A randomized double blind placebo controlled trial to assess the safety and efficacy of a patented fenugreek (Trigonella foenum-graecum) seed extract in Type 2 diabetics

  • Rajinder Singh Gupta Department of Medicine, Gian Sagar Medical College & Hospital, Banur, Patiala, India
  • Amarjit Singh Grover Department of Surgery, Gian Sagar Medical College & Hospital, Banur, Patiala, India
  • Pawan Kumar R&D Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
  • Apurva Goel Regulatory Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
  • Samudra P. Banik Department of Microbiology, Maulana Azad College, Kolkata, India
  • Sanjoy Chakraborty Department of Biological Sciences, New York City College of Technology/CUNY, Brooklyn, NY, USA
  • Mehul Rungta R&D Department, Chemical Resources (CHERESO), Panchkula, Haryana, India
  • Manashi Bagchi Department of R&D, Dr. Herbs LLC, Concord, CA, USA
  • Partha Pal Department of Statistics, Maulana Azad College, Kolkata, India
  • Debasis Bagchi University of Houston College of PharmacyHouston, TX, USA
Keywords: Fenugreek (Trigonella foenum-graecum) seeds, T2D, Clinical Investigation, Fasting Glucose, Post-Prandial Glucose, HbA1c, Antihyperglycemic therapeutic

Abstract

Background: Fenugreek plant (Trigonella foenum-graecum) constitutes a traditionally acclaimed herbal remedy for many human ailments including diabetes, obesity, neurodegenerative diseases, and reproductive disorders. It is also used as an effective anti-oxidative, anti-inflammatory, antibacterial, and anti-fungal agent. The seed of the plant is especially enriched in several bioactive molecules including polyphenols, saponins, alkaloids, and flavonoids and has demonstrated potential to act as an antidiabetic phytotherapeutic. A novel patented formulation (Fenfuro®) was developed in our laboratory from the fenugreek seeds which contained >45% furostanolic saponins (HPLC).

Objective: A placebo-controlled clinical compliance study was designed to assess the effects of complementing Fenfuro® on a randomized group of human volunteers on antidiabetic therapy (Metformin and sulphonylurea) in controlling the glycemic index along with simultaneous safety assessment.

Study methodology and trial design: In a randomized double-blind, placebo-controlled trial, 42 individuals (21 male and 21 female volunteers) in the treatment group (out of 57 enrolled) and 39 individuals (17 male and 22 female volunteers) in the placebo group (out of 47 enrolled), all on antidiabetic therapy with Metformin/Metformin with sulphonyl urea within the age group of 18–65 years were administered either 1,000 mg (500 mg × 2) (Fenfuro®) capsules or placebo over a period of 12 consecutive weeks. Fasting and postprandial glucose along with glycated hemoglobin were determined as primary outcomes to assess the antidiabetic potential of the formulation. Moreover, in order to evaluate the safety of the formulation, C-peptide and Thyroid Stimulating Hormone (TSH) levels as well as immunohematological parameters were assessed between the treatment and placebo groups at the completion of the study.

Results: After 12 weeks of administration, both fasting as well as postprandial serum glucose levels decreased by 38 and 44% respectively in the treatment group. Simultaneously, a significant reduction in glycated hemoglobin by about 34.7% was also noted. The formulation did not have any adverse effect on the study subjects as there was no significant change in C- peptide level and TSH level; liver, kidney, and cardiovascular function was also found to be normal as assessed by serum levels of key immunohematological parameters. No adverse events were reported.

Conclusion: This clinical compliance study re-instated and established the safety and efficacy of Fenfuro® as an effective phytotherapeutic to treat hyperglycemia.

Downloads

Download data is not yet available.

Author Biography

Debasis Bagchi, University of Houston College of PharmacyHouston, TX, USA

Debasis Bagchi, PhD, MACN, CNS, MAIChE, received his Ph.D. in Medicinal Chemistry in 1982. He is the Chief Scientific Officer at Cepham Research Center, Piscataway, NJ; an Adjunct Professor in the Department of Pharmacological and Pharmaceutical Sciences at the University of Houston College of Pharmacy, Houston, TX, and, an Adjunct Faculty in Texas Southern University, Houston, TX. He served as the Senior Vice President of Research & Development of InterHealth Nutraceuticals Inc, Benicia, CA, from 1998 till Feb 2011, and then as Director of Innovation and Clinical Affairs, of Iovate Health Sciences, Oakville, ON, till June 2013. Dr. Bagchi received the Master of American College of Nutrition Award in October 2010. He is the Past Chairman of International Society of Nutraceuticals and Functional Foods (ISNFF), Past President of American College of Nutrition, Clearwater, FL, and Past Chair of the Nutraceuticals and Functional Foods Division of Institute of Food Technologists (IFT), Chicago, IL. He is serving as a Distinguished Advisor on the Japanese Institute for Health Food Standards (JIHFS), Tokyo, Japan. Dr. Bagchi is a Member of the Study Section and Peer Review Committee of the National Institutes of Health (NIH), Bethesda, MD. Dr. Bagchi has 315 papers in peer reviewed journals, 27 books and 18 patents. Dr. Bagchi is also a Member of the Society of Toxicology, Member of the New York Academy of Sciences, Fellow of the Nutrition Research Academy, and Member of the TCE stakeholder Committee of the Wright Patterson Air Force Base, OH. Dr. Bagchi is the Associate Editors of the Journal of Functional Foods, Journal of the American College of Nutrition, and Archives of Medical and Biomedical Research, and also serving as Editorial Board Member of numerous peer reviewed journals, including Antioxidants & Redox Signaling, Cancer Letters, Toxicology Mechanisms and Methods, The Original Internist, and other peer reviewed journals.

References

1.
Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas. Diabetes Res Clin Pract 2019; 157: 107843. doi: 10.1016/j.diabres.2019.107843


2.
Lee SH, Park SY, Choi CS. Insulin resistance: from mechanisms to therapeutic strategies. Diabetes Metab J 2022 Jan; 46(1): 15–37. doi: 10.4093/dmj.2021.0280


3.
Rizza RA. Pathogenesis of fasting and postprandial hyperglycemia in type 2 diabetes: implications for therapy. Diabetes 2010 Nov; 59(11): 2697–707. doi: 10.2337/db10-1032


4.
Petersen MC, Shulman GI. Mechanisms of insulin action and insulin resistance. Physiol Rev 2018 Oct 1; 98(4): 2133–223. doi: 10.1152/physrev.00063.2017


5.
Teaney NA, Cyr NE. FoxO1 as a tissue-specific therapeutic target for type 2 diabetes. Front Endocrinol (Lausanne). 2023 Oct 23; 14: 1286838. doi: 10.3389/fendo.2023.1286838


6.
van Gerwen J, Shun-Shion AS, Fazakerley DJ. Insulin signaling and GLUT4 trafficking in Insulin resistance. Biochem Soc Trans 2023 Jun 28; 51(3): 1057–69. doi: 10.1042/BST20221066


7.
Samuel VT, Shulman GI. The pathogenesis of insulin resistance: integrating signaling pathways and substrate flux. J Clin Invest 2016 Jan; 126(1): 12–22. doi: 10.1172/JCI77812


8.
Angelidi AM, Filippaios A, Mantzoros CS. Severe insulin resistance syndromes. J Clin Invest 2021 Feb 15; 131(4): e142245. doi: 10.1172/JCI142245


9.
Khoramipour K, Chamari K, Hekmatikar AA, Ziyaiyan A, Taherkhani S, Elguindy NM, et al. Adiponectin: structure, physiological functions, role in diseases, and effects of nutrition. Nutrients 2021 Apr 2; 13(4): 1180. doi: 10.3390/nu13041180


10.
Ziemke F, Mantzoros CS. Adiponectin in insulin resistance: lessons from translational research. Am J Clin Nutr 2010 Jan; 91(1): 258S–61S. doi: 10.3945/ajcn.2009.28449C


11.
Lee CJ, Sears CL, Maruthur N. Gut microbiome and its role in obesity and insulin resistance. Ann N Y Acad Sci 2020 Feb; 1461(1): 37–52. doi: 10.1111/nyas.14107


12.
Perreault L, Pan Q, Schroeder EB, Kalyani RR, Bray GA, Dagogo-Jack S, et al. Regression from prediabetes to normal glucose regulation and prevalence of microvascular disease in the Diabetes Prevention Program Outcomes Study (DPPOS). Diabetes Care 2019 Sep; 42(9): 1809–15. doi: 10.2337/dc19-0244


13.
Sola D, Rossi L, Schianca GP, Maffioli P, Bigliocca M, Mella R, et al. Sulfonylureas and their use in clinical practice. Arch Med Sci 2015 Aug 12; 11(4): 840–8. doi: 10.5114/aoms.2015.53304


14.
Pathak R, Bridgeman MB. Dipeptidyl Peptidase-4 (DPP-4) inhibitors in the management of diabetes. P T 2010 Sep; 35(9): 509–13.


15.
Hauner H. The mode of action of thiazolidinediones. Diabetes Metab Res Rev 2002 Mar-Apr; 18 Suppl 2: S10–5. doi: 10.1002/dmrr.249


16.
Kashtoh H, Baek K-H. Recent updates on phytoconstituent alpha-glucosidase inhibitors: an approach towards the treatment of type two diabetes. Plants 2022; 11: 2722. doi: 10.3390/plants11202722


17.
Hsia DS, Grove O, Cefalu WT. An update on sodium-glucose co-transporter-2 inhibitors for the treatment of diabetes mellitus. Curr Opin Endocrinol Diabetes Obes 2017 Feb; 24(1): 73–9. doi: 10.1097/MED.0000000000000311


18.
Scheen AJ, Paquot N. Metformin revisited: a critical review of the benefit-risk balance in at-risk patients with type 2 diabetes. Diabetes Metab 2013 May; 39(3): 179–90. doi: 10.1016/j.diabet.2013.02.006


19.
Pandey MM, Rastogi S, Rawat AK. Indian tíaditional ayuívedic system of medicine and nutíitional supplementation. Evid Based Complement Alteínat Med 2013; 2013: 376327. doi: 10.1155/2013/376327


20.
Wani SA, Kumaí P. Fenugreek: a review on its nutraceutical properties and utilization in various food products. J Saudi Soc Agric Sci 2018; 17(2): 97–106. doi: 10.1016/j.jssas.2016.01.007


21.
Amor AJ, Gómez-Guerrero C, Ortega E, Sala-Vila A, Lázaro I. Ellagic acid as a tool to limit the diabetes burden: updated evidence. Antioxidants (Basel). 2020 Dec 3; 9(12): 1226. doi: 10.3390/antiox9121226


22.
Su M, Zhao W, Xu S, Weng J. Resveratrol in treating diabetes and its cardiovascular complications: a review of its mechanisms of action. Antioxidants (Basel). 2022 May 30; 11(6): 1085. doi: 10.3390/antiox11061085


23.
Martorell M, Castro N, Victoriano M, Capó X, Tejada S, Vitalini S, et al. An update of anthraquinone derivatives emodin, diacerein, and catenarin in diabetes. Evid Based Complement Alternat Med 2021 Sep 20; 2021: 3313419. doi: 10.1155/2021/3313419


24.
Pivari F, Mingione A, Brasacchio C, Soldati L. Curcumin and Type 2 Diabetes Mellitus: prevention and treatment. Nutrients 2019 Aug 8; 11(8): 1837. doi: 10.3390/nu11081837


25.
Szkudelski T, Szkudelska K. The anti-diabetic potential of baicalIn: evidence from rodent studies. Int J Mol Sci 2024: 25: 431. doi: 10.3390/ijms25010431


26.
Abbasi E, Khodadadi I. Antidiabetic effects of genistein: mechanism of action. Endocr Metab Immune Disord Drug Targets 2023; 23(13): 1599–610. doi: 10.2174/1871530323666230516103420


27.
Yang Y, Chen Z, Zhao X, Xie H, Du L, Gao H, et al. Mechanisms of Kaempferol in the treatment of diabetes: a comprehensive and latest review. Front Endocrinol (Lausanne). 2022 Sep 7; 13: 990299. doi: 10.3389/fendo.2022.990299


28.
Vessal M, Hemmati M, Vasei M. Antidiabetic effects of quercetin in streptozocin-induced diabetic rats. Comp Biochem Physiol C Toxicol Pharmacol 2003 Jul; 135C(3): 357–64. doi: 10.1016/s1532-0456(03)00140-6


29.
Geberemeskel GA, Debebe YG, Nguse NA. Antidiabetic effect of fenugreek seed powder solution (Trigonella foenum-graecum L.) on hyperlipidemia in diabetic patients. J Diabetes Res 2019 Sep 5; 2019: 8507453. doi: 10.1155/2019/8507453


30.
Nagulapalli Venkata KC, Swaroop A, Author , Bishayee A. A small plant with big benefits: Fenugreek (Trigonella foenum-graecum Linn.) for disease prevention and health promotion. Mol Nutr Food Res 2017 Jun; 61(6). doi: 10.1002/mnfr.201600950


31.
Singh P, Bajpai V, Gond V, Kumar A, Tadigoppula N, Kumar B. Determination of bioactive compounds of Fenugreek (Trigonella foenum-graecum) seeds using LC-MS techniques. Methods Mol Biol 2020; 2107: 377–93. doi: 10.1007/978-1-0716-0235-5_21


32.
Malik A, Jamil U, Butt TT, Waquar S, Gan SH, Shafique H, et al. In silico and in vitro studies of lupeol and iso-orientin as potential antidiabetic agents in a rat model. Drug Des Devel Ther 2019 May 6; 13: 1501–13. doi: 10.2147/DDDT.S176698


33.
Saadh MJ. Hypoglycemic and hypolipidemic activity of combined milk thistle and fenugreek seeds in alloxan-induced diabetic albino rats. Vet World 2020 Aug; 13(8): 1732–6. doi: 10.14202/vetworld.2020.1732-1736


34.
Neelakantan N, Narayanan M, de Souza RJ, van Dam RM. Effect of fenugreek (Trigonella foenum-graecum L.) intake on glycemia: a meta-analysis of clinical trials. Nutr J 2014 Jan 18; 13: 7. doi: 10.1186/1475-2891-13-7


35.
Baset ME, Ali TI, Elshamy H, El Sadek AM, Sami DG, Badawy MT, et al. Anti-diabetic effects of fenugreek (Trigonella foenum-graecum): a comparison between oral and intraperitoneal administration – an animal study. Int J Funct Nutr 2020; 1: 2. doi: 10.3892/ijfn.2020.2


36.
Verma N, Usman K, Patel N, Jain A, Dhakre S, Swaroop A, et al. A multicenter clinical study to determine the efficacy of a novel fenugreek seed (Trigonella foenum-graecum) extract (Fenfuro™) in patients with type 2 diabetes. Food Nutr Res 2016 Oct 11; 60: 32382. doi: 10.3402/fnr.v60.32382


37.
Hota D, Padhy BM, Maiti R, Bisoi D, Sahoo JP, Patro BK, et al. A Placebo-Controlled, Double-Blind Clinical Investigation to Evaluate the Efficacy of a Patented Trigonella foenum-graecum Seed Extract “Fenfuro®” in Type 2 Diabetics. J Am Nutr Assoc. 2024 Feb; 43(2): 147–56. doi: 10.1080/27697061.2023.2233008


38.
Pearson ER. Type 2 diabetes: a multifaceted disease. Diabetologia 2019 Jul; 62(7): 1107–12. doi: 10.1007/s00125-019-4909-y


39.
Fu Q, Shi Q, West TM, Xiang YK. Cross-talk between insulin signaling and G Protein-coupled receptors. J Cardiovasc Pharmacol 2017 Aug; 70(2): 74–86. doi: 10.1097/FJC.0000000000000481


40.
Romero A, Eckel J. Organ crosstalk and the modulation of insulin signaling. Cells 2021 Aug 13; 10(8): 2082. doi: 10.3390/cells10082082


41.
Spillier HA, Sawyer TA. Toxicology of oral antidiabetic medications. Am J Health Syst Pharm 2006 May 15; 63(10): 929–38. doi: 10.2146/ajhp050500


42.
Stottlemyer BA, McDermott MC, Minogue MR, Gray MP, Boyce RD, Kane-Gill SL. Assessing adverse drug reaction reports for antidiabetic medications approved by the food and drug administration between 2012 and 2017: a pharmacovigilance study. Ther Adv Drug Saf 2023 Jun 12; 14: 20420986231181334. doi: 10.1177/20420986231181334


43.
Gaddam A, Galla C, Thummisetti S, Marikanty RK, Palanisamy UD, Rao PV. Role of Fenugreek in the prevention of type 2 diabetes mellitus in prediabetes. J Diabetes Metab Disord 2015 Oct 2; 14: 74. doi: 10.1186/s40200-015-0208-4


44.
Kiss R, Szabó K, Gesztelyi R, Somodi S, Kovács P, Szabó Z, et al. Insulin-sensitizer effects of fenugreek seeds in parallel with changes in plasma MCH levels in healthy volunteers. Int J Mol Sci 2018 Mar 8; 19(3): 771. doi: 10.3390/ijms19030771


45.
Shabil M, Bushi G, Bodige PK, Maradi PS, Patra BP, Padhi BK, et al. Effect of fenugreek on hyperglycemia: a systematic review and meta-analysis. Medicina 2023; 59: 248. doi: 10.3390/medicina59020248


46.
Hua Y, Ren SY, Guo R, Rogers O, Nair RP, Author D, et al. Furostanolic saponins from Trigonella foenum-graecum alleviate diet-induced glucose intolerance and hepatic fat accumulation. Mol Nutr Food Res 2015 Oct; 59(10): 2094–100. doi: 10.1002/mnfr.201500197


47.
Pandey AR, Ahmad S, Singh SP, Mishra A, Bisen AC, Sharma G, et al. Furostanol saponins from Asparagus racemosus as potential hypoglycemic agents. Phytochemistry 2022 Sep; 201: 113286. doi: 10.1016/j.phytochem.2022.113286


48.
Swaroop A, Author M, Kumar P, Preuss HG, Tiwari K, Marone PA, et al. Safety, efficacy and toxicological evaluation of a novel, patented anti-diabetic extract of Trigonella Foenum-Graecum seed extract (Fenfuro). Toxicol Mech Methods 2014 Oct; 24(7): 495–503. doi: 10.3109/15376516.2014.943443


49.
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(2): 83–6. doi: 10.1002/ptr.2650080206


50.
Hassani SS, Fallahi Arezodar F, Esmaeili SS, Gholami-Fesharaki M. Effect of fenugreek use on fasting blood glucose, glycosylated hemoglobin, body mass index, waist circumference, blood pressure and quality of life in patients with type 2 diabetes mellitus: a randomized, double-blinded, placebo-controlled clinical trials. Galen Med J 2019 Mar 30; 8: e1432. doi: 10.31661/gmj.v8i0.1432


51.
Najdi RA, Hagras MM, Kamel FO, Magadmi RM. A randomized controlled clinical trial evaluating the effect of Trigonella foenum-graecum (fenugreek) versus glibenclamide in patients with diabetes. Afr Health Sci 2019 Mar; 19(1): 1594–601. doi: 10.4314/ahs.v19i1.34


52.
Majumdar J, Chakraborty P, Mitra A, Sarkar NK, Sarkar S. Fenugreek, a potent hypoglycaemic herb can cause central hypothyroidism via leptin – a threat to diabetes phytotherapy. Exp Clin Endocrinol Diabetes 2017 Jul; 125(7): 441–8. doi: 10.1055/s-0043-103458


53.
Arivalagan M, Gangopadhyay KK, Kumar G. Determination of steroidal saponins and fixed oil content in fenugreek (Trigonella foenum-graecum) genotypes. Indian J Pharm Sci 2013 Jan; 75(1): 110–3. doi: 10.4103/0250-474X.113542


54.
Herrera T, Navarro del Hierro J, Fornari T, Reglero G, Martin D. Acid hydrolysis of saponin-rich extracts of quinoa, lentil, fenugreek, and soybean to yield sapogenin-rich extracts and other bioactive compounds. J Sci Food Agric 2019; 99: 3157–67. doi: 10.1002/jsfa.9531
Published
2024-06-03
How to Cite
Singh Gupta R., Singh Grover A., Kumar P., Goel A., Banik S. P., Chakraborty S., Rungta M., Bagchi M., Pal P., & Bagchi D. (2024). A randomized double blind placebo controlled trial to assess the safety and efficacy of a patented fenugreek <em>(Trigonella foenum-graecum)</em&gt; seed extract in Type 2 diabetics. Food & Nutrition Research, 68. https://doi.org/10.29219/fnr.v68.10667
Section
Original Articles