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Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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Risk of bias summary: review authors' judgements about each 'Risk of bias' item for each included study.
Figuras y tablas -
Figure 2

Risk of bias summary: review authors' judgements about each 'Risk of bias' item for each included study.

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Risk of bias graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each 'Risk of bias' item presented as percentages across all included studies.

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Forest plot of comparison: Cinnamon versus placebo; Outcome ‐ fasting blood glucose level (mmol/L; excludes studies of questionable quality).
Figuras y tablas -
Figure 4

Forest plot of comparison: Cinnamon versus placebo; Outcome ‐ fasting blood glucose level (mmol/L; excludes studies of questionable quality).

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Forest plot of comparison: Cinnamon versus placebo; Outcome ‐ total number of adverse events (n).
Figuras y tablas -
Figure 5

Forest plot of comparison: Cinnamon versus placebo; Outcome ‐ total number of adverse events (n).

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Forest plot of comparison: Cinnamon versus placebo; Outcome ‐ glycosylated haemoglobin A1c (HbA1c, %).
Figuras y tablas -
Figure 6

Forest plot of comparison: Cinnamon versus placebo; Outcome ‐ glycosylated haemoglobin A1c (HbA1c, %).

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Comparison 1 Cinnamon versus placebo, Outcome 1 Fasting blood glucose level (random‐effects model).
Figuras y tablas -
Analysis 1.1

Comparison 1 Cinnamon versus placebo, Outcome 1 Fasting blood glucose level (random‐effects model).

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Comparison 1 Cinnamon versus placebo, Outcome 2 Fasting blood glucose level (excluding studies of questionable quality).
Figuras y tablas -
Analysis 1.2

Comparison 1 Cinnamon versus placebo, Outcome 2 Fasting blood glucose level (excluding studies of questionable quality).

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Comparison 1 Cinnamon versus placebo, Outcome 3 Postprandial blood glucose level.
Figuras y tablas -
Analysis 1.3

Comparison 1 Cinnamon versus placebo, Outcome 3 Postprandial blood glucose level.

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Comparison 1 Cinnamon versus placebo, Outcome 4 Adverse events.
Figuras y tablas -
Analysis 1.4

Comparison 1 Cinnamon versus placebo, Outcome 4 Adverse events.

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Comparison 1 Cinnamon versus placebo, Outcome 5 Glycosylated haemoglobin A1c (HbA1c).
Figuras y tablas -
Analysis 1.5

Comparison 1 Cinnamon versus placebo, Outcome 5 Glycosylated haemoglobin A1c (HbA1c).

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Comparison 1 Cinnamon versus placebo, Outcome 6 Serum insulin.
Figuras y tablas -
Analysis 1.6

Comparison 1 Cinnamon versus placebo, Outcome 6 Serum insulin.

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Comparison 1 Cinnamon versus placebo, Outcome 7 Insulin sensitivity (CHO/unit insulin).
Figuras y tablas -
Analysis 1.7

Comparison 1 Cinnamon versus placebo, Outcome 7 Insulin sensitivity (CHO/unit insulin).

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Comparison 1 Cinnamon versus placebo, Outcome 8 Insulin sensitivity (HOMA‐IR).
Figuras y tablas -
Analysis 1.8

Comparison 1 Cinnamon versus placebo, Outcome 8 Insulin sensitivity (HOMA‐IR).

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 1 Fasting blood glucose level and dosage.
Figuras y tablas -
Analysis 2.1

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 1 Fasting blood glucose level and dosage.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 2 Fasting blood glucose level and study duration.
Figuras y tablas -
Analysis 2.2

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 2 Fasting blood glucose level and study duration.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 3 Adverse events and dosage.
Figuras y tablas -
Analysis 2.3

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 3 Adverse events and dosage.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 4 Adverse events and study duration.
Figuras y tablas -
Analysis 2.4

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 4 Adverse events and study duration.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 5 Glycosylated haemoglobin A1c (HbA1c) and dosage.
Figuras y tablas -
Analysis 2.5

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 5 Glycosylated haemoglobin A1c (HbA1c) and dosage.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 6 Glycosylated haemoglobin A1c (HbA1c) and study duration.
Figuras y tablas -
Analysis 2.6

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 6 Glycosylated haemoglobin A1c (HbA1c) and study duration.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 7 Glycosylated haemoglobin A1c (HbA1c) and diabetes type.
Figuras y tablas -
Analysis 2.7

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 7 Glycosylated haemoglobin A1c (HbA1c) and diabetes type.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 8 Serum insulin and dosage.
Figuras y tablas -
Analysis 2.8

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 8 Serum insulin and dosage.

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Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 9 Serum insulin and study duration.
Figuras y tablas -
Analysis 2.9

Comparison 2 Subgroup analysis (cinnamon versus placebo), Outcome 9 Serum insulin and study duration.

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Comparison 3 Sensitivity analysis (cinnamon versus placebo), Outcome 1 Fasting blood glucose level and study quality.
Figuras y tablas -
Analysis 3.1

Comparison 3 Sensitivity analysis (cinnamon versus placebo), Outcome 1 Fasting blood glucose level and study quality.

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Comparison 3 Sensitivity analysis (cinnamon versus placebo), Outcome 2 Adverse events and study quality.
Figuras y tablas -
Analysis 3.2

Comparison 3 Sensitivity analysis (cinnamon versus placebo), Outcome 2 Adverse events and study quality.

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Comparison 3 Sensitivity analysis (cinnamon versus placebo), Outcome 3 Serum insulin and study quality.
Figuras y tablas -
Analysis 3.3

Comparison 3 Sensitivity analysis (cinnamon versus placebo), Outcome 3 Serum insulin and study quality.

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Cinnamon compared with placebo, no treatment, or active medication for diabetes mellitus

Patient or population: patients with diabetes mellitus

Settings: predominantly university outpatient clinics

Intervention: oral monopreparations of cinnamon

Comparison: placebo, no treatment, or active medication (such as insulin, oral hypoglycaemic agents, or other herbal / nutritional preparations)

Outcomes

Assumed risk

Corresponding risk

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Death from any cause

(follow‐up: 30 days to 16 weeks)

Not estimable

See comment

See comment

Not investigated

Morbidity

(follow‐up: 30 days to 16 weeks)

Not estimable

See comment

See comment

Not investigated

Health‐related quality of life
(follow‐up: 30 days to 16 weeks)

Not estimable

See comment

See comment

Not investigated

Adverse events

(follow‐up: 30 days to 16 weeks)

0.82 (0.21 to 3.23)

264 (4)

⊕⊕⊕⊝
moderate 1

Adverse reactions to oral cinnamon were infrequent and generally mild in nature

Costs

(follow‐up: 30 days to 16 weeks)

Not estimable

See comment

See comment

Not investigated

HbA1c

(follow‐up: 3 to 4 months)

The mean HbA1c ranged across control groups from
6.8% to 8.8%

The mean HbA1c in the intervention groups was

0.3% lower to 0.2% higher

MD ‐0.1% (‐0.3% to 0.2%)

405 (6)

⊕⊕⊕⊝
moderate 2

1 Only four out of 10 studies reported adverse events; short follow‐up; unclear or high risk of bias in several domains.

2 Short follow‐up; imprecision of results; unclear or high risk of bias in several domains.

Figuras y tablas -
Ir a la tabla de la revisión
Table 1. Overview of study populations

Characteristic

Study ID

Intervention(s) and
control(s)

[n] Screened/eligible

[n] Randomised

[n] Safety

[n] ITT

[n] Finishing study

Percentage of randomised participants
finishing study

Akilen 2010

I1: cinnamon

C1: placebo

I1: ‐

C1: ‐

T: 68

I1: 30

C1: 28

T: 58

‐

I1: 30

C1: 28

T: 58

I1: 29

C1: 26

T: 55

I1: 97

C1: 93

T: 95

Altschuler 2007

I1: cinnamon

C1: placebo

I1: ‐

C1: ‐

T: 132

I1: 36

C1: 36

T: 72

‐

I1: 28

C1: 29

T: 57

I1: 28

C1: 29

T: 57

I1: 78

C1: 81

T: 79

Blevins 2007

I1: cinnamon

C1: placebo

I1: ‐

C1: ‐

T: 77

I1: 30

C1: 30

T: 60

‐

I1: 29

C1: 28

T: 57

I1: 21

C1: 22

T: 43

I1: 70

C1: 73

T: 72

Crawford 2009

I1: cinnamon

C1: usual care

I1: ‐

C1: ‐

T: 190

I1: 55

C1: 54

T: 109

‐

I1: 55

C1: 54

T: 109

I1: 46

C1: 43

T: 89

I1: 84

C1: 80

T: 82

Khan 2003

I1: cinnamon 1 g

I2: cinnamon 3 g

I3: cinnamon 6 g

C1: placebo 2 cap

C2: placebo 6 cap

C3: placebo 12 cap

‐

I1: 10

I2: 10

I3: 10

C1: 10

C2: 10

C3: 10

T: 60

‐

I1: 10

I2: 10

I3: 10

C1: 10

C2: 10

C3: 10

T: 60

I1: 10

I2: 10

I3: 10

C1: 10

C2: 10

C3: 10

T: 60

I1: 100

I2: 100

I3: 100

C1: 100

C2: 100

C3: 100

T: 100

Khan 2010

I1: cinnamon

C1: placebo

‐

I1: 7

C1: 7

T: 14

‐

‐

I1: 7

C1: 7

T: 14

I1: 100

C1: 100

T:100

Mang 2006

I1: cinnamon

C1: placebo

‐

I1: ‐

C1: ‐

T: 79

‐

I1: 33

C1: 32

T: 65

I1: 33

C1: 32

T: 65

T: 82

Rosado 2010

I1: cinnamon

C1: placebo

‐

I1: 20

C1: 20

T: 40

‐

I1: 20

C1: 20

T: 40

I1: 20

C1: 20

T: 40

I1: 100

C1: 100

T: 100

Suppapitiporn 2006

I1: cinnamon

C1: placebo

‐

I1: 20

C1: 40

T: 60

‐

I1: 20

C1: 40

T: 60

I1: 20

C1: 40

T: 60

I1: 100

C1: 100

T: 100

Vanschoonbeek 2006

I1: cinnamon

C1: placebo

‐

I1: 12

C1: 13

T: 25

‐

I1: 12

C1: 13

T: 25

I1: 12

C1: 13

T: 25

I1: 100

C1: 100

T: 100

Total

All interventions

240 1

All controls

258 1

All interventions and controls

577

"‐" denotes not reported

1data not available for all included studies

C: control; cap: capsules; I: intervention; ITT: intention to treat; T: total.
Figuras y tablas -
Table 1. Overview of study populations
Ir a la tabla de la revisión
Comparison 1. Cinnamon versus placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fasting blood glucose level (random‐effects model) Show forest plot

8

338

Mean Difference (IV, Random, 95% CI)

‐0.91 [‐1.93, 0.11]

2 Fasting blood glucose level (excluding studies of questionable quality) Show forest plot

6

304

Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.34, 0.18]

3 Postprandial blood glucose level Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 Adverse events Show forest plot

4

264

Risk Ratio (M‐H, Random, 95% CI)

0.83 [0.22, 3.07]

5 Glycosylated haemoglobin A1c (HbA1c) Show forest plot

6

405

Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.29, 0.18]

6 Serum insulin Show forest plot

2

81

Mean Difference (IV, Random, 95% CI)

‐6.77 [‐35.00, 23.46]

7 Insulin sensitivity (CHO/unit insulin) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

8 Insulin sensitivity (HOMA‐IR) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected
Figuras y tablas -
Comparison 1. Cinnamon versus placebo
Ir a la tabla de la revisión
Comparison 2. Subgroup analysis (cinnamon versus placebo)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fasting blood glucose level and dosage Show forest plot

8

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 FBGL (cinnamon ≤ 1 g)

3

116

Mean Difference (IV, Random, 95% CI)

‐1.35 [‐3.71, 1.01]

1.2 FBGL (cinnamon 1.5‐2 g)

4

157

Mean Difference (IV, Random, 95% CI)

‐0.51 [‐1.57, 0.56]

1.3 FBGL (cinnamon 3 g)

2

85

Mean Difference (IV, Random, 95% CI)

‐1.72 [‐4.80, 1.36]

2 Fasting blood glucose level and study duration Show forest plot

8

338

Mean Difference (IV, Random, 95% CI)

‐0.83 [‐1.67, 0.02]

2.1 FBGL (< 12 weeks' duration)

4

99

Mean Difference (IV, Random, 95% CI)

‐1.74 [‐3.89, 0.41]

2.2 FBGL (12 weeks' duration or longer)

4

239

Mean Difference (IV, Random, 95% CI)

‐0.13 [‐0.64, 0.38]

3 Adverse events and dosage Show forest plot

4

264

Odds Ratio (M‐H, Random, 95% CI)

0.82 [0.21, 3.23]

3.1 Number of adverse events (cinnamon ≤ 1 g)

3

206

Odds Ratio (M‐H, Random, 95% CI)

1.02 [0.22, 4.65]

3.2 Number of adverse events (cinnamon 2 g)

1

58

Odds Ratio (M‐H, Random, 95% CI)

0.30 [0.01, 7.69]

4 Adverse events and study duration Show forest plot

4

264

Odds Ratio (M‐H, Random, 95% CI)

0.82 [0.21, 3.23]

4.1 Number of adverse events (6 weeks' duration or less)

1

40

Odds Ratio (M‐H, Random, 95% CI)

0.32 [0.01, 8.26]

4.2 Number of adverse events (12 weeks' duration or longer)

3

224

Odds Ratio (M‐H, Random, 95% CI)

1.00 [0.22, 4.57]

5 Glycosylated haemoglobin A1c (HbA1c) and dosage Show forest plot

6

405

Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.29, 0.18]

5.1 HbA1c (cinnamon 1 g)

3

222

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.51, 0.31]

5.2 HbA1c (cinnamon 1.5‐2 g)

2

118

Mean Difference (IV, Random, 95% CI)

‐0.38 [‐1.06, 0.29]

5.3 HbA1c (cinnamon 3 g)

1

65

Mean Difference (IV, Random, 95% CI)

0.15 [‐0.22, 0.52]

6 Glycosylated haemoglobin A1c (HbA1c) and study duration Show forest plot

6

405

Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.29, 0.18]

6.1 HbA1c (12 weeks' duration or longer)

6

405

Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.29, 0.18]

7 Glycosylated haemoglobin A1c (HbA1c) and diabetes type Show forest plot

6

405

Mean Difference (IV, Random, 95% CI)

‐0.06 [‐0.29, 0.18]

7.1 HbA1c (type 1 diabetes only)

1

57

Mean Difference (IV, Random, 95% CI)

0.10 [‐0.68, 0.88]

7.2 HbA1c (type 2 diabetes only)

5

348

Mean Difference (IV, Random, 95% CI)

‐0.10 [‐0.38, 0.18]

8 Serum insulin and dosage Show forest plot

2

81

Mean Difference (IV, Random, 95% CI)

‐6.77 [‐35.00, 23.46]

8.1 Serum insulin (cinnamon 1 g)

1

56

Mean Difference (IV, Random, 95% CI)

‐16.66 [‐61.46, 28.14]

8.2 Serum insulin (cinnamon 1.5 g)

1

25

Mean Difference (IV, Random, 95% CI)

1.5 [‐39.46, 42.46]

9 Serum insulin and study duration Show forest plot

2

81

Mean Difference (IV, Random, 95% CI)

‐6.77 [‐35.00, 23.46]

9.1 Serum insulin (6 weeks' duration)

1

25

Mean Difference (IV, Random, 95% CI)

1.5 [‐39.46, 42.46]

9.2 Serum insulin (12 weeks' duration)

1

56

Mean Difference (IV, Random, 95% CI)

‐16.66 [‐61.46, 28.14]
Figuras y tablas -
Comparison 2. Subgroup analysis (cinnamon versus placebo)
Ir a la tabla de la revisión
Comparison 3. Sensitivity analysis (cinnamon versus placebo)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fasting blood glucose level and study quality Show forest plot

8

338

Mean Difference (IV, Random, 95% CI)

‐0.83 [‐1.67, 0.02]

1.1 FBGL (moderate risk of bias)

2

98

Mean Difference (IV, Random, 95% CI)

‐0.08 [‐0.39, 0.22]

1.2 FBGL (high risk of bias)

6

240

Mean Difference (IV, Random, 95% CI)

‐1.12 [‐2.45, 0.21]

2 Adverse events and study quality Show forest plot

4

264

Odds Ratio (M‐H, Random, 95% CI)

0.82 [0.21, 3.23]

2.1 Number of adverse events (moderate risk of bias)

2

98

Odds Ratio (M‐H, Random, 95% CI)

0.31 [0.03, 3.07]

2.2 Number of adverse events (high risk of bias)

2

166

Odds Ratio (M‐H, Random, 95% CI)

1.40 [0.25, 7.84]

3 Serum insulin and study quality Show forest plot

2

81

Mean Difference (IV, Random, 95% CI)

‐6.77 [‐35.00, 23.46]

3.1 Serum insulin (high risk of bias)

2

81

Mean Difference (IV, Random, 95% CI)

‐6.77 [‐35.00, 23.46]
Figuras y tablas -
Comparison 3. Sensitivity analysis (cinnamon versus placebo)
Ir a la tabla de la revisión