Anti-diabetic and antioxidant effect of cinnamon in poorly controlled type-2 diabetic Iraqi patients: A randomized, placebo-controlled clinical trial

Ahmed Salih Sahib, Ahmed Salih Sahib

Abstract

Aim: To determine the effect of cinnamon on fasting blood glucose, hemoglobin (Hb) A1c, and oxidative stress markers in poorly controlled type 2 diabetes.

Patients and methods: A total of 25 type 2 diabetic patients of both sexes, aged 49.1 ± 6.0, treated only with hypoglycemic agent sulfonylurea (glibenclamide) were randomly assigned to receive either 1 g of cinnamon or placebo daily for 12 weeks.

Results: A highly significant (P ≤ 0.001) reduction (10.12%) of fasting blood glucose level after 6 and 12 weeks of treatment 10.12% and 17.4%, respectively, compared to baseline value and to placebo group at corresponding duration. Meanwhile, the value of glycosylated Hb reduced in cinnamon treated group by (2.625%) and (8.25%) after 6 and 12 weeks, respectively, although this reduction was non-significant compared to baseline value. Concerning the oxidative stress markers, the level of serum glutathione showed highly significant (P ≤ 0.001) elevation after 12 weeks as compared to baseline value and placebo group at corresponding duration, malondialdehyde serum level decreased after treatment of diabetic patients with cinnamon resulted in highly significant (P ≤ 0.001) reduction after 6 and 12 weeks compared to placebo group, but when compared to baseline value, there is a (15%) reduction only after 12 weeks of treatment which was considered highly significant (P ≤ 0.001) change, Finally, administration of cinnamon to diabetic patients for 12 weeks resulted in significant (P ≤ 0.05) elevation of superoxide dismutase level.

Conclusion: Intake of 1 g of cinnamon for 12 weeks reduces fasting blood glucose and glycosylated Hb among poorly controlled type 2 diabetes patients, as well as, there is improvement in the oxidative stress markers, indicating the beneficial effect of adjuvant cinnamon as anti-diabetic and antioxidant along with conventional medications to treat poorly controlled type 2 diabetes mellitus.

Keywords: Antioxidants; cinnamon; poorly controlled diabetes mellitus; type 2 diabetes.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Effect of 1 g cinnamon powder on fasting blood glucose in diabetic patients. **Highly significant difference from baseline (P < 0.001). bHighly significant difference (P < 0.001) between cinnamon group and placebo group at corresponding duration
Figure 2
Figure 2
Effect of 1 g cinnamon powder on hemoglobin A1c % in diabetic patients
Figure 3
Figure 3
Effect of 1 g cinnamon powder on reduced glutathione serum level in diabetic patients. *Significant difference from baseline (P < 0.05), **Highly significant difference from baseline (P < 0.001). bHighly significant difference (P < 0.001) between cinnamon group and placebo group at corresponding duration
Figure 4
Figure 4
Effect of 1 g cinnamon powder on malondialdehyde serum level in diabetic patients. **Highly significant difference from baseline (P < 0.001). bHighly significant difference (P < 0.001) between cinnamon group and placebo group at corresponding duration
Figure 5
Figure 5
Effect of 1 g cinnamon powder on superoxide dismutase serum level in diabetic patients. *Significant difference from baseline (P < 0.05), aSignificant difference (P < 0.05) between cinnamon group and placebo group at corresponding duration

References

    1. World Health Organization: WHO Diabetes Fact Sheet No 312. Available from: .
    1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53.
    1. Zimmet P, Alberti KG, Shaw J. Global and societal implications of the diabetes epidemic. Nature. 2001;414:782–7.
    1. Fiorentino TV, Prioletta A, Zuo P, Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Curr Pharm Des. 2013;19:5695–703.
    1. Johansen JS, Harris AK, Rychly DJ, Ergul A. Oxidative stress and the use of antioxidants in diabetes: Linking basic science to clinical practice. Cardiovasc Diabetol. 2005;4:5.
    1. Baynes JW. Role of oxidative stress in development of complications in diabetes. Diabetes. 1991;40:405–12.
    1. Sabu MC, Kuttan R. Anti-diabetic activity of medicinal plants and its relationship with their antioxidant property. J Ethnopharmacol. 2002;81:155–60.
    1. Aldallal AA. Potential role of cinnamon in improvement of glycemic control in untreated diabetic patients. Kerbala J Pharm Sci. 2013;6:85–91.
    1. Mang B, Wolters M, Schmitt B, Kelb K, Lichtinghagen R, Stichtenoth DO, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36:340–4.
    1. Dugoua JJ, Seely D, Perri D, Cooley K, Forelli T, Mills E, et al. From type 2 diabetes to antioxidant activity: A systematic review of the safety and efficacy of common and cassia cinnamon bark. Can J Physiol Pharmacol. 2007;85:837–47.
    1. Cao H, Polansky MM, Anderson RA. Cinnamon extract and polyphenols affect the expression of tristetraprolin, insulin receptor, and glucose transporter 4 in mouse 3T3-L1 adipocytes. Arch Biochem Biophys. 2007;459:214–22.
    1. Anderson RA, Broadhurst CL, Polansky MM, Schmidt WF, Khan A, Flanagan VP, et al. Isolation and characterization of polyphenol type-A polymers from cinnamon with insulin-like biological activity. J Agric Food Chem. 2004;52:65–70.
    1. Sheng X, Zhang Y, Gong Z, Huang C, Zang YQ. Improved insulin resistance and lipid metabolism by cinnamon extract through activation of peroxisome proliferator-activated receptors. PPAR Res. 2008;2008:581348.
    1. Adisakwattana S, Lerdsuwankij O, Poputtachai U, Minipun A, Suparpprom C. Inhibitory activity of cinnamon bark species and their combination effect with acarbose against intestinal a-glucosidase and pancreatic a-amylase. Plant Foods Hum Nutr. 2011;66:143–8.
    1. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr. 2007;85:1552–6.
    1. Barham D, Trendoer P. An improved color reagent from the determination of blood glucose by the oxidative system. Analyst. 1972;97:142–5.
    1. Mayer TK, Freedman ZR. Protein glycosylation in diabetes mellitus: A review of laboratory measurements and of their clinical utility. Clin Chim Acta. 1983;127:147–84.
    1. Stocks J, Dormandy TL. The autooxidation of human red cells lipids induced by hydrogen peroxide. Br J Haematol. 1971;20:95–111.
    1. Gilbert HS, Stump DD, Roth EF., Jr A method to correct errors caused generation of interfering compounds during lipid peroxidation. Anal Biochem. 1984;173:282–6.
    1. Godin DV, Wohaieb SA, Garnett ME, Goumeniouk AD. Antioxidant enzyme alterations in experimental and clinical diabetes. Mol Cell Biochem. 1988;84:223–31.
    1. Khan A, Safdar M, Ali Khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26:3215–8.
    1. Crawford P. Effectiveness of cinnamon for lowering hemoglobin A1C in patients with type 2 diabetes: A randomized, controlled trial. J Am Board Fam Med. 2009;22:507–12.
    1. Akilen R, Tsiami A, Devendra D, Robinson N. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic Type 2 diabetic patients in the UK: A randomized, placebo-controlled, double-blind clinical trial. Diabet Med. 2010;27:1159–67.
    1. Suppapitiporn S, Kanpaksi N, Suppapitiporn S. The effect of cinnamon cassia powder in type 2 diabetes mellitus. J Med Assoc Thai. 2006;89(Suppl 3):S200–5.
    1. Anderson RA, Zhan Z, Luo R, Guo X, Guo Q, Zhou J, et al. Cinnamon extract lowers glucose, insulin and cholesterol in people with elevated serum glucose. J Tradit Complement Med. 2015 DOI:10.1016/j.jtcme.2015.03.005.
    1. Medagama AB. The glycaemic outcomes of Cinnamon, a review of the experimental evidence and clinical trials. Nutr J. 2015;14:108.
    1. Plexopathy DL. Cinnamon dose-dependently reduces insulin concentration. Am J Clin Nutr. 2009;89:815–21.
    1. Hlebowicz J, Hlebowicz A, Lindstedt S, Björgell O, Höglund P, Holst JJ, et al. Effects of 1 and 3 g cinnamon on gastric emptying, satiety, and postprandial blood glucose, insulin, glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and ghrelin concentrations in healthy subjects. Am J Clin Nutr. 2009;89:815–21.
    1. Anand P, Murali KY, Tandon V, Murthy PS, Chandra R. Insulinotropic effect of cinnamaldehyde on transcriptional regulation of pyruvate kinase, phosphoenolpyruvate carboxykinase, and GLUT4 translocation in experimental diabetic rats. Chem Biol Interact. 2010;186:72–81.
    1. Palem SP, Abraham P. A study on the level of oxidative stress and inflammatory markers in Type 2 diabetes mellitus patients with different treatment modalities. J Clin Diagn Res. 2015;9:BC04–7.
    1. Hamidpour R, Hamidpour M, Hamidpour S, Shahlari M. Cinnamon from the selection of traditional applications to its novel effects on the inhibition of angiogenesis in cancer cells and prevention of Alzheimer's disease, and a series of functions such as antioxidant, anticholesterol, antidiabetes, antibacterial, antifungal, nematicidal, acaracidal, and repellent activities. J Tradit Complement Med. 2015;5:66–70.
    1. Rao PV, Gan SH. Cinnamon: A multifaceted medicinal plant. Evid Based Complement Alternat Med. 2014;2014:642942.
    1. Shalaby MA, Saifan HY. Some pharmacological effects of cinnamon and ginger herbs in obese diabetic rats. J Intercult Ethnopharmacol. 2014;3:144–9.
    1. Roussel AM, Hininger I, Benaraba R, Ziegenfuss TN, Anderson RA. Antioxidant effects of a cinnamon extract in people with impaired fasting glucose that are overweight or obese. J Am Coll Nutr. 2009;28:16–21.

Source: PubMed

3
Tilaa