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Human Journals
Research Article
February 2018 Vol.:11, Issue:3
© All rights are reserved by Myriam Sfar et al.
The Effect of Fenugreek on Blood Glucose, Lipid Parameters,
Insulin and Resistin in Obese Women with Type 2 Diabetes
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Keywords: obesity, diabetes, fenugreek, blood glucose, lipids,
resistin
ABSTRACT
Introduction: Fenugreek, scientifically known as Trigonella
foenum-graecum, is one of the oldest cultivated medicinal
plants which belong to the family Fabaceae. In fact, several
beneficial effects on health, attributed to the consumption of
fenugreek, have been demonstrated during tests in both animals
and humans. The purpose of our work is to study its effect in a
group of obese patients with type 2 diabetes.Methods: We
followed a population of 56 obese type 2 diabetic women, after
a daily consumption of 15g of fenugreek powder in the morning
before breakfast during 4 weeks and following regular physical
activity. We measured the anthropometric, biochemical and
hormonal parameters (insulin and resistin) before and aftercare.
Then, we evaluated the variations of these parameters and we
studied the correlations between them.Results: Improvement of
the various parameters monitoring after taking care of patients.
Consumption of fenugreek powder show negatively correlated
with BMI, waist circumference, HOMA-IR and resistin,
whereas it shows positively correlated with HDL-cholesterol.
Discussion: Fenugreek powder, by its constituents, promotes a
better glucose and lipid profile by improving insulin sensitivity
and increasing HDL-cholesterol levels. This leads to a
regression of the resistin levels, decreasing its effects on insulin
sensitivity and its pro-inflammatory role. In addition to its
effect in predisposed patients to decrease the prevalence of
diabetes.Conclusion: This study combined with the literature,
allowed us to confirm the role of fenugreek consumption to
improve glucose and lipid parameters of obese diabetic patients,
thus controlling their complications and leading to a better
prognosis.
Myriam Sfar*1, Aya Jaouani2, Kamel Ben-Mahrez1,
Hajer Aounallah Skhiri3, Chihab Ben Rayana4,
Rachid Chemli2, Faika Ben Mami5, Fethi Ben
Slama1,3
1- Université de Tunis El Manar, Faculté des
Sciences de Tunis, LR01ES05 Laboratoire de Biochimie
et Biotechnologie, 2092, Tunis, Tunisie
2- Faculty of Pharmacy of Monastir, University of
Monastir, Monastir-5000, Tunisia
3- National Institute of Public Health of Tunis, Tunis-
1024, Tunisia
4- Laboratory of Clinical Biochemistry, National
Institute of Nutrition and Food Technology, Tunis-1029,
Tunisia
5- Service "C" of nutrition diseases and diabetology,
National Institute of Nutrition and Food Technology,
Tunis-1029, Tunisia
Submission: 21 January 2018
Accepted: 27 January 2018
Published: 28 February 2018
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Citation: Myriam Sfar et al. Ijppr.Human, 2018; Vol. 11 (3): 108-123.
109
INTRODUCTION
Type 2 diabetes mellitus and obesity are a major threat to human health due to their increasing
prevalence, chronic treatment and disabling complications, in fact the chronic hyperglycemia
associated to diabetes and the metabolic disorders of the obesity are associated to
microvascular complications in long-term affecting the eyes, kidneys and nerves as well as an
increased risk of cardiovascular disease[1]. Clinically, there has been a decline in
transmissible diseases, leaving room for no communicable diseases, including diabetes and
obesity. These diseases and their associated complications such as atherosclerosis and major
cardiovascular diseases become major causes of mortality and their prevalences are
continuously growing [2]. In both humanitarian and economic terms, diabetes and obesity are
now among the most expensive diseases. The problem becomes more complex because of
their multiple manifestations and their complications affecting all body systems [1].
Thus, after years in which allopathy was the only valid treatment, several epidemiological and
clinical studies have shown a significant decrease in the morbidity and mortality of these no
communicable diseases in subjects following a specific physical activity and diet, indeed,
phototherapy is back healing chronic diseases and improving the general health thanks to the
scientific progress that has allowed to rationalize its practice and to open new perspectives
following galenic innovations in term of more practical forms of use. For this, a dietary
treatment at early stages of the disease but with fewer side effects and at lower cost will be an
excellent alternative for diabetic patients. Among the medicinal plants, we found the
fenugreek, scientifically known as Trigonella foenum-graecum. In fact, several beneficial
effects on health have been attributed to the consumption of fenugreek. These effects have
been reported in animal’s studies as well as human studies. In our work, we propose to study
the effect of fenugreek seed powder consumption associated to a regular physical activity in a
group of 56 female obese patients with type 2 diabetes.
MATERIALS AND METHODS
Subjects
It involved a group of 56 obese type 2 diabetic female patients, from service C of nutrition
diseases and diabetology of the National Institute of Nutrition, Tunis, Tunisia; whose diabetes
age was not older than 5 years, these patients are older than 30 years old and they take an oral
antidiabetic drugs with unsettled blood glucose and lipids during previous consultations. Type
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110
1 diabetics, patients treated with insulin and who have associated severe conditions such as
renal and hepatic deficiency, pregnant and beast-feeding women were excluded from our
study. All the patients involved in the study agreed to voluntarily participate by oral consent
after an explication of the objectives and the protocol of the study.
Protocol study
During their usual consultation, our participants received a dose of 15g of fenugreek daily in
the morning for a period of four weeks. Every week, they come to get the dose of the week.
The women consume the fenugreek powder dispersed in a glass of water before breakfast.
The fenugreek seeds were cleaned, washed and dried for 10 minutes in the oven on a light fire
so that the seeds became easy to grind, and after grinding we measured 15g of fenugreek
powder, which was divided in small sanitary bags to be given to each patient. The manner of
drinking the powder has been well explained to the patients. The study protocol was approved
by the Ethics Committee of the National Institute of Nutrition
Method and tools for Data collection
During this study, every patient benefited for detailed interrogation specifying the general
characteristics, family pathological history (type 2 diabetes, arterial hypertension,
dyslipidemia, obesity), associated pathology, the duration of evolution of diabetes and any
physical activity. The Anthropometric parameters of body Weight, height and waist size were
measure during standard techniques in every 56 subjects, the body mass index (BMI) was
calculated. The systolic and diastolic blood pressure was taken from each patient.
Assays
The fasting blood levels of glucose and lipids were measured in the clinical biochemistry
laboratory of the national institute of nutrition. Cholesterol, triglycerides and blood glucose
levels were measured by Beckman enzymatic KIT method on Beckman USA Synchron Cx7,
while HDL-C values are measured after selective precipitation (Randox UK Kit).The level of
plasma resistin were determined by the "Millipore #" ELISA method EZHR-95K with a
sensitivity ranging from 0.16ng / ml to 10ng / ml. Insulin levels were measured by IRMA
(Immunoradiometric assay).All these measurements were carried in two phases, at the
beginning of the survey and after four weeks of the first intake
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Statistical analysis
Data were analyzed using Microsoft Excel 2007 and Statistical Package for Social Sciences
"SPSS" in version 19.0. We used the statistical tests related to the matched series the student t
test, for the comparison of the mean of the variable measured and assayed on matched series.
The concordances between 2 quantitative variables were studied by the Pearson correlation
coefficient and in case of non-validity by Spearman's rank correlation coefficient. In all
statistical tests, p<0.05 considered as statistically significant.
RESULTS
Table 1: Correlations between anthropometric, biochemical and hormonal parameters
before fenugreek (N = 56)
FBS
TC
TG
HDL-C
BMI
Insulin
Resistin
FBS
Pearson Correlation
(r)
1
,079
,352
(**)
-,291
(*)
,625
(**)
,672
(**)
,355
(**)
Sig. (bilateral)
,
,562
,008
,030
,000
,000
,007
TC
Pearson Correlation
(r)
,079
1
,292
(*)
-,423
(**)
,387
(**)
,266
(*)
,280
(*)
Sig. (bilateral)
,562
,
,029
,001
,003
,048
,036
TG
Pearson Correlation
(r)
,352
(**)
,292
(*)
1
-,496
(**)
,549
(**)
,263
,097
Sig. (bilateral)
,008
,029
,
,000
,000
,051
,476
HDL-C
Pearson Correlation
(r)
-,291
(*)
-,423
(**)
-,496
(**)
1
-,419
(**)
-,339
(*)
-,104
Sig. (bilateral)
,030
,001
,000
,
,001
,011
,444
BMI
Pearson Correlation
(r)
,625
(**)
,387
(**)
,549
(**)
-,419
(**)
1
,340
(*)
,484
(**)
Sig. (bilateral)
,000
,003
,000
,001
,
,010
,000
Insulin
Pearson Correlation
(r)
,672
(**)
,266
(*)
,263
-,339
(*)
,340
(*)
1
,313
(*)
Sig. (bilateral)
,000
,048
,051
,011
,010
,
,019
Resistin
Pearson Correlation
(r)
,355
(**)
,280
(*)
,097
-,104
,484
(**)
,313
(*)
1
Sig. (bilateral)
,007
,036
,476
,444
,000
,019
,
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FBS: fasting blood glucose, TC: total serum cholesterol, TG: triglyceride, HDL-C: hight
density lipoprotein cholesterol, BMI: body mass index
* The correlation is significant at the 0,05 level (bilateral).
** The correlation is significant at the 0,01 level (bilateral).
The plasma concentration of insulin is positively correlated with blood glucose, total
cholesterol, triglycerides and BMI, in contrast to HDL-C, whose value correlates negatively
with that of insulin with r = -0.339 and p = 0.011.
The concentration of resistin is positively correlated with blood glucose, total cholesterol,
triglyceride, BMI and insulin with the exception of HDL-C to which it is negatively correlated
with r = -0.104 and p = 0.444.
Table 2: Correlations between anthropometric, biochemical and hormonal parameters
after fenugreek intake (N = 56)
FBS
TC
TG
HDL-C
BMI
Insulin
Resistin
FBS
Pearson Correlation
(r)
1
,332
(*)
,443
(**)
-,464
(*)
,657
(**)
,570
(**)
,443
(**)
Sig. (bilateral)
,
,012
,001
,000
,000
,000
,001
CT
Pearson Correlation
(r)
,332
(*)
1
,292
(*)
-,416
(**)
,381
(**)
,338
(*)
,396
(**)
Sig. (bilateral)
,012
,
,029
,001
,004
,011
,003
TG
Pearson Correlation
(r)
,443
(**)
,292
(*)
1
-,243
,515
(**)
,208
,198
Sig. (bilateral)
,001
,029
,
,071
,000
,125
,143
HDL-C
Pearson Correlation
(r)
-,464
(**)
-,416
(**)
-,243
1
-,471
(**)
-,358
(**)
-,288
(*)
Sig. (bilateral)
,000
,001
,071
,
,000
,007
,032
BMI
Pearson Correlation
(r)
,657
(**)
,381
(**)
,515
(**)
-,471
(**)
1
,403
(**)
,476
(**)
Sig. (bilateral)
,000
,004
,000
,000
,
,002
,000
Insulin
Pearson Correlation
(r)
,570
(**)
,338
(*)
,208
-,358
(**)
,403
(**)
1
,367
(**)
Sig. (bilateral)
,000
,011
,125
,007
,002
,
,005
Resistin
Pearson Correlation
(r)
,443
(**)
,396
(**)
,198
-,288
(*)
,476
(**)
,367
(**)
1
Sig. (bilateral)
,001
,003
,143
,032
,000
,005
,
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FBS: fasting blood glucose, TC: total serum cholesterol, TG: triglyceride, HDL-C: hight
density lipoprotein cholesterol, BMI: body mass index
* The correlation is significant at the 0,05 level (bilateral).
** The correlation is significant at the 0,01 level (bilateral).
Insulin remains positively correlated with the same parameters, and we note above all a
significant positive correlation with blood glucose (r = 0.570, p = 0.000) and BMI (r = 0.403,
p = 0.002) and it remains always negatively correlated with HDL-C with r = -0.358 and p =
0.007.
Resistin remained positively significantly correlated with BMI (r = 0.476, p = 0.000) and
blood glucose with r = 0.443 and p = 0.001, contrary to a strong negative correlation with
HDL-C (r = 0.288, p = 0.032).
Table 3: Comparison of mean of anthropometric parameters before and after fenugreek
intake (N = 56)
Mean
standard
deviation
Mean
standard
error
Matched differences
P
Mean
standard
deviation
Pair 1
BMI (Kg/m2)
35,1691
4,45957
0,59593
5,5666
1,42241
,000
BMI after taking
fenugreek (Kg/m2)
29,6024
3,66814
0,49018
Pair 2
Waist circumference
(cm)
105,71
9,249
1,236
10,46
5,923
,000
Waist circumference
after taking fenugreek
(cm)
95,25
8,308
1,236
Pair 3
SAP (mmHg)
142,14
10,568
1,412
24,16
1,797
,000
SAP after taking
Fenugreek (mmHg)
117,98
8,772
1,172
Pair 4
DAP (mmHg)
89,21
4,168
0,557
7,58
0,354
,000
DAP after taking
Fenugreek (mmHg)
81,63
3,814
0,510
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BMI: body mass index, SAP: systolic arterial pressure, DAP: diastolic arterial pressure
After taking fenugreek and applying a regular physical activity that is walking, there is a
significant improvement in systolic and diastolic arterial pressure and a decrease in
anthropometric parameters with -5.5 ± 1 Kg / m2 for BMI and -10.4 ± 5 cm for waist
circumference.
Table 4: Comparison of the means of the biochemical parameters before and after
taking fenugreek (N = 56)
Mean
standard
deviation
Mean
standard
error
Matched
differences
P
Mean
standard
deviation
Pair 1
FBS (mg/dL)
7,5139
1,28438
0,17163
1,1605
0,74097
,000
FBS after
taking
fenugreek
(mg/dL)
6,3534
0,96177
0,12852
Pair 2
TC (mg/dL)
5,3336
1,09265
0,14601
0,6400
0,13112
,000
TC after
taking
fenugreek
(mg/dL)
4,6935
0,96153
0,12849
Pair 3
TG (mg/dL)
1,8259
0,21112
0,02821
0,2008
0,02322
,000
TG after
taking
fenugreek
(mg/dL)
1,6250
0,18789
0,02511
Pair 4
HDL-C
(mg/dL)
0,7468
0,18332
0,02450
-0,1894
0,17979
,000
HDL-C after
taking
fenugreek
(mg/dL)
0,9361
0,22923
0,03063
FBS: fasting blood glucose, TC: total serum cholesterol, TG: triglyceride, HDL-C: hight
density lipoprotein cholesterol
We notice that after taking fenugreek and the application of regular physical activity, there is
a drop in blood glucose, total cholesterol and triglycerides while there is an increase in HDL-
cholesterol.
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Citation: Myriam Sfar et al. Ijppr.Human, 2018; Vol. 11 (3): 108-123.
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Table 5: Comparison of the means of hormonal parameters and HOMA-IR values
before and after taking fenugreek (N = 56)
Mean
standard
deviation
Mean
standard
error
Matched
differences
P
Mean
standard
deviation
Pair 1
Insulin
(µUI/L)
14,6018
4,76297
0,63648
3,2280
2,76684
,000
Insulin after
taking
fenugreek
(µUI/L)
11,3737
3,43655
0,45923
Pair 2
Resistin
(ng/mL)
10,5273
3,11330
0,41603
2,0758
1,04940
,000
Resistin after
taking
fenugreek
(ng/mL)
8,4515
2,54323
0,33985
Pair 3
HOMA-IR
5,0559
2,33958
0,31264
1,7619
1,41779
,000
HOMA-IR
after taking
fenugreek
3,2939
1,39359
0,18623
After treatment, there was a significant decrease in insulin and resistin levels of -3.22 ± 2μUI /
L for insulin and -2.07 ± 1ng / mL for resistin. In addition, a drop in the value of the HOMA-
IR of -1.76 ± 1.
DISCUSSION
The objective of our study is to evaluate the effect of fenugreek on the improvement of blood
glucose and lipid, anthropometric and hormonal parameters in a group of obese type 2
diabetics. We, therefore, looked for the different correlations between the different parameters
needed before and after taking fenugreek and applying a regular physical activity, which is
walking. Our population sample consists of 56 female obese and type 2 diabetic patients with
the mean of age is 47 years, on oral antidiabetic drugs with unbalanced blood glucose and
lipid parameters during previous consultations. Patients received a 15g dose of fenugreek
powder daily in the morning for a period of four weeks. The biochemical parameters were
compared before and after the management of the study population, with regard to the
glycemic balance, there is a good evolution. In fact, there is a decrease in the mean glucose
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level of -1.16 ± 0.74 mmol / L and a decrease in the mean of insulin 3.22 ± 2.76 μIU / L and
the mean of resistin level of -2.07 ± 1.04 ng / mL and consequently the decrease of the
HOMA-IR mean of -1.76 ± 1, 41.These results are consistent with the work of Bawadi H et al.
after a study in 166 patients with type 2 diabetes, it was shown that after taking 2.5 or 5g of
fenugreek powder, the blood glucose value decreased in a dose-dependent manner by -24, 8 ±
9.3 and 41.1 ± 7.2 mg / dL [3.4].In another study by Kassaian N et al. in 2009 in 24 patients
with type 2 diabetes and after daily consumption of 10g of fenugreek powder mixed with
yoghurt or after infusion in hot water for 8 weeks, blood glucose decreased by 25% after
consumption of the infused in hot water while the decrease was not significant by its
consumption mixed with yogurt [5].The study of Madar Z et al. led to the same results after
ingestion of 15g of whole fenugreek seeds deceived in water [6]. One study compared the
effect of 1g daily intake of the hydroalcoholic extract of fenugreek seeds with the effect of
dietary regimen and physical activity on the fasting blood glucose value in 25 patients
recently diagnosed with After 2 months, there was a decrease of 148.3 to 119.9 mg/dL and
137.5 to 113.0 mg/dL, respectively [7].The team of Gupta A et al. conducted a study in a
group of 25 patients type 2 diabetics, half received capsules of the hydro-alcoholic extract of
fenugreek seeds for a daily intake for 2 months of treatment. After this period, she noted a
significant decrease in fasting glucose values from 148 ± 44 to 119.9 ± 25 as well as
postprandial glucose values from 210.6 ± 79 to 181.1 ± 69 in this group of patients treated
with fenugreek capsules. With regard to glycated hemoglobin, also noted a significant
decrease from 8.25 ± 1.2 to 7.54 ± 0.9 with p = <0.5. Similarly, for the secreted insulin level,
after 2 months of treatment, there is a change in the AUC from 5630 ± 2428 to 2942 ± 1536
with p <0.01 and, consequently, an increase in the sensitivity of the insulin secretion. insulin
from 57.14 ± 41.15 to 112.9 ± 67 with p <0.05 [8].Other animal studies have produced similar
results, such as the study by Winiarska H et al. in a population of 60 diabetic rats after
intraperitoneal treatment with streptozocin, a change in fasting blood glucose from 119.7 ±
7.7 to 84.0 ± 7.9 after 4 weeks’ treatment with fenugreek extract due to 1g / kg [9].In the same
context Abdel-Barry JA et al. conducted a study in a rat population in which he concluded
that intraperitoneal administration of the aqueous extract of fenugreek significantly decreased
the glycemic value in both the control and diabetic rats, whereas oral administration of the
aqueous extract resulted in a significant decrease only in alloxan-treated rats [10].Annida B et
al. by a similar study in a group of 36 rats, 6 of which were normal and 30 treated with
streptozocin, showed that supplementation with fenugreek extract significantly decreased the
blood glucose value in treated rats by 265.7 ± 21.3 at 195.8 ± 16.7 for a dose of 0.5 g / kg and
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117
118.3 ± 6.3 for a dose of 1 g / kg [11].An Egyptian study led by Ramadan G et al. in 2010
proved the hypoglycemic effect of fenugreek powder as well as other benefits at low and high
doses (0.5 and 1g / kg) in a rat population with more modulation of disturbed parameters by
increasing the dose of fenugreek [12].On the other hand, a recent study by karimeh Haghani
Ph.D. et al. evaluated the effects of swimming training and aqueous extract of fenugreek,
alone or in combination, on blood glucose and the activity of cardiac antioxidant enzymes in
rats after induction of diabetes by intraperitoneal injection of streptozocin. After 8 weeks of
management, there was a marked increase in blood glucose in the group of rats treated with
streptozocin compared to the control group, and the blood glucose value in rats treated with
fenugreek and after swimming training. has shown a significant decrease and this decrease is
more marked after the combination of swimming and taking the aqueous fenugreek extract
[13]. The hypoglycemic effect of the soluble fraction of fenugreek dietary fiber was thus
evaluated by Hannan JM et al. by administering a dose of 0.5 g / kg to healthy rats, type 1 and
type 2 diabetics. A significant decrease was noted with a more marked decrease after
simultaneous gavage administration of glucose, this fraction of fenugreek suppressed the peak
glucose level after 30 minutes after oral ingestion of sucrose in both healthy rats and
streptozocin-treated rats [14].
To conclude, Neelakantan N et al. conducted a meta-analysis of clinical trials investigating
the hypoglycemic effect of fenugreek, and as a result, a total of 10 trials were identified that
showed that fenugreek was drastically altered fasting blood glucose -0.96mmol / L,
postprandial 2H blood glucose -2.19mmol / L, and glycated hemoglobin -0.85% compared to
control groups. The heterogeneity of the results in the studies is partly explained by the
diabetes status and the dose of fenugreek used, the significant effect is noted only with the
studies using a medium or high dose of fenugreek [15].On the other hand, several studies have
identified different active principles of fenugreek that have been responsible for the effects
mentioned above [16], several authors, such as Basch E, Sauvaire Y, Haber SL and Jasim
Naaim were interested in the acid amino-4-hydroxyisoleucine, an amino acid extracted and
purified from fenugreek seeds, they have shown that it is the agent responsible for increasing
the level of insulin secreted postprandial by pancreatic β cells, the stimulation of the effect of
this amino acid is strictly glucose-dependent due to its exclusive secretagogue activity of
insulin by pancreatic cells [7,17,18,19], as well as Mohammad Ishraq Zafar in his study
focusing on this amino acid as a target of a new diabetes treatment, has shown that in addition
to its secretagogue effect of postprandial insulin, 4-amino-hydroxyisoleucine acid has been
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118
shown to inhibit of TNF-α, which increases the sensitivity of insulin, in addition to an
increase in TNF-α conversion and a decrease in the expression of TIMP3, hence a decrease in
resistance to insulin and better sensitivity. In addition, this study shows that this amino acid
accelerates the use of glucose, inhibits hepatic glucose production and possibly a decrease in
the plasma glucose value [20,21]. Another potential active ingredient of fenugreek is
trigonellin, this is the major alkaloid component of fenugreek responsible for hypoglycemic
activity, reduction of diabetic neuropathies and regeneration of pancreatic β cells and
secretion of insulin [16].In addition, we find the saponins that are most abundant in the
fenugreek composition [22], Yoshikawa discovered six saponins in fenugreek seeds that are
generally divided into two major classes: spirostanole and furostanole, of which the
furostanole are the majority [22].In his study, Swaroop A et al. cited furan-containing
saponins as the active ingredient in fenugreek hypoglycemic activity, which showed strong
hypoglycemic activity in type 2 diabetic rats after treatment with streptozocin, compared with
the effect of metformin for 30 days of study [23], in addition that Saravanan G et al.
considered diosgenin, which is formed secondarily after enzymatic reactions from furostanol
saponins [22], as an active ingredient of fenugreek, and evaluated its effect on carbohydrate
metabolic modification and glycogen content in carbohydrate. muscles and kidneys made of
diabetic rats after treatment with streptozocin, they thus showed a moderation of the
parameters disturbed by streptozocin administration such as a significant drop in blood
glucose after 45-day treatment with high doses of diosgenin and an increase in plasma insulin
concentration [24].While Perla V et al. have established that the biguanide-related compounds
may be, in part, the active ingredients since fenugreek seeds contain a good amount (18.98 μg
/ g) [25].Fenugreek seeds are a source of dietary fiber, they contain 45% dietary fiber, 32% of
which is insoluble fiber and 13.3% is soluble, the insoluble fiber is not assimilated by the
enzymes present in the human digestive tract, they have an emollient activity for stool and are
considered to be hungry [22].Soluble fiber is known by its ability to suppress postprandial
glucose elevation in addition to decreased intestinal glucose uptake and decreased
gastrointestinal mobility [26], another study of small fenugreek fibers by Hannan JMA
showed that soluble fiber significantly improved glucose hemostasis in type 1 and 2 diabetics
by delaying digestion and carbohydrate absorption in addition to stimulating the action of
insulin [14]. On the other hand, Aditya G showed that the presence of polyphenols and
flavonoids, such as vitexin, tricine, naringenin, quercetin and tricine-7-Obeta- D-
glucopyranosides, led to an inhibition of α-activity. -amylase and α-glucosidase, two enzymes
responsible respectively for the hydrolysis of starch oligosaccharides and oligosaccharides,
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trisaccharides and disaccharides in glucose and other monosaccharides, a decrease in blood
glucose is the result of this inhibition of metabolism carbohydrates [27].Klim K et al. in a
recent study, identified a new compound of fenugreek with potential therapeutic application in
the treatment of type 2 diabetes, N-linoloyl-2-amino-γ-butyrolactone (N55), the latter binding
to GLP-1R (7-36) -amide, improves the stimulation power of the cAMP pathway. Glucagon-
like peptide-1-receptor (GLP-1R) is expressed in several tissues and is involved in many
physiological functions, GLP-1R analogs are proven in the treatment of type 2 diabetes
subject of different clinical studies of several abnormalities. N55 is known to promote the
production of cAMP and stimulate endocytosis of GLP-1 in pancreatic cells [28].Gaddam A
et al. studied another property of fenugreek concerning its role in the prevention of type 2
diabetes in predisposed subjects, this is a 3-year investigation of the effect of a twice-daily
dose of 5g of fenugreek before meals in subjects predisposed to type 2 diabetes, a control
group consisting of 66 and a group of 74 adults treated with fenugreek, at the end of this
intervention the prevalence of diabetes was significantly reduced in subjects treated with
fenugreek compared to the control group, a reduction in fasting glucose and postprandial
blood glucose levels was also noted, as well as a significant increase in plasma insulin levels.
The control group is 4.2 times more likely to develop diabetes compared to fenugreek treated
subjects, this is positively correlated with plasma insulin and negatively correlated with
insulin resistance (HOMA-IR) [29]. Regarding the lipid balance, our study shows a significant
decrease after the fenugreek intake of total cholesterol and triglyceride levels respectively
with a difference of -0.6400 ± 0.13 mmol / L (p =, 000) and -0, 2008 ± 0.02mmol / L (p =
.000) with an increase in HDL-cholesterol of +0.194 ± 0.17 mmol / L (p = .000).These results
are consistent with the work of Sharma et al. who noted a significant reduction in total
cholesterol of approximately 1.3mMol / L with p <0.001 and LDL cholesterol of 1.0 mMol /
L with p <0.001 but the HDL-cholesterol value remains unchanged [7,30].Another study
conducted in 60 subjects with type 2 diabetes with a supplementation with 25g of fenugreek
powder daily for 24 weeks, showed a decrease in total cholesterol, LDL-cholesterol and
triglycerides by 14-16% during the study period and an increase in HDL-cholesterol by 10% [
31].In the same context, Soumaya and Rajyalakshmi also observed a significant reduction in
the values of the same parameters in a group of 20 adults with dyslipidemia by consuming
12.5 to 18g of fenugreek powders per day for 1 month [7,32]. In another study, Sharma also
reported a reduction in total cholesterol in 5 diabetics treated with 25g of fenugreek seeds for
a 21-day period [33].Thus, the study of Bordia et al. investigating the effect of 2.5g fenugreek
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powder taken orally twice daily in 40 subjects with coronary heart disease, a reduction in total
cholesterol and triglycerides was observed while there was no change in HDL-cholesterol
value [34].Annida B et al. in their study in the six groups of rats, showed a rise in total
cholesterol and triglyceride values in the group of rats treated with streptozocin compared to
the control group, respectively 208.1 ± 12.8 compared to 72, 3 ± 2.1 mg / dL and 25.6 ± 1.8 vs
12.4 ± 0.4 mg / dL. Taking 0.5 and 1 g / kg of fenugreek seeds led the total cholesterol value
respectively to 186.0 ± 10.6 mg / dL and 129.2 ± 9.5 mg / dL and the triglyceride value to
21,8±1,5mg/dL and 18.9 ± 1.4 mg / dL [11].The Egyptian study conducted by Gamal R et al.
proved the fenugreek modulating effect of lipid parameters disturbed by the treatment of rats
with alloxan and by a diet rich in lipid, in fact, they cause a significant increase in total lipids,
total cholesterol, triglycerides and atherogenic index compared to the control group. The use
of fenugreek has improved these parameters whose effect is dose-dependent; indeed, better
modulation is induced by the high dose of fenugreek seeds [12]. Mukthamba P performed
similar results in his study in high-fat lipid-fed Wistar rats after 8 weeks of treatment with
fenugreek and oil separately or in combination. The increase in serum triglycerides caused by
the lipid diet was bypassed by taking 20% fenugreek and 20%, and the increase in total
cholesterol and LDL cholesterol was corrected by 24% and 38%, respectively increased HDL-
cholesterol by 17%, these corrections are more marked in the case of the combination of
fenugreek and oil [15].A Moroccan study by Harchane H et al. on a group of 40 Wistar rats
shows that prolonged treatment with aqueous extract of fenugreek seeds improves the lipid
profile resulting in a 34% decrease in total cholesterol, 32% in triglycerides, 38% in LDL-
cholesterol with a 36% increase in HDL-cholesterol [16].In Tunisia, Khlifi S et al. conducted
a study of the effect of a 2.5 and 5g dose of fenugreek for 30 days on the serum lipid profile of
a population of type 2 diabetics, they found a significant dose dependent decrease triglyceride
levels and non-significant reductions in total cholesterol and HDL-cholesterol were recorded
[17].Ethan Basch attributed these effects on the lipid parameters of fenugreek to its
sapogenins [7], these effects seem to be related to the ability of diosgenin to inhibit the
absorption of cholesterol, to lower the concentration of hepatic cholesterol and to increase
secretion gallbladder [19].Regarding the anthropometric parameters that were compared
before and after taking the fenugreek extract, we found a good evolution of the different
measures. Indeed, there has been a decrease in BMI, TT respectively -5.56 ± 1.42 Kg / m2
and -10.46 ± 5.92 cm. Linear regression analysis introducing blood glucose as a dependent
variable and BMI, waist circumference, insulin and resistin as explanatory variables show a
strong correlation between blood glucose and BMI and insulin, which explains significant
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reduction in BMI after treatment with extract fenugreek. Another study by Wan-Li Xue Ph.D.
et al. in China, in a group of 70 male mice weighing between 100 and 110 g and made
diabetic by treatment with streptozotocin, in addition to a diet rich in lactose and lipid for 8
weeks to induce insulin resistance. After 6 weeks of treatment with metformin and the
aqueous extract of fenugreek at different doses, weight gain was noted in this group of mice
treated against a remarkable weight loss in the group of untreated mice, this is in favor of the
fenugreek extract attenuates the streptozocin-induced toxicity especially at high doses [39].
Ikeuchi et al. evaluated the dose-dependent efficacy of fenugreek extract due to 300mg / kg
body mass in a group of male mice, on endurance capacity in swimming over a 4-week
period. The administration of fenugreek has therefore resulted in a significant increase in
training time, these results have shown that this improvement is due to the increase in the use
of fatty acids as a source of energy [40].In addition to Kumar et al. reported a significant
weight loss, a reduction of body mass index, plasma lipids and cardiac risk factors in rats
consuming aqueous extract of fenugreek, and this by the regulation of appetite by reducing
the level of leptin in adipose tissue [22].The likely mechanism of fenugreek in weight loss and
fat reduction may be the removal of carbohydrates from the body before they enter the
bloodstream resulting in weight loss [19].Some studies show that consumption of fenugreek
has led to a change in eating behavior in humans, which can help better weight management,
consider the new sedentary lifestyle, poor eating habits high in calories and by consequently
the rising epidemic of obesity worldwide [25].In addition to the high proportion of soluble
fiber that has a gelatinous structure slowing the digestion and absorption of food which gives
a sensation of fullness thus suppressing appetite and promoting weight loss [37].
CONCLUSION
Type 2 diabetes is a disease in its own right that can lead to many complications affecting
quality of life. Its increase and frequency are a public health problem in our country. It would
be wise to seek effective therapeutic means, other than allopathy, to improve anthropometric,
biochemical and hormonal parameters and thus reduce the risk of morbidity. Therapeutic
means with fewer side effects and lower cost. In our study, we tried to prove the role of
fenugreek seeds associated with a regular physical activity in the improvement of parameters
disturbed by type 2 diabetes. There was a clear improvement in anthropometric, biochemical
and hormonal parameters. In fact, there was a significant decrease in BMI and waist
circumference, an increase in HDL-C and a decrease in LDL-C levels, as well as a decrease in
fasting blood glucose and insulin levels. The reduction of resistin would, therefore, be
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beneficial to the health of our patients by its detrimental effects on insulin sensitivity and its
pro-inflammatory role. From these results, our work approves the benefits of consuming
fenugreek seeds in obese patients with type 2 diabetes and especially its association with
regular physical activity. It is therefore important to promote the phytotherapy that is starting
to fit into the health system as part of the therapeutic arsenal of diabetes
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