Hypoglycemic activity of Garcinia mangostana L. extracts on diabetes rodent models: A systematic review and network meta-analysis

Abstract

Background: Diabetes mellitus is a significant global health issue, and alternative treatments from natural products like Garcinia mangostana L. [Clusiaceae] or GM are being explored for their potential benefits. This study focused on evaluating the hypoglycemic effects of GM on diabetic rodent models.

Methods: A comprehensive search was conducted in PubMed, Scopus, and Embase for studies reporting blood glucose levels within 2 weeks as the primary outcome and changes in total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) as secondary outcomes. A network meta-analysis (NMA) was performed to determine the pooled effectiveness of each intervention, estimating the weighted mean difference (WMD) and 95% confidence interval (CI) from both direct and indirect evidence. The surface under the cumulative ranking curve (SURCA) was used to rank the interventions.

Results: Ten articles were identified, with nine included for quantitative analysis. All GM extracts showed greater effectiveness than the control in decreasing blood glucose levels within 2 weeks. GM at 200 mg/kg (GM200) was the top-ranked extract for reducing glucose levels beyond 2 weeks and increasing HDL-C levels. The ethanol extract of GM at 200 mg/kg (GME200) was the most effective for blood glucose reduction within 2 weeks and for TC and TG reductions. The methanol extract of GM at 200 mg/kg (GMM200) was the top-ranked extract for LDL-C reductions.

Conclusion: GM and its extracts demonstrated significant hypoglycemic activity and improvements in lipid profiles in diabetic rodent models, highlighting their potential as therapeutic agents for the prevention and treatment of diabetes mellitus. Further research in human trials is warranted to confirm these findings and establish clinical applications.

Clinical trial registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023426254.

Keywords: Garcinia mangostana; diabetes mellitus; glucose; mangosteen; network meta-analysis.

FIGURE 1

Selection process of the articles according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA guideline).

FIGURE 2

Risk of bias of the included randomized studies evaluated by the Cochrane RoB2 tool. (A) Risk of bias summary: review authors’ judgments about each risk of bias item for each included study and (B) risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies.

FIGURE 3

Network of eligible comparisons for glycemic control and lipid metabolism (primary and secondary outcomes) and network plots of eligible direct and indirect comparisons. Each node represents each treatment. Here, the size of the node is proportional to the number of rodents randomized to the GM treatments, and the width of the line is proportional to the number of trials comparing each pair of treatments. *Primary outcome. †Secondary outcomes. (A) Glucose (within 2 weeks), (B) glucose (more than 2 weeks), (C) total cholesterol, (D) triglyceride, (E) low-density lipoprotein cholesterol, and (F) high-density lipoprotein cholesterol.

FIGURE 4

Surface under the cumulative ranking curve (SURCA) of each GM or drug treatment for blood glucose improvement within 2 weeks.