***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND AND OBJECTIVES Momordica charantia , locally known as Ampalaya , is being widely used and advertised for its hypoglycemic effects . However , to date , no large clinical trial has been published on the efficacy of any type of preparation . The main objective of this study is to determine if addition of M. charantia capsules to st and ard therapy can decrease glycosylated hemoglobin ( hemoglobin A1c or HbA1c ) levels in diabetic patients with poor sugar control . STUDY DESIGN AND SETTING A r and omized , double-blind , placebo-controlled trial was conducted between April and September 2004 at the outpatient clinics of the Philippine General Hospital . The trial included 40 patients , 18 years old and above , who were either newly diagnosed or poorly controlled type 2 diabetics with A1c levels between 7 % and 9 % . On top of the st and ard therapy , the patients were r and omized to either M. charantia capsules or placebo . The treatment group received two capsules of M. charantia three times a day after meals , for 3 months . The control group received placebo at the same dose . The primary efficacy endpoint was change in the A1c level in the two groups . The secondary efficacy endpoints included its effect on fasting blood sugar , serum cholesterol , and weight . Safety endpoints included effects on serum creatinine , hepatic transaminases ( Alanine aminotransferase/ALT and Aspartate aminotransferase/AST ) , sodium , potassium , and adverse events . RESULTS Baseline characteristics between the treatment and control groups were similar . The difference in mean change in A1c between the two groups was 0.22 % in favor of M. charantia ( 95 % CI : -0.40 to 0.84 ) with P=0.4825 . There was no significant effect on mean fasting blood sugar , total cholesterol , and weight or on serum creatinine , ALT , AST , sodium , and potassium . There were few adverse events and these were generally mild . CONCLUSION This is the first r and omized controlled trial to shed light on the issue concerning the hypoglycemic effects of M. charantia . The investigators targeted a 1 % decline in A1c at the outset with an estimated power of 88 % . With the observed decline of 0.24 % , the achieved power was only 11 % . For this reason , we are unable to make a definite conclusion about the effectiveness of M. charantia . However , the results of this study can be used estimate the sample size for bigger studies The effect of karela ( Momordica charantia ) , a fruit indigenous to South America and Asia , on glucose and insulin concentrations was studied in nine non-insulin-dependent diabetics and six non-diabetic laboratory rats . A water-soluble extract of the fruits significantly reduced blood glucose concentrations during a 50 g oral glucose tolerance test in the diabetics and after force-feeding in the rats . Fried karela fruits consumed as a daily supplement to the diet produced a small but significant improvement in glucose tolerance . Improvement in glucose tolerance was not associated with an increase in serum insulin responses . These results show that karela improves glucose tolerance in diabetes . Doctors supervising Asian diabetics should be aware of the fruit 's hypoglycaemic properties ETHNOPHARMACOLOGICAL RELEVANCE Bitter melon ( Momordica charantia L. ) has been widely used as an traditional medicine treatment for diabetic patients in Asia . In vitro and animal studies suggested its hypoglycemic activity , but limited human studies are available to support its use . AIM OF STUDY This study was conducted to assess the efficacy and safety of three doses of bitter melon compared with metformin . MATERIAL S AND METHODS This is a 4-week , multicenter , r and omized , double-blind , active-control trial . Patients were r and omized into 4 groups to receive bitter melon 500 mg/day , 1,000 mg/day , and 2,000 mg/day or metformin 1,000 mg/day . All patients were followed for 4 weeks . RESULTS There was a significant decline in fructosamine at week 4 of the metformin group ( -16.8 ; 95 % CI , -31.2 , -2.4 μmol/L ) and the bitter melon 2,000 mg/day group ( -10.2 ; 95 % CI , -19.1 , -1.3 μmol/L ) . Bitter melon 500 and 1,000 mg/day did not significantly decrease fructosamine levels ( -3.5 ; 95 % CI -11.7 , 4.6 and -10.3 ; 95 % CI -22.7 , 2.2 μmol/L , respectively ) . CONCLUSIONS Bitter melon had a modest hypoglycemic effect and significantly reduced fructosamine levels from baseline among patients with type 2 diabetes who received 2,000 mg/day . However , the hypoglycemic effect  of bitter melon was less than metformin 1,000 mg/day Momordica charantia ( MC ) fruit was subjected to phytochemical and pharmacological interaction studies with oral hypoglycemis in NIDDM patients . Phytochemical , chromatographical analysis and extraction of methanolic MC fruit soft ( semi-solid form ) in CCl4 + C6H6 solvent system yielded 15 diverse chemical constituents -- alkaloids , glycosides , aglycone , tannin , sterol , phenol and protein . The CCl4 + C6H6 MC soft extract was used orally in a dose of 200 mg twice daily ( BD ) for pharmacological interactions with two diversely acting oral hypoglycemic agents--1 ) metformin BD and 2 ) glibenclamide BD in 15 patients of either sex ( 52 - 65 years of age ) of NIDDM . It was observed that with CCl4 + C6H6 MC soft extract plus half doses of metformin or glibenclamide or both in combination caused hypoglycemia greater than that caused by full doses used in the study with 7 days treatment . Conclusively the extract acts in synergism with oral hypoglycemics and potentiates their hypoglycemia in NIDDM Clinical study of an insulin-like compound obtained from vegetable source ( vegetable insulin ) was carried out on nine patients with diabetes mellitus . The active hypoglycaemic principle , purified protein extract , was obtained from fruits as well as from tissue cultures of the plant Momordica charantia L. This extract was homologous to insulin obtained from animal pancreas . It showed a consistent hypoglycaemic effect in patients with diabetes mellitus . The average fall in blood sugar level at the peak effect of vegetable insulin was found to be statistically significant . The onset of action was within 30 - 60 min with the peak effect six hours after the administration of the dose of plant insulin . No hypersensitivity reaction to this extract was observed in the group of patients studied Effect of Momordica charantia , a bitter vegetable popularly known as Karolla , on fasting and post pr and ial ( 2 hours after 75 gm oral glucose intake ) serum glucose levels were studied in 100 cases of moderate non-insulin dependent diabetic subjects . Drinking of the aqueous homogenized suspension of the vegetable pulp led to significant reduction ( p < 0.001 ) of both fasting and post-pr and ial serum glucose levels . This hypoglycaemic action was observed in 86 ( 86 % ) cases . Five cases ( 5 % ) showed lowering of fasting serum glucose only 
    Output:
    
When momordica charantia was compared to metformin or glibenclamide , there was also no significant change in reliable parameters of glycaemic control .
AUTHORS ' CONCLUSIONS There is insufficient evidence on the effects of momordica charantia for type 2 diabetes mellitus .