Hindawi Publishing Corporation

Journal of Diabetes Research

Volume 2015, Article ID 913651, 6 pages
http://dx.doi.org/10.1155/2015/913651

Research Article
Effect of Cinnamon Tea on Postprandial Glucose Concentration

Maria Alexandra Bernardo,1 Maria Leonor Silva,1

Elisabeth Santos,1 Margarida Maria Moncada,1 José Brito,1
Luis Proença,1 Jaipaul Singh,2 and Maria Fernanda de Mesquita1
1
Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Cooperativa de Ensino Superior Egas Moniz,
Monte de Caparica, 2829-511 Caparica, Portugal
2
School of Forensic and Investigative Sciences and School of Pharmacy and Biomedical Sciences, University of Central Lancashire,
Preston PR1 2HE, UK

Correspondence should be addressed to Maria Fernanda de Mesquita; [email protected]

Received 21 May 2015; Accepted 1 July 2015

Academic Editor: Francesco Chiarelli

Copyright © 2015 Maria Alexandra Bernardo et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Glycaemic control, in particular at postprandial period, has a key role in prevention of different diseases, including diabetes and
cardiovascular events. Previous studies suggest that postprandial high blood glucose levels (BGL) can lead to an oxidative stress
status, which is associated with metabolic alterations. Cinnamon powder has demonstrated a beneficial effect on postprandial
glucose homeostasis in animals and human models. The purpose of this study is to investigate the effect of cinnamon tea (C.
burmannii) on postprandial capillary blood glucose level on nondiabetic adults. Participants were given oral glucose tolerance
test either with or without cinnamon tea in a randomized clinical trial. The data revealed that cinnamon tea administration
slightly decreased postprandial BGL. Cinnamon tea ingestion also results in a significantly lower postprandial maximum glucose
concentration and variation of maximum glucose concentration (p < 0.05). Chemical analysis showed that cinnamon tea has a high
antioxidant capacity, which may be due to its polyphenol content. The present study provides evidence that cinnamon tea, obtained
from C. burmannii, could be beneficial for controlling glucose metabolism in nondiabetic adults during postprandial period.

1. Introduction a reference test standardized, 75 g oral glucose tolerance

test (OGTT) [9]. During OGTT, plasma glucose level is
Postprandial glucose level (PBG) has been reported to be an obtained by secretion/action of insulin [10]. However, many
important factor in glycaemic control [1, 2]. The importance other factors can also influence glucose metabolism including
of postprandial glycaemia regulation is in accordance with timing, quantity, and meal composition [11–13].
epidemiological studies, which have demonstrated that post- Many traditional plants and spices possess medicinal
prandial hyperglycaemia is a predictor of diabetes and car- properties, such as control blood glucose levels. Cinnamon
diovascular events [3, 4]. The postprandial state can stimulate is one of these spices that has been demonstrated to be
the reactive oxygen species (ROS) production leading to an effective in improving glycaemia [14, 15] both in healthy
oxidative stress status. This status involves molecular mech- and diabetic subjects. In healthy subjects, a study revealed
anism for development of different complications associated that 5 g of cinnamon powder lowered PBG after OGTT
with hyperglycaemia [5–7]. Moreover, postprandial oxidative [16] and another showed that 6 g added to a rice pudding
stress can be accompanied by postprandial inflammation and improved PBG area under the curve (AUC) [17]. In type
endothelial dysfunction as reported by Ceriello et al. [8]. 2 diabetic subjects, cinnamon revealed that it can exert
Postprandial glucose concentration refers to plasma glu- a hypoglycaemic effect, decreasing PBG and fasting blood
cose concentration after eating, which can be evaluated using glucose level (FBG) [18]. These beneficial effects seem to be
2 Journal of Diabetes Research

related to its water-soluble polyphenols. An in vitro study 2.5. Chemicals and Equipment for Antioxidant Capacity Stud-
showed that polyphenols possess an insulin-like action [19]. ies. Ferric chloride (III) hexahydrate (FeCl3 ⋅6H2 O), Folin-
In addition, these cinnamon bioactive compounds revealed Ciocalteu (2,2-azinobis(3-ethylbenzothiazoline-6-sulfonic
high antioxidant properties in human and animal models on acid)), Trolox (6-hydroxy-2,5,7,8-tetramethylchroman-2-car-
oxidative stress through inhibiting lipid peroxidation [20, 21]. boxylic acid), TPTZ 2,4,6-tri(2-pyridyl)-s-triazine, methanol
The aim of the present study is to investigate the effect of (CH3 OH), nicotinamide adenine dinucleotide (NADH),
a cinnamon tea (6 g C. burmannii/100 mL) on postprandial nitroblue tetrazolium (NBT) 2-amino-2-hydroxymethyl-
capillary blood glucose level on nondiabetic adults. propane-1,3-diol (tris), and phenazine methosulfate (PMS)
were purchased from Sigma-Aldrich, gallic acid-1-hydrate
(C6 H2 (OH)3 COOH⋅H2 O) was purchased from Acros
2. Material and Methods Organics, and sodium carbonate (Na2 CO3 ) was purchased
from ICS Science group. All reagents were pro analysis grade.
2.1. Subjects. Following ethical committee approval 30 non- All the absorbance measurements were performed in a
diabetic adults with ages between 20 and 53 years were Perkin-Elmer Lambda 25. The regents were weighed in an
selected from the local community to participate in this analytical balance (Sartorius, ±0.0001 g) and all the solutions
study. A written informed consent was obtained from each were done with distilled water.
volunteer after explaining the aim and experiment risk
procedures. Inclusion criteria included subjects aged 18 or 2.6. Cinnamon Tea Preparation. The Cinnamomum burman-
more, both genders with nondiabetic condition (fasting nii bark was purchased from Sucrame Company (Portugal)
blood glucose level < 100 mg/dL [22]). Exclusion criteria with Indonesia origin. Sticks of cinnamon (60 g) were soaked
comprised individuals who use medication for glycaemia into 1000 mL of water. After 24 h at room temperature,
control and have gastrointestinal symptoms or diseases. The cinnamon solution was heated for 30 min at 100∘ C and then
study also excluded subjects who have altered medication, filtered at room temperature. This method was adapted by
pregnancy, lactation, and allergy to cinnamon. Shen and coauthors [23]. After the cinnamon tea preparation
a 100 mL individual dose was distributed to each participant.
2.2. Study Design. Thirty nondiabetic adults were selected For chemical analysis, a hydromethanolic extract (50 : 50) was
and randomly allocated in 2 groups (𝑛 = 15): control group, performed with cinnamon tea previously obtained.
oral glucose tolerance test (OGTTcontrol ) alone, and interven-
tion group, OGTT followed by cinnamon tea administration 2.7. Total Phenolic Content Determination. The total phenolic
(OGTTcinnamon ). The participants were asked not to ingest concentration in the extract was determined according to
any cinnamon at the day before the intervention. Folin-Ciocalteu method [24] employing gallic acid as stan-
dard. The results were expressed as mg for gallic acid equiv-
alent (GAE)/g of extract. A volume of 375 𝜇L of cinnamon
2.3. Subject Groups Characterization. At baseline (before
extract and 4 mL of sodium carbonate were added to 5 mL
interventions), general characteristic data, such as anthropo-
of Folin-Ciocalteu reagent. After 15 min the absorbance was
metric data, medical condition, and pharmacological ther-
measured at 765 nm. This test was performed for 8 replicates.
apy, were collected using a questionnaire development by
investigator. Participants were also questioned about usual
cinnamon intake. A 24-hour dietary recall was taken pre- 2.8. Antioxidant Assay Using Ferric Reducing Antioxidant
Power (FRAP) Method. The method for determination of
ceding each intervention to compare food intake at the day
ferric reducing effect was based on the reduction, at low
before the intervention between groups. The Food Processor
SQL (version 10.5.0) programme was used to analyse the pH, employing a colourless ferric complex (Fe3+ ) to a
nutritional composition of the food. blue-coloured ferrous complex (Fe2+ ) by electron-donating
antioxidants action in 2,4,6-tri(2-pyridyl)-s-triazine (TPTZ)
presence [25]. A fresh solution was prepared by mixing 25 mL
2.4. Oral Glucose Tolerance Test (OGTT). The glucose of acetate buffer (300 mM, pH = 3.6) into 2.5 mL of TPTZ
(dextrose) was weighed (75 g) using an analytical balance solution (10 mM) to HCl (40 mM) and 2.5 mL of FeCl3 ⋅6H2 O
and dissolved in 200 mL of water, according to American solution (20 mM). The solution was heated at 37∘ C. Samples
Dietetic Association [22]. Following overnight fasting (12 h) (150 𝜇L) were introduced in tubes with 2850 𝜇L of the FRAP
blood glucose level was measured using a capillary drop solution and were maintained in the dark condition for
blood, before intervention (𝑡0 ). In control group, subjects 30 min. The absorbance was measured at 593 nm. Trolox (6-
ingested glucose solution (200 mL) alone (OGTTcontrol ). In hydroxy-2,5,7,8-tetramethylchroman-2-carboxylic acid) was
intervention group subjects ingested 100 mL cinnamon tea used as standard and the results were expressed in 𝜇mol
(OGTTcinnamon ) immediately after glucose solution (200 mL) Trolox/L. This test was performed for 6 replicates.
intake. Blood samples were collected, for each participant, at
30 (𝑡30 ), 60 (𝑡60 ), 90 (𝑡90 ), and 120 (𝑡120 ) minutes in control and 2.9. Superoxide Anion Radicals Scavenging Activity (O2 ∙− ).
intervention groups. Sterilized lancet, glucose meter equip- Superoxide anion was generated by reacting phenazine
ment, and strips for glucose meter (FreeStyle Abbott Diabetes methosulfate (PMS), nicotinamide adenine dinucleotide
Care) were used for blood glucose level measurement. hydride (NADH), and oxygen causing reduced NBT in
Journal of Diabetes Research 3

Formazan [26, 27]. A volume of 0.5 mL of sample was added Table 1: Characteristics of the study participants (𝑛 = 30). Data
to 2 mL of a solution containing NADH (189 𝜇M) and NBT represented mean (±SEM).
(120 𝜇M) with Tris-HCl (40 mM, pH = 8). The reaction
Control group Cinnamon group
started after the addition of 0.5 mL of PMS (60 mM). Control
sample was measured using only distilled water. After 5 min Mean (±SEM) Mean (±SEM)
of incubation, control absorbance was measured at 560 nm Age (years)
at room temperature. Absorbance was measured for different Males 35.3 (±6.7) 30.2 (±3.7)
concentrations of cinnamon samples in order to represent Females 38.3 (±3.5) 34.3 (±3.1)
a curve of % of inhibition versus phenolic concentration. BMI (Kg/m2 )
The percentage of superoxide anion inhibition was calculated Males 23.6 (±1.2) 24.9 (±0.7)
using the following equation: Females 24.8 (±1.1) 24.1 (±0.7)
Abs control − Abs corrected sample FM (%)
%𝐼= × 100. (1) Males 15.1 (±2.1) 17.2 (±0.8)
Abs control
Females 27.6 (±1.7) 28.0 (±1.7)
2.10. Statistical Analysis. Statistical analysis was performed MM (%)
using Excel and SPSS Statistics (Statistical Package for Social Males 52.7 (±2.1) 67.1 (±1.5)
Sciences) version 20.0 software for Windows. Data are pre- Female 42.1 (±1.7) 41.8 (±1.3)
sented as mean ± SD. Repeated Measures ANOVA of mixed BMI: body mass index; FM: fat mass; MM: muscular mass.
type was used to assess the difference between the 2 groups
for postprandial BGL at different times.
Independent samples 𝑡-test was used to assess the dif-
Table 2: Dietary analysis of total energy intake (TEI), carbohydrates
ference between the 2 groups for total caloric value, carbo-
(CD), protein (P), and lipid (L) intake at the day before OGTT(control)
hydrates, protein and lipid, 𝐶max , Δ𝐶max , and AUCIncremental and at the day before OGTT(cinnamon) by participants. Data are mean
values. ± SEM; 𝑛 = 15, each group.
All statistical tests were performed at the 5% level of
significance. Day before Day before
Dietary 𝑝
OGTT(control) OGTT(cinnamon)
Parameters
Mean (±SEM) Mean (±SEM)
3. Results
TEI (Kcal) 1708.01 (±97.04) 1736.51 (±113.74) 0.850
3.1. General Characteristics of Participants. The general char- CD (g) 216.04 (±19.32) 225.40 (±15.33) 0.707
acteristics of the study participants are shown in Table 1, P (g) 75.66 (±6.15) 77.67 (±6.49) 0.823
reporting age, anthropometrics parameters, medical condi- L (g) 58.54 (±4.6) 58.47 (±6.61) 0.993
tions, and pharmacologic therapy. The BMI data for both
Independent sample 𝑡-test was used for statistical analysis.
genders revealed that most of participants have regular
weight [28]. Regarding body fat mass (FM) the results show
that the sample subjects are also in normal range in both
genders [28], but female had significantly more fat mass than Table 3: Mean blood glucose levels (mmol/L) obtained after oral
male. In addition, female subject had significantly (𝑝 < 0.05) glucose tolerance test (OGTT(control) ) and after oral glucose tolerance
less muscular mass than male. test with cinnamon tea (OGTT(cinnamon) ) at different moments:
In what concerns the ingestion of total energy intake and before OGTT (𝑡0 ) and after 30 (𝑡30 ), 60 (𝑡60 ), 90 (𝑡90 ), and 120 (𝑡120 )
minutes. Data are mean ± SEM; 𝑛 = 15, each group.
macronutrient composition regarding carbohydrates, protein
and lipid at the day before the intervention, the 2 groups OGTT(control) OGTT(cinnamon)
can be considered homogeneous since they did not reveal Time Mean (±SEM) Mean (±SEM)
significant differences (𝑝 > 0.05) (Table 2). mmol/L mmol/L
𝑡0 4.97 (±0.1) 4.99 (±0.1)
3.2. Postprandial Blood Glucose Level. Blood glucose levels 𝑡30 10.14 (±0.4) 8.87 (±0.4)
(BGL) were measured for the 2 groups (OGTT(control) and 𝑡60 8.75 (±0.5) 8.24 (±0.4)
OGTT(cinnamon) ) (Table 3). Statistical analysis revealed that
𝑡90 7.66 (±0.5) 7.29 (±0.3)
there is no interaction between the independent and repeated
measures factors (𝑝 = 0.209), which means that it is 𝑡120 6.40 (±0.2) 5.86 (±0.2)
not possible to infer about differences in BGL in different
moments.
However, the data showed that the administration of
cinnamon tea after OGTT slightly decreased BGL mean incremental area under the curve (AUCi) compared with
values compared to OGTT in the absence of cinnamon intake OGTT(control) . However, the variation of maximum glucose
(Figure 1). concentration and maximum glucose concentration mean
The administration of cinnamon tea after OGTT resulted values were significantly lower (𝑝 < 0.05) in OGTT(cinnamon)
in a lower but not significantly postprandial blood glucose compared with OGTT(control) (Table 4).
4 Journal of Diabetes Research

Table 4: Blood glucose level area under the curve (AUC), maximum 12,00
glucose concentration (𝐶max ), and variation of maximum glucose

Blood glucose level (mmol/L)

11,00
concentration (Δ𝐶max ) in nondiabetic subjects at OGTT(control) and
OGTT(cinnamon) . Data are mean ± SEM (𝑛 = 15). 10,00
9,00
OGTT(control) OGTT(cinnamon) 8,00
Mean (±SEM) Mean (±SEM) 𝑝
7,00
(mmol/L) (mmol/L)
6,00
AUCi (0–120 min) 403.73 (±48.5) 297.47 (±33.9) 0.084
5,00
𝐶max 10.63 (±0.6) 8.98 (±0.5) 0.040∗
Δ𝐶max 5.71 (±0.6) 4.0 (±0.5) 0.029∗ 4,00
∗
0 30 60 90 120
Independent samples 𝑡-test was assessed ( differences for 𝑝 < 0.05).
Time (min)

Table 5: Total phenolic content, antioxidant capacity of cinnamon OGTT(control)

tea. Values are mean ± SEM. OGTT(cinnamon)

Chemical analysis Mean (±SEM) Figure 1: Mean (±SEM) time course of blood glucose levels
Total phenols (mg/L gallic acid, 𝑛 = 8) 2286,3 (±48,0) (mmol/L) in nondiabetic subjects after OGTT(control) (I) and
OGTT(cinnamon) (◻).
Antioxidant capacity: FRAP assay 11853,4 (±322,8)
(𝜇mol Trolox/L, 𝑛 = 6)

Magistrelli and coauthors [33] showed no effect at 120 min

3.3. Total Phenol Content and Antioxidant Capacity. The data after meal with cinnamon administration, compared with
in Table 5 showed the total phenolic content, antioxidant control meal. Other published data reported that cinnamon
capacity of cinnamon tea ingested by the participant. The does not alter BGL at 120 minutes after OGTT [16, 17].
superoxide anion radical scavenging activity (O2 ∙− ) was Although previous studies demonstrated that 3 g of cin-
measured at different concentration of C. burmannii tea. The namon powder did not significantly alter AUC, 𝐶max and
results revealed that cinnamon tea has a strong inhibitory Δ𝐶max BGL [34], the results from the present work showed
capacity, in a dose dependent manner, reaching 96% at that C. burmannii tea after OGTT significantly reduced 𝐶max
1143 mg/L gallic acid (half of the total phenols). (𝑝 = 0.040) and Δ𝐶max (𝑝 = 0.029) compared with OGTT
without cinnamon tea. This effect may be due to the high
4. Discussion concentration employed in this study (6 g) compared with the
other study, which uses 3 g.
Cinnamon capsule ingestion with either aqueous extract Different molecular mechanisms have been suggested
or cinnamon powder appears to improve fasting blood for the hypoglycaemic properties of this spice including
glucose level, independently of cinnamon species or extracts reducing gastric empting [17], insulin-mimetic action [35,
[15, 29]. Doubly linked polyphenol type-A polymers were 36], which can lead to cellular glucose uptake [23], and
identified, in the Ziegenfuss et al. study, as one of the possible reducing intestinal glycosidase activity. This effect on enzyme
bioactive compounds responsible for this effect [30]. In this decreased breakdown of disaccharides into glucose, allowing
study the administration of aqueous C. burmannii extract a slow absorption of glucose and reducing PBG level [37].
capsule (Cinnulin PF), with 1% of doubly linked polyphenol The hypoglycaemic effect of cinnamon observed in the
type-A polymers, improved fasting blood glucose levels, in present study could also be attributed to the phenolic content
prediabetes subjects. Moreover, in type 2 diabetic subjects of C. burmannii tea. According to literature, the molecular
or impaired fasting blood glucose, the administration of mechanism of action of cinnamon polyphenols includes
aqueous cinnamon extract also significantly reduced fasting the increase of insulin receptor-𝛽 protein in adipocytes
blood glucose levels [31, 32]. suggesting acting beneficially in insulin signalling [35].
In spite of consistent results regarding fasting blood glu- The data from this study suggest that the use of cinnamon
cose levels, the effect of cinnamon on postprandial glycaemia tea can be beneficial to postprandial glucose levels; moreover
revealed heterogeneous results, which could be attributed its high phenolic content and antioxidant activity could also
to the bioactive compounds composition (which depends act beneficially. A significant relationship was found between
on extraction process, doses, species, and formulation), antioxidant properties and total phenolic content in plants,
population samples, and study design employed in different suggesting that phenols are the bioactive compounds which
studies [29]. contributed to their antioxidants activity [38]. In a study
The results of the present study demonstrated that cin- of Peng and coauthors, they show that proanthocyanidins
namon tea administration (6 g of C. burmannii into 100 mL of aqueous cinnamon extract can prevent the formation of
water) slightly reduced PBG level after OGTT. The beneficial advanced glycation-end product (AGE) [39]. AGE could be
effects of this spice on glycaemia were reported after cinna- originated in high blood glucose levels conditions leading
mon powder ingestion where a significant reduction of PBG to reactive oxygen species production [5, 40]. Particularly,
after 30 min of OGTT was observed [16, 17, 33]. However, cinnamon tea employed in this study revealed a high activity
Journal of Diabetes Research 5

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