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Cited by 42Natural Antidiabetic Agents StudiesGestational Diabetes Research and ManagementComplementary and Alternative Medicine Studies

Evaluating Traditional Chinese Medicine and Herbal Products for the Treatment of Gestational Diabetes Mellitus

Open access
Xu, Yang Xin Zi, Xi, Shengyan, Qian, Xiaoyan·2019·Journal of Diabetes Research
DOI 10.1155/2019/9182595PMC PMC6915007
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Abstract

Gestational diabetes mellitus is the most common metabolic disorder during pregnancy with health consequences for both lives during and after pregnancy. Studies found that many pregnant women turn to complementary and alternative medicine for health maintenance or symptom relief, such as herbal medicine and acupuncture from traditional Chinese medicine. With the growing popularity of traditional Chinese medicine, we conducted a systemic search in PubMed, Web of Science, and Embase databases on research studies that investigated traditional Chinese medicine during pregnancy. The resultant hits were further searched in relation to all diabetes mellitus. In total, we found three major herbal medicine/herbal products that were associated with glycemic control in gestational diabetes, including Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus. We further reviewed them and their relatives in relation to type 2 diabetes mellitus and found more evidence of metabolic benefits. None of the herbal medicine and products examined reported toxicity in the experimental models. Overall, treatments of gestational diabetes by western or alternative interventions are grossly understudied. It is critical to have a standardized protocol when evaluating efficacy of herbal medicine and produce quality results for women and their health-care providers to make informed treatment decisions.

AI snapshot

Written from the paper’s full text.

TL;DR

This review searched for studies on traditional Chinese medicine and herbal products for gestational diabetes mellitus (GDM) and identified three main candidates: Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus. The authors conclude that GDM treatments, whether mainstream or alternative, are grossly understudied, and no definitive benefit of TCM for GDM can be concluded from direct studies.

Key findings

  • The review identified three major herbal medicines/products associated with glycemic control in GDM: Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus.
  • In a streptozotocin-induced rodent model of GDM, Zuo Gui Wan reduced fasting blood glucose, body weight, total cholesterol, and serum insulin; offspring of treated GDM mice were protected against high fasting plasma glucose, insulin, leptin, total cholesterol, and low-density lipoprotein when later fed a high-fat/high-sugar diet.
  • A case study reported that a pregnant woman with GDM experienced hypoglycemia after consuming two servings of raspberry leaf tea for 3 days, with reduced insulin requirements; self-withdrawal and reintroduction supported causality.
  • Orthosiphon stamineus aqueous extracts (0.2–1.0 g/kg) significantly decreased plasma glucose in a dose-dependent manner in normal and diabetic rats, with the highest dose comparable to glyburide; a developmental toxicity study tested 250, 500, 1000, and 2000 mg/kg/day and found no clinical signs of maternal toxicity, weight gain, or prenatal growth retardation, though the highest dose increased anogenital distance.
  • The paper states that none of the herbal medicines and products examined reported toxicity in the experimental models.

Methods

  • Design: narrative/systematic literature review of studies investigating traditional Chinese medicine during pregnancy, with further searching in relation to all diabetes mellitus.
  • Data sources: PubMed, Web of Science, and Embase databases, using keyword combinations including gestational diabetes, traditional Chinese medicine, Chinese herbal medicine, antidiabetic, and hyperglycemia.
  • Analysis: the resultant hits were reviewed for herbal medicine/herbal products associated with glycemic control in GDM, and the identified products and their relatives were further reviewed in relation to type 2 diabetes mellitus.

Limitations

  • The paper states that treatments for GDM by mainstream or alternative interventions are grossly understudied, and that there has been no data on long-term risk assessment of various antiglycemic formulations and strengths in human pregnancy.
  • The paper states that comparison of effectiveness between insulin and other interventions was inconclusive due to poorly reported evidence, and that it is hard to conclude a definitive benefit of TCM practice for GDM per se based on lack of direct studies.
  • Evident from the text: the evidence for the three main herbs is largely from animal models, in vitro studies, or a single human case report, with inconsistent findings for some related Rubus species; the review does not report a formal quality assessment or meta-analysis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1155/2019/9182595

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 29 cited sources checked · 0 supported · 0 flagged

  • Findingnone given

    None of the herbal medicines and products examined in the review reported toxicity in the experimental models.

    “None of the herbal medicine and products examined reported toxicity in the experimental models.”
    Quote in the paperSubstantial claim
  • Findingown data

    The systematic search in PubMed, Web of Science, and Embase identified three major herbal medicines/herbal products associated with glycemic control in gestational diabetes: Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus.

    “In total, we found three major herbal medicine/herbal products that were associated with glycemic control in gestational diabetes, including Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus.”
    Quote in the paperSubstantial claim
  • Study design and conductcitation

    The causal relationship between red raspberry leaf tea consumption and hypoglycemia in that GDM patient was supported by self-withdrawal and reintroduction of the herb.

    “The causal relationship was further supported by the patient's self-withdrawal and reintroduction of the herb.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] source

      Not checked in the free run.

  • Interpretationreasoning

    Zuo Gui Wan has a cross-generational effect on GDM mother and offspring through an unknown mechanism.

    “These results suggest a cross-generational effect of Zuo Gui Wan on GDM mother and offspring through an unknown mechanism.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Findings from animal models of GDM (rodents) are predictive of effects in human GDM.
  • Premisecitation

    In offspring of Zuo Gui Wan-treated GDM mice fed a high fat and sugar diet, Zuo Gui Wan treatment protected against high levels of fasting plasma glucose, insulin, leptin, total cholesterol, and low-density lipoprotein.

    “Furthermore, the same group found that when the offspring of Zuo Gui Wan-treated GDM mice were fed a high fat and sugar diet, they were protected against high levels of fasting plasma glucose, insulin, leptin, total cholesterol, and low-density lipoprotein [23].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] source

      Not checked in the free run.

  • May combine two claims. 16
  • Classified as probably not a substantial claim. 10

  • May combine two claims.

    Premisecitation

    In a streptozotocin-induced rodent model of GDM, Zuo Gui Wan treatment reduced fasting blood glucose, body weight, total cholesterol, and serum insulin level in mice fed a high fat and sugar diet.

    “In a streptozotocin-induced rodent model of GDM, Zuo Gui Wan treatment reduced fasting blood glucose, body weight, total cholesterol, and serum insulin level of mice fed on high fat and sugar diet [22].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Zuo Gui Wan may be a good therapeutic alternative or an augmentation to western medicine for GDM patients.

    “Given its dual benefits for both the mother and fetus, Zuo Gui Wan may be a good therapeutic alternative or an augmentation to western medicine for GDM patients.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Findings from animal models of GDM (rodents) are predictive of effects in human GDM.
    • Rests on an assumption: Absence of reported toxicity in experimental models indicates safety for the mother and fetus in human pregnancy.

  • May combine two claims.

    Premisecitation

    In a case study, a pregnant woman with GDM experienced hypoglycemia after consuming two servings of red raspberry leaf tea for 3 days, resulting in a reduction in insulin requirements.

    “This GDM patient experienced hypoglycemia after consumption of two servings of raspberry leaf tea for 3 days and resulted in a reduction in insulin requirements.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Treatments of gestational diabetes by western or alternative interventions are grossly understudied.

    “Overall, treatments of gestational diabetes by western or alternative interventions are grossly understudied.”
    • Also stated in: § 3. Concluding Remarks · plain
      “In general, treatments for GDM by mainstream or alternative interventions are grossly understudied.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    In a developmental toxicity study of Orthosiphon stamineus, out of 4 doses tested (250, 500, 1000, and 2000 mg/kg/day), there were no clinical signs of maternal toxicity, weight gain, and prenatal growth retardation.

    “A developmental toxicity study was conducted on Orthosiphon stamineus; out of the 4 doses (250, 500, 1000, and 2000 mg/kg/day) tested, there was no clinical signs of maternal toxicity, weight gain, and prenatal growth retardation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [52] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Consumption of Rubus idaeus fruit in diabetic (db/db) mice reduced proinflammatory plasma interleukin 6 and may protect against diabetes-induced oxidative stress.

    “Consumption of Rubus idaeus fruit in diabetic (db/db) mice reduced proinflammatory plasma interleukin 6 and may protect against diabetes-induced oxidative stress [37].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Another review found Qi Gong practice produced an overall positive outlook on T2DM, but there was large variation in styles and definitions of qigong in the reviewed studies.

    “Another review found that practice of Qi Gong produced an overall positive outlook on T2DM, but there was a large variation in styles and definitions of qigong of the studies reviewed [58].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [58] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A recent review examining safety and effectiveness of acupuncture for T2DM did not find convincing evidence but indicated acupuncture may be recommended as supplementary treatment.

    “In a recent review examining the safety and effectiveness of acupuncture for T2DM, reviewers again did not find convincing evidence but indicated that acupuncture may be recommended to patients as a supplementary treatment [57].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Women who visit their general practitioners and midwives more frequently are also more likely to visit acupuncturists for conditions such as gestational diabetes.

    “Women who visit their general practitioners and midwives more frequently are also more likely to visit acupuncturists for conditions such as gestational diabetes [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    There has been no data on the long-term risk assessment of various antiglycemic formulations and strengths in human pregnancy.

    “Given the biggest concern for pregnant mothers is the safety of therapies, there has been no data on the long-term risk assessment of various antiglycemic formulations and strengths in human pregnancy.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Qiwei Baizhu powder has demonstrated effectiveness against GDM of spleen deficiency type and decreased postprandial blood glucose.

    “For instance, Qiwei Baizhu powder has demonstrated effectiveness against GDM of spleen deficiency type and decreased postprandial blood glucose [53].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [53] 2013, New Journal of Traditional Chinese Medicine

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Zuo Gui Wan, red raspberry tea, and Orthosiphon stamineus displayed promising effect in lowering glucose and alleviating the associated pathophysiology of GDM with minimum toxicity to the mother and fetus.

    “Zuo Gui Wan, red raspberry tea, and Orthosiphon stamineus displayed promising effect in lowering glucose and alleviating the associated pathophysiology of GDM with minimum toxicity to the mother and fetus.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Findings from animal models of GDM (rodents) are predictive of effects in human GDM.
    • Rests on an assumption: Absence of reported toxicity in experimental models indicates safety for the mother and fetus in human pregnancy.

  • May combine two claims.

    Premisecitation

    In both nonpregnant and pregnant diabetic rats, oral administration of Orthosiphon stamineus stimulated glucose-induced insulin secretion, which translated to an increase in ghrelin and glucagon-like peptide 1, and an overall lowering of glucose.

    “In both nonpregnant and pregnant diabetic rats, oral administration of Orthosiphon stamineus stimulated glucose-induced insulin secretion, which translated to an increase in ghrelin and glucagon-like peptide 1, and an overall lowering of glucose [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A meta-analysis found poorly reported results and potential bias from randomized trials comparing treatments for GDM.

    “A meta-analysis found poorly reported results and potential bias from randomized trials comparing treatments for GDM [11].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    About half of pregnant women visit complementary and alternative medicine practitioner for pregnancy-related health conditions.

    “On the other hand, about half of pregnant women visit complementary and alternative medicine practitioner for pregnancy-related health conditions [12].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The lack of knowledge and inconsistent data are the biggest hurdles in understanding the efficacy of TCM in a variety of disorders.

    “In conclusion, the lack of knowledge and inconsistent data are the biggest hurdles in understanding the efficacy of TCM in a variety of disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Chemical profiling of Rubus idaeus found the highest total phenolic and flavonoid contents in the leaves, which exhibit antioxidant activities and inhibit digestive enzymes α-glucosidase and α-amylase from producing monosaccharides.

    “Chemical profiling of Rubus idaeus found the highest total phenolic and flavonoid contents in the leaves, which exhibit antioxidant activities and inhibit digestive enzymes, α-glucosidase, and α-amylase from producing monosaccharides [36].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A randomized trial found no significant difference in occurrence of gestational diabetes and hypertensive disorder, or any measured parameter, between women with or without acupuncture treatment during IVF.

    “A randomized trial that looked at pregnancy outcomes of women with or without acupuncture treatment during their IVF treatment did not find any significant difference between occurrence of gestational diabetes and hypertensive disorder, or any of the parameter measured [56].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [56] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    GDM is the most common metabolic complication for pregnant women and positively correlates with type 2 diabetes mellitus later in life.

    “Gestational diabetes mellitus (GDM) is the most common metabolic complication for pregnant women, which positively correlates with type 2 diabetes mellitus (T2DM) later in life [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In the last trimester, anti-insulin hormones, growth factors, and cytokines released by the placenta produce an insulin resistance-like state, which is further exacerbated for those with excess weight, increased maternal age, polycystic ovarian syndrome, and family history of diabetes.

    “In the last trimester, anti-insulin hormones, growth factors, and cytokines released by the placenta produce an insulin resistance-like state, which is further exacerbated for those with excess weight, increased maternal age, polycystic ovarian syndrome, and family history of diabetes [2, 3].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] source

      Not checked in the free run.

    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Under GDM, maternal insulin resistance increases the flux of glucose to the fetal circulation and contributes to increased fetal glucose uptake and growth.

    “Under GDM, maternal insulin resistance increases the flux of glucose to the fetal circulation and contributes to increased fetal glucose uptake and growth [8].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [8] source

      Not checked in the free run.

21 of 21

  • The paper relies on this without support.

    Findings from animal models of GDM (rodents) are predictive of effects in human GDM.

    “In a streptozotocin-induced rodent model of GDM, Zuo Gui Wan treatment reduced fasting blood glucose, body weight, total cholesterol, and serum insulin level of mice fed on high fat and sugar diet [22].”
    “In both nonpregnant and pregnant diabetic rats, oral administration of Orthosiphon stamineus stimulated glucose-induced insulin secretion, which translated to an increase in ghrelin and glucagon-like peptide 1, and an overall lowering of glucose [48].”
    “Zuo Gui Wan, red raspberry tea, and Orthosiphon stamineus displayed promising effect in lowering glucose and alleviating the associated pathophysiology of GDM with minimum toxicity to the mother and fetus.”

  • The paper relies on this without support.

    Absence of reported toxicity in experimental models indicates safety for the mother and fetus in human pregnancy.

    “None of the herbal medicine and products examined reported toxicity in the experimental models.”
    “Zuo Gui Wan, red raspberry tea, and Orthosiphon stamineus displayed promising effect in lowering glucose and alleviating the associated pathophysiology of GDM with minimum toxicity to the mother and fetus.”

  • The paper relies on this without support.

    Evidence of metabolic benefits in type 2 diabetes mellitus is relevant to gestational diabetes mellitus treatment.

    “We further reviewed them and their relatives in relation to type 2 diabetes mellitus and found more evidence of metabolic benefits.”
    “GDM is often diagnosed between 24- and 28-week gestation (second or third trimester of pregnancy) and shares many pathological similarities with T2DM.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Three major herbal medicines including Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus were found beneficial to gestational diabetes by controlling glucose.

    “In another study, three major herbal medicine including Zuo Gui Wan, red raspberry leaves, and Orthosiphon stamineus were found beneficial to gestational diabetes by controlling glucose (196).”

    From Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments (2020) · cites this paper as [196]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Zuo Gui Wan maternal study is described as using mice, but its cited study used rats

    Minor

    The text describes the GDM model as mice, while the title of the cited study identifies the animals as rats.

  • Zuo Gui Wan offspring study is described as using mice, but its cited study used rats

    Minor

    The text calls the mothers and offspring mice, whereas the cited study's title identifies the offspring as rats.

2 of 2

Cites

1 retracted

Flagged first, then by citations

Research works printed but not linked: 4

  1. 2019, Pregnancy: the marriage of yin and yang
  2. 2003, Chang Gung Medical Journal, 26, 449
  3. 2013, New Journal of Traditional Chinese Medicine, 100
  4. 2009, Nan Fang Yi Ke Da Xue Xue Bao, 29, 1402

Cited by

Sorted by citations

Related

Authors
Xu, Y. X. Z., Xi, S., & Qian, X.
Affiliations
  • University of Manitoba (CA)
  • Xiamen University (CN)
Corresponding author
Qian, Xiaoyan
ORCID
Venue
Journal of Diabetes Research
Publisher
Wiley
Published
2019-12-03
Volume
2019
Pages
1-6
ISSN
  • 2314-6745 (ISSN-L)
  • 2314-6753
DOI
10.1155/2019/9182595
PMC
PMC6915007
OpenAlex
W2992124098
Semantic Scholar
78813d488a58c33c1e5b1a2ba1fbd26620a6d80e
Cited by
42
References
55
Citations by year
2025: 5 · 2024: 9 · 2023: 8 · 2022: 8 · 2021: 8 · 2020: 4
FWCI
0.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Diabetes Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Natural Antidiabetic Agents Studies
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
  • Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
Keywords
gestational diabetes mellitus, traditional Chinese medicine, herbal medicine, complementary and alternative medicine, Orthosiphon stamineus, glycemic control, type 2 diabetes, herbal product safety, pregnancy
MeSH terms
Animals, Blood Glucose, Drugs, Chinese Herbal, Female, Humans, Hypoglycemic Agents, Medicine, Chinese Traditional, Pregnancy, Biomarkers, Diabetes, Gestational, Treatment Outcome

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