Does berberine help manage diabetes mellitus (DM)?

From the Guidelines

Berberine should not be used as a replacement for standard diabetes treatments, but it may be considered as a complementary therapy to help manage diabetes, as suggested by recent studies, although the provided evidence does not directly support its use 1. The management of type 2 diabetes typically involves lifestyle modifications and pharmacologic therapy, with metformin being the preferred initial pharmacologic agent, as recommended by the American College of Physicians 1.

• The American College of Physicians recommends that clinicians prescribe metformin to patients with type 2 diabetes when pharmacologic therapy is needed to improve glycemic control, with a strong recommendation and moderate-quality evidence 1.
• When selecting an additional therapy, clinicians should consider the evidence of benefits, harms, patient burden, and cost of medications, as well as performing an individualized assessment of each patient’s preferences, glycemic control target, comorbid conditions, and risk for symptomatic hypoglycemia 1.
• Berberine may help lower blood sugar levels by improving insulin sensitivity and reducing glucose production in the liver, although its use is not directly supported by the provided evidence. Some key points to consider when managing diabetes include:
• Lifestyle modifications, such as physical activity and weight loss, are essential for achieving glycemic control.
• Metformin is the preferred initial pharmacologic agent for type 2 diabetes, due to its efficacy, safety, and low cost.
• When adding a second oral therapy, clinicians should consider the patient's individual needs, preferences, and comorbid conditions, as well as the potential benefits and harms of each medication.
• Berberine, if considered, should be used under the guidance of a healthcare provider, as it may interact with other diabetes medications and cause potentially dangerous side effects, such as hypoglycemia.

From the Research

Berberine and Diabetes Management

• Berberine has been shown to have a positive effect on managing diabetes, particularly type 2 diabetes, by reducing fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and glycated haemoglobin (HbA1c) levels 2, 3, 4, 5.
• The glucose-lowering effect of berberine is associated with its ability to inhibit the voltage-gated K+ channels of pancreatic β-cell membrane, promote insulin secretion, and increase sensitivity to insulin in peripheral tissues 3, 4.
• Berberine has also been found to have a protective effect on pancreatic β-cells, reduce insulin resistance, and decrease glucose absorption in the intestines 4.

Clinical Studies and Meta-Analyses

• A systematic review and meta-analysis of 37 studies involving 3,048 patients found that berberine reduced FPG, HbA1c, and 2-hour plasma blood glucose (2hPBG) levels, with all results being statistically significant 3.
• Another meta-analysis of 28 studies involving 2,313 patients found that berberine treatment was associated with a better reduction in FPG, PPG, and HbA1c levels compared to control groups 5.
• Subgroup analyses suggested that the effects of berberine on blood glucose became less remarkable as the treatment lasted more than 90 days, the daily dosage exceeded 2 g/d, and patients aged more than 60 years 5.

Safety and Efficacy

• Berberine has been found to be safe and well-tolerated, with no significant increase in the incidence of total adverse events and hypoglycemia compared to control groups 3, 5.
• The combination of berberine with hypoglycemic agents has been found to be more effective than either berberine or hypoglycemic agents alone in reducing blood glucose levels 5.