Cocoa's Potential as Functional Food for Diabetes Glucose Management
Abstract
Background: Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia due to impaired insulin secretion or function, and its management relies heavily on drug therapy and lifestyle modifications, which are often challenging to maintain consistently. Therefore, more effective alternatives, such as functional foods like cocoa, which contains various bioactive compounds that may play a role in blood glucose regulation, are needed.
Objectives: This literature review aims to explore the potential of cocoa as a functional food for blood glucose management in diabetic patients based on existing scientific evidence.
Methods: This study is a systematic literature review conducted by searching the Web of Science, Scopus, and PubMed databases within the period of 2015–2025. The analyzed articles include in vivo studies on diabetic animal models, meta-analyses, and clinical trials in humans related to cocoa consumption and its effects on diabetes parameters.
Results: In vivo studies show that a flavanol-rich cocoa diet improves insulin sensitivity, reduces HbA1c levels, and protects endothelial and pancreatic cells from oxidative stress. Meta-analyses of clinical trials indicate that cocoa flavanol supplementation (200-600 mg/day) significantly reduces HOMA-IR, triglycerides, and inflammation. Observational studies also suggest that moderate chocolate consumption may reduce the risk of type 2 diabetes.
Conclusions: Cocoa has the potential to serve as a functional food for blood glucose management through improved insulin sensitivity, antioxidant effects, and gut microbiota modulation. However, further large-scale clinical trials are needed to determine the optimal dosage and long-term efficacy of cocoa in diabetes prevention and management.
References
1. Darenskaya MA, Kolesnikova LI, Kolesnikov SI. Oxidative Stress: Pathogenetic Role in Diabetes Mellitus and Its Complications and Therapeutic Approaches to Correction. Bull Exp Biol Med. 2021 May;171(2):179–89. https://doi.org/10.1007/s10517-021-05191-7
2. Priyanto A, Juwariah T. Hubungan Self Care Dengan Kestabilan Gula Darah Pasien Diabetes Mellitus Type II. jik. 2021 Dec 15;10(1):74–81. https://doi.org/10.32831/jik.v10i1.376
3. International Diabetes Federation (IDF). IDF Diabetes Atlas, Ninth edition 2019. BELGIUM: International Diabetes Federation; 2019.
4. Badan Kebijakan Pembangunan Kesehatan. Survei Kesehatan Indonesia (SKI) tahun 2023 dalam Angka. Jakarta: Kemenkes BKPK; 2023.
5. Riset Kesehatan Dasar (Riskesdas). Jakarta: Kemenkes RI; 2018.
6. Perkumpulan Endokrinologi Indonesia (PERKENI). Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa. Jakarta: PB PERKENI; 2019.
7. Nurhayati N, Marseno DW, Setyabudi FS, Supriyanto S. Pengaruh Steam Blanching terhadap Aktivitas Polifenol Oksidase, Total Polifenol dan Aktivitas Antioksidan Biji Kakao. J Apl Teknol Pang. 2018 Oct 23;7(3). https://doi.org/10.17728/jatp.2314
8. Tobias PA, Downs J, Epaina P, Singh G, Park RF, Edwards RJ, et al. Parental assigned chromosomes for cultivated cacao provides insights into the genetic architecture underlying resistance to vascular streak dieback. The Plant Genome. 2024 Dec;17(4):e20524. https://doi.org/10.1002/tpg2.20524
9. Ayustina PM, Rai Suarni NM, Ermayanti NGAM. Potensi Ekstrak Etanol Daun Kelor (Moringa Oleifera) Terhadap Kualitas Spermatozoa dan Hormon Testosteron Tikus Putih Jantan yang Diinduksi Meloxicam. metamorfosa. 2022 Oct 13;9(2):247. https://doi.org/10.24843/metamorfosa.2022.v09.i02.p03
10. Assagaf M, Asur G, Kasuba S. Preferensi Konsumen terhadap Dodol Coklat dari Biji Kakao. PRO. 2022 July 25;1(1):260–70. https://doi.org/10.55180/pro.v1i1.262
11. Ramos S, Martin, MA, Goya L. Effects of Cocoa Antioxidants in Type 2 Diabetes Mellitus. Antioxidants. 2017;6(4). https://doi.org/10.3390/antiox6040084
12. Martin M, Ramos S. Impact of Cocoa Flavanols on Human Health. Food Chem Toxicol. 2021;151:112121. https://doi.org/10.1016/j.fct.2021.112121
13. Restuti ANS, Yulianti A, Nuraini N. Intervensi Bubuk Kakao terhadap Perubahan Kadar Gula Darah Puasa Tikus Sprangue Dawley Diabetes Melitus. Jurnal Riset Kesehatan. 2018 Dec 1;7(2):57–60. https://doi.org/10.31983/jrk.v7i2.3646
14. Barišić V, Icyer NC, Akyil S, Toker OS, Flanjak I, Ačkar Đ. Cocoa based beverages – Composition, nutritional value, processing, quality problems, and new perspectives. Trends in Food Science & Technology. 2023 Feb;132:65–75. https://doi.org/10.1016/j.tifs.2022.12.011
15. Fernández-Millán E, Ramos S, Alvarez-Cilleros D, Samino S, Amigó N, Correig X, et al. Urinary Metabolomics Study on the Protective Role of Cocoa in Zucker Diabetic Rats via 1H-NMR-Based Approach. Nutrients. 2022;14(19). https://doi.org/10.3390/nu14194127
16. Davis D, Tallent R, Navalta J, Salazar A, Lyons T, Basu A. Effects of Acute Cocoa Supplementation on Postprandial Apolipoproteins, Lipoprotein Subclasses, and Inflammatory Biomarkers in Adults with Type 2 Diabetes after a High-Fat Meal. Nutrients. 2020;12(7). https://doi.org/10.3390/nu12071902
17. Alvarez-Cilleros D, López-Oliva M, Morales-Cano D, Barreira B, Pérez-Vizcaíno F, Goya L, et al. Dietary Cocoa Prevents Aortic Remodeling and Vascular Oxidative Stress in Diabetic Rats. Molecular Nutrition & Food Research. 2019;63(18). https://doi.org/10.1002/mnfr.201900044
18. Lin X, Zhang I, Li A, Manson J, Sesso H, Wang L, et al. Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Nutrition. 2016;146(11):2325–33. https://doi.org/10.3945/jn.116.237644
19. Aris HM, Kasim ZM, Zubairi SI. Antihypertensive, Anti-inflammatory, Glycaemic, and Satiety Effects of Cocoa-Flavoured Soy-Based Powder Drink Mix Enriched with Bioactive Hydrolysates from Nests of Aerodramus fuciphagus. Food Quality and Safety. 2025 Jan 18;9:fyae044. https://doi.org/10.1093/fqsafe/fyae044
20. Maskarinec G, Jacobs S, Shvetsov Y, Boushey CJ, Setiawan VW, Kolonel LN, et al. Intake of cocoa products and risk of type-2 diabetes: the multiethnic cohort. Eur J Clin Nutr. 2019 May;73(5):671–8. https://doi.org/10.1038/s41430-018-0188-9
21. Yuan S, Li X, Jin Y, Lu J. Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies. Nutrients. 2017;9(7). https://doi.org/10.3390/nu9070688
22. Leyva-Soto A, Chavez-Santoscoy R, Lara-Jacobo L, Chavez-Santoscoy A, Gonzalez-Cobian L. Daily Consumption of Chocolate Rich in Flavonoids Decreases Cellular Genotoxicity and Improves Biochemical Parameters of Lipid and Glucose Metabolism. Molecules. 2018;23(9). https://doi.org/10.3390/molecules23092220
23. Rynarzewski J, Dicks L, Zimmermann BF, Stoffel-Wagner B, Ludwig N, Helfrich HP, et al. Impact of a Usual Serving Size of Flavanol-Rich Cocoa Powder Ingested with a Diabetic-Suitable Meal on Postprandial Cardiometabolic Parameters in Type 2 Diabetics—A Randomized, Placebo-Controlled, Double-Blind Crossover Study. Nutrients. 2019 Feb 16;11(2):417. https://doi.org/10.3390/nu11020417
24. Dicks L, Kirch N, Gronwald D, Wernken K, Zimmermann B, Helfrich H, et al. Regular Intake of a Usual Serving Size of Flavanol-Rich Cocoa Powder Does Not Affect Cardiometabolic Parameters in Stably Treated Patients with Type 2 Diabetes and Hypertension-A Double-Blinded, Randomized, Placebo-Controlled Trial. Nutrients. 2018;10(10). https://doi.org/10.3390/nu10101435
25. Sesso HD, Manson JE, Aragaki AK, Rist PM, Johnson LG, Friedenberg G, et al. Effect of Cocoa Flavanol Supplementation For The Prevention of Cardiovascular Disease Events: The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) Randomized Clinical Trial. Am J Clin Nutr. 2022;115(6):1490–500. https://doi.org/10.1093/ajcn/nqac055
26. Santos HO, Macedo RC. Cocoa-induced (Theobroma cacao) Effects on Cardiovascular System: HDL Modulation Pathways. Clinical Nutrition Espen. 2018;27(10):10–5. https://doi.org/10.1016/j.clnesp.2018.06.001
27. Racine K, Iglesias-Carres L, Herring J, Ferruzzi M, Kay C, Tessem J, et al. Cocoa Extract Exerts Sex-Specific Anti-Diabetic Effects In An Aggressive Type-2 Diabetes Model: A Pilot Study. Biochemical and Biophysical Research Communications. 2022;626:205–10. https://doi.org/10.1016/j.bbrc.2022.08.018
28. García-Díez E, López-Oliva M, Caro-Vadillo A, Pérez-Vizcaíno F, Pérez-Jiménez J, Ramos S, et al. Supplementation with a Cocoa-Carob Blend, Alone or in Combination with Metformin, Attenuates Diabetic Cardiomyopathy, Cardiac Oxidative Stress and Inflammation in Zucker Diabetic Rats. Antioxidants. 2022;11(2). https://doi.org/10.3390/antiox11020432
29. Simpson E, Mendis B, Dunlop M, Schroeter H, Kwik-Uribe C, Macdonald I. Cocoa Flavanol Supplementation and the Effect on Insulin Resistance in Females Who Are Overweight or Obese: A Randomized, Placebo-Controlled Trial. Nutrients. 2023;15(3). https://doi.org/10.3390/nu15030565
30. Yaribeygi H, Sathyapalan T, Atkin SL, Sahebkar A. Molecular Mechanisms Linking Oxidative Stress and Diabetes Mellitus. Oxidative Medicine and Cellular Longevity. 2020 Mar 9;2020:1–13. https://doi.org/10.1155/2020/8609213
31. Alvarez-Cilleros D, Ramos S, López-Oliva M, Escrivá F, Alvarez C, Fernández-Millán E, et al. Cocoa Diet Modulates Gut Microbiota Composition and Improves Intestinal Health in Zucker Diabetic Rats. Food Research International. 2020;132. https://doi.org/10.1016/j.foodres.2020.10905
2. Priyanto A, Juwariah T. Hubungan Self Care Dengan Kestabilan Gula Darah Pasien Diabetes Mellitus Type II. jik. 2021 Dec 15;10(1):74–81. https://doi.org/10.32831/jik.v10i1.376
3. International Diabetes Federation (IDF). IDF Diabetes Atlas, Ninth edition 2019. BELGIUM: International Diabetes Federation; 2019.
4. Badan Kebijakan Pembangunan Kesehatan. Survei Kesehatan Indonesia (SKI) tahun 2023 dalam Angka. Jakarta: Kemenkes BKPK; 2023.
5. Riset Kesehatan Dasar (Riskesdas). Jakarta: Kemenkes RI; 2018.
6. Perkumpulan Endokrinologi Indonesia (PERKENI). Pedoman Pengelolaan dan Pencegahan Diabetes Melitus Tipe 2 Dewasa. Jakarta: PB PERKENI; 2019.
7. Nurhayati N, Marseno DW, Setyabudi FS, Supriyanto S. Pengaruh Steam Blanching terhadap Aktivitas Polifenol Oksidase, Total Polifenol dan Aktivitas Antioksidan Biji Kakao. J Apl Teknol Pang. 2018 Oct 23;7(3). https://doi.org/10.17728/jatp.2314
8. Tobias PA, Downs J, Epaina P, Singh G, Park RF, Edwards RJ, et al. Parental assigned chromosomes for cultivated cacao provides insights into the genetic architecture underlying resistance to vascular streak dieback. The Plant Genome. 2024 Dec;17(4):e20524. https://doi.org/10.1002/tpg2.20524
9. Ayustina PM, Rai Suarni NM, Ermayanti NGAM. Potensi Ekstrak Etanol Daun Kelor (Moringa Oleifera) Terhadap Kualitas Spermatozoa dan Hormon Testosteron Tikus Putih Jantan yang Diinduksi Meloxicam. metamorfosa. 2022 Oct 13;9(2):247. https://doi.org/10.24843/metamorfosa.2022.v09.i02.p03
10. Assagaf M, Asur G, Kasuba S. Preferensi Konsumen terhadap Dodol Coklat dari Biji Kakao. PRO. 2022 July 25;1(1):260–70. https://doi.org/10.55180/pro.v1i1.262
11. Ramos S, Martin, MA, Goya L. Effects of Cocoa Antioxidants in Type 2 Diabetes Mellitus. Antioxidants. 2017;6(4). https://doi.org/10.3390/antiox6040084
12. Martin M, Ramos S. Impact of Cocoa Flavanols on Human Health. Food Chem Toxicol. 2021;151:112121. https://doi.org/10.1016/j.fct.2021.112121
13. Restuti ANS, Yulianti A, Nuraini N. Intervensi Bubuk Kakao terhadap Perubahan Kadar Gula Darah Puasa Tikus Sprangue Dawley Diabetes Melitus. Jurnal Riset Kesehatan. 2018 Dec 1;7(2):57–60. https://doi.org/10.31983/jrk.v7i2.3646
14. Barišić V, Icyer NC, Akyil S, Toker OS, Flanjak I, Ačkar Đ. Cocoa based beverages – Composition, nutritional value, processing, quality problems, and new perspectives. Trends in Food Science & Technology. 2023 Feb;132:65–75. https://doi.org/10.1016/j.tifs.2022.12.011
15. Fernández-Millán E, Ramos S, Alvarez-Cilleros D, Samino S, Amigó N, Correig X, et al. Urinary Metabolomics Study on the Protective Role of Cocoa in Zucker Diabetic Rats via 1H-NMR-Based Approach. Nutrients. 2022;14(19). https://doi.org/10.3390/nu14194127
16. Davis D, Tallent R, Navalta J, Salazar A, Lyons T, Basu A. Effects of Acute Cocoa Supplementation on Postprandial Apolipoproteins, Lipoprotein Subclasses, and Inflammatory Biomarkers in Adults with Type 2 Diabetes after a High-Fat Meal. Nutrients. 2020;12(7). https://doi.org/10.3390/nu12071902
17. Alvarez-Cilleros D, López-Oliva M, Morales-Cano D, Barreira B, Pérez-Vizcaíno F, Goya L, et al. Dietary Cocoa Prevents Aortic Remodeling and Vascular Oxidative Stress in Diabetic Rats. Molecular Nutrition & Food Research. 2019;63(18). https://doi.org/10.1002/mnfr.201900044
18. Lin X, Zhang I, Li A, Manson J, Sesso H, Wang L, et al. Cocoa Flavanol Intake and Biomarkers for Cardiometabolic Health: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of Nutrition. 2016;146(11):2325–33. https://doi.org/10.3945/jn.116.237644
19. Aris HM, Kasim ZM, Zubairi SI. Antihypertensive, Anti-inflammatory, Glycaemic, and Satiety Effects of Cocoa-Flavoured Soy-Based Powder Drink Mix Enriched with Bioactive Hydrolysates from Nests of Aerodramus fuciphagus. Food Quality and Safety. 2025 Jan 18;9:fyae044. https://doi.org/10.1093/fqsafe/fyae044
20. Maskarinec G, Jacobs S, Shvetsov Y, Boushey CJ, Setiawan VW, Kolonel LN, et al. Intake of cocoa products and risk of type-2 diabetes: the multiethnic cohort. Eur J Clin Nutr. 2019 May;73(5):671–8. https://doi.org/10.1038/s41430-018-0188-9
21. Yuan S, Li X, Jin Y, Lu J. Chocolate Consumption and Risk of Coronary Heart Disease, Stroke, and Diabetes: A Meta-Analysis of Prospective Studies. Nutrients. 2017;9(7). https://doi.org/10.3390/nu9070688
22. Leyva-Soto A, Chavez-Santoscoy R, Lara-Jacobo L, Chavez-Santoscoy A, Gonzalez-Cobian L. Daily Consumption of Chocolate Rich in Flavonoids Decreases Cellular Genotoxicity and Improves Biochemical Parameters of Lipid and Glucose Metabolism. Molecules. 2018;23(9). https://doi.org/10.3390/molecules23092220
23. Rynarzewski J, Dicks L, Zimmermann BF, Stoffel-Wagner B, Ludwig N, Helfrich HP, et al. Impact of a Usual Serving Size of Flavanol-Rich Cocoa Powder Ingested with a Diabetic-Suitable Meal on Postprandial Cardiometabolic Parameters in Type 2 Diabetics—A Randomized, Placebo-Controlled, Double-Blind Crossover Study. Nutrients. 2019 Feb 16;11(2):417. https://doi.org/10.3390/nu11020417
24. Dicks L, Kirch N, Gronwald D, Wernken K, Zimmermann B, Helfrich H, et al. Regular Intake of a Usual Serving Size of Flavanol-Rich Cocoa Powder Does Not Affect Cardiometabolic Parameters in Stably Treated Patients with Type 2 Diabetes and Hypertension-A Double-Blinded, Randomized, Placebo-Controlled Trial. Nutrients. 2018;10(10). https://doi.org/10.3390/nu10101435
25. Sesso HD, Manson JE, Aragaki AK, Rist PM, Johnson LG, Friedenberg G, et al. Effect of Cocoa Flavanol Supplementation For The Prevention of Cardiovascular Disease Events: The Cocoa Supplement and Multivitamin Outcomes Study (COSMOS) Randomized Clinical Trial. Am J Clin Nutr. 2022;115(6):1490–500. https://doi.org/10.1093/ajcn/nqac055
26. Santos HO, Macedo RC. Cocoa-induced (Theobroma cacao) Effects on Cardiovascular System: HDL Modulation Pathways. Clinical Nutrition Espen. 2018;27(10):10–5. https://doi.org/10.1016/j.clnesp.2018.06.001
27. Racine K, Iglesias-Carres L, Herring J, Ferruzzi M, Kay C, Tessem J, et al. Cocoa Extract Exerts Sex-Specific Anti-Diabetic Effects In An Aggressive Type-2 Diabetes Model: A Pilot Study. Biochemical and Biophysical Research Communications. 2022;626:205–10. https://doi.org/10.1016/j.bbrc.2022.08.018
28. García-Díez E, López-Oliva M, Caro-Vadillo A, Pérez-Vizcaíno F, Pérez-Jiménez J, Ramos S, et al. Supplementation with a Cocoa-Carob Blend, Alone or in Combination with Metformin, Attenuates Diabetic Cardiomyopathy, Cardiac Oxidative Stress and Inflammation in Zucker Diabetic Rats. Antioxidants. 2022;11(2). https://doi.org/10.3390/antiox11020432
29. Simpson E, Mendis B, Dunlop M, Schroeter H, Kwik-Uribe C, Macdonald I. Cocoa Flavanol Supplementation and the Effect on Insulin Resistance in Females Who Are Overweight or Obese: A Randomized, Placebo-Controlled Trial. Nutrients. 2023;15(3). https://doi.org/10.3390/nu15030565
30. Yaribeygi H, Sathyapalan T, Atkin SL, Sahebkar A. Molecular Mechanisms Linking Oxidative Stress and Diabetes Mellitus. Oxidative Medicine and Cellular Longevity. 2020 Mar 9;2020:1–13. https://doi.org/10.1155/2020/8609213
31. Alvarez-Cilleros D, Ramos S, López-Oliva M, Escrivá F, Alvarez C, Fernández-Millán E, et al. Cocoa Diet Modulates Gut Microbiota Composition and Improves Intestinal Health in Zucker Diabetic Rats. Food Research International. 2020;132. https://doi.org/10.1016/j.foodres.2020.10905
Authors
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.