Momordica charantia for type 2 diabetes mellitus

 

Abstract

Background

Momordica charantia is not only a nutritious vegetable, but is also used in traditional medical practices to treat type 2 diabetes mellitus. Experimental studies with animals and humans suggested that the vegetable has a possible role in glycaemic control.

Objectives

To assess the effects of mormodica charantia for type 2 diabetes mellitus.

Search methods

Several electronic databases were searched, among these The Cochrane Library (issue 4, 2009), MEDLINE, EMBASE, CINAHL, SIGLE and LILACS (all up to November 2009), combined with handsearches. No language restriction was used.

Selection criteria

Randomized controlled trials that compared momordica charantia with a placebo or a control intervention with or without pharmacological or non-pharmacological interventions were included.

Data collection and analysis

Two authors independently extracted the data. Risk of bias of trials was evaluated using the parameters of randomization, allocation concealment, blinding, completeness of outcome data, selective reporting and other potential sources of bias. A meta-analysis was not performed given the quality of data and the variability of preparations of momordica charantia used in interventions (no similar preparation was tested twice).

Main results

Three randomised controlled trials with up to three months duration and investigating 350 participants met the inclusion criteria. Risk of bias of these trials (only one study was published as a full peer-reviewed publication) was generally high. Two RCTs compared the effect of preparations from different parts of the momordica charantia plants and placebo on the glycemic control in type 2 diabetes mellitus. There was no statistically significant difference compared to placebo. The effects of preparation from the leaves of the plant and glibenclamide were comparable in the third trial. No serious adverse effects were reported in all the trials. There were no documentations of death from any cause, morbidity, (health-related) quality of life and costs.

Authors' conclusions

There is insufficient evidence to recommend momordica charantia for type 2 diabetes mellitus. Further studies are therefore required to address the issues of standardization and the quality control of preparations. For medical nutritional therapy, further observational trials evaluating the effects of momordica charantia are needed before RCTs are established to guide any recommendations in clinical practice.

 

Plain language summary

Momordica charantia for type 2 diabetes mellitus

Mormordica charantia (bitter gourd) is a climbing perennial that is characterized by elongated, warty fruit-like gourd or cucumber and is native to the tropical belt. Although momordica charantia is commonly used in traditional medical practices along with research suggesting its benefits for people with type 2 diabetes, the current evidence does not warrant using the plant in treating this disease. This review of trials found only three studies of low quality which showed no significant differences between momordica charantia and placebo or an antidiabetic drug (glibenclamide) in the blood sugar response. The duration of treatment ranged from four weeks to three months, altogether 350 patients with type 2 diabetes mellitus were investigated. No death from any cause, health-related quality of life and costs involved were reported. Adverese effects were mostly moderate, including diarrhoea and abdominal pain. There are many varieties of momordica charantia preparations as well as its use as a vegetable. Further trials are needed to assess the quality of the various momordica charantia preparations as well as to further evaluate its use in the diet of diabetic people.

 

摘要

背景

苦瓜 (Momordica charantia) 對於第2型糖尿病 (type 2 diabetes mellitus) 的功效

苦瓜不僅是具營養性的蔬菜，也是被使用在傳統醫學上去治療第2型糖尿病。在動物和人體的實驗研究中建議，苦瓜在血糖的控制可能扮演某些的角色。

目標

評估苦瓜在第2型糖尿病的功效

搜尋策略

在這些被搜尋的許多電子資料庫中，包含如下: CochraneThe Cochrane Library (issue 4, 2009), MEDLINE, EMBASE, CINAHL, SIGLE and LILACS (皆為2009年11月以前的資料) ，並且與手動搜尋結合。無使用語言限制。

選擇標準

隨機對照試驗 (Randomized controlled trials:RCTs) 中包括隨機比較苦瓜與安慰劑或控制組有無藥物的介入。

資料收集與分析

2位作者獨立摘錄數據。使用隨機化 (randomization) ，分組隱匿 (allocation concealment) ，盲法 (blinding) ，結果數據的完整性，有選擇性的報告和其他潛在偏差來源的參數來評估研究報告偏差的風險。統合分析 (metaanalysis) 未執行乃因給與之數據品質和使用在介入因子中苦瓜的製備物具變異性所致 (沒有使用相似的製備物被測試兩次) 。

主要結論

3篇隨機對照試驗長達了三個月的試驗期間，350位參加者符合研究標準。這些文獻都含有高度偏差風險 (僅一篇研究以完全的被同儕評核 (peerreviewed) 的出版物刊登) 。二篇隨機對照試驗比較從苦瓜植物不同的部位之製備物和安慰劑對第2型糖尿病的血糖控制功效。結果顯示與安慰劑比較沒有統計學上的差異。第3篇研究是針對苦瓜葉子之制備物和糖尿病藥物 (glibenclamide) 來作比較。所有試驗沒有嚴重的不良反應報告。沒有文獻報告提及任何病因造成的死亡、併發症、 (與健康相關的) 生活品質和費用。

作者結論

沒有足夠的證據去推薦可將苦瓜用在第2型糖尿病。因此未來的研究需要將問題標準化和製備物品質的控制。對於醫學營養療法，在隨機對照試驗被建立去作任何推薦苦瓜具臨床使用之前，進一步觀察性研究 (observational trials) 評估苦瓜的功效是必須的。

翻譯人

本摘要由衛生署臺北醫院林素菁翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

苦瓜在第2型糖尿病的功效：苦瓜是一年生的蔓性植物，其特徵為瘦長，表面有似金瓜或黃瓜般的疣狀突起，並且是熱帶區特有的植物。雖然苦瓜在傳統醫學上的使用是常見的以及文獻建議用在第2型糖尿病是有益的，但目前證據不保證這種植物使用在治療第2型糖尿病。這些研究報告指出只有3篇較差等級的研究，其中顯示血糖對苦瓜，安慰劑或抗糖尿藥物其反應皆沒有統計學差異。治療的期間從4星期到3個月，共包括350名第2型糖尿病患者。沒有相關的因任何原因造成的死亡，與健康有關的生活品質和費用被報告。常見之輕度副作用包括腹瀉，和腹痛。如同它可作為蔬菜使用，苦瓜製備物具多變異性。未來進一步研究需要去評估多樣化的苦瓜製備物以及進一步評估它在糖尿病人飲食上的使用。