Non-randomized (moderate): Randomization not used or not reported

No control group (high): Single-arm or uncontrolled design

Open-label or unblinded (moderate): No blinding reported

High risk of bias (high): Overall bias rated high

Blood glucose levels decreased significantly in patients after taking BSP, with reduction observable after 1 week of treatment, suggesting a rapid onset of glycemic action.

HbA1c levels decreased measurably after 30 days and remained below 7% after 60 days of BSP treatment, indicating sustained improvement in glycemic control over the study period.

More than 300 out of 332 patients reported a significant increase in urine volume and frequency in the initial days of treatment, consistent with increased urinary glucose excretion via SGLT2 inhibition.

Weight loss was observed particularly among overweight individuals during BSP treatment, but BMI was not systematically recorded at baseline, limiting the reliability of this finding.

Commercial dosage form (Boscisucrophage, BSP) of Boscia senegalensis seed dry extract containing glucocapparin as the primary active metabolite. Administered as 350 mg capsules three times daily for 12 weeks. Proposed mechanism: dual SGLT1/SGLT2 inhibitor.

Positive: 4; Negative: 0; No effect: 0; Mixed: 0

Extracted 4 outcome signals across the study

All four measured outcomes (blood glucose, HbA1c, urine glucose excretion, body weight) showed results beneficial for T2DM management with consistent direction across the study population.

↓ Blood glucose (significant reduction observed after 1 week of treatment)

↓ HbA1c (below 7% after 60 days of treatment)

Mostly intermediate or surrogate outcomes

BSP significantly reduced blood glucose and HbA1c in T2DM patients resistant to oral antihyperglycemic drugs

Increased urine glucose excretion (UGE) suggests dual SGLT1/SGLT2 inhibition mechanism

No significant adverse effects on liver or kidney function were observed

Eto B, Elrherabi A, Nasr FA, et al. Boscisucrophage: A Natural SGLT1/2 Inhibitor From Boscia senegalensis for Managing Type 2 Diabetes. Food Sci Nutr. 2026;14(3):e71621.

Single-arm uncontrolled design limits attribution of effects to BSP alone

No randomization or blinding introduces potential bias

BMI was not systematically recorded at baseline, limiting weight-related analysis

A 12-week study in 332 type 2 diabetes patients found that Boscisucrophage (BSP), a natural Boscia senegalensis seed extract, significantly lowered blood glucose and HbA1c when added to existing therapy.

↑ Urine glucose excretion via SGLT1/SGLT2 inhibition

The ADA's clinical practice guidelines provide evidence-based recommendations for pharmacologic management of type 2 diabetes, including the use of SGLT2 inhibitors for glycemic control and their role in add-on therapy for patients with inadequate glycemic response to oral medications.

American Diabetes Association Standards of Care in Diabetes—2025: Pharmacologic Approaches to Glycemic Treatment

The WHO diabetes factsheet provides key statistics on the global diabetes burden, including prevalence trends and mortality data cited in the study. It also outlines the global target to halt the rise in diabetes by 2025.

World Health Organization - Diabetes Fact Sheet

The NCCIH provides evidence-based information about herbal supplements and complementary approaches for diabetes management, including cautions about evaluating supplement safety and efficacy in the absence of rigorous clinical trials.

NIH National Center for Complementary and Integrative Health - Herbal Supplements for Diabetes

Individuals with type 1 diabetes and those with type 2 diabetes at risk for low blood glucose should take steps to avoid lows when driving.

Annual ADA clinical practice guideline issue covering broad diabetes management.

NICE clinical guideline for adult type 2 diabetes management.

Learn about type 2 diabetes, a chronic condition that affects blood glucose. Understand type 2 symptoms, causes, and detection. Take our 60- second type 2 risk test.

Learn about the different classes of non-insulin type 2 diabetes medications used to lower blood glucose levels. Explore options like Metformin, DPP-4 inhibitors, GLP-1, and more.

What Are My Options for Type 2 Diabetes Medications? | ADA

<h4>Introduction</h4>To systematically analyze the effect of diet combined with exercise intervention on blood glucose control in patients with type 2 diabetes.<h4>Evidence acquisition</h4>Six databases including PubMed, The Cochrane Library, Web of Science, EMBASE, MEDLINE and CNKI were searched from establishment to September 2024. Randomized Control Trial (RCT) articles that met the inclusion and exclusion criteria were screened. Meta-analysis was performed using Review Manager 5.3 software. The quality of the literature was assessed using the Cochrane Handbook of Systematic Reviews. Subgroup analysis and sensitivity analysis were used to find the source of heterogeneity.<h4>Evidence synthesis</h4>Sixteen studies were included, with a total of 7212 patients with type 2 diabetes. There were 3678 cases in the intervention group and 3534 cases in the control group. The results of meta-analysis showed that dietary combined exercise intervention significantly improved fasting blood glucose (MD=-0.39, 95% CI: -0.72~-0.06, P=0.02) and 2-hour postprandial blood glucose (MD=-1.67, 95% CI: -3.62~0.27, P=0.09), glycosylated hemoglobin, HbA1c (MD=-0.49, 95% CI: -1.27~-0.33, P<0.001), body weight (MD=-2.47, 95% CI: -4.82~-0.13, P=0.04), body mass (MD=-3.64, 95% CI: -4.07~-3.21, P<0.001), SBP (MD=-2.1, 95% CI: -4.30~0.28, P=0.09), DBP (MD=-0.93, 95% CI: -1.88~0.02, P=0.05), total cholesterol (MD=17, 95% CI: -0.02~0.35, P=0.07), triglyceride (MD=-0.08, 95% CI: -0.15~-0.01, P=0.03), QOL (MD=3.83, 95% CI: 0.69~6.98, P=0.02). Body Mass Index (BMI) (MD=-0.4, 95% CI: -0.32~0.24, P=0.79), waist circumference (MD=-1.4, 95% CI: -4.94~1.25, P=0.24), HDL (MD=-0.02, 95% CI: -0.08~0.03, P=0.43), LDL (MD=12, 95% CI: -0.37~0.61, P=0.63) may be due to insufficient patient compliance, short intervention time, or insufficient study sample size to detect significant improvement.<h4>Conclusions</h4>Diet combined with exercise intervention has significant effect on blood glucose control in patients with type 2 diabetes, and can significantly reduce HbA1c, fasting blood glucose, 2 h postprandial blood glucose, body weight, body mass, total cholesterol, triglyceride, SBP, DBP and QOL. Therefore, it is recommended that exercise combined with dietary intervention for at least 3 to 6 months can better improve the blood glucose indicators in patients with type 2 diabetes.

Effectiveness of diet-combined exercise interventions for glycemic control in patients with type 2 diabetes: a meta-analysis of randomized controlled trials.

<h4>Introduction</h4>In SURPASS-SWITCH, switching from dulaglutide to tirzepatide resulted in greater improvements in glycemic control and body weight in adults with type 2 diabetes (T2D). This study aimed to investigate the efficacy and safety of switching from weekly dulaglutide to weekly tirzepatide in adults with T2D in prespecified baseline subgroups from SURPASS-SWITCH.<h4>Research design and methods</h4>This phase IV, randomized, open-label, active-controlled, parallel-group, multicenter, multinational trial included adults with hemoglobin A1c (HbA1c) ≥7.0% to ≤9.5%, on a stable dose of dulaglutide for at least 6 months, on a stable dose of 0-3 oral antihyperglycemic medications for at least 3 months, with stable body weight, and body mass index (BMI) ≥25 kg/m<sup>2</sup> at screening. Participants were randomly assigned 1:1 to continue with and escalate to dulaglutide 4.5 mg or maximum tolerated dose (MTD) or switch to tirzepatide with escalation to 15 mg or MTD. Changes from baseline in HbA1c and body weight at week 40 in baseline subgroups of age (<65, ≥65 years), HbA1c (≤8.5%, >8.5%), duration of T2D (≤5, >5 to ≤10, >10 years), baseline dulaglutide dose (0.75 mg, 1.5 mg), duration of dulaglutide dose (<1, ≥1 year), BMI (<27, ≥27; <30, ≥30 to <35, ≥35 kg/m<sup>2</sup>), and ethnicity (Hispanic or Latino, non-Hispanic or non-Latino), and sex (female, male) were determined.<h4>Results</h4>Reductions in HbA1c and body weight at week 40 were significant and consistently greater with tirzepatide across all prespecified baseline subgroups. HbA1c reduction was greater in the subgroups with higher baseline HbA1c and low baseline BMI. Weight reduction was greater for participants in the non-Hispanic or non-Latino subgroup. The safety profile was similar across subgroups. Nausea and diarrhea were usually the most frequently reported treatment-emergent adverse events in each subgroup.<h4>Conclusions</h4>In this subgroup analysis of SURPASS-SWITCH, switching to tirzepatide from dulaglutide was generally well-tolerated and associated with significant and consistent improvements in HbA1c and weight reductions versus dulaglutide across all baseline subgroups evaluated. These results indicate that switching to tirzepatide may provide a clinical option across a range of baseline characteristics when treatment goals are not being met with dulaglutide.<h4>Trial registration number</h4>NCT05564039.

Safety and efficacy of switching from dulaglutide to tirzepatide across clinically relevant baseline characteristics in participants with T2D: subgroup analysis of SURPASS-SWITCH.

<h4>Background</h4>Type 2 diabetes mellitus (T2DM) affects over 500 million people worldwide, with traditional therapies often failing to maintain long-term glycaemic control. Ecnoglutide, a novel long-acting GLP-1 receptor agonist, has emerged as a promising therapeutic option. This systematic review and meta-analysis evaluated the efficacy and safety of ecnoglutide in adults with T2DM.<h4>Methods</h4>Following PRISMA guidelines, we systematically searched PubMed, Cochrane Library, ScienceDirect, ClinicalTrials.gov, and Google Scholar through September 2025. Randomized controlled trials comparing ecnoglutide with placebo or active comparators in adults with T2DM were included. Primary outcomes were changes in HbA1c and body weight. Secondary outcomes included fasting plasma glucose, insulin resistance markers, lipid profile, liver enzymes, and adverse events. Risk of bias was assessed using the Cochrane RoB-2 tool. Meta-analysis was performed using random-effects models, with mean differences and risk ratios calculated at 95% confidence intervals.<h4>Results</h4>Four RCTs comprising 1643 participants (1162 receiving ecnoglutide, 444 controls) were included. Ecnoglutide significantly reduced HbA1c (MD = -0.44, 95% CI -0.55 to -0.33, p < 0.00001), body weight (MD = -5.63, 95% CI -7.90 to -3.35, p < 0.01), and fasting plasma glucose (MD = -0.81, 95% CI -1.03 to -0.59, p < 0.00001). Improvements were observed in insulin sensitivity, lipid profile, and liver enzymes. Adverse events occurred more frequently with ecnoglutide (RR = 1.09, p < 0.01), although predominantly gastrointestinal and mild-to-moderate, with no significant differences in serious adverse events.<h4>Conclusions</h4>Ecnoglutide demonstrates robust efficacy in glycaemic control, weight reduction, and cardiometabolic parameters with an acceptable safety profile in adults with T2DM, supporting its therapeutic potential as a next-generation GLP-1 receptor agonist.

Comparative Efficacy and Safety of Ecnoglutide in Type 2 Diabetes: A Systematic Review and Meta-Analysis.

<h4>Background</h4>Lifestyle interventions, including Nordic walking, a whole-body exercise session, are beneficial for metabolic diseases, including diabetes. However, evidence from research studies or meta-analyses on the efficacy of Nordic walking in improving clinical outcomes in patients with diabetes/prediabetes remains inconclusive.<h4>Purpose</h4>This systematic review and meta-analysis investigated the efficiency of Nordic walking on anthropometrics, glycemic control, lipid profiles, blood pressure, and peak oxygen uptake (VO<sub>2</sub>peak) in adults with prediabetes/diabetes.<h4>Methods</h4>A systematic literature search was performed across PubMed, Web of Science, the Cochrane Library, Scopus, and Embase until June 2025. We included randomized controlled trials (RCTs) involving adults with prediabetes or diabetes that compared the Nordic walking effect with a control trial. Data on clinical outcomes, including anthropometrics, glycemic control, lipid profiles, blood pressure, and VO<sub>2</sub>peak, were extracted for meta-analysis and presented as mean difference (MD).<h4>Results</h4>A total of six RCTs, comprising 321 adults with prediabetes or diabetes (63% male), were included in the analysis. Meta-analysis results showed that compared with control, Nordic walking significantly decreased body weight (MD = -0.79 kg, <i>p</i> = 0.02), and marginally reduced waist circumference (MD = -0.82 cm, <i>p</i> = 0.07). Notably, Nordic walking decreased glycated hemoglobin (HbA1c) (MD = -0.37<i>%</i>, <i>p</i> = 0.0001) but showed high heterogeneity (<i>I</i> <sup>2</sup> = 69<i>%</i>). Subgroup analysis revealed a greater reduction of HbA1c in adults with diabetes (MD = -0.49<i>%</i>, <i>p</i> < 0.00001) than that of adults with prediabetes (MD = -0.2<i>%</i>, <i>p</i> = 0.001). However, Nordic walking did not affect fasting blood glucose or homeostasis model assessment of insulin resistance (HOMA-IR). Additionally, Nordic walking significantly increased high-density lipoprotein (HDL) cholesterol (MD = 0.07 mmol/L, <i>p</i> = 0.005), while showing no beneficial effects on total cholesterol, triglycerides, and low-density lipoprotein. Nordic walking appears to improve VO<sub>2</sub>peak but does not affect systolic or diastolic blood pressure.<h4>Conclusions</h4>Nordic walking exerted beneficial effects on body weight, HbA1c, and HDL in adults with prediabetes or diabetes. Our findings support that Nordic walking can be a practical intervention in managing or treating diabetic complications.

Effect of Nordic Walking on Anthropometrics, Glycemia, and Lipid Profile in Adults With Prediabetes or Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

<h4>Objective</h4>To evaluate the effectiveness of real-time continuous glucose monitoring compared with self-monitoring of blood glucose in adults with type 2 diabetes, focusing on glycaemic control, cardiometabolic outcomes, and patient-centred measures.<h4>Methods</h4>Randomised controlled trials published in English with study intervention period ≥12 weeks, which compared real-time continuous glucose monitoring with self-monitoring of blood glucose in adults with type 2 diabetes were included in this systematic review. Analyses were conducted using Review Manager version 9.6. Risk of bias was evaluated using the Cochrane risk-of-bias tool. The Grading of Recommendations Assessment, Development and Evaluations approach was used to assess certainty of evidence.<h4>Data sources</h4>The search was conducted across PubMed, CINAHL, Web of Science, the Cochrane Library databases and ClinicalTrials.gov from inception to July 2025.<h4>Results</h4>This systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eleven studies which compared real-time continuous glucose monitoring (n=437) with self-monitoring of blood glucose (n=352) were included. Real-time continuous glucose monitoring use was associated with a significant reduction in HbA1c (mean difference=-0.20%), improved time-in-range (mean difference=7.41%), reduced time-above-range (mean difference=6.93%) and reduced time-below-range (mean difference=0.26%). Glucose variability was significantly lower (mean difference=-1.06%) and users demonstrated greater improvements in readiness for diabetes self-management (standardised mean difference=0.69). No significant differences were observed in cardiometabolic or psychosocial outcomes.<h4>Conclusion</h4>Real-time continuous glucose monitoring improves glycaemic control and self-management capacity compared with self-monitoring of blood glucose in adults with type 2 diabetes. These findings support the integration of real-time continuous glucose monitoring into routine clinical care, particularly for individuals requiring intensive glucose monitoring and tailored self-care support.<h4>Systematic review registration</h4>https://www.crd.york.ac.uk/prospero/, identifier CRD42025625444.

Impact of real-time continuous glucose monitoring on glycaemic control in adults with type 2 diabetes: systematic review and meta-analysis.

No control group (high): No parallel control group reported

Includes self-reported outcomes (moderate): Self-reported outcomes used

Limited population scope (moderate): Narrow population scope

Boscia senegalensis extract (BSP), a natural SGLT1/2 inhibitor, may lower blood sugar and HbA1c in type 2 diabetes

This study tested Boscisucrophage (BSP), a supplement made from Boscia senegalensis seeds, in 332 people with type 2 diabetes who still had high blood sugar despite medication. After 12 weeks of taking 350 mg capsules three times daily, most patients had lower blood glucose and HbA1c, along with increased urine glucose excretion.

This was a preliminary single-arm study without a control group, so the results may be influenced by other factors like increased attention or natural disease changes. Randomized controlled trials are needed before firm conclusions can be drawn about BSP's effectiveness compared to standard treatments.

Whether Boscia senegalensis extract (BSP) improves blood sugar control in T2DM

People with type 2 diabetes who have difficulty controlling blood sugar with oral medications alone, particularly in regions where Boscia senegalensis is traditionally used as a food and medicine source.

Boscia senegalensis extract (BSP), a natural SGLT1/2 inhibitor, may lower blood sugar and HbA1c in type 2 diabetes

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