Effect of boswellia (Boswellia serrata L.) supplementation on glycemic markers and lipid profile in type 2 diabetic patients: a systematic review and meta-analysis

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a significant global health challenge whose prevalence is projected to increase alarmingly. Recently, due to better safety and fewer adverse effects, herbal medicines have been used to manage T2DM. This study aimed to evaluate the efficacy of boswellia in improving glycemic markers and lipid profiles in T2DM patients.

Methods: A comprehensive search was conducted on the PubMed, Web of Science, and Scopus databases for all relevant studies published up to April 30, 2024. The effects of boswellia supplementation were evaluated using glycemic markers and lipid profiles. The data were extracted and meta-analyzed using Stata software.

Results: This meta-analysis included five studies with a total of 287 patients with T2DM. It was found that boswellia in patients with T2DM compared to the placebo or control group significantly reduced hemoglobin A1C (HbA1C) (SMD: -1.01; 95%CI: -1.55 to -0.46; P=0.00), total cholesterol (TC) (SMD: -0.44; 95%CI: -0.68 to -0.21; P=0.00), Triglycerides (TG) (SMD: -0.42; 95%CI: -0.66 to -0.19); P=0.00) and low-density lipoprotein (LDL) (SMD: -0.43; 95%CI: -0.73 to -0.12); P=0.006) levels, while reduced fasting blood glucose (FBG) but it was not significant (SMD: -1.34, 95%CI: -2.68 to 0.00; P=0.05). Notably, it did not affect high-density lipoprotein (HDL) (SMD: 0.56, 95%CI: -0.14 to -1.26; P=0.118).

Conclusion: In summary, boswellia supplementation has the potential to improve glycemic markers and lipid profiles in patients with T2DM. It may help diabetic patients in addition to a controlled diet and other treatments.

Systematic review registration: crd.york.ac.uk/PROSPERO/display_record.php?RecordID=538347, identifier CRD42024538347.

Keywords: Kundur; anti-diabetic; boswellia; diabetes; glycemic markers; herb; lipid profile; meta-analysis.

Figure 1

PRISMA flow diagram of study selection for inclusion trials in the systematic review.

Figure 2

Forest plot of SMD for the FBG (A: before vs. after in the control groups; B: before vs. after in the intervention groups; C: intervention vs. control groups before supplementation; D: intervention vs. control groups after supplementation).

Figure 3

Forest plot of SMD for the HbA1C. (A: before vs. after in the control groups; B: before vs. after in the intervention groups; C: intervention vs. control groups before supplementation; D: intervention vs. control groups after supplementation).

Figure 4

Forest plot of SMD for the TC. (A: before vs. after in the control groups; B: before vs. after in the intervention groups; C: intervention vs. control groups before supplementation; D: intervention vs. control groups after supplementation).

Figure 5

Forest plot of SMD for the TG. (A: before vs. after in the control groups; B: before vs. after in the intervention groups; C: intervention vs. control groups before supplementation; D: intervention vs. control groups after supplementation).

Figure 6

Forest plot of SMD for the HDL. (A: before vs. after in the control groups; B: before vs. after in the intervention groups; C: intervention vs. control groups before supplementation; D: intervention vs. control groups after supplementation).

Figure 7

Forest plot of SMD for the LDL. (A: before vs. after in the control groups; B: before vs. after in the intervention groups; C: intervention vs. control groups before supplementation; D: intervention vs. control groups after supplementation).

Figure 8

(A) Meta-regression analysis of SMD for the intervention and control in the post-treatment TC levels with a supplement dose. (B) Meta-regression analysis of SMD for the intervention and control in the post-treatment LDL levels with a supplement dose.

Figure 9

Egger’s publication bias plot for TC.