volunteers. Eur J Clin Pharmacol. 2009;65:1175–1178. doi: 10.1007/s00228-009-0733-5.
    1. Suksomboon N, Poolsup N, Boonkaew S, Suthisisang CC. Meta-analysis of the effect of herbal supplement on glycemic control in type 2 diabetes. J Ethnopharmacol. 2011;137:1328–1333. doi: 10.1016/j.jep.2011.07.059.
    1. Yeh GY, Eisenberg DM, Kaptchuk TJ, Phillips RS. Systematic review of herbs and dietary supplements for glycemic control in diabetes. Diabetes Care. 2003;26:1277–1294. doi: 10.2337/diacare.26.4.1277.
    1. Xie W, Zhao Y, Zhang Y. Traditional chinese medicines in treatment of patients with type 2 diabetes mellitus. Evid Based Complement Alternat Med. 2011;2011:726723.
    1. Ulbricht C, Basch E, Burke D, Cheung L, Ernst E, Giese N, Foppa I, Hammerness P, Hashmi S, Kuo G. et al.Fenugreek (Trigonella foenum-graecum L. Leguminosae): an evidence-based systematic review by the natural standard research collaboration. J Herb Pharmacother. 2007;7:143–177.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151:264–269. doi: 10.7326/0003-4819-151-4-200908180-00135. W264.
    1. Gagnier JJ, Boon H, Rochon P, Moher D, Barnes J, Bombardier C. Reporting randomized, controlled trials of herbal interventions: an elaborated CONSORT statement. Ann Intern Med. 2006;144:364–367. doi: 10.7326/0003-4819-144-5-200603070-00013.
    1. The International System of Units. 8. Paris: BIPM; 2006.
    1. Higgins JPT, Green S, editor. Cochrane handbook for systematic reviews of interventions version 5.1.0. 2011. (The Cochrane Collaboration).
    1. Elbourne DR, Altman DG, Higgins JP, Curtin F, Worthington HV, Vail A. Meta-analyses involving cross-over trials: methodological issues. Int J Epidemiol. 2002;31:140–149. doi: 10.1093/ije/31.1.140.
    1. Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol. 1992;45:769–773. doi: 10.1016/0895-4356(92)90054-Q.
    1. Hedges LV, Olkin I. Statistical methods for meta-analysis. London: Academic Press, Inc; 1985.
    1. Abrams KR, Gillies CL, Lambert PC. Meta-analysis of heterogeneously reported trials assessing change from baseline. Stat Med. 2005;24:3823–3844. doi: 10.1002/sim.2423.
    1. Curtin F, Altman DG, Elbourne D. Meta-analysis combining parallel and cross-over clinical trials I: Continuous outcomes. Stat Med. 2002;21:2131–2144. doi: 10.1002/sim.1205.
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21:1539–1558. doi: 10.1002/sim.1186.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634. doi: 10.1136/bmj.315.7109.629.
    1. Egger M, Smith GD, Altman DG. Systematic reviews in health care: meta-analysis in context. 2. London: BMJ books; 2001.
    1. Bordia A, Verma SK, Srivastava KC. Effect of ginger (Zingiber officinale Rosc.) and fenugreek (Trigonella foenumgraecum L.) on blood lipids, blood sugar and platelet aggregation in patients with coronary artery disease. Prostaglandins Leukot Essent Fatty Acids. 1997;56:379–384. doi: 10.1016/S0952-3278(97)90587-1.
    1. Chevassus H, Gaillard JB, Farret A, Costa F, Gabillaud I, Mas E, Dupuy AM, Michel F, Cantie C, Renard E. et al.A fenugreek seed extract selectively reduces spontaneous fat intake in overweight subjects. Eur J Clin Pharmacol. 2010;66:449–455. doi: 10.1007/s00228-009-0770-0.
    1. Sharma RD, Raghuram TC, Rao NS. Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutr. 1990;44:301–306.
    1. Faqih AM, Al-Nawaiseh FY. The immediate glycemic response to four herbal teas in healthy adults. J Med J. 2006;40:266–275.
    1. Bawadi HA, Maghayadah SN, Tayyem RF, Tayyem RF. The post prandial hypoglycemic activity of fenugreek seed and seeds’ extract in type 2 diabetics: a pilot study. Pharmacogn Mag. 2009;4:134–138.
    1. Zhou J, Chan L, Zhou S. Trigonelline: a plant alkaloid with therapeutic potential for diabetes and central nervous system disease. Curr Med Chem. 2012;19:3523–3531. doi: 10.2174/092986712801323171.
    1. van Dijk AE, Olthof MR, Meeuse JC, Seebus E, Heine RJ, van Dam RM. Acute effects of decaffeinated coffee and the major coffee components chlorogenic acid and trigonelline on glucose tolerance. Diabetes Care. 2009;32:1023–1025. doi: 10.2337/dc09-0207.
    1. Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170:1566–1575.
    1. Deacon CF, Mannucci E, Ahren B. Glycaemic efficacy of glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors as add-on therapy to metformin in subjects with type 2 diabetes-a review and meta analysis. Diab Obes Metab. 2012;14:762–767. doi: 10.1111/j.1463-1326.2012.01603.x.
    1. Prasanna M. Hypolipidemic effect of fenugreek: a clinical study. Indian J Pharmacol. 2000;32:34–36.

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