Effect of Tinospora cordifolia as an add - on therapy on the blood glucose levels of patients with Type 2 diabetes
Keywords:Type 2 diabetes, Tinospora cordifolia, Oral hypoglycemic agents
Background: Type 2 diabetes is a fast growing epidemic affecting people globally. Good glycemic control helps in reducing the risk of macro and microvascular complications in diabetics. Alternative medicines have been used since ancient times in India to achieve good glycemic control. Tinospora cordifolia (Tc) is a well reported plant possessing anti-diabetic property. Therefore, we undertook this study to evaluate the effectivity of Tc in reducing the blood glucose levels of Type 2 diabetic patients in the form of add-on therapy.
Methods: In the present study, we enrolled 100 Type 2 diabetic patients who met our inclusion criteria. These patients were then randomly divided into two Groups, A and B. Patients in Group A were treated as controls and they continued with their anti-diabetic medications. In Group B, Tc was added to the conventional treatment at a dose of 500 mg 3 times daily along with meals. The fasting and postprandial blood glucose levels and glycosylated hemoglobin (HbA1c) were recorded baseline and after 6 months.
Results: During the course of study, we observed a decrease in the fasting, postprandial, and HbA1c levels of the patients. However, this decrease was found to be more statistically significant (p≤0.005) in Group B.
Conclusion: The results obtained from the present study conclude that Tc, when given in the form of add-on therapy, was found to be synergistic and effective in the better management of Type 2 diabetes. The drug was well tolerated by the patients and no adverse drug event was recorded.
Defronzo RA. Banting lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus. Diabetes. 2009;58(4):773-95.
National Kidney Foundation. KDOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. Am J Kidney Dis. 2007;49:S12-154.
Fong DS, Aiello L, Gardner TW, King GL, Blankenship G, Cavallerano JD, et al. Retinopathy in diabetes. Diabetes Care. 2004;27 Suppl 1:S84-7.
Boulton AJ, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-62.
Almdal T, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med. 2004;164(13):1422-6.
Juutilainen A, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Type 2 diabetes as a “coronary heart disease equivalent”: an 18-year prospective population-based study in finnish subjects. Diabetes Care. 2005;28(12):2901-7.
Schramm TK, Gislason GH, Køber L, Rasmussen S, Rasmussen JN, Abildstrøm SZ, et al. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people. Circulation. 2008;117:1945-54.
Look AHEAD Research Group, Pi-Sunyer X, Blackburn G, Brancati FL, Bray GA, Bright R, et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007;30(6):1374-83.
Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: review with meta-analysis of clinical studies. J Am Coll Nutr. 2003;22(5):331-9.
Klein S, Sheard NF, Pi-Sunyer X, Daly A, Wylie-Rosett J, Kulkarni K, et al. Weight management through lifestyle modification for the prevention and management of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care. 2004;27(8):2067-73.
Brown JB, Nichols GA, Perry A. The burden of treatment failure in type 2 diabetes. Diabetes Care. 2004;27(7):1535-40.
Fonseca VA. Defining and characterizing the progression of type 2 diabetes. Diabetes Care. 2009;32 Suppl 2:S151-6.
Turner RC, Cull CA, Frighi V, Holman RR. Glycemic control with diet, sulfonylurea, metformin, or insulin in patients with type 2 diabetes mellitus: progressive requirement for multiple therapies (UKPDS 49). UK Prospective Diabetes Study (UKPDS) Group. JAMA. 1999;281(21):2005-12.
Kahn SE, Haffner SM, Heise MA, Herman WH, Holman RR, Jones NP, et al. Glycemic durability of rosiglitazone, metformin, or glyburide monotherapy. N Engl J Med. 2006;355(23):2427-43.
Bennett WL, Maruthur NM, Singh S, Segal JB, Wilson LM, Chatterjee R, et al. Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Intern Med. 2011;154(9):602-13.
Riddle MC. Combined therapy with insulin plus oral agents: is there any advantage? An argument in favor. Diabetes Care. 2008;31 Suppl 2:S125-30.
Phung OJ, Scholle JM, Talwar M, Coleman CI. Effect of noninsulin antidiabetic drugs added to metformin therapy on glycemic control, weight gain, and hypoglycemia in type 2 diabetes. JAMA. 2010;303(14):1410-8.
Barnett AH, Cradock S, Fisher M, Hall G, Hughes E, Middleton A. Key considerations around the risks and consequences of hypoglycaemia in people with type 2 diabetes. Int J Clin Pract. 2010;64(8):1121-9.
Peyrot M, Skovlund SE, Landgraf R. Epidemiology and correlates of weight worry in the multinational diabetes attitudes, wishes and needs study. Curr Med Res Opin. 2009;25(8):1985-93.
Anonymous. Quality Standards of Indian Medicinal Plants. Vol. 1. New Delhi: Indian Council of Medical Research; 2003: 212.
Dhar ML, Dhar MM, Dhawan BN, Mehrotra BN, Ray C. Screening of Indian plants for biological activity: I. Indian J Exp Biol. 1968;6(4):232-47.
Singh KP, Gupta AS, Pendse VK, Mahatma CP, Bhandari DS, Mahawar MM. Experimental and clinical studies on Tinospora cordifolia. J Res Indian Med. 1975;10:9-14.
Kundnani KM, Mahajan VR, Jolly CI. A new hypoglycaemic agent from Tinospora cordifolia: Miers. Indian Drugs. 1985;23:119-20.
Goel HC, Prem Kumar I, Rana SV. Free radical scavenging and metal chelation by Tinospora cordifolia, a possible role in radioprotection. Indian J Exp Biol. 2002;40(6):727-34.
Subramanian M, Chintalwar GJ, Chattopadhyay S. Antioxidant properties of a Tinospora cordifolia polysaccharide against iron-mediated lipid damage and gamma-ray induced protein damage. Redox Rep. 2002;7(3):137-43.
Gupta SS, Verma SC, Garg VP, Rai M. Anti-diabetic effects of Tinospora cardifolia. I. Effect on fasting blood sugar level, glucose tolerance and adrenaline induced hyperglycaemia. Indian J Med Res. 1967;55(7):733-45.
Rout GR. Identification of Tinospora cordifolia (Willd.) Miers ex Hook F & Thomas using RAPD markers. Z Naturforsch C. 2006;61(1-2):118-22.
Sudha P, Zinjarde SS, Bhargava SY, Kumar AR. Potent a-amylase inhibitory activity of indian ayurvedic medicinal plants. BMC Complement Altern Med. 2011;11:5.
Chougale AD, Ghadyale VA, Panaskar SN, Arvindekar AU. Alpha glucosidase inhibition by stem extract of Tinospora cordifolia. J Enzyme Inhib Med Chem. 2009;24(4):998-1001.
Umamaheswari S, Mainzen Prince PS. Antihyperglycaemic effect of ‘Ilogen-Excel’, an ayurvedic herbal formulation in streptozotocin-induced diabetes mellitus. Acta Pol Pharm. 2007;64(1):53-61.
Babu PS, Stanely Mainzen Prince P. Antihyperglycaemic and antioxidant effect of hyponidd, an ayurvedic herbomineral formulation in streptozotocin-induced diabetic rats. J Pharm Pharmacol. 2004;56(11):1435-42.
Bhattacharya SK, Satyan KS, Chakrabarti A. Effect of trasina, an ayurvedic herbal formulation, on pancreatic islet superoxide dismutase activity in hyperglycaemic rats. Indian J Exp Biol. 1997;35(3):297-9.
Patel SS, Shah RS, Goyal RK. Antihyperglycemic, antihyperlipidemic and antioxidant effects of dihar, a polyherbal ayurvedic formulation in streptozotocin induced diabetic rats. Indian J Exp Biol. 2009;47(7):564-70.