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Moringa oleifera leaf powder for type 2 diabetes: a pilot clinical trial

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  • MINISTERE DE LA SANTE DU MALI

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Background: Moringa oleifera Lam. (Moringaceae) leaves are commonly used for diabetes in Mali. This pilot clinical study aimed to evaluate its effect on post-prandial blood glucose in preparation for a larger trial. Methods: Diabetic patients and non-diabetic healthy volunteers (35 each) were asked to fast for 13 hours on three occasions. Blood glucose was measured before and after eating 100g of white bread (at 30, 60, 90, 120, 150 and 180 minutes). On their second and third study visits, they were given 1g and 2g respectively of M. oleifera leaf powder, 30 minutes after eating the bread. We calculated the mean paired reduction in blood glucose at each time interval and the incremental area under the curve. Results: Ingestion of Moringa powder had no effect on blood glucose in non-diabetic participants, but in diabetic patients, it lowered blood glucose at 90 minutes. There was a trend towards lower incremental area under the curve when diabetic patients took 2g of Moringa. No side-effects were reported by any participants. Conclusions: Moringa oleifera leaf powder reduced post-prandial glycaemia in diabetic patients. A larger study is needed to define the optimal dose and to assess whether this translates into longer-term benefits.
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Merlin et al., Afr., J. Complement Altern Med. (2020) 17 (2): 29-36
https://doi.org/10.21010/ajtcam.v17i2.3
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MORINGA OLEIFERA LEAF POWDER FOR TYPE 2 DIABETES: A PILOT CLINICAL TRIAL
Lassana Sissoko1,2, Nouhoum Diarra2, Ibrahim Nientao3, Beth Stuart4, Adiaratou Togola1, Drissa
Diallo1,2, Merlin Luke Willcox4*
1Département de Médecine Traditionnelle, Institut National de Recherche en Santé Publique, BP 1746,
Bamako, Mali. 2l’Université des Sciences, des Techniques et des Technologies de Bamako, Bamako,
Mali., 3ONG Santé Diabète Mali, Bamako, Mali., 4School of Primary Care, Population Sciences and
Medical Education, University of Southampton, Aldermoor Health Centre, Aldermoor Close,
Southampton SO16 5ST, UK.
*Corresponding author’s E-mail: M.L.Willcox@soton.ac.uk
Abstract
Background: Moringa oleifera Lam. (Moringaceae) leaves are commonly used for diabetes in Mali. This pilot clinical
study aimed to evaluate its effect on post-prandial blood glucose in preparation for a larger trial.
Methods: Diabetic patients and non-diabetic healthy volunteers (35 each) were asked to fast for 13 hours on three
occasions. Blood glucose was measured before and after eating 100g of white bread (at 30, 60, 90, 120, 150 and 180
minutes). On their second and third study visits, they were given 1g and 2g respectively, of M. oleifera leaf powder, 30
minutes after eating the bread. The mean paired reduction in blood glucose at each time interval and the incremental
area under the curve were calculated.
Results: Ingestion of Moringa powder had no effect on blood glucose in non-diabetic participants, but in diabetic
patients, it lowered blood glucose at 90 minutes. There was a trend towards lower incremental area under the curve
when diabetic patients took 2g of Moringa. No side-effects were reported by any participant.
Conclusions:Moringa oleifera leaf powder reduced post-prandial glycaemia in diabetic patients. A larger study is
needed to define the optimal dose and to assess whether this translates into longer-term benefits.
Key words: Moringa oleifera; Type 2 diabetes; clinical trial
List of Abbreviations: 95% CI = 95% Confidence Interval, AUC = Area Under the Curve, BMI = Body Mass Index
HbA1c = Haemoglobin A1c, IC50 = Inhibitory Concentration 50%, NIHR = National Institute of Health Research
mmol/l = millimoles per litre, SD = Standard Deviation, SGLT-1 = sodium glucose transporter-1
Introduction
The prevalence of diabetes in Mali has increased six-fold from 0.27% in 2002-3 to 1.8% in 2017 (95% CI 1.4-
4.2%) in adults aged 20-79 years (International Diabetes Federation, 2017; Liu et al., 2012). Diabetes was the second
most common reason for admission to the two university teaching hospitals in Bamako (Mali), and was also
responsible for 40% of general medical consultations in 1996 (Santé Diabète Mali, 2012). A survey of 100 diabetic
patients at Gabriel Touré University Hospital in 2006-7 showed that 71% of patients had a monthly income of less than
US$100, but the average yearly treatment costs for diabetes were US$1169 (Sanogo et al., 2015). This has been
confirmed in a later study which found that total annual healthcare-associated costs for diabetic patients were $1127
compared to $308 for non-diabetic control patients, in a sample of 500 diabetic patients and 500 controls in Mali
(Bermudez-Tamayo et al., 2017). A further survey of 100 type 2 diabetic patients attending the University Hospital
clinic in 2009 found that 65% were not complying with their medications; in 57% of cases this was due to cost, and in
20% due to poor access to medicines (Sanogo et al., 2013). In rural areas, financial barriers to accessing medications
are even greater; most of the population in Mali cannot easily access modern medicines and prefer to use herbal
medicine as the first line.
Article History
Received: March 8th 2020
Revised Received: March 28th 2020
Accepted: Sept. 17th 2020
Published Online: Nov. 18th 2020
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Many herbal medicines are used for the treatment of diabetes, and the most widely-used modern antidiabetic
medicine (metformin) is derived from guanidine and galegine, active compounds of the Western herbal remedy Galega
officinalis (Simmonds and Howes, 2006). Moringa oleifera Lam. (Moringaceae) is widely used in the tropics as a
herbal remedy for diabetes. In Bangladesh, an ethnobotanical survey showed that M. oleifera was one of the plants
most frequently cited by traditional healers across 15 districts (Kadir et al., 2012). In South Africa, 17% of Bapedi
healers of Limpopo district use the raw seeds and leaves, cooked for 5-10 minutes, to treat diabetes mellitus (Semenya
et al., 2012). In Senegal, M. oleifera was used by nearly 66% of diabetic patients interviewed at a university teaching
hospital (Dièye et al., 2008). The most popular use of M. oleifera is as medicine for treating diabetes and regulating
blood pressure through the consumption of the fresh or dried leaves. These uses are common knowledge throughout
Senegal (Yousefian, 2012), and have also been reported in Nigeria (Popoola and Obembe, 2013). In Ugandan rural
communities, the use of Moringa leaves to treat diabetes mellitus was cited by 90% of respondents (Kasolo et al.,
2010).
M. oleifera, commonly referred to as the “drumstick tree” because of its large seed-pods (figure 1), is native to
the western sub-Himalayan regions of India, Pakistan, Bangladesh and Afghanistan, but has been cultivated for food
and medicine in tropical Asia, sub-Saharan Africa, Latin America and the Caribbean (Fahey, 2005; Jahn et al., 1986;
Morton, 1991). The consumption of the leaves, pods and flowers as food is very common. In West Africa, the leaves
and sometimes the flowers, are eaten in a peanut sauce, whereas the immature pods are not frequently consumed but
rather pressed for oil and used as medicine (Yousefian, 2012). In India, the immature pods are cooked in curries as
vegetables, the mature pods are used in soups and stews and the drumstick pulp is used in various dishes (Pandey et al.,
2011). The leaves are also widely used as vegetable, condiment and in salads. The leaves are rich in protein, essential
amino acids, iron, copper, calcium, Vitamin C and carotenoids (Fahey, 2005; Fuglie, 2002) so have been promoted as a
nutritional supplement for malnourished children, lactating women and people with osteoporosis (Pandey et al., 2011).
Therefore, various non-governmental organisations and governments have supported large scale planting of
Moringa (Hirt and Lindsey, 2008; Thurber and Fahey, 2009; Yousefian, 2012). As would be expected for a food, M.
oleifera leaves are non-toxic. This has been confirmed by laboratory experiments. The aqueous extract of M. oleifera
leaves was administered orally to 30 male Wistar rats and even at doses of 2000 mg/kg, no mortality ensued (Adedapo
et al.,2009 ). Sub-acute toxicity was assessed by administering daily doses of up to 1600 mg/kg to male rats, and no
signs of serious toxicity were observed on biochemical or haematological tests, or on histopathology of the organs
(Adedapo et al., 2009). The safety of M. oleifera leaves has been confirmed in other studies (Isitua and Ibeh, 2013).
Figure 1: Moringa oleifera tree (Photo: Merlin Willcox)
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In vitro studies
A water extract of dried Moringa leaf strongly inhibited the activity of intestinal sucrase (IC50 0.98mg/ml) and
weakly inhibited the activity of maltase and pancreatic α-amylase (22.3% and 5.3% respectively, at 5mg/ml). It also
inhibited the activity of pancreatic cholesterol esterase (IC50 4.34 mg/ml) (Adisakwattana and Chanathong, 2011).
A methanol extract at a concentration of 250 µg/ml inhibited α-amylase activity by 68% (Leone et al., 2018).
Moringa oleifera water, ethanol and methanol extracts have a dose-dependent α-D-glucosidase inhibition activity
(Togola, 2014). Moringa leaf contains a high concentration of quercetin-3-glucoside (Q3G) (Ndong et al., , 2007)
which competitively inhibits sodium (Na+) dependent mucosal uptake of glucose via SGLT-1 (sodium glucose
transporter-1) in the small intestine (Cermak et al., 2004).
In vivo studies
Several studies in diabetic rats have shown that M. oleifera leaf extracts have antidiabetic properties. An
ethanolic leaf extract of M. oleifera was one of the most potent among 30 hypoglycaemic medicinal plants from
indigenous folk medicines for lowering blood glucose level in alloxan-induced diabetic albino rats (Kar et al., 2003).
M. oleifera leaf tablets reduced blood glucose by 54.4%, compared to 40% in those who received
glibenclamide, while the negative control groups had an increased blood glucose level with time (Momoh et al.,2013).
M. oleifera leaf powder significantly improved glucose tolerance and lowered fasting plasma glucose in
diabetic rats (Jaiswal et al.,2009). M. oleifera significantly decreased postprandial blood glucose levels in both Wistar
and Goto-Kakizaki (GK) rats (Ndong et al., 2007). This study suggests that M. oleifera leaves increase glucose
tolerance, though the effect was greater in GK rats than in Wistar rats.
Other parts of the plant also have antidiabetic properties: an alcoholic bark extract prevented dexamethasone-
induced insulin resistance in peripheral tissues of rats (Sholapur and Patil, 2013). A methanol extract of the pods
reduced blood sugar levels in diabetic rats (Gupta et al., 2012) and a hydroalcoholic flower extract had significant
activity against hyperglycemia in diabetic rats (Sunilkumar, 2011).
Clinical studies
There have been three clinical trials to study the hypoglycaemic effect of Moringa leaf in diabetic patients.
The first studied the effect of 50g of cooked leaves on post-prandial blood glucose after a standard meal, compared to
bitter gourd and curry leaves, in six type 2 diabetic patients who were not taking any medication (William et al., 1993).
The meal including Moringa leaves was followed by a significantly reduced incremental area under the
glucose curve, unlike the other two vegetables, suggesting that Moringa does indeed have hypoglycaemic properties
over and above the reduction in glycaemic index seen with any vegetable or fibre in the diet. The insulin levels were
not raised compared to the other foods, suggesting that the mechanism of action is not an increase in insulin secretion.
A second trial measured HbA1c and post-prandial blood glucose levels after three months in 30 patients with
type 2 diabetes who took a Moringa leaf tablet after breakfast and after dinner every day, in addition to sulphonylureas,
compared to 30 control patients without Moringa (Giridhari et al., 2011). The experimental group had a significant
reduction of HbA1c (from 7.8% to 7.4%) and in postprandial blood glucose, whereas there was no significant change in
the control group.
More recently, a trial in 17 diabetic patients found that 20g of dried Moringa leaf powder significantly reduced
post-prandial glucose in diabetic patients after eating a standard meal, but that this significantly reduced the
acceptability of the meal due to the bitter taste (Leone et al., 2018). The authors, therefore, recommended trials with
lower doses of Moringa. All these trials are small and have methodological flaws, so there is a need for better evidence
on the effectiveness and optimal dosage of Moringa leaf powder in diabetic patients.
Aims and Objectives
We aimed to conduct a pilot study of the effect of Moringa oleifera leaf powder on postprandial blood glucose
in diabetic patients and non-diabetic controls. The objectives were to test whether it was possible to recruit and retain
patients to such a study, and to inform sample size calculation for a definitive study. This study was approved by the
Institut National de Recherche en Santé Publique in Mali.
Materials and Methods
Preparation of plant material
The youngest leaves (at the tips of the branches) were harvested early in the morning at the start of the rainy
season in June 2014, in Bamako district (Mali). The plant was identified by the Head Botanist of the Department of
Traditional Medicine (Seydou Dembélé), and a voucher specimen has been deposited in its herbarium (Number
1391/DMT). The leaves were washed with tap water, dried in the shade, then pounded and sifted to give a fine powder.
The powder was stored in hermetically sealed glass jars and kept in a dry area. The dose was determined by
32
weighing the dose normally given by traditional healers – this was approximately one gram. We decided to test this,
and double this dose, to look for a dose-response effect.
Participants
We recruited 70 participants (35 with diet-controlled type 2 diabetes, and 35 non-diabetic) from Bamako and
Kati. Diabetic patients were excluded if they were pregnant, if they had any cardiac, respiratory, renal or liver disease;
if their fasting blood glucose was <7.0 mmol/l, if their post-prandial glucose was <11.0 mmol/l, or if they had any
allergy to Moringa leaf powder. Non-diabetic participants were recruited from among the relatives of the diabetic
patients, and from the staff of local schools.
Study procedures
Participants came on three occasions, at least 15 days apart. On all occasions, they were asked to fast for 13
hours before the test. Participants were weighed, and body mass index was calculated. Fasting blood glucose was
measured with a hand-held glucometer (Infopia Element, USA), following which the patient ate 100 g of white bread,
with water. On the first occasion, nothing else was administered, and blood glucose was measured again 30, 60, 90, 120,
150 and 180 minutes after eating the bread. On the second occasion, participants were given 1g of Moringa oleifera
leaf powder with 75 ml water, 30 minutes after eating the bread (after the first post-prandial measurement of blood
glucose). On the third occasion, they took 2 g of Moringa oleifera leaf powder with 75 ml in the same way.
Patients were asked about any symptoms.
Analysis
Data was recorded on paper forms, and then entered into a database using Epi-info version 3.5.4 (CDC,
Atlanta, USA). After completing data entry, data were exported and analysed using SPSS 20 (IBM). A paired t-test
was used to compare mean post-prandial blood glucose at 60, 90 and 120 minutes, with and without different doses of
Moringa. The results were analysed separately for the patients with diabetes, and the healthy controls. The primary
outcome measure was defined as the mean paired difference in blood glucose at 90 minutes, with and without Moringa
at the two different doses.
As a secondary outcome measure, positive incremental area under the curve was calculated for all glucose
measurements from baseline to 180 minutes in accordance with FAO/WHO’s ‘Joint Guidelines on glycaemic index
testing of foods’ and the International Standard ‘ISO 26642/2010: Food Products – determination of the glycaemic
index (GI) and recommendation for food classification’. Repeated measures ANCOVA was used to compare
treatments across time-points, recognising that responses were clustered within individual participants. This analysis
was carried out in Stata v14.
Sample size for a definitive study was calculated using NQuery, assuming 90% power, and using the
difference in the positive incremental area under the curve and standard deviation estimated during this pilot study.
Ethical issues
The research followed guidelines of the Declaration of Helsinki and Tokyo. The protocol received ethical
approval from the ethics committee of the National Institute for Public Health Research (INRSP) in Bamako, Mali
(decision No 12/13 CE-INRSP, 6th November 2013). The study was explained to participants, who were given an
information sheet and allowed an opportunity to ask questions. If they agreed to participate, they were asked to sign a
consent form. Participants were compensated for the time and travel to each appointment.
Results
Participants
Baseline characteristics are summarised in Table 1. The diabetic group was on average slightly older, included
more women, and had a higher BMI than the non-diabetic group. It was feasible to recruit and retain patients to this
study.
Table 1: Baseline characteristics of participants
Diabetic (n=35)
Non-diabetic (n=35)
Mean age in years (SD)
45.8 (10.6)
50.1 (11.6)
Number of women (%)
25 (71%)
14 (40%)
Mean BMI (SD)
29.6 (4.4)
24.5 (3.8)
No of obese patients, BMI>30 (%)
18 (51%)
3 (9%)
Mean baseline fasting glucose,
mmol/l (SD)
9.1 (2.7)
5.4 (0.7)
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Effect of Moringa on blood glucose
In diabetic patients, blood glucose was on average about 1mmol/l lower after ingesting Moringa than it was
after eating the same meal without Moringa (Table 2 and Figure 3). The difference reached statistical significance at 90
minutes when the dose was 1g, and at 120 mins when the dose was 2 g. In non-diabetic participants, there was no
significant difference in blood glucose, except in the group that took 2 g, at 60 minutes; this reduction was lower than
in diabetic patients (0.58 mmol/l). No side-effect was reported by any participant.
Table 2: Mean paired difference in blood glucose (mmol/l) at different time intervals after eating 100g white bread
without Moringa, compared to white bread 100 g with Moringa 30 minutes later (* p<0.05, paired t-test)
Group
60 mins (95% CI)
90 mins (95% CI)
120 mins (95% CI)
Non-
diabetic
0.07 (-0.57 to 0.72)
-0.03 (-0.55 to 0.50)
0.11 (-0.31 to +0.52)
0.58 (0.19 to 0.98)*
0.17 (-0.31 to 0.66)
0.15 (-0.32 to + 0.61)
Diabetic
0.70 (-0.39 to 1.78)
1.26 (0.07 to 2.46)*
0.76 (-0.26 to +1.80)
1.04 (-0.21 to 2.29)
1.04 (- 0.18 to 2.27)
1.25 (0.24 to 2.26)*
Time (minutes)
Figure 3: Observed mean blood glucose in non-diabetic and diabetic patients taking different doses of Moringa. (DM=
Diabetic; ND = Non-Diabetic)
There were no significant differences between the control and Moringa treatments in the positive incremental
area under the curve (AUC) for the whole study population controlling for age, sex, BMI and whether the participant
was diabetic (Table 3). There was a trend towards a dose-response effect, with a larger reduction for diabetic patients
who took 2 g of Moringa compared to when they took no Moringa (by 92 mmol min/l) but this difference was not
statistically significant.
Blood glucose (mmol/l)
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Table 3: Positive incremental area under the curve (mmol min/l)
The sample size calculation, using a simple crossover design to detect a difference between 2 g of Moringa
oleifera leaf powder and control, for a difference in the positive incremental area under the curve of 92 and a standard
deviation of 360, suggests that a full study would require 82 diabetic patients.
Discussion
Principal findings
We were able to recruit and retain diabetic patients to a trial examining the effect of Moringa oleifera leaf
powder on post-prandial glucose. We were able to collect the primary outcome measure (post-prandial glycaemia,
measured from a finger prick); administration of Moringa appears to reduce the post-prandial rise in blood glucose in
diabetic patients but not in healthy controls. The duration of effect may be greater and longer after taking 2 g of
Moringa oleifera leaf powder than after taking 1g. A larger study of 82 diabetic patients is needed to confirm this effect.
No adverse effects were reported.
Strengths and limitations
This was a small pilot study, and because of logistical difficulties, healthy volunteers were not perfectly
matched by age and sex to the diabetic patients. We used glucometers rather than venous blood samples to measure
glucose, because of limited resources and practical considerations. Nevertheless it is unlikely that these factors could
have caused the observed differences in blood glucose. Moringa leaf powder was administered 30 minutes after the
bread, but in future studies it would be better to administer it at the same time as the food (which is the traditional
practice, and which would fit with the putative mechanism of action). It would also be good to escalate the dose further
beyond 2 g to evaluate whether there would be a larger and more significant effect, while maintaining acceptability.
In future studies it would be better to use the positive incremental area under the curve as the primary outcome
measure.
Implications
This pilot study supports the results of previous research which also show that M. oleifera leaf powder lowers
blood glucose. It is particularly interesting that this effect only seemed to occur in diabetic patients. Future studies are
needed to confirm this, to study whether a larger dose would have a greater effect, and to evaluate the effect of its daily
use over a period of several months, on glycated haemoglobin. It would also be interesting to evaluate its effect on
blood cholesterol, since preclinical studies suggest that M. oleifera may also have cholesterol-lowering effects (Ghasi et
al., 2000). Diabetic patients are at increased risk of cardiovascular disease, and cholesterol is a major risk factor for this.
M. oleifera leaves are primarily a food, part of the normal diet in many tropical countries, so are particularly
interesting as a potential dietary intervention for patients with diabetes, because it is possible to increase the dose
significantly with no risk of toxicity. Giving the leaf powder in capsules could avoid the issue with acceptability of the
taste. While awaiting results of further research, there would be no harm in encouraging diabetic patients to incorporate
M. oleifera into their daily diet (if they do not already do so).
Conclusions
Moringa oleifera leaf powder, administered 30 minutes after a food bolus, seemed to reduce post-prandial
blood glucose in diabetic patients only, but not in non-diabetic volunteers. A definitive trial would need 82 diabetic
patients to demonstrate whether there is a statistically significant difference in the area under the curve. Further
research is also needed to assess whether this translates into reductions in HbA1c after use of Moringa for three or more
months, and reductions in long-term complications of diabetes.
Group
Mean positive incremental area
under the curve (SD)
Difference compared to
control (95% CI)
Non-diabetics
Control
222.77 (108.29)
1 g Moringa
301.29 (453.67)
78.52 (-51.54, 208.59)
2 g Moringa
221.82 (125.28)
-0.94 (-131.01, 129.12)
Diabetics
Control
552.79 (344.47)
1 g Moringa
549.83 (318.29)
-2.96 (-121.70, 115.77)
2 g Moringa
461.41 (414.88)
-91.38 (-210.11, 27.35)
35
Acknowledgements
The authors are grateful to all the patients who participated in this trial, and to Ms Emma Weisbord for helping
to conduct a preliminary literature review which contributed to the background section. This work was funded by the
European Union Research Directorate through the MUTHI project, FP7 Grant Agreement No.: 266005. The salary of
Dr Merlin Willcox is funded by NIHR Academic Clinical Lectureship, under grant CL-2016-26-005.
Declaration of Conflict of Interest: The authors have declared no conflicts of interest.
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... Previous studies have provided insights into the benefits of Moringa supplementation for diabetic patients (8). For instance, a pilot clinical trial demonstrated that Moringa oleifera leaf powder could reduce post-prandial glycemia in diabetic patients, suggesting its potential as a complementary therapy for diabetes management (9). Another study highlighted the effectiveness of Moringa leaves in controlling blood sugar levels in patients with T2DM(10). ...
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Background: The action of aerobic exercise and Moringa Oleifera supplementation on type 2 diabetes mellitus (T2DM) have been individually documented, but their combination remains unclear. This study evaluates the synergistic effects of a 12-week aerobic exercise program and Moringa supplementation on metabolic and inflammatory markers in T2DM patients. Methods: A total of 120 T2DM patients were randomly assigned to four groups: control, aerobic exercise, moringa supplementation (250mg/kg/day), and a combination. BMI, blood glucose, serum insulin, serum C-peptide, renal function tests, HbA1c, adiponectin, IL-6, and lipid profile, were assessed before and after the intervention. Blood glucose levels were monitored weekly. Results: All intervention groups showed significant improvements in HbA1c levels compared to the control group, with the combination group demonstrating the greatest reduction. Blood glucose levels decreased significantly in the exercise and combination groups, with the aerobic exercise group outperforming moringa alone. Serum insulin levels significantly decreased in the moringa and combination groups, while serum C-peptide levels decreased in all groups. Lipid profile improvements were noted in all intervention groups, with the combination treatment showing superior results in reducing total cholesterol and BMI. Both adiponectin levels increased and IL-6 levels decreased significantly in all intervention groups, particularly in the combination group. Renal function tests showed no adverse changes, with a significant reduction in BUN levels observed only in the combination group. Conclusion: The combination of aerobic exercise and moringa supplementation provides a synergistic therapeutic effect, significantly improving glycemic control, lipid profile, adiponectin levels in T2DM patients.
... However, in diabetic patients, blood glucose levels significantly reduced after 90 min. Diabetic patients who took 2 g of M. oleifera showed a trend toward a smaller progressive area under the glucose curve (21). Another study found that leaf extract from M. oleifera significantly normalized fasting blood glucose levels in mice (22). ...
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Diabetes is a metabolic disease characterized by deregulated insulin levels and hyperglycemia. The global healthcare system widely acknowledges the use of medicinal plants as therapeutic agents. One such traditional plant with antidiabetic properties is Moringaoleifera, which has been used for centuries.M.oleifera,due to its important bioactive compounds such asflavonoid, carotenoidandpolyphenols,is used totreatvariousailments,includingdiabetes, cancer, kidney problemsandbacterial and viral infections. This review summarizes the applications of M.oleiferaanditsmechanismsforpreventingdiabetes. Additionally, it explores the influences of M.oleifera in treating diabetes, with a specific focus on its mechanism and effectiveness in reducing insulin levels and managing the conditions. The objectives of this review aretopresentsthe most recent information and elucidate the mechanism by which M.oleiferapreventsdiabetes. Additionally, it provides a thorough analysis of M.oleifera’sapplicationsasanatural treatment and its industrial uses. The reviewhighlightscurrentknowledge gapsandsuggests areas for further research. In conclusion, this study enhancesourunderstanding of the comprehensive applications of M.oleifera,advancing knowledge and help to preventdiabetes-related complications.
... Moringa may also aid in reducing pain and inflammation. Moringa has a wide range of applications, including the treatment of diabetes, lactation, and asthma (Sissoko et al. 2020). ...
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The biosynthesis of nanoparticles is an important research area focused on developing innovative, cost-effective, efficient, and environmentally friendly synthesis techniques with a wide range of applications. This study employs a straightforward and practical method to produce TiO2 nanoparticles (NPs) for use in photocatalysis, antibacterial, antifungal, and antidiabetic applications. It utilizes extract-assisted biosynthesis with Moringa oleifera. To enhance the material and evaluate the impact of bioinspiration on various parameters, the resulting TiO2 NPs undergo calcination at 500 °C. Structural confirmation, bandgap analysis, and functional group studies of MO/TiO2 (Moringa oleifera/TiO2) nanoparticles are conducted using XRD, UV-DRS, FT-IR, and PL analysis. To examine the surface morphological characteristics of the anatase TiO2 nanoparticles, SEM and TEM-EDS electron microscopy analyses were accomplished. The produced TiO2 nanoparticles are also assessed for their photocatalytic and antidiabetic properties. Photocatalytic activity is determined by decolorizing methylene blue dye in the presence of sunlight, revealing that optimal conditions for complete color removal involve using 0.3 g of TiO2 and a concentration of 4 × 10− 5 M at pH 7. A total decolorization efficiency is achieved after 180 min in the presence of MO/TiO2. The biosynthesized Moringa oleifera leaf extracted TiO2 (MO/TiO2) was used for photocatalytic and biomedical applications. MO/TiO2 exhibited the best photocatalytic activity and showed maximum inhibitoin in invitro antidiabetic activity. Invivo antidiabetic activity showed the Moringa oleifera leaf-extracted TiO2 catalyst significantly reduced blood glucose levels.
... Moringa oleifera (moringa) has been used as a traditional indigenous medicine in Asian countries against various ailments including diabetes, inflammatory and infectious diseases, cancer, asthma, infertility, hyperglycemia, dyslipidemia, flu, heartburn, syphilis, malaria, diarrhea, scurvy, and skin diseases (Gopalakrishnan et al., 2016;Morimitsu et al., 2000;Segwatibe et al., 2023;Sreelatha & Padma, 2009). The extracts from M. oleifera have been reported for their abilities to scavenge free radicals (Santos et al., 2012;Xu, Y. B. et al., 2019), inhibit α-amylase and α-glucosidase activities (Karray et al., 2022;Magaji et al., 2020;Ogundipe et al., 2022), decrease blood glucose concentration (Tang et al., 2017), ameliorate diabetes (Sissoko et al., 2020), reduce blood pressure and cholesterol (Gopalakrishnan et al., 2016) as well as prevent neurodegenerative disorders and infections (Mundkar et al., 2022;Xiao et al., 2020). ...
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Extracts from powders of geminated brown rice (Oryza sativa L.), Moringa oleifera, and Cordyceps militaris were combined in various ratios and their health-beneficial properties were investigated. All combined extracts exerted the synergistic effects on antioxidant activity as well as inhibitions against α-amylase and α-glucosidase. Extract formulas T4 (70% germinated brown jasmine rice, 20% M. oleifera dry leaves, and 10% C. militaris) and T2 (80% germinated brown jasmine rice, 10% M. oleifera dry leaves, and 10% C. militaris) elicited the significantly highest antioxidant activity and the significantly highest inhibition against α-glucosidase, respectively. Both formulas exhibited the significantly highest inhibition against α-amylase. As compared to each other, extract formulas T4 and T2 possessed the higher glucose consumption-promoting and antiinflammatory activities, respectively. Both formulas were not toxic to normal RAW-264.7 and SW-480 human colon cancer cells. Bioactive compounds with health-supporting properties were identified using UHPLC-QTOF-MS/MS. These combined extracts can be promising therapeutic food.
... As a result, there is a need to develop natural therapies that can be utilized as alternatives to pharmaceutical drugs for type 2 diabetes [4]. Many herbal treatments are used to treat diabetes, and the most extensively used modern anti-diabetic drug (metformin) is derived from the active ingredients of the Western herbal cure's guanidine and galegine [5]. ...
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Background: Diabetes mellitus, particularly type 2 (T2DM), is one of the most common diseases. T2DM
... We successfully enrolled and maintained participation of diabetic patients in a trial that explored the effects of MO leaves powder on serum biochemical parameters levels and also on weight, BMI and blood pressure, for 90 days across five time points (D0, D3, D7, D30, and D90). The choice of the posology (Sissoko et al., 2020) and the duration of its administration was based on scientific evidence, the advice of the diabetologists following the diabetic participants as well as the traditional healers in the region. No adverse effects were reported. ...
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Moringa oleifera Lam. leaves are commonly used for diabetes worldwide. To date, there has been no research study done to investigate its effect on lipid and carbohydrate profile in Algerian diabetic patients. This pilot clinical study aimed to evaluate its long term-effect on lipid and carbohydrate profile in Algerian diabetic patients in preparation for a larger trial. 44 diabetic patients from Adrar city were administrated with 3600 mg of MO leaves powder twice a day at breakfast and at 7 p.m. for a period of 90 consecutive days, along with their regular hypoglycemic medications, in order to evaluate their serum lipid (TC, C-HDL, C-LDL and TG) and carbohydrate profile (blood sugar and HBA1c), weight, BMI and blood pressure, across five time-points (on days 0, 3, 7, 30, and 90). The results showed that oral administration of Moringa oleifera powder had a statistically significant effect on blood sugar (HBA1c), LDL-C, HDL-C levels in diabetic patients (p<0.05). Moringa oleifera leaf powder seemed reduced LDL-C, and HBA1c and elevated HDL-C, in diabetic patients. No side effect was reported by any participant. However, it did not have a statistically significant effect on weight, BMI and blood pressure. The data from the present clinical trial provide persuasive, although preliminary evidence supporting the therapeutic potential of Moringa oleifera leaf powder for managing chronic hyperglycemia and dyslipidemia in Algerian patients with diabetes. A more extensive trial is necessary to determine the Moringa oleifera leaf powder optimal dose and evaluate if its effect results into long-term advantages. In addition, further investigations are required to clear the underlying mechanisms involved with these effects.
... Subsequently, Sissoko et al. reported similar potent reduction in postprandial blood glucose levels after ingestion of 1 g or 2 g of M. oleifera leaf powder in diabetic patients. In addition, the glycated hemoglobin reduced from 7.8% to 7.4% in the group administered with M. oleifera leaf powder ( Sissoko et al., 2020 ). The two studies are in line with several studies reported outside Africa conducted in healthy ( Kushwaha et al., 2014 ;Anthanont et al., 2016 ;Ngamukote et al., 2016 ) and diabetic ( Mozo and Caole-Ang, 2015 ;Taweerutchana et al., 2017 ) individuals, and further support the antidiabetic activity of M. oleifera leaf. ...
... Leaves are very low in calories and can be incorporated into an obese person's diet. Moringa leaf powder contains several compounds, indicating its value as a nutritional supplement [23,24]. ...
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Cookies are the most popular bakery food consumed worldwide. The development of reduced-sugar soft cookies by using Finger Millet, Syzygium cumini L. (Jamun) and stevia extract was investigated. In addition to it, Buttermilk powder was used as a bulking agent to improve the flavor, color and texture of the cookies along with other ingredients like flour, margarine, salt, sodium bicarbonate, and water. The creamery method of production was used for cookie preparation. Amounts of water, stevia, and buttermilk powder and baking duration for each formulation were determined by preliminary experiments. Different formulations use different ratios to find out the best composition for cookies on the basis of palatability. After the selection of the best composition, cookies were prepared for the physiochemical, sensory and nutritional analysis. Sensory analysis was evaluated based on organoleptic properties: color, taste, aroma and overall acceptability on the basis of a 9-point hedonic scale. The physiochemical evaluation included total ash value, total water, and alcoholic extraction, and total moisture content. On the basis of nutritional value comparison, it was found that protein content is higher in our formulation than in other marketed products. Due to the high antioxidant potential and phenolic content of the Finger Millet cookie, it can be used as a therapeutic or functional food source for the treatment of overweight, obesity, and diabetes.
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Diabetes mellitus is a significant threat to society and even results in death. The content of soybeans that can lower blood glucose levels are protein, isoflavones, fiber, and a low glycemic index. Moringa leaves contain antioxidants such as flavonoids, vitamin A, E, C, and selenium, which help lower blood glucose levels. However, it is unknown whether combining soy milk with boiled moringa leaves is also beneficial in reducing blood sugar levels. This study aimed to determine how combining soy milk and boiled moringa leaves affects blood sugar levels in type 2 diabetes mellitus patients at Posbindu Puskesmas Nusa Indah. Bengkulu city in 2023. The design used in this study is a pre-experimental design with a pre-test and post-test design. Fifteen pre-elderly samples aged 45 to 59 years with blood sugar levels of 140 to 199 mg/dL were randomly selected as intervention targets in this study. The treatment combined 200 ml of soy milk with 150 mL of Moringa leaf decoction, and then 350 mL of soymilk was produced. The intervention was given twice daily, as much as 175 mL for seven days. Data analysis using the Paired T-test showed that there was a significant relationship between intervention and the sugar level of type 2 diabetes mellitus (p < 0.001). There was a substantial decrease in blood glucose levels after administering the soymilk intervention with Moringa leaf decoction after seven days of intervention with p < 0.001. This combination product can be used as a functional food ingredient as an alternative for lowering blood glucose levels.
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Diabetes mellitus (DM) is a global health problem owing to its high prevalence and increased morbidity and mortality. The prevalence of DM and impaired glucose tolerance in Uganda is approximately 4.1% and 6.6%, respectively. Medicinal plants are commonly used for the management of DM, especially in developing countries, such as Uganda . According to several ethnobotanical surveys conducted in Uganda, various medicinal plants are used in DM management. Meanwhile, ethnopharmacological studies have confirmed the anti-diabetic efficacy of various plants and plant-derived formulations from Uganda. However, these information remain highly fragmented without a single repository for plants used in the management and treatment of DM in Uganda, hindering further investigations. Therefore, this study aimed to comprehensively explore plants used for DM treatment in Uganda and retrieve relevant ethnopharmacological and ethnomedicinal information that can be used for DM therapy development. English peer-reviewed articles and books were searched in scientific databases, especially PubMed, Scopus, Google Scholar, Science Direct, SciFinder, and Medline, to retrieve information on medicinal plants used for DM treatment and management in Uganda. The databases were searched to obtain published literature on the anti-diabetic activities and safety of plants among the identified plants. The family name, plant parts used, anti-diabetic activities, dosage, and mechanisms of action of plant extracts were captured. In total, 46 species belonging to 26 families are used to treat DM in Uganda. Most species belonged to the Fabaceae (20%), Asteraceae (13%), and Solanaceae (7%) families. Anti-diabetic activities of 27 (59%) species have been scientifically investigated, whereas the rest have not been evaluated. This review indicated that various medicinal plants are used in the traditional treatment and management of DM across different regions in Uganda. Scientific investigations have revealed the anti-diabetic potential and safety of several of these plants. However, there is a need to validate the anti-diabetic potential of other unstudied plants. Additionally, isolating and characterizing active principles and elucidating the anti-diabetic mechanism of these plants and performing preclinical and clinical studies in the future could aid in the formulation of an effective and safe treatment for DM.
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The hypoglycemic effect in humans of Moringa oleifera (MO) leaf powder has, to date, been poorly investigated. We assessed the chemical composition of MO leaf powder produced at Saharawi refugee camps, its in vitro ability to inhibit α-amylase activity, and its sensory acceptability in food. We then evaluated its effect on postprandial glucose response by randomly administering, on 2 different days, a traditional meal supplemented with 20 g of MO leaf powder (MOR20), or not (control meal, CNT), to 17 Saharawi diabetics and 10 healthy subjects. Capillary glycaemia was measured immediately before the meal and then at 30 min intervals for 3 h. In the diabetic subjects the postprandial glucose response peaked earlier with MOR20 compared to CNT and with lower increments at 90, 120, and 150 min. The mean glycemic meal response with MOR20 was lower than with CNT. The healthy subjects showed no differences. Thus, MO leaf powder could be a hypoglycemic herbal drug. However, given the poor taste acceptability of the 20 g MO meal, lower doses should be evaluated. Moreover, the hypoglycemic effects of MO leaf powder should also be demonstrated by trials evaluating its long-term effects on glycaemia.
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Background Diabetes mellitus (DM) is one of the most burdensome chronic diseases and is associated with shorter lifetime, diminished quality of life and economic burdens on the patient and society as a result of healthcare, medication, and reduced labor market participation. We aimed to estimate the direct (medical and non-medical) and indirect costs of DM and compare them with those of people without DM (ND), as well as the cost predictors. Methods and findings Observational retrospective case–control study performed in Mali. Participants were identified and randomly selected from diabetes registries. We recruited 500 subjects with DM and 500 subjects without DM, matched by sex and age. We conducted structured, personal interviews. Costs were expressed for a 90-day period. Direct medical costs comprised: inpatient stays, ICU, laboratory tests and other hospital visits, specialist and primary care doctor visits, others, traditional practitioners, and medication. Direct non-medical costs comprised travel for treatment and paid caregivers. The indirect costs include the productivity losses by patients and caregivers, and absenteeism. We estimate a two-part model by type of service and a linear multiple regression model for the total cost. We found that total costs of persons with DM were almost 4 times higher than total cost of people without DM. Total costs were $77.08 and $281.92 for ND and DM, respectively, with a difference of $204.84. Conclusions Healthcare use and costs were dramatically higher for people with DM than for people with normal glucose tolerance and, in relative terms, much higher than in developed countries.
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Ethno-pharmacological relevance: All parts of Moringa oleifera are medicinally valuable with overlapping uses in treating myriads of ailments and diseases including body pains and weakness, fever, asthma, cough, blood pressure, arthritis, diabetes, epilepsy, wound, and skin infection. Moringa also has robust ability to challenge terminal diseases such as HIV/AIDs infections, chronic anemia, cancer, malaria and hemorrhage. The present study was to obtain ethnobotanical information on the use and local knowledge variation, geographical distribution, and to collect different landraces of Moringa oleifera from the different agro-ecological regions in Nigeria, for further studies. Materials and methods: Ethnobotanical data were collected through face to face interviews, semi structured questionnaires and discussions with selected people who had knowledge about the plant. The fidelity level (FL %) and use value for different use categories of Moringa oleifera and its parts were estimated. The variation in ethnobotanical knowledge was evaluated by comparing the mean use value among ethnic, gender and age groups using sample T test. Garmi GPS was used to determine the locations (latitude and longitude) and height in different areas to assess the geographical spread of the species. Results: Seven (7) categories of use (Food, medicine, fodder, fencing, firewood, gum and coagulant) were recorded for Moringa oleifera. Food and medicinal uses showed highest fidelity level while the leaves and the seeds were the plant parts most utilized for the same purposes. There were significant differences among the ethnic, gender and age groups regarding the ethno-botanical use value. The geographical distribution pattern shows that the Moringa oleifera is well distributed in all ecological zones of Nigeria, well adapted to the varied climatic conditions and gaining unprecedented awareness among the people. Conclusion: Though considered an introduced species, Moringa oleifera has found wide acceptance, recognition and usefulness among the various ethnicities in the studied areas. The sources of introduction, domestication and ethnic differentiation influenced the distribution pattern across the geographical areas.
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Moringa oleifera grown and used in many countries around the world is a multi-purpose tree with medicinal, nutritional and socio-economic values. In Senegal and Benin, M. oleifera leaves are dispensed as powder at health facilities to treat moderate malnutrition in children. It established the medicinal uses of M. oleifera leaves by local communities in Uganda and identified phytochemicals present in M. oleifera leaves extracts. It used quantitative and experimental methods that established the uses, and identified phytochemicals in M. oleifera leaves. Employed serial extractions, using ether, ethanol and water as solvents. The phytochemicals were qualitatively identified using standard chemicals and standard outcomes. Twenty-four medicinal uses of M. oleifera leaves were established. Phytochemicals present included: tannins, steroids and triterpenoids, flavonoids, saponins, anthraquinones, alkaloids and reducing sugars. The local communities in Uganda use M. oleifera leaves to treat common ailments. Presence of phytochemicals in the extracts, indicate possible preventive and curative property of M. oleifera leaves. There is need to standardize M. oleifera leaves use for nutrition and herbal medicine.
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Introduction La prevalence de l’inobservance est elevee dans les maladies chroniques, ou les soins sont le fait des patients, devenus des « gestionnaires » de leur etat de sante. L’inobservance therapeutique reste une cause majeure d’echec therapeutique et remet en question l’efficacite reelle des soins. Objectif : Evaluer l’observance therapeutique des patients diabetiques de type 2 traites par antidiabetiques oraux. Materiels et methodes Notre etude etait de type descriptif et s’est deroulee de Janvier 2009 a Decembre 2009 avec un effectif de 100 patients. Etaient inclus tous les diabetiques de type 2 traites par antidiabetique oral, suivis au CHU Gabriel Toure de Bamako. Resultats La moyenne d’âge etait de 65 ans avec un sexe ratio de 0,28. L’observance therapeutique etait bonne chez 45 % de nos patients et mauvaise chez 55 %. Lorsque la duree du traitement n’excedait pas 2 ans l’observance therapeutique etait respectee par 69 % des patients, par contre lorsque le patient etait sous antidiabetique oral depuis plus de 6 ans, celle-ci etait respectee dans seulement 35 % des cas. Lorsque le nombre de prise journaliere de l’antidiabetique etait egal a trois, 65 % des patients etaient inobservants, par contre lorsque l’antidiabetique etait en mono prise l’observance etait bonne chez 70 % des patients. Les autres causes d’inobservance etaient : le manque de moyens financiers (57 %), la lassitude du patient (23 %), l’inaccessibilite au medicament (20 %). Conclusion Dans ce travail princeps, les difficultes financieres ont ete la cause la plus frequemment associee a l’inobservance therapeutique au Mali, d’ou la necessite d’une couverture sociale pour ameliorer la prise en charge des patients diabetiques.
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Introduction: A survey among diabetic patients at the National Diabetic Centre of Bamako (Mali) showed that patients use medicinal plants in combination with conventional treatment. Anacardium occidentale, Moringa oleifera, Sclerocarya birrea and Ziziphus mauritiana were the most used plants in the management of diabetes according to patients. Literature reports scientific hypoglycaemic activity for all these plants [1 – 4] but no scientific information exists on the mechanism of their activity. Objective: This study aims at determining the α-D-glucosidase inhibition properties of Sclerocarya birrea, Anacardium occidentale, Moringa oleifera and Ziziphus mauritiana extracts Methodology: Water, ethanol and methanol extracts of the leaves and stem bark of Sclerocarya birrea and Anacardium occidentale and the leaves of Moringa oleifera and Ziziphus mauritiana were prepared. A thin layer chromatography bio autography technique was used. The enzyme α-D-glucosidase was dissolved in sodium acetate buffer. TLC plate was sprayed with enzyme solution and incubated at room temperature for 60 min. Enzyme inhibitors were visualised as white spots on the TLC plates after spraying with solutions of 2-naphthyl-α-D- glucopyranoside and Fast Blue Salt. Acarbose was used as positive control. Results and Discussion: The results showed a dose-dependent α-D-glucosidase inhibition property of Moringa oleifera water, ethanol and methanol extracts. Water and alcohol-soluble compound(s) are then responsible of the activity. The result explains the mechanism of the hypoglycaemic property of Moringa oleifera although the compounds responsible of the activity are not known. The finding also helps doctors to adjust the treatment or advice patients who combine conventional α-D glucosidase inhibitors drugs with Moringa oleifera on the risk of drug-herbs interactions. Keywords: plants, diabetes, mechanism of action, α-D glucosidase inhibition References: [1] Lawrence A. Olatunji, John I. Okwusidi, and Ayodele O. Soladoye 2005 Antidiabetic Effect of Anacardium occidentale Stem-Bark in Fructose-Diabetic Rats Pharmaceutical Biology, Vol. 43, No. 7, pp. 589 – 593 [2] Luangpiom Ampa Kourjampa Watchara Junaimaung Tanaree 2013, Anti-hyperglycemic Properties of Moringa oleiferaLam. Aqueous Leaf Extract in Normal and Mildly Diabetic Mice: British Journal of Pharmacology and Toxicology, 4; 3; 106 [3] Gondwe M; Kamadyaapa DR, Tufts M, Chuturgoon AA and Musabayane CT 2008 Slerocarya birrea [(A. Rich.) Hochts.] [Anacardiaceae] stem bark ethanolic extract modulates blood glucose, glomerular filtration rate and mean arterial blood pressure of STZ-induced diabetic rats. Phytomedicine 15 699 – 709 [4] Cisse A, Ndiaye A, Lope z-Sall P, Seck F, Faye B. Etude de l'activite antidiabetic de Zizyphus mauritiana Lam (Rhamnaceae). Antidiabetic activity of Zizyphus mauritiana Lam (Rhamnaceae). Dakar- Med. 2000; 45(2): 105 – 7.
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Context: Moringa oleifera leaves have been reported to have antidiabetic, antitumor, hypotensive, anti-inflammatory, and diuretic properties as well as antibiotic, antitryponosomal, hypotensive, and anti-inflammatory activities. They are outstanding source of vitamins A, B, C, and also rich in calcium and protein. Objectives: The aim of the study was to formulate Moringa oleifera powdered leaf tablets and to study the in vitro and in vivo properties of the herbal drug from the tablets. Material and methods: The Moringa oleifera powdered leaf was formulated into tablets by direct compression. The in vitro properties of the tablets were evaluated in terms of uniformity of weight, hardness, disintegration time, friability and dissolution rate. Also, the in vivo antidiabetic properties of Moringa oleifera tablets were studied using Wistar rats. Results and discussion: The results of the tablets' weight uniformity gave percentage deviation that was below 5%. Tablet disintegration time ranged from 11.50 ± 0.11 to 14.90 ± 0.27 min. The tablets exhibited friability results lower than 2% and exhibited about 82% to 83% release of the extract at 15 min. In vivo antidiabetic studies showed that at 8 hr, about 54.4% and 40% of glucose reduction occurred in groups that received Moringa oleifera tablets and glibenclamide (Daonil®) respectively, while the negative control groups showed increased blood glucose level with time. Conclusions: This study has shown that Moringa oleifera leaves formulated into tablets possess good physicochemical and antidiabetic properties in addition to being a supplement.
Article
Background: Experimental study has revealed the antidiabetic potentials of ethanolic extract of the bark of Moringa oleifera Lam., (Moringaceae), a multipurpose tree of south Asia. Objective: To investigate the effects of alcoholic and petroleum ether extracts of Moringa oleifera bark on acute and chronic insulin resistance induced by dexamethasone in rats. Materials and Methods: Dexamethasone (dexa) was administered for 11 days (1 mg/kg, s. c., once daily) and single dose (1 mg/kg, i. p.) to induce chronic and acute insulin resistance respectively. 2 doses each of alcoholic (AE125 and AE250 mg/kg) and petroleum ether extracts (PEE30 and PEE60 mg/kg) and single dose each of alcoholic (AE250 mg/kg) and petroleum ether extract (PEE 60 mg/kg) of Moringa oleifera bark were tested in chronic and acute studies. At the end of the studies fasting plasma glucose, triglyceride levels and oral glucose tolerance were measured. Results: In chronic study, treatment of rats with AE125 and AE250 prevented dexamethasone-induced hypertriglyceridemia and oral glucose intolerance but not fasting hyperglycemia, whereas both PEE30 and PEE60 had no effects on any of these parameters measured except that significant reduction of triglyceride level was observed in PEE60 treated rats. Oral glucose intolerance induced by single dose administration of dexamethasone was prevented by AE250 but not by PEE60. In normal rats AE250 treatment improved the glucose tolerance, where as PEE60 had no effect on this parameter. Conclusion: The present study indicates that AE of Moringa oleifera prevents dexamethasone-induced insulin resistance in peripheral tissues.