Role of Herbal Medicines in the Treatment of Diabetes Mellitus: An Updated Review
Jyoti Rathi
1, Sunil Kumar
1, Beena Kumari
1,2*, Aparna Khansili
2, Sangeeta Narwal
1,3, Deepika Purohit
1,Deeksha Manchanda
1, Manish Makhija
1,Sangita Saini
3, Parijat Pandey
41,Department of Pharmaceutical Sciences, Indira Gandhi University, Meerpur, Rewari, Haryana, India - 123401
2*Department of Pharmacy, G.D. Goenka University, Gurugram, Haryana, India – 122103
3Shri Baba Mastnath Institute of Pharmaceutical Sciences, Baba Mastnath University, Rohtak, Haryana-124021
4Department of Pharmaceutical Sciences, Gurugram University, Gurugram, Haryana-122413
ABSTRACT
Diabetes is a serious public health problem because 70% of the patients have uncontrolled diabetes which leads to complications early. Poor monitoring is the main reason because many of the patients are not monitoring at all. So this is the main challenge to know about controlling parameters for this disease. But the best news is that major strides are operative in diabetes prohibition, diagnosis, and care. For the treatment of type 1 diabetes patients require administration of insulin 3-4 times in a day during their lives and the blood sugar level of patients should be observed routinely to prevent obstacles such as retinopathy and cardiovascular disease risks.
Well-monitored glycemic control is required for the management of type 2 diabetes. As it may results in the loss of glycemic regulation, the need to regulation the continuing degradation of β-cell function is necessary.
Insulin and conventional drugs are effective, but the associated glucoregulatory and metabolic dysfunctions can not be repaired. Over the years, herbal medicine has been used to cure various illnesses, such as diabetes. In addition to their mainstream therapies, herbal medicines with antidiabetic properties are used by many diabetic patients, which can present both an advantage and a possible risk for successful control of their disease. The review provides detailed report of diabetes, its diagnosis and role of herbal medicines in its treatment.
Keywords
Diabetes Mellitus, Diagnosis, Drugs, Herbs, Applications
Introduction
Diabetes mellitus (DM) is a chronic condition characterized by insulin synthesis lack and its intervention, or together. This results to chronic hyperglycemia with disruptions in most of the human body's metabolic processes [1]. Untreated cases display vascular damage and severe tissue which leads to severe complications such as neuropathy, retinopathy, cardiovascular complications and ulcerations [2-4]. Polyuria, polydipsia, weight loss, polyphagia, cardiac arrhythmia, tachycardia and hypotension are signs and symptoms of hyperglycemia [5-7].
Diabetes mellitus is categorized into 3 types: Type 1, Type 2 and third one is gestational diabetes mellitus.
Type 1 Diabetes mellitus is referred to as insulin-dependent DM due to non-functioning of the β-cell of the pancreatic islets of langerhans.
Type 2 Diabetes mellitus is referred to insulin independent DM in which transient loss of β cell mass arises that is attributed to hereditary predisposition which often occurs in obese people and is related to high cholesterol level and high blood pressure. Type 2 DM therapy aims at decreasing the insulin conflict and increasing secretion of insulin.
Gestational diabetes is a form of diabetes that found in pregnant women with hyperglycemia. It typically occurs in the 2nd or 3rd trimester in 2-4 percent pregnancies [8].
Diagnosis of Diabetes Mellitus
Random plasma test: This is the easiest test, and before taking the rest, it does not require fasting. If blood sugar is 200 or more than 200 mg / dl, it is most likely to suggest diabetes but must be reconfirmed.
Fasting plasma glucose test: Before taking the test, there should be eight hours of fasting. A diagnosis of diabetes is confirmed by glucose greater than 130 mg/dl on performed two or more than two tests on entirely separate days [9].
Oral glucose tolerance test: If the value is 160-200 mg / dl for random plasma glucose test and 110-125 mg/dl for the fasting plasma test then this test is carried out. This blood test assesses the reaction to glucose in the body. This
test requires at least eight hours of fasting, but not more than 16 hours. If the amount of glucose is determined for fasting, then 75gm of glucose and 100gm for pregnant women are given. Then the blood is checked for two to three hours every thirty minutes to one hour. If level of glucose is below 140 mg/dl for two hours, this test is normal. The diagnosis of diabetes is indicated by a fasting level of 130 mg/dl or above and a level of glucose 200 mg/dl or above for two hours [9].
Antidiabetic drugs
It is possible to avoid diabetes mellitus disease by controlling blood sugar levels with different medications, acquiring various exercise or yoga therapies or diet plans [10]. Actually available diabetes mellitus therapies include insulin therapy for the type 1 DM and some other oral hypoglycemic medicines i.e. peptide analogues, thiazolidinediones and sulphonylureas for type 2 diabetes treatment [11,12]. Different side effects like sickness, malignant anaemia, vomiting, swelling, dysentery, migraine and faintness are associated with synthetic drugs used for diabetes care, so the need of herbal medicines created [13]. In ancient times, traditional plants with therapeutic value were used by physicians and lay public for the treating various diseases i.e. Cardiac disease, cancer, skin diseases and diabetes etc. Traditional plants used to regulate diabetes have a long history in India and China. Several books are available like CharakaSamhita and SusrutaSamhita that describe the phytopharmacology characteristics of diabetes and its adverse effect [14]. The details of some drugs with their class, action and disadvantages are summarized in table 1.
Table 1: Representative antidiabetic agents used in the treatment of T2DM patients
Drug (s) Class Action Disadvantages References
Acarbose/
Miglitol/
Voglibose
AGIs Decrease absorption of carbohydrate
GI side effects and high dose frequency
[15]
Metformin Biguanides Enhance sensitivity of insulin, decreases risk of cardiovascular and hypoglycemia.
Side effects of Gastrointestinaland too much lactic acid produces in the body
[16]
Repaglinide (Prandin) Nateglinide (Starlix)
Meglitinides Stimulate the release of insulin
Decreases blood glucose level and increases body weight
[17]
Pioglitazone/Roziglitazone/
Troglitazone
TZDs High sensitivity of insulin and low risk of hypoglycemia
Increases risk of cancer and
weight of body
[18,19]
Saxagliptin (Onglyza) Sitagliptin (Januvia) Linagliptin (Tradjenta) Alogliptin
Dipeptidyl- peptidase 4 (DPP-4)
inhibitors
Enhances insulin release and inhibits glucose release
Infection of upper respiratory tract, headache and pharyngitis
[20,21]
Liraglutide/ Exenatide Glucagon like peptide -1 receptor
agonists
Increases secretion of insulin and decreases secretion of glucagon
Side effects of gastrointestinal tract, renal dysfunction and acute pancreatitis
[15,22]
Empagliflozin/
Dapagliflozin/ Canagliflozin
Sodium-glucose transporter 2 inhibitors
Inhibits reabsorption of glucose
Nausea or vomiting [23]
Glyburide/
Glipizide/
Gliclazide/
Glimepiride
Sulfonylureas Incresease secretion of insulin
Hypoglycemia weight gain
[15,23]
Colesevelam (Welchol) Bile acid sequestrants
Reduces level of cholesterol and blood glucose
Flatulence Constipation Indigestion
[22]
Pramlintide (Symlin) Amylin mimetics
help in controlling level of blood sugar
Hypoglycemia Nausea or vomiting
[24]
Role of herbs in the treatment of Diabetes Mellitus
Due to fewer bad effects and adverse effects, natural medications have proven to be a safer option over prescription drugs.
Herbal formulations can be purchased without prescription. These are safe natural drugs i.e. no adverse effects are present. Herbal preparations include natural herbs and extracts of fruits and vegetables that are effective without harmful effects in the treatment of multiple diseases. In the other hand, chemicals are synthetically prepared, which also have side effects. Herbal formulations compared with allopathic drugs are inexpensive. Herbal formulations are Enviroment friendly because these are made from normal products whereas allopathic drugs are made from substances which are chemically modified. Herbal preparations are available without prescription while most allopathic medicines required prescription [25-26].
Herbal antidiabetic drugs
The medicinal plants and herbs are currently used for their anti-diabetic activity in extract forms and restore the action of pancreatic β- cells [27]. Flavonoids, tannins, phenolics, and alkaloids are the basic most usual herbal active ingredients used in the diabetes treatment [28]. The continuation of these substances implies the significance of the anti-diabetic properties of these plants [29]. Tannin, for instance, increases the function of beta cells of pancrease and enhance insulin discharge. Quercetin is an antioxidant that interacts with many oxygen radicals removal pathways, preventing peroxidation of lipid and chelation of metal ion [29]. In fact, the mechanisms of actions for hypoglycemic plants include: increase in the secretion of insulin, increase in the absorption by muscle and adipose tissues, from the intestine preventing the incorporation of glucose, and preventing the output of glucose by the cells of liver [30]. The reduction or removal of diabetes complications is mainly responsible for these factors and the medicinal plants list used for antidiabetic activity is given in table 2, while marketed herbal formulations for antidiabetic activity are enlisted in table 3.
Table 2: List of herbal plants used in diabetes mellitus S.
No .
Plant species
Family Common
Name
Plant Part
Main Chemical constituents
Mechanism of action Ref
1. Aeglemarme los
Rutaceae Golden apple
Leaves extracts
Aeglemarmelos ine
Enhance the functional c ondition of pancreatic β- cells
[31]
2. Allium cepa Lilliaceae Pyaaz Bulbs Allyl propyl disulphide and diallyldisulphid e
Improve antioxidant activity
[32]
3. Allium sativum
Lilliaceae Garlic Petroleum ether exract of bulbs
Allylpropyldisu lphide oxide, allicin
Improve plasma lipid metabolism and plasma antioxidant activity
[33]
4. Aloe barbadensis
Asphodelacea e
Ghikanwa r
Leaf pulp extract
β- sitosterol, campesterol
Improvement in
impaired glucose tolerance
[34]
5. Andro- graphispani culata
Acanthaceae Kalmegh Ethanolic extract of plant
Kalmeghin Increases the glucose utilization and lower plasma glucose
[35]
6. Annonasqua mosa
Annonaceae Sharifa Leaves Borneol, camphor, eugenol
Improve tolerance of glucose
[36]
7. Azadirachtai ndica
Meliaceae Margosa Leaf extract
Nimbin, quercetin
Glycogenolytic effect was blocked because of epinephrine action
[37]
8. Brassica juncea
Brassicaceae Mustard Aqueous extract
Sulforaphane Enhances Glycogen synthetase activity
[38]
9. Cajanuscaja n
Leguminosae Pigeon pea
Seeds 2’-2’ methyl cajanone, isoflavones, cajanin, cahanones
Substantialdecrease in serum glucose level
[39]
10. Carica papaya
Caricaceae Papaya Aqueous seed extract
Papain, chymopapain
Lowered fasting blood sugar, triglyceride, total cholesterol
[40]
11. Carumcarvi Apiaceae Caraway Aqueous extract of seed
Furfurol, carvone
Substantial decrease in blood glucose level
[41]
12. Cassia auriculata
Leguminosae Tanner’s cassia
Aqueous extract of seed
Limonene, terpinol
Enhances the activity of hepatic hexokinase, phosphor-fructokinase
[42]
13. Catharanthu sroseus
Apocynaceae Vinca Hot water decoction of leaves
Catharanthine, vincristine, vinblastine
Lowering of glycemia [43]
14. Cocciniaindi ca
Cucurbitacea e
Baby water- melon
Ethanolic extract of whole plant
Glutamic acid, Asparagine
Lesser blood glucose level because of suppressed glucose synthesis
[44]
15. Coriandrum sativum
Apiaceae Coriander Seed extract
p-cymene, linalool
Enhancing the activity of β-cells and decrease serum glucose
[45]
16. Cinnamomu m cassia
Lauraceae Cinnamon Bark Cinnam-
aldehyde, eugenol
Increases the sensitivity of insulin receptor
[46]
17. Cinnamomu m
tamala
Lauraceae Tejpatta Leaf extract
Linalool, β- caryophyllene
Insulin release from pancreatic β-cells
[47]
18. Curcuma longa
Zingiberaceae Turmeric Rhizomes Curcuminoids, bisdemethoxy -curcumin, dimethoxy- curcumin
Reduces blood sugar level, Improves metabolism of glucose
[48]
19. Eugenia jambolana
Myrtaceae Jambolan Fruit pulp Oleanolic acid, gallic acid
Decreases blood glucose level
[49]
20. Ficusbengal ensis
Moraceae Bargad Alcoholic extract of stem bark
Leucodelphinidi n
Enhanced insulin secretion from β-cells
[50]
21. Ficushispida Moraceae Daduri Alcoholic extract of leaves
Ficustriol, O- methyltylophori nidine
Reduces level of blood glucose and improved level of serum insulin
[51]
22. Gymnemasyl vestre
Asclepidacea e
Gudmar Dried leaves
Gymnemic acid, dammarene
Decreases blood glucose level
[52]
23. Mangiferain dica
Anacardiacea e
Mango Extract of leaves
Mangiferin Reduces intestinal absorption of glucose
[53]
24. Momordicac harantia
Curcubitacea e
Bitter gourd
Fresh green leaves
Charantin, sterol
Activates PPARs alpha a nd lowers plasma apo β100 in high- fat diet mice
[54]
25. Musa Musaceae Banana Flower Tryptophan, Reduces blood [55]
Paradisia tannin, serotonin
glucose and glycosylated haemoglobin levels 26. Ocimum
sanctum
Labiateae Tulsi Whole
plant
Eugenol Increases release of insulin
[56]
27. Panax ginseng
Araliaceae Ginseng Root extract
Ginsenosideprot opanaxdiol
Inhibit activity of α- glycosidase and reduces absorption of glucose
[57]
28. Phyllanthus emblica
Euphorbiacea e
Amla Entire plant
Alkaloids Reduces level of blood glucose
[58]
29. Punicagrant um
Puniaceae Pomegran ate
Seeds Gallic acid, protein, tannin, vitamin C
Decreases the blood glucose level
[59]
30. Swertiachira ta
Gentinaceae Chirata Whole plant
Gentianine, Xanthonemangi ferin,
Methyl swertianin
Reduces level of blood glucose
[60]
31. Terminaliaa rjuna
Combretacea e
Arjuna Bark and stem
Arjunolic acid, arjunic acid
Decreases blood glucose level and Glucose-6- Phosphate activity
[61]
32. Terminaliac atappa
Combretacea e
Almond Petroleum ether fruit extract
Omega-9-ftty acid
Reduction in blood glucose level
[62]
33. Tinosporaca rdifolia
Menispermac eae
Giloy Aqueous extract of root
Tinosporone, tinosporic acid
Declineinglycemia as well aslipids of brain
[63]
34. Trigonellafo enum
Fabaceae Methi Seeds Fat, volatile oil, carbohydrate, protein
Stimulating insulin relea se, reducing insulin resistance, and reducing blood sugar levels
[64]
35. Zingiberoffi cinalis
Zingiberaceae Sunth Rhizome Gingerol Insulin level improved [65]
Table 3: Antidiabetic herbal formulation marketed in India [66]
Sr.
No.
Brand Name Manufecturer Ingredients
1. Diabecon Himalaya Asparagus racemosus, Balsamodendronmukul, Trikatu, Aloe vera, Caseariaesculenta, Gymnemasylvestre, Ocimum sanctum, Swertiachirata, Abutilon indicum, Tribulusterrestris, Shilajit, Gmelinaarborea, Berberisaristata, Boerhaaviadiffusa, Sphaeranthusindicus,powders of Momordicacharantia, Eugenia jambolana, Piper nigrum, Tinosporacordifolia, Curcuma longa, Rumexmaritimus, Phyllanthusamarus, Gossypiumherbaceum, Pterocarpusmarsupium.
2. Pancreatic tonic 180 cp Ayurvedic herbal supplement
Aeglemarmelos, Cinnamomumtamala, Ficusracemosa, Momordicacharantia, Azadirachtaindica, Gymnemasylvestre,
Trigonellafoenumgraceum,Syzygiumcumini, Pterocarpusmarsupium
3. Bitter gourd powder Garry and Sun natural Remedies
Momordicacharantia
4. Diasulin Curcuma longa, Cassia auriculata, Momordicacharantia,
Tinosporacordifolia, Syzygiumcumini, Gymnemasylvestre, Scopariadulcis, Cocciniaindica, Emblicaofficinalis, Trigonellafoenumgraecum
5. Dia-care Admark Herbals
Limited
Himej, Neemchal, Kadu, Namejav, Jambubeej, SanjeevanMool
6. Diabetes-daily care Nature’s Health Supply
Momordicacharantia extract, Gymnemasylvestreextract, Chromax, Alpha Lipoic acid, Vanadium, Fenugreek extract, Cinnamon exract, Liquorice Root extract
7. Gurmar powder Garry and Sun
Natural Remedies
Gymnemasylvestre 8. Ayurveda alternative
herbal formula to Diabetes
Chakrapani Ayurveda
Azadirachtaindica, Tinosporacordifolia, Trigonellafoenumgraecum, Inularacemosa, Syzigiumcumini, Gymnemasylvestre, Momordicacharantia
9. Epinsulin Swastik
Formulations
Pterocarpusmarsupium
10. Diabeta Ayurvedic cure
Ayurvedic Herbal Health Products
AzadirachtaIndica, Momordicacharantia, Acacia arabica, Curcuma longa, Vincarosea, Gymnemasylvestre, Pterocarpusmarsipium, Tinosporacordifolia, Syzigiumcumini, Zingiberofficinale
11. Syndrex Plethico
Laboratories
Germinated Fenugreek seed extract
12. Diabecure Nature beautesanté Taraxacum, Erythereacentaurium, Berberis vulgaris, Juglansregia, Millefolium,
13.
MahumehaKusumakara Rasa
Shree
Dhoothapapeshwar Limited
Aeglemarmelos, Curucma longa, Pterocarpusmarsupium, Vasantkusumakar Rasa, Emblicaofficinalis,ShudhShilajit, Yashadabhasma, Enicostemmalittorale, Tinosporacordifolia, Vasantkusumakar Rasa
14. Zypter Om
Pharmaceuticals Limited
Vijayasar, Haridra, Bibhitaki, Amalaki, Guduchi and Gurmar, Haritaki, JasadBhasma, Chtak, Dalchini
15. HypoNIDD CharakPharma Shilajit, Curcuma longa,Meliaazadirachta,
Emblicaofficinalis, Momordicacharantia, Eugenia jambolana, Gymnemasylvestre, Pterocarpusmarsupium, EnicostemmalittoraleTinosporacordifolia, Cassia auriculata, Swertiachirata, YashadBhasma
16. DaburMadhuRakshak Dabur Eugenia jambolana, Piper nigrum, Terminaliachebula, Pterocarpusmarsupium, Gymnemasylvestre, Azadirachtaindica, Phyllanthusemblica, Trigonellafoenum- graecum, BhavanaDravyas, ShudhShilajit, MomordicaCharantia, Cinnamomumtamala, Terminaliabelerica
17. Ojamin Tates remedies Aeglemarmelos, Meliaazadirachta, Gymnemasylvestre, Carumcarvi, Terminaliachebula, Curcuma longa, Eugenia jambolana, Picrorrhizakurroa, Trigonellafoenum-graecum, Emblicaofficinalis, Terminaliabelarica, Swertiachirata, Salaciachinensis, Tinosporacordifolia
18. Madhumehari Granules Baidyanath Aeglemarmelos, Azadirachtaindica, Emblicaofficinalis, Curcuma longa, PicrorrhizaKurroa, Gymnemasylvestre, Tinosporacordifolia, Syzygiumcumini, Momordicacharantia, Acacia catechu, Cinnamomumtamala, ShilajitAsphaltum,
Ficusglomerata, Plumbagozeylanica,
Pterocarpusmarsupium, Trigonellafoenum-graecum
Conclusion
Diabetes mellitus, which affects millions of individuals worldwide, is the most common endocrine condition. There are so many compounds that assist in the treatment of diabetes, but as such no fixed therpy is there that can cure a patient completely from this disease. After doing a large number of trials, several modern medicines have been reported for diabetes. Isolated constituents and extracts from various ordinary resources, mainly plants have various constituests that results in control and treatment of diabetes problems and complications. Plants, partially because of their antidiabetic compounds, such as flavonoids,tannins, phenolics, and alkaloids are natural antioxidants and powerful herbal medicines. This review paper plays a very important role in the design of drugs and the treatment of diabetes mellitus hyperglycemic issues and it can be useful to establish result based different medicines using herbal preparation to cure different types of diabetes problem for health practitioners, scientists and scholars.
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