Running head: CINNAMON IN DIABETES MELLITUS

Does the Inclusion of Cinnamon in the Diet of Patients with Diabetes Mellitus Increase or
Decrease A1C Levels?
Heather Shepherd
University of New Hampshire

CINNAMON IN DIABETES MELLITUS

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Abstract

This paper will address the PICO question, does the inclusion of cinnamon in the diet of
patients with diabetes mellitus increase or decrease A1C levels? Four separate articles were
found from databases accessed through the University of New Hampshire library website. All the
articles concluded that cinnamon is not shown to lower A1C levels when introduced into the
diets of participants with diabetes. These patients included the cinnamon into their diet anywhere
from four to eighteen weeks. The dose of cinnamon used in these trials ranged from 120
milligrams to six grams in pill form. Placebo pills were used as a control in some of these trials.
To effectively determine if cinnamon can help reduce A1C levels, future research must be done
to further explore the effects of all species of cinnamon, all doses of cinnamon, and longer time
frames used for research. After completing this additional research, nurses should not administer
cinnamon to diabetic patients as it may be costly and timely with no added benefits to lowering
A1C levels.

CINNAMON IN DIABETES MELLITUS

Diabetes mellitus is a disease that has become a major health concern in the United States
within the last decade; there has been a significant increase especially in diagnoses of type two
diabetes. Type two diabetes is related to patients weight and has started to affect the pediatric
population. Hemoglobin A1C levels are a good indication of how well diabetes is managed in
patients with this diagnosis. Without adequate control over blood glucose levels, multiple comorbidities can be encountered later on in the lives of these individuals.
Cinnamon is thought to lower the blood glucose levels of patients with diabetes because
it contains substances that are said to have insulin mimetic properties. Further research must be
done to determine if this spice can indeed lower blood glucose levels and ultimately lower the
A1C levels of patients in this population. If cinnamon does initiate this positive effect, then this
spice should be incorporated into new diet and education modifications for diabetics in nursing
practice.
Does the inclusion of cinnamon in the diet of patients with Diabetes Mellitus increase or
decrease A1C levels? The author of this paper used the search engine, Ebsco Host, accessed
through the UNH library website. After accessing this search engine, the databases CINAHL
Complete and the Cochrane Database of Systematic Reviews were searched. Three key words
were used to search these databases. These words were diabetes, A1C, and cinnamon.
Limits to this search included, English language only, full text, abstract available, and peer
reviewed. Four citations, three from CINAHL and one from the Cochrane Database of
Systematic Reviews, were found. Inclusion criteria for this paper included that the articles
analyzed must pertain to blood glucose levels of patients with diabetes mellitus, which may be
type one and type two, and those patients must have cinnamon incorporated into their diet for an

CINNAMON IN DIABETES MELLITUS

effective amount of time, which may be determined by individual studies. Exclusion criterion for
this paper was the relation of cinnamon to blood glucose levels in patients who do not have
diabetes mellitus.
The first article that was analyzed is titled, Cinnamon use in type 2 diabetes: an updated
systematic review and meta-analysis Allen,R.,Schwartzman,E.,Baker,W.,Coleman,C.,and
Phung,O. (2013), provide a systematic review and meta-analysis of studies that looked at
cinnamons effect on glycemic and lipid levels in the human body. The results concluded from
this study included that cinnamon does correlate with a statistically significant reduction in levels
of fasting glucose, total cholesterol, LDL levels, and triglycerides. It was also concluded that
cinnamon increases HDL levels, often referred to as good cholesterol. Overall, A1C levels were
not affected by the inclusion of cinnamon in the diabetic diet. A major strength of this study was
the consistency used to lead to the certain outcomes. Cinnamon doses of 120 milligrams per
deciliter to six grams per deciliter used over a period of four to eighteen weeks was
implemented. A weakness of this study was that this certain dosage range of cinnamon and the
time frame used for diet modifications may have not been effective. Perhaps if a wider range of
doses and time frames were used, results would have shown that cinnamon does reduce A1C
levels. Lastly, the preferred dose of cinnamon as well as the specific time frame of use was not
clear to the reader. Low doses compared to high doses and four weeks compared to eighteen
weeks was not analyzed. Therefore, patient education may be difficult if not impossible due to
the lack of information.
The next study that was found, The effect of cinnamon on A1C among adolescents with
type 1 diabetes, by Altschuler,J.,Casella,S.,MacKenzie,T.,andCurtis,K. (2007), was a

CINNAMON IN DIABETES MELLITUS

double-blind, placebo controlled design. Within this study, seventy-two teens with type one
diabetes were given a dose of one gram of cinnamon per day, or the same dose of a placebo
spice. After ninety days, there was no significant decrease in A1C levels. There was also no
significant difference in total daily insulin usage or number of hypoglycemic incidences with the
use of cinnamon as compared to the placebo spice. A strength of this study was that patients took
their pills at a time that was convenient for them and then continued to take those pills at the
same time each day. They were also asked to keep a log of their insulin use and hypoglycemic
episodes throughout the day over the ninety day period. This allows researchers to evaluate the
possible negative effects of cinnamon incorporated into the participants diet. Weaknesses of this
study were that participants were examined only every two weeks throughout the ninety day
period. Also, some patients may have been able to tell the difference in appearance between the
cinnamon pill and the placebo pill; therefore, outcomes could have been altered. Compliance
may also have been an issue in this study and extensive nursing education should have been
implemented.
The third study found on the CINAHL database is titled, Effect of cinnamon on glucose
control and lipid parameters. Baker,W.,GuiterrezWilliams,G.,White,C.,Kluger,J.,and
Coleman,C. (2008), provided this literature review from which five randomized control trials
were analyzed. It concluded that cinnamon did not decrease A1C levels. It also stated that finger
stick blood glucose levels and lipid parameters were not improved by incorporating cinnamon
into the diet of type one and type two diabetic patients. The average duration of time that these
patients were included in these trials was twelve weeks. This duration is thought to be a
weakness of the study. Researchers think that this time frame may be too short to lead to
definitive conclusions about cinnamon in diabetic diets. However, researchers also identified that

CINNAMON IN DIABETES MELLITUS

a small trend would have still been seen if cinnamon did indeed decrease, or increase, A1C
levels. A strength of this study was that it only included clinical trials in the meta analysis as well
as only trials using cinnamon. Information from other studies involving other spices were not
included and did not affect information provided on how cinnamon affects diabetes. However,
only six clinical trials were discovered and only five were utilized because one was not a trial
using cinnamon as the primary spice. Another weakness of this study was that researchers
hypothesized that if more patients were included, possibly 1,166 to 6,853 patients, then the
results of the study may have been clinically significant. Such a large number of participants may
be difficult to obtain as well as effectively monitor within the specific trial parameters.
The final study that will be included in this paper to answer the authors PICO question
was found on the Cochrane Database of Systematic Reviews. Leach, M. and Kumar, S. (2012),
authored Cinnamon for diabetes mellitus. In this study, two reviewers independently selected
control trials, assessed for bias, and gathered data. Ten randomized control trials were included in
this review and a total of 577 patients with type one and two Diabetes Mellitus were included.
The dose of cinnamon assessed was two grams daily for four to sixteen weeks. There was no
correlation found between the incorporation of cinnamon into the diet and increased or decreased
fasting blood glucose levels. There was no statistically significant difference between A1C levels
of those patients who took the cinnamon dose and those who were given placebo doses.
Weaknesses of this study included a high or unclear risk of bias in all trials except two and poor
standards under which these trials were performed. This study suggested that additional research
trials should be performed under better standards and more controlled settings as well as
researching more species of cinnamon. Strengths of this study included that the two authors of
this study independently searched and assessed databases to gather information and there was an

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assessment of bias to better analyze these trials. The presence of bias may have altered the
conclusion of these trials which may have led researchers to consider not including trials with a
very high risk of bias.
After four articles were analyzed using data bases found through the UNH library
website, the author of this paper concluded that cinnamon does not improve hemoglobin A1C
levels in patients with diabetes mellitus. All studies concluded that there was no significant
evidence showing that cinnamon lowered overall A1C levels. However, there was evidence to
support that cinnamon can reduce fasting blood glucose levels and overall cholesterol levels.
LDL levels were shown to decrease after the implementation of cinnamon into the diabetic diet
while HDL levels were shown to increase. In relation to the initial question, cinnamon is an
ineffective way to lower A1C levels of diabetic patients. If an adequate diet and enough exercise
were also implemented into each of the subjects lives, perhaps the evidence would have shown
that cinnamon has an additive effect to lowering A1C levels. Because subjects were not clearly
described, we cannot conclude that this would make a difference in the evidence found. We only
know that the participants used in these studies were diabetic. Much like implementing only an
exercise regimen or only improving ones diet, cinnamon is not shown to act independently on
reducing long term blood glucose levels. As previously mentioned, if all participants were to
comply with proper diabetic lifestyle modifications, perhaps cinnamon could act as a catalyst to
decreasing the A1C levels of diabetic patients.
Cinnamon has been shown to affect A1C levels on animals but fewer trials have been
performed on humans. There are multiple species of cinnamon that have been used in trials that
have taken place but not all species have been used. For future reference, more human trials must
be performed. All species of cinnamon must be incorporated into these additional research trials.

CINNAMON IN DIABETES MELLITUS

A larger group of diabetic participants must also be utilized. In the past, trends have failed to
surface from current research. Perhaps if more people participated, trends would become more
obvious to researchers. Another consideration of this research question is perhaps past trials have
not lasted long enough. Eighteen weeks is the longest amount of time that participants included
cinnamon into their diets. Perhaps an entire year must pass before A1C levels are shown to
decrease. Any further studies done to answer this PICO question must extend the time frame of
the previous studies. All doses of cinnamon must also be analyzed and used in future trials. The
maximum dose of cinnamon that can be taken in a single day is thought to be no more than six
grams. Instead of just using a cinnamon pill and a placebo pill for participants, a placebo pill and
differing dosages of cinnamon pills should be utilized among groups of the participants. A larger
population of diabetic patients will be needed for this future research in order to better
understand how the overall diabetic population may react to this treatment.
Additional research would be beneficial to conduct in order to get a clear understanding
of how cinnamon can affect A1C levels in diabetic patients. Anything that can reduce A1C levels
and better control blood glucose levels will help with the management of diabetes in the
healthcare system. Type two diabetes especially will be a continuing problem seen in hospitals
and other health care facilities. Other than diabetic ketoacidosis and hyperosmolar
hyperglycemic syndrome, co-morbidities of diabetes are difficult to manage by patients and the
healthcare team. Compliance is a major issue in this population, especially with weight
management in type two diabetes. If a cinnamon pill, taken once a day, could create an additive
beneficial effect of lowering fasting blood glucose levels and thus A1C levels, then a reduction in
co-morbidities and other diabetic complications may also be seen. Along with all the trial
standard adjustments, participants of future trials must also be able to alter their lifestyles.

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Adequate food choices and exercise must be implemented, if not already in place. Once these
changes are made and blood glucose levels are more controlled, then cinnamon can be added into
the diet of these individuals to determine if cinnamon can further improve A1C levels. Unless
additional research can provide evidence that cinnamon does reduce A1C levels, the use of this
spice is not recommended to include in the diet of diabetic patients. It may be costly and timely
to provide cinnamon pills as well as education on how it may or may not be effective in the diet.
Therefore, with the information provided in this paper, cinnamon should not be given to patients
with diabetes. It should also not be included in any patient education by the nurse as it is not
necessary or beneficial.

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Works Cited
Allen,R.,Schwartzman,E.,Baker,W.,Coleman,C.,&Phung,O.(2013).Cinnamonuseintype
2diabetes:Anupdatedsystematicreviewandmetaanalysis.AnnalsofFamilyMedicine,
5(15441709),452459.RetrievedMarch17,2015,fromCINAHLComplete.
Altschuler,J.,Casella,S.,MacKenzie,T.,&Curtis,K.(2007).EffectofcinnamononA1C
amongadolescentswithtype1diabetes.DiabetesCare,4(01495992),813816.
RetrievedMarch17,2015,fromCINAHLComplete.
Baker,W.,GuiterrezWilliams,G.,White,C.,Kluger,J.,&Coleman,C.(2008).Effectof
cinnamononglucosecontrolandlipidparameters.DiabetesCare,1(01495992),4143.
RetrievedMarch16,2015,fromCochraneDatabaseofSystematicReviews.
Leach, M. & Kumar, S. Cinnamon for diabetes mellitus. Cochrane Database of Systematic
Reviews 2012, Issue 9. Art. No.: CD007170. DOI: 10.1002/14651858.CD007170.pub2.
Roth, E. (2014, June 23). Can Cinnamon Ease Diabetes Symptoms? Retrieved March 17, 2015,
from http://www.healthline.com/health/can-cinnamon-ease-diabetes-symptoms#How?4