Herbal medicines hold therapeutic potential for diabetes management. This study compared the efficacy and safety of mulberry twig alkaloids (SZ-A) versus canagliflozin administration in poorly oral-antidiabetic controlled patients with type 2 diabetes mellitus (T2DM) by using the flash glucose monitoring (FGM) system. Sixty poorly controlled diabetic patients were randomly assigned to two groups: SZ-A group (n = 30) and canagliflozin group (n = 30). All patients received add-on therapy either SZ-A or canagliflozin treatment for 12 weeks. FGM was applied for 7 days before the start of treatment (baseline) and for 7 days during the final week (week 12) of the 12-week treatment period. General clinical data were collected and analyzed. After 12 weeks of treatment, both SZ-A and canagliflozin significantly reduced HbA1c, fasting and postprandial glucose, 24 h mean blood glucose, and time above range (TAR). Time in range (TIR) was comparable between SZ-A (72.08%) and canagliflozin (73.85%), with no increase in time below range (TBR). In contrast to canagliflozin, SZ-A significantly reduced postprandial glucose excursion (PPGE) after breakfast and dinner. Both SZ-A and canagliflozin also improved insulin resistance and enhanced insulin sensitivity in patients. Additionally, both treatments significantly improved metabolism parameters, including weight, waist circumference, and triglyceride. SZ-A showed hypoglycemic and metabolic effects comparable to canagliflozin, with superior control of postprandial glucose excursion after breakfast and dinner. Clinical trial registration www.clinicaltrials.gov identifier is NCT05856578 (Registered 15 March 2022).
Li et al. (Tue,) studied this question.