clinical evidence of extract ginseng g-115 in diabetes mellitus patients (dr. j. hudyono, ms, spo

7/27/2019 Clinical Evidence of Extract Ginseng G-115 in Diabetes Mellitus Patients (Dr. J. Hudyono, MS, SpO

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Manajer Pelaksana Uji Klinik Obat Farmakologi FKUI -RSCM Staf Panitia Penilai Obat Jadi (PPOJ) Badan POM RI Kelompok Kerja Uji Klinik Badan Pengawas Obat &

Makanan RI (Badan POM-RI) Staf Pengajar Ilmu Kedokteran Okupasi FK. Ukrida &FKUI Magister & Spesialis Kedokteran Okupasi UniversitasIndonesia Anggota Indonesian Association for the Study ofMedicinals Member Faculty of Pharmaceutical Medicine (MFPM)Royal College, UK Anggota IDI, PERDOKI, PERDAFKI, IKAFI

Curriculum Vitaedr. J. Hudyono, MS, SpOk, MFPM


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J. Hudyono

Clinical Evidence of Extract Ginseng G-115

in Diabetes Mellitus PatientsJ. Hudyono
http://www.google.com/url?sa=i&rct=j&q=books&source=images&cd=&cad=rja&docid=jUUqJWyZZISufM&tbnid=nahTdqTm0Aa7PM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.themillions.com%2F2013%2F01%2Fmy-new-years-resolution-read-fewer-books.html&ei=h6U1UYSGHYS0kQX7w4GwDw&psig=AFQjCNH6Go_tn5uVww6apBKkVLvpzxoq3A&ust=1362556597048876http://www.google.com/url?sa=i&rct=j&q=books&source=images&cd=&cad=rja&docid=jUUqJWyZZISufM&tbnid=nahTdqTm0Aa7PM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.themillions.com%2F2013%2F01%2Fmy-new-years-resolution-read-fewer-books.html&ei=h6U1UYSGHYS0kQX7w4GwDw&psig=AFQjCNH6Go_tn5uVww6apBKkVLvpzxoq3A&ust=1362556597048876http://www.google.com/url?sa=i&rct=j&q=books&source=images&cd=&cad=rja&docid=jUUqJWyZZISufM&tbnid=nahTdqTm0Aa7PM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.themillions.com%2F2013%2F01%2Fmy-new-years-resolution-read-fewer-books.html&ei=h6U1UYSGHYS0kQX7w4GwDw&psig=AFQjCNH6Go_tn5uVww6apBKkVLvpzxoq3A&ust=1362556597048876http://www.google.com/url?sa=i&rct=j&q=books&source=images&cd=&cad=rja&docid=jUUqJWyZZISufM&tbnid=nahTdqTm0Aa7PM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.themillions.com%2F2013%2F01%2Fmy-new-years-resolution-read-fewer-books.html&ei=h6U1UYSGHYS0kQX7w4GwDw&psig=AFQjCNH6Go_tn5uVww6apBKkVLvpzxoq3A&ust=1362556597048876http://www.google.com/url?sa=i&rct=j&q=books&source=images&cd=&cad=rja&docid=jUUqJWyZZISufM&tbnid=nahTdqTm0Aa7PM:&ved=0CAUQjRw&url=http%3A%2F%2Fwww.themillions.com%2F2013%2F01%2Fmy-new-years-resolution-read-fewer-books.html&ei=h6U1UYSGHYS0kQX7w4GwDw&psig=AFQjCNH6Go_tn5uVww6apBKkVLvpzxoq3A&ust=1362556597048876


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INTRODUCTION

Diabetes mellitus is a complex disease

associated with peripheral and central

complications.

These complications include retinopathy,

nephropathy and neuropathy.

One of the most widely used herbs is Panax

ginseng; it is valuable in traditional medicine inmany countries (Karaca et al., 2010).


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Panax Ginseng in Diabetes Mellitus

Several investigations have

confirmed the role of

oxidative stress in

developmental diabetic

mediated disorders,possibly via the formation

offree radicals (Manna et

al., 2009).

It is the most efficacious forimmune stimulation and

the prevention of diabetes

(Liu et al., 2003)


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The Chemical Constituents of Ginseng

Approximately 40 active ingredients have been

identified, including

ginsenosides,

polyacetylenes,

sesquiterpenes,

polysaccharides, and peptidoglycans, have been isolated

Lu, J.M., Yao, Q., Chen, C., 2009. Ginseng compounds: an update on their molecular

mechanisms and medical applications. Curr. Vasc. Pharmacol. 7, 293302.


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Three medicinal species of ginseng are

currentlyrecognized

1. Panax ginseng C.A. Meyer(Chinese or Koreanginseng, a perennial herb indigenous to themountainous forests of eastern Asia),

2. Panax japonicus C.A. Meyer(Japanese ginseng,from India, Southern China, and Japan),

3. Panax quinquefolius(American ginseng, foundgrowing in rich woodland in the eastern and

central United States and Canada)(Court, 1975; Popov & Goldwag, 1973; Williams,1957).


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Which One Do We Prefer ??

1. Panax ginseng C.A. Meyer(Chinese or Koreanginseng, a perennial herb indigenous to themountainous forests of eastern Asia),

2. Panax japonicus C.A. Meyer(Japanese ginseng,from India, Southern China, and Japan),

3. Panax quinquefolius(American ginseng, foundgrowing in rich woodland in the eastern and

central United States and Canada(Court, 1975; Popov & Goldwag, 1973; Williams,1957).


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Is Panax Ginseng C.A.Meyer has Antioxidant

Effect????

Do We Need Antioxidant???


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Figure 1. Oxidative stress-induced diseases in humans

www.ijbs.org Int J Biomed Sci vol. 4 no. 2 June 2008


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Antioxidant

Agent has ability to block oxidation process at various bio-

molecular targets such as carbohydrate, lipid, protein, DNA

by free radicals

Free radicals Antioxidant Free Radical

radicals antioxidant

(non-reaktif)

Transfer

e-Reduction oxidation

electrone


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What Evidence-Based Says About Panax

Ginseng C.A. Meyer ?


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13

ROS=reactive oxygen species

MDA=Malondialdehyde


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14

(Oxidant)


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15

(Oxidant)


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This Systematic Review Aims

To evaluate the available evidence from randomized

clinical trials of the clinical efficacy and safety of

ginseng.

Systematic literature searches were performed in 13databases up to March 2009 without language

restriction.

All randomized clinical trials evaluating the clinical

effects or safety of the use of ginseng

monopreparations (Panax ginseng or P. quinquefolium)

were considered for inclusion.


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Methodology

A total of 411 potentially relevant studies

were identified and 57 randomized clinical

trials were included.

The main indications included glucose metabolism,

physical performance,

psychomotor function,

sexual function,

cardiac function,

pulmonary disease, and

cerebrovascular disease.


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Conclusion of the Study

In conclusion, our review compiles the evidence on the

use of ginseng, finding a strong positive potential for

glucose metabolism, level 1 of best-

evidence synthesis.

psychomotor function, which indicated strong

evidence (level 1) of efficacy.

and pulmonary disease, there is strong evidence

(level 1) that ginseng is effective in pulmonary

function.


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Preclinical Study in Diabetes Mellitus


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FBG and Insulin Level

Induction of DM: Streptozotocin (STZ) was dissolved in 50 mM sodium citrate solution

(pH 4.5) containing 150 mM sodium chloride. The solution (6 mg/0.5 ml/100 g body

weight) was subcutaneously administered in rats (Uchiyama and Yamaguchi, 2003).


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Lipid Profile and Cytokin

Proinflammation Profile


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Liver Oxidant/antioxidant Parameters


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Conclusion of the Study

P. ginseng has antihyperglycemic, anti-

inflammatory, antilipidemic and antioxidant

effect which may help in the treatment of

diabetes and diabetic complications


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Clinical Studies


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Results


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The results of two acute placebo-controlled, double-blind cross-over

studies assessing the effect of Panax ginseng (G115) on blood glucose

levels are reported.

In study 1, thirty participants received three treatments: placebo; 200 mg

G115; 400 mg G115. In study 2, twenty-seven participants received four

treatments: placebo (0 mg ginseng and 30 mg saccharin); ginseng (200 mg

ginseng and 30 mg saccharin); placeboglucose (0 mg ginseng and 25 g

oral glucose); ginsengglucose (200 mg ginseng and 25 g oral glucose).

Blood glucose levels were measured at baseline (at 09.00 hours after an

overnight fast) and then 60, 90 (study 1 only) and 120 min post-dose. Both

studies demonstrated that G115 alone significantly lowers fasting blood

glucose levels. Conversely, in study 2 there was a significant drink X

ginseng interaction suggesting opposing glycaemic effects of ginseng

under fasting and raised blood glucose conditions. These data haveimplications for the use of ginseng in individuals with poor gluco-

regulation.

Panax: Ginseng: Acute: Placebo: Blood glucose: Hypoglycaemia: Healthy

adults


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The results of two acute placebo-controlled, double-blind cross-over

studies assessing the effect of Panax ginseng (G115) on blood glucose

levels are reported.

In study 1, thirty participants received three treatments: placebo; 200 mg

G115; 400 mg G115. In study 2, twenty-seven participants received four

treatments: placebo (0 mg ginseng and 30 mg saccharin); ginseng (200 mg

ginseng and 30 mg saccharin); placeboglucose (0 mg ginseng and 25 g

oral glucose); ginsengglucose (200 mg ginseng and 25 g oral glucose).

Blood glucose levels were measured at baseline (at 09.00 hours after an

overnight fast) and then 60, 90 (study 1 only) and 120 min post-dose. Both

studies demonstrated that G115 alone significantly lowers fasting blood

glucose levels. Conversely, in study 2 there was a significant drink X

ginseng interaction suggesting opposing glycaemic effects of ginseng

under fasting and raised blood glucose conditions. These data haveimplications for the use of ginseng in individuals with poor gluco-

regulation.

Panax: Ginseng: Acute: Placebo: Blood glucose: Hypoglycaemia: Healthy

adults


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http://www.jacn.org/


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Conclusions

Together the studies indicate 2 g KRG-rootlets

is sufficient to achieve reproducible reductions

in postprandial glycemia.

But the longterm sustainability of KRG

selected using this approach remains to be

tested.


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Possible mechanisms:

Modulation of:

glucose disposal (Yokozawa et al., 1984) ,

glucose transport (Yamasaki et al., 1993) or

insulin secretion. Vuksan et al. (2000a), (Waki et

al., 1982

The three are not mutually exclusive and the

latter two may both be mediated by increasedNO production (Roy et al. 1998; Spinas et al.

1998).


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Summary

Ginseng G115 (P. Ginseng C.A. Meyer)

Has been widely used to treat diabetes

Has strong positive potential for glucose

metabolism, level 1 of best-evidence synthesis

ginseng has antihyperglycemic, anti-

inflammatory, antilipidemic and antioxidant

effect which may help in the treatment ofdiabetes and diabetic complications


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Thank You for Your Attention

clinical evidence of extract ginseng g-115 in diabetes mellitus patients (dr. j. hudyono, ms, spo

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