[Unconventional antidiabetic agents]

The current pharmacological therapy of type 2 diabetes reduces the risk of diabetic complications, but is not able to achieve a long-lasting normalization of the metabolic disorder. Thus diabetic patients in increasing numbers are taking dietary supplements and herbs from which they expect additional health benefits. These unconventional antidiabetic agents consist mainly in trace metals like chromium, vanadium and zinc and a heterogeneous group of traditionally used antidiabetic herbs (e. g. Momordica charantia, Gymnema sylvestre, Trigonella foenum-graecum) often derived from the ayurvedic medicine. In this overview the current evidence for the antidiabetic effect is presented. The trace elements chromium and vanadium have a number of potentially antidiabetic actions in vitro, however, the results obtained with diabetic patients are not convincing so far. Similarly, the available data on the therapeutic use of herbs suggest that in principle a number of them possess a blood glucose-lowering effect, but at present no firm conclusions as to their efficacy and safety can be made. To set up reliable dose-effect relationships requires the identification of the relevant antidiabetic molecules as was apparently achieved by isolating 4-hydroxyisoleucine from the seeds of T. foenum-graecum. This requirement is also valid in the case of the antidiabetic action of cinnamon. Coffee and a moderate alcohol consumption were found to be surprisingly effective in lowering the risk of type 2 diabetes manifestation, their effect being roughly equal to that of conventional drugs used in diabetes prevention trials. Diabetic patients should inform their physician about the use of unconventional agents and should be warned against uncontrolled starting or stopping their use.