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Supplemental Digital Content is available in the text, Background: Polyunsaturated fats (PUFAs) have been shown to reduce type 2 diabetes (T2DM) risk and improve insulin responsiveness in T2DM subjects, but whether the plant sources of omega-3 PUFA (alpha-linolenic acid [ALA]) have an effect on glycemic control requires further investigation. Methods: The parameters of interest were glycated hemoglobin (HbA1c), fasting blood glucose (FBG), fasting blood insulin (FBI), homeostatic model assessment for insulin resistance (HOMA-IR), fructosamine, and glycated albumin. A comprehensive search was conducted with MEDLINE, Embase, CINAHL, and Cochrane. Eligible studies included randomized controlled trials (RCTs) ≥1 month in duration that compared diets enriched in ALA with usual diets on glycemic parameters. For each study, the risk of bias as well as the study quality was assessed. Using the statistical software RevMan (v5.3), data were pooled using the generic inverse method with random effects model, and final results were expressed as mean differences (MD) with 95% confidence intervals (CI). Heterogeneity was assessed by the Cochran Q statistic and quantified by the I2 statistic. Results: A total of 8 trials (N = 212) were included in the meta-analysis. Compared to a control diet, a median dose of 4.4 g/day of ALA intake for a median duration of 3 months did not affect HbA1c (%) (MD = –.01; [95%: –.32, .31], P = .96). A median ALA dose of 5.4 g/day did not lower FBG (MD = .07; [95% CI: –.61, .76], P = .84) or FBI (MD = 7.03, [95% CI: –5.84, 19.89], P = .28). Summary effect estimates were generally compromised by considerable and unexplained heterogeneity (I2 ≥75%). In the subgroup analysis of continuous predictors, a reduction in HbA1c (%) and FBG (mmol/L) was significantly associated with an increased intake of ALA. Further adjustment for Publication Bias using Duval and Tweedie's trim-and-fill analysis provided an adjusted, significant MD of –.25 (95% CI: –.38, –.12; P

Since diabetes tends to progressively worsen over time, glycemic control often deteriorates in spite of taking regular therapy. Therefore, numerous research studies are by and large focused on finding more efficient therapy, both new medicines for treating type 2 diabetes mellitus, as well as supplements that could serve as an addition to conventional treatment modalities. A variety of herbal preparations have been shown to have modest short-term beneficial effects on glycemia, but of these, the best studied is American ginseng (AG). AG has been shown to be effective in improving glycemic control in type 2 diabetes through increasing post-prandial insulin levels and decreasing postprandial glycemic response. However, high variability in ginsenosides may result in just as high variability in antidiabetic efficacy of over-the-counter ginseng products. Therefore, the availability of standardized extracts of AG could assist greatly in advancing our knowledge on the role of this traditionally used herb and result in a wider application of ginseng product in diabetes management. The aim of this review is to outline the efficacy and safety of American ginseng for AG preparations on glycemic control in patients with type 2 diabetes as well as to increase awareness of the evidence supporting the use of these therapies in diabetes care.

Cilj istraživanja bio je ispitati sigurnost odabranog ekstrakta američkog ginsenga (AG-a) kao dopune uobičajenoj terapiji šećerne bolesti tipa 2 (ŠBT2) (prehrana i/ili lijekovi), koristeći randomizirani, dvostruko-slijepi, placebom-kontrolirani, paralelni dizajn studije. Svakom ispitaniku bio je dodijeljen ili odabrani preparat AG-a (etanolni ekstrakt) ili placebo (500 mg/po obroku = 3 g/ dnevno) u razdoblju od 12 tjedana. Ishodi istraživanja uključivali su mjere sigurnosti: bubrežna funkcija (kreatinin), jetrena funkcija (AST, ALT), koagulacijski parametri (PV, INR) ; suradljivosti (TT, ITM, %TM, OS) i kardiovaskularne čimbenike rizika uključujući lipidni profil (TK, LDL, HDL, TG), krvni tlak (sistolički i dijastolički KT) i upalno stanje organizma (CRP). Sedamdeset četiri ispitanika s kontroliranom ŠBT2 (spol: 28M: 46 Ž, dob: 62, 9±9, 49, ITM: 32±5, 3, HbA1c: 7±1, 3%), randomiziranih u intervencijsku (n= 35) ili kontrolnu (n= 39) skupinu, završilo je studiju. Nije bilo promjene u vrijednosti niti jednog od parametara sigurnosti, suradljivosti ili čimbenika kardiovaskularnog rizika, osim statistički signifikantnog sniženja sistoličkog krvnog tlaka. Nije bilo razlike u ozbiljnosti ili broju nuspojava između intervencijske i kontrolne skupine. Dopuna odabranog ekstrakta AG-a u trajanju od 12 tjedana nije utjecala na parametre sigurnosti usprkos povoljnim metaboličkim učincima u pacijenata sa ŠBT2. Budući da su istraživanja neprestano upozoravala na nuspojave ginsenga koji uključuju oslabljenu hemostatsku funkciju i povišen krvni tlak, demonstrirana sigurnost je od značaja.

The objective of the present study was to test the efficacy and safety of supplementation with the selected American ginseng extract (AG) as an adjunct to their usual anti-diabetic therapy (diet and/or medications), using a double-blind, randomized, placebo-controlled, parallel design. Each participant received either the selected AG preparation (ethanol extract) or placebo (500 mg/meal = 3 g/day) for a period of 12 weeks. Outcomes included measures of efficacy (glycated hemoglobin (HbA1c)-primary, fasting plasma glucose (FPG), fasting plasma insulin (FPI), and HOMA-IR) ; safety (liver and kidney function) ; and compliance (returned capsules and body-weight). Seventy-four participants with well-controlled type 2 diabetes (sex: 28 M: 46 F, age: 62, 9±9, 49, BMI: 32±5, 3, HbA1c: 7±1, 3), randomized to either intervention (n= 35) or control (n=39) group, completed the study. There was no change in the primary endpoint, HbA1c. However, decrease in HbA1c following AG intervention was significantly correlated to baseline glycemic control assessed by HbA1c (P=0.008). Subgroup analysis of poorly controlled T2DM patients (HbA1c> 7, 5%) demonstrated significant reductions in HbA1c following AG consumption compared to well controlled participants (HbA1c≤ 7, 5%). Safety and compliance outcomes remained unchanged. Although clinical efficacy, as assessed by HbA1c, was not demonstrated, 12 weeks of supplementation with the selected AG treatment demonstrated significant reductions in HbA1c in people with poorly controlled type 2 diabetes without adverse effects.

Background: Substantial pre-clinical and some clinical data are available showing that Asian ginseng (Panax ginseng C.A Meyer) varieties or its particular ginsenosides exert a vasodilatating effect, thus may modulate vascular function. However, the clinical evidence for American ginseng (Panax quinquefolius L.) is scarce. Objective: This study explores the effect of American ginseng (AG) treatment on peripheral blood pressure (BP) and arterial stiffness, as measured by augmentation index (AI), in subjects with well-controlled type 2 diabetes and concomitant hypertension. Methods: Using a double-blind, randomized, placebo-controlled design, each participant received either the selected AG root preparation (10% extract) or placebo at the dose of 500 mg/meal = 3 g/day for 12 weeks as an adjunct to their usual antihypertensive and anti-diabetic therapy (diet and/or medications). BP and AI were measured by applanation tonometry at baseline and after 12 weeks of treatment. Results: A total of 64 individuals with well-controlled essential hypertension and type 2 diabetes (gender: 22 M: 42 F, age: 63, 1 ± 9, 27 years, systolic/diastolic BP: 145, 4 ± 10, 81/ 84, 8 ± 8, 03 mmHg, HbA1c: 7, 0 ± 1, 31 %, FPG: 8, 1 ± 2, 31 mmol/L) completed the study. Compared to placebo, 3 g of AG significantly lowered radial AI by 5.25% (P=0.041) and systolic BP by 11.72% (P< 0.001) (Figure 1), and no significant effect was observed with diastolic BP (Table 1 and Table 2). Conclusions: The present study was the first to demonstrate that AG can generate favourable effects on pulse wave reflection and systolic BP. The selected AG treatment showed convincing preliminary long-term clinical efficacy when administered as an adjunct to usual antihypertensive and antidiabetic therapy. This study supports the results seen with other ginseng species in both preclinical and clinical studies and warrants potential clinical application.