Management of Type 2 Diabetes Mellitus by Lifestyle, Diet and Medicinal Plants
Globally, the prevalence of chronic, noncommunicable diseases is increasing at an alarming rate and diabetes is one of them. If diabetes is not controlled then a lot of complication like coronary artery disease, cerebrovascular disease, peripheral vascular disease, retinopathy, nephropathy and neuropathy arise in diabetic patients and causes morbidity and/or mortality. Diabetes is increasing at an epidemic form and in near future the largest increases will take place in the regions dominated by developing economies. So, it will be a great social and economical burden to developing countries as well as the developed. But if we be aware about our diet and lifestyle and take proper medication we may prevent and reduce the prevalence of diabetes. Oral medicine plays an important role in management of diabetes. But most of the oral drugs are costly and have a lot of side effects. For this it is also necessary to take medicines with fewer or no side effects. And antidiabetic medicinal plants may play an important role in this case. In this article we have tried to describe how diet and lifestyle with using medicinal plants may help to prevent or maintain diabetes and help to reduce the mortality and morbidity due to diabetes or complication related to it.
Received: August 02, 2010;
Accepted: November 23, 2010;
Published: January 19, 2011
Diabetes Mellitus (DM) can be found in almost every population in the world
and epidemiological evidence suggests that, without effective prevention and
control programmes, diabetes will likely continue to increase globally. Type
1 diabetes usually accounts for only a minority of the total burden of diabetes
in a population but is increasing in incidence in both poor and rich countries.
Type 2 diabetes constitutes about 85% to 95% of all diabetes in high-income
countries and may account for an even higher percentage in low and middle-income
countries. Type 2 diabetes is now a common and serious global health problem,
which, for most countries, has evolved in association with rapid cultural and
social changes, ageing populations, increasing urbanization, dietary changes,
reduced physical activity and other unhealthy lifestyle and behavioral patterns
(International Diabetes Federation, 2006).
Nowadays type 2 DM is one of the major public health concerns in both developing
and developed countries in the Asian-Pacific region. It has become epidemic
in a number of countries, particularly in newly industrialized nations. The
direct and indirect social and economic costs of treating diabetes and its complications
have the potential to cripple the countries healthcare budgets. In recent
times, a new dimension has been added with the increasing appearance of type
2 diabetes in adolescents and even children (Asian-Pacific
Type 2 Diabetes Policy Group, 2005).
Diabetes has recently been described as the perfect epidemic (Lau,
2001) is rapidly emerging as a global health care problem that threatens
to reach pandemic levels by 2030. It is estimated that approximately 285 million
people worldwide, or 6.6% adult have diabetes, 70% of whom live in low- and
middle-income countries. This number is expected to increase by more than 50%
in the next 20 years if preventive programmes are not put in place. By 2030,
some 438 million people, or 7.8% of the adult population, are projected to have
diabetes. The largest increases will take place in the regions dominated by
developing economies (International Diabetes Federation, 2009).
Regardless of the type of diabetes, patients are required to control their
blood glucose levels with medications and/or by adhering to an exercise program
and a dietary plan. Insulin therapy by injection is given to those with type
1 DM and to some patients with type 2 DM. Patients with type 2 DM are usually
placed on a restricted diet and are instructed to exercise, the purpose of which
primarily is weight control. If diet and exercise fail to lower and stabilize
blood glucose levels, oral anti-diabetic medication is prescribed. In some cases,
insulin injections are necessary. Oral anti-diabetic agents exert their effects
by various mechanisms: (1) stimulating beta cells in the pancreas to produce
more insulin (sulfonylureas and meglitinides), (2) increasing the sensitivity
of muscles and other tissues to insulin (thiazolidinediones), (3) decreasing
gluconeogenesis by the liver (biguanides) and (4) delaying the absorption of
carbohydrates from the gastrointestinal tract (alpha-glucosidase). These treatments
are associated with adverse effects and some may produce toxic effects (e.g.,
thiazolidinediones may cause liver toxicity) (Dey et
Most of the oral therapeutic anti-diabetic agents are costly having with a lot of side effects. Moreover, it is very tough to the lower or middle income people to take costly anti-diabetic medication. As blood glucose monitoring is an essential task for patients suffering from diabetes; thus, beside diet and exercise any change caused by inexpensive herbal products to blood glucose levels without having any or fewer side effects may alter the amount of medication needed to control blood glucose.
CAUSES OF TYPE 2 DIABETES MELLITUS
There are a lot of causes (less insulin secretion by pancreas, insulin resistance
etc.) and risk factors (age, obesity, ethnicity, strong family history of type
2 diabetes etc.) that are directly related to the pathogenesis of type 2 DM.
Beside the risk factors the relation between lifestyle and diet habit with prevalence
of type 2 DM has been proved by several articles (Asian-Pacific
Type 2 Diabetes Policy Group, 2005).
In the past two decades, the rates of obesity have tripled in developing countries
that have been adopting a Western lifestyle involving decreased physical activity
and over consumption of cheap, energy-dense food (Hossain
et al., 2007). The upsurge in obesity is closely linked to the increase
in the prevalence of type 2 DM. About 90% of type 2 DM is attributable to excess
weight (Hossain et al., 2007). Like developing
countries over the last decade, profound changes in the quality, quantity and
source of food consumed in many developed countries combined with a decrease
in levels of physical activity have led to an increase in the prevalence of
diabetes and its complications (Yach et al., 2006).
Furthermore, some manifestations of Peripheral Diabetic Neuropathy (PDN) and
cardiovascular disease in overweight and obese subjects develop at the stage
of Impaired Glucose Tolerance (IGT) (Sumner et al.,
2003; Reindel et al., 2004; Pittenger
et al., 2005).
Several researches also showed the relation with the high fat diet, obesity
and insulin resistance (Thounaojam et al., 2010).
It is generally agreed that insulin resistance is an invariable accompaniment
of obesity but that normoglycemia is maintained by compensatory hyperinsulinemia
until the pancreatic β cells become unable to meet the increased demand
for insulin, at which point type 2 DM begins. The mechanism by which β
cells become unable to meet rising insulin demand has never been elucidated,
primarily because of the unavailability of human pancreatic islets for appropriate
study. However, post-mortem studies in patients with type 2 DM indicate that
the β cell mass is reduced (Rahier et al., 1983).
Some animal studies implicate fat deposition in islets as the cause of the β
cell decompensation, so-called lipotoxicity (Lee et al.,
1994). Excess fat in β cells and other nonadipocytes in this form of
obesity is ascribed to the high plasma levels of Free Fatty Acids (FFAs) (Lee
et al., 1994), coupled with a greatly enhanced capacity for lipogenesis
(Lee et al., 1997). There is compelling in
vitro evidence that the modest 5- to 10-fold increase in islet fat content
that occurs in vivo in the prediabetic phase of the disease causes the
compensatory β cell hyperplasia and hyperinsulinemia; a further increase
in islet fat to ~50 times normal reverses the foregoing compensatory changes
and causes β cell dysfunction, a reduction in the number of β cells
and diabetes (Milburn et al., 1995; Hirose
et al., 1996).
DIET AND LIFESTYLE TO PREVENT AND MANAGE TYPE 2 DIABETES MELLITUS
Type 2 diabetes mellitus is a common disease with substantial associated morbidity
and mortality (Harris et al., 1998). Most adverse
diabetes outcomes are a result of vascular complications, both at a macrovascular
level (coronary artery disease, cerebrovascular disease, or peripheral vascular
disease) and a microvascular level (retinopathy, nephropathy, or neuropathy)
(UK Prospective Diabetes Study Group, 1998). Macrovascular
complications are more common; up to 80% of patients with type 2 diabetes will
develop or die of macrovascular disease (Wingard et
al., 1993; Meigs et al., 1997) and the
costs associated with macrovascular disease are an order of magnitude greater
than those associated with microvascular disease (American
Diabetes Association, 1998).
Because diabetes is defined by blood glucose levels, much of the attention
in diabetes care focuses on the management of hyperglycemia. This has been magnified
by the causal link between hyperglycemia and microvascular outcomes (Diabetes
Control and Complications Trial Research Group, 1993). However, while some
observational evidence suggests that level of glycemia is a risk factor for
macrovascular disease (Laakso, 1996), experimental studies
to date have not clearly shown a causal relationship between improved glycemic
control and reductions in serious cardiovascular outcomes (Diabetes
Control and Complications Trial Research Group, 1993). Given these results
and the epidemiologic characteristics of diabetes complications, it would seem
more logical to focus diabetes care on prevention of macrovascular complications
rather than on glucose control and microvascular complications (Vijan
and Hayward, 2003).
For this to prevent and maintain diabetes first we have to concentrate ourselves
on diet and physical activities. Two landmark studies have confirmed that attainment
of glycemic control as close to normal as possible is necessary for prevention
of long term complications in both type 1 (Diabetes Control
and Complications Trial Research Group, 1993) and type 2 (Ohkubo
et al., 1995) diabetes and this requires an intensive approach to
management. Nutrition is of utmost importance in intensive management and has
often been described as the cornerstone of diabetes care (Kalergis
et al., 2005). The main focus in the nutritional management of diabetes
is to improve glycemic control by balancing food intake with endogenous and
/or exogenous insulin levels. Historically, there have been several attempts
to control the glycemic response to food, particularly carbohydrate-containing
foods, including use of very low carbohydrate and starvation diets, artificial
sweeteners and pharmacological preparations such as fast acting insulin and
inhibitors of carbohydrate absorption (Kalergis et al.,
2005). One way to classify the glycemic response of various carbohydrate-containing
foods is Glycemic Index (GI). This term was first coined by Jenkins to describe
the extent that blood glucose rises after a test food in comparison to a reference
food, usually white bread (Jenkins et al., 1984).
Beside proper diet physical exercise is also necessary to maintain blood glucose
level and to prevent type 2 diabetes related complications, such as nephropathy,
retinopathy, arteriosclerotic heart disease and peripheral neuropathy, which
most often result from the prolonged exposure to hyperglycemia (Kahn,
1995). Several animal studies have been showed the effect of physical exercise
on maintenance of glucose level by improve glucose uptake through various mechanisms
(Phillips et al., 1996; Ivy,
1997; Wojtaszweski et al., 1997; Heled
et al., 2002).
MEDICINAL PLANTS TO PREVENT AND MANAGE TYPE 2 DIABETES MELLITUS
Oral anti-diabetic drugs are usually taken when diet and exercise failed to maintain hyperglycemia. Oral anti-diabetic agents are used to stimulate beta cells in the pancreas to produce more insulin (sulfonylureas and meglitinides), increase the sensitivity of muscles and other tissues to insulin (thiazolidinediones), decrease gluconeogenesis by the liver (biguanides), delay the absorption of carbohydrates from the gastrointestinal tract (alpha-glucosidase), treat hyperlipidemia and hyperinsulimea.
But presently, there is growing interest in herbal remedies due to the side
effects associated with the oral hypoglycemic agents (therapeutic agent) for
the treatment of diabetes mellitus (Day, 1998; Grover
et al., 2002). In recent years, herbal medicines have started to
gain importance as a source of hypoglycemic agents. Marles
and Farnsworth (1995) estimated that more than 1000 plant species are being
used as folk medicine for diabetes. Biological actions of the plant products
used as alternative medicines to treat diabetes are related to their chemical
composition. Herbal products or plant products are rich in phenolic compounds,
flavonoids, terpenoids, coumarins and other constituents which show reduction
in blood glucose levels (Jung et al., 2006; Hong-Fang
et al., 2009). Several species of herbal drugs have been described
in the scientific and popular literature as having antidiabetic activity (Valiathan,
1998). Several investigators reported anti-diabetic properties of various
herbs not only in rats (Shanmugasundaram et al.,
1990; Okabayashi et al., 1990) but also in
humans (Hirata et al., 1992). Some of these showed
the mechanisms by which medicinal plants produce anti-diabetic effects include:
recovery of beta cells (Shanmugasundaram et al.,
1990), inhibition of glucose absorption (Hirata et
al., 1992), stimulation of insulin release (Sugihara
et al., 2000) and increased glucose tolerance (Kar
et al., 1999). Furthermore, the lipid lowering properties have been
described (Shigematsu et al., 2001). Due to their
perceived effectiveness, fewer side effects in clinical experience and relatively
low costs, herbal drugs are now being prescribed widely by so many health practitioners
(Verspohl, 2002). In the following paragraphs we describe
the effect and mechanism of medicinal plants in maintenance of DM.
Ginseng (Panax ginseng): Several species are members of the Panax
genus (Araliaceae family). These species include Panax quinquefolius
(the American ginseng), Panax japonicus (the Japanese ginseng) and Panax
ginseng (the Asian or Korean ginseng) (Ernst, 2002).
Traditionally, the roots of the ginseng plant are used medicinally. Herbs in
the Panax species contain ginsenosides that are unique to Panax. Ginsenosides
are sapogenins (steroidal saponins) with a backbone chemical structure of either
dammarane-type tetracyclic triterpene or oleananetype pentacyclic triterpene
(Shibata, 2001). In addition to the ginsenosides, P
ginseng contains at least 14 different glycans, known as panaxans (Konno
et al., 1985; Oshima et al., 1985).
Components in P ginseng alter blood glucose concentration by different
mechanisms. Sever animal studies showed that the aqueous extract of ginseng
root has the capability of producing hypoglycemia in both glucose-loaded healthy
animals and in animals with experimentally induced diabetes, but not in healthy
animals. This extract altered blood glucose levels by stimulating the biosynthesis
of insulin by the pancreas and inducing the production of a glucose transporter
in the liver (Waki et al., 1982; Ohnishi
et al., 1996). The glycans in ginseng root also produce hypoglycemic
effects in both normal animals and in those with experimentally induced diabetes
(Ng and Yeung, 1985). The polysaccharides in ginseng
lower blood glucose levels either by decreasing glucose production by the liver
or by increasing the glucose use by tissues (Yang et
al., 1990). Likewise, the polypeptides reduce blood glucose concentrations
via their effect on adrenergic receptors (Wang et al.,
Fenugreek (Trigonella foenum-graecum): The seeds of Trigonella
foenum-graecum Linn. (Fabaceae) are traditionally used for their tonic,
carminative, glucose-lowering functions and in the management of gastrointestinal
ulcers (Zia et al., 2001). Several animal studies
showed that the aqueous and alcoholic extracts of the seeds, as well as the
seeds themselves, have a hypoglycemic effect when given orally (Raju
et al., 2001; Puri et al., 2002; Yadav
et al., 2008). Another animal study showed the hypoglycemic effect
of the alcoholic extract of fenugreek in both healthy and diabetic rats, but
the diabetic rats experienced a more pronounced decrease in blood glucose (Vats
et al., 2002). Beside animal studies in a placebo-controlled clinical
trial the hypoglycemic effect of hydro-alcoholic fenugreek seed extract has
been proved in insulin resistant patients with type 2 DM (fasting glucose <200
mg dL-1). In this trial one group received 1 g per day of hydro-alcoholic
fenugreek seed extract for two consecutive months (12 patients) and another
a placebo with dietary control and exercise (13 patients). All patients were
insulin resistant. There was no statistical difference between the two groups
with respect to fasting blood glucose levels or the two-hour post-glucose tolerance
test at the end of the two-month treatment; however, a decrease in insulin secretion
by the pancreas as well as improved sensitivity to insulin was observed after
the fenugreek treatment but not with placebo (Gupta et
al., 2001). In another study it has been showed that the patients with
type 1 DM who received fenugreek seed powder in two divided doses (50 g each)
with their lunch and dinner for 10 days experienced a significant reduction
in their fasting blood glucose levels and a 54% reduction in 24 h urinary glucose
secretion (Sharma et al., 1990). It appears that
fenugreek can reduce blood glucose levels in patients with type 1 or type 2
DM, although its effect is less pronounced in patients with more severe diabetes.
The effect of fenugreek on blood sugar in healthy individuals does not seem
to be of importance. Clinicians counseling diabetic patients should be aware
of this potential interaction between fenugreek and antidiabetic drugs (Al-Achi,
Bitter Melon (Momordica charantia): Momordica charantia
Descourt. (Cucurbitaceae) is a complex plant medicine that has a remarkably
long history of use, both as a food and as a medicine. In Asia and South America,
this herb is widely used in folk medicine to treat diabetes. Several experimental
animal studies support its effect on lowering blood glucose levels in both healthy
and diabetic animals (Vikrant et al., 2001; Virdi
et al., 2003). A clinical trial showed the effect of bitter melon
juice that significantly improved glucose tolerance and the fried melon also
improved glucose tolerance. Serum insulin levels did not increase, suggesting
that bitter melon may have influenced hepatic or peripheral glucose disposal
directly. This is doubly important because any agents that stimulate insulin
release (so-called insulin secretagogues) may worsen insulin resistance in patients
with NIDDM and accelerate beta-cell loss in patients with IDDM. Glycosylated
hemoglobin also decreased in the patients suggesting an extrapancreatic action
(Leatherdale et al., 1981).
In bitter melon there is a protein that is structurally and pharmacologically
similar to bovine insulin (Baldwa et al., 1977).
It is often referred to as v-insulin and research is ongoing to determine if
this type of insulin may be suitable for patients who do not tolerate, or for
philosophical reasons prefer not to use, animal sourced insulin. In a small
study, 9 patients (6 with juvenile onset, 1 maturity onset and 2 asymptomatic
IDDM) were given v-insulin subcutaneously. Five healthy and 5 patients with
overt diabetes served as controls and were given a placebo injection. A hypoglycemic
effect in the treatment group was observed that started 30-60 min after injection
but peaked after 4-12 h (compared to 2-3 h for regular insulin) (Baldwa
et al., 1977). In another study, subcutaneous v-protein produced
a hypoglycemic effect in a small controlled study (n = 19) of juvenile and maturity
onset IDDM. One juvenile patient who suffered side-effects when on bovine insulin
(swelling, stomach pain and bouts of hypoglycemia) was maintained on v-protein
for 5 months without experiencing any adverse effects (Khanna
et al., 1981).
Gymnema (Gymnema sylvestre): G. sylvestre R. Br. (Asclepiadaceae)
leaves contain triterpene saponins belonging to oleanane and dammarene classes.
Oleanane saponins are gymnemic acids and gymnemasaponins, while dammarene saponins
are gymnemasides. Besides this, other plant constituents are flavones, anthraquinones,
hentri-acontane, pentatriacontane, α and β-chlorophylls, phytin, resins,
dquercitol, tartaric acid, formic acid, butyric acid, lupeol, β-amyrin
related glycosides and stigmasterol. The plant extract also tests positive for
alkaloids. Leaves of this species yield acidic glycosides and anthroquinones
and their derivatives (Dateo and Long, 1973).
Gymnemic acids have antidiabetic, antisweetener and anti-inflammatory activities.
The antidiabetic array of molecules has been identified as a group of closely
related gymnemic acids after it was successfully isolated and purified from
the leaves of G. sylvestre (Liu et al., 1992).
G. sylvestre leaves have been found to cause hypoglycemia in laboratory
animals and have found a use in herbal medicine to help treat adult onset diabetes
mellitus (NIDDM) (Shanmugasundaram et al., 1990;
Okabayashi et al., 1990; Hirata
et al., 1992).
The mechanisms by which G. sylvestre produce antidiabetic effects include:
recovery of beta cells (Shanmugasundaram et al.,
1990), inhibition of glucose absorption (Hirata et
al., 1992; Shimizu et al., 1997), stimulation
of insulin release (Sugihara et al., 2000) and
increased glucose tolerance (Kar et al., 1999).
Furthermore, the lipid lowering properties have been described (Wang
et al., 1990; Shigematsu et al., 2001).
However, it must be considered that all these studies were performed using a
mixture of glycosides (Shimizu et al., 1997),
a fraction denominated G. sylvestre (Shanmugasundaram
et al., 1990; Okabayashi et al., 1990),
alcoholic extract of leaves (Kar et al., 2003)
and gymnemic acid (Hirata et al., 1992; Sugihara
et al., 2000).
Banaba (Lagerstroemia speciosa): Lagerstroemia speciosa L.
Pers. (Lythraceae), commonly known as banaba in the Philippines is a tropical
flowering tree used as a folk medicine for the treatment of a myriad of diseases
(De Padua et al., 1997). In the Philippines, the
tea made from the leaves of L. speciosa has been used as a beverage for
the treatment and prevention of diabetes mellitus (Quisumbing,
1978). Kakuda et al. (1996) studied banabas
antidiabetic activity by preparing water and methanol extracts of the plant.
After feeding the extracts to hereditary type 2 diabetic KK-Ay/Ta Jcl mice,
they found that food containing either 5% of water extract (BE) or 3% of methanol
extract was effective in reducing blood glucose and insulin levels (p<0.05)
(Kakuda et al., 1996). In a second study it has
been demonstrated that the extract possesses an anti-adipogenic activity by
reducing weight gain on parametrial adipose tissue in female diabetic KKAY mice
(Suzuki et al., 1999). Other in vitro studies
using 3T3- L1 showed that the extract exhibits activities that stimulated both
glucose transport and inhibited adipocyte differentiation (Liu
et al., 2001; Bai et al., 2008). In
rat adipocyte, leaves of L. speciosa increased the rate of glucose uptake
and decreased the isoproterenol-induced glycerol release (Hayashi
et al., 2002).
Tanquilut et al. (2009) showed the first physiological
evidence that L. speciosa possesses anti-hyperglycemic effect in alloxan-induced
diabetic mice that may offer a valuable therapeutic measure in the treatment
of diabetes mellitus (Tanquilut et al., 2009).
Moreover, clinical use of L. speciosa in diabetic patients has also been
shown to suppress glucose level in a dose-dependent manner (Judy
et al., 2003).
Holy basil (Ocimum sanctum): Ocimum sanctum Linn. (Labiatae)
commonly known as Holy Basil. Different parts of this plant have been claimed
to be valuable in a wide spectrum of diseases. Here the antidiabetic properties
of O. sanctum are our main concern. The anti-diabetic properties of O.
sanctum have been evaluated in several experimental animal models and very
few studies on human are available. One animal study showed administration of
fresh O. sanctum leaves (1 and 2 g day-1) for four weeks
exerted significant hypoglycaemic and uricosuric effects on fasting glucose
and 24 h urine samples in experimental adult albino rabbits (Sarkar
et al., 1990). Some other animal studies showed the hypoglycemic
effect of different types of O. sanctum leaf extract in experimental
rats with diabetes mellitus induced by alloxan (Giri et
al., 1987) or by glucose and/or streptozotocin (Chattopadhyay,
1993; Chandra et al., 2008). O. sanctum
also showed hypoglycaemic activity along with other herbal formulations. Dry
O. sanctum leaf powder when fed at 1% of total diet for 30 days to the
rats with diabetes induced by alloxan, fasting blood sugar, uronic acid, total
amino acids, total cholesterol, triglyceride, phospholipids and total lipids
reduced significantly (Rai et al., 1997a). Similarly,
methanolic extract of O. sanctum when given to experimental animals at
a dose of 200 mg kg-1, bw for 30 days, the activities of glucokinase
and hexokinase was increased significantly (Vats et al.,
2004). It was also found that feeding of 200 mg kg-1, body weight
aqueous extract of whole O. sanctum plant for 60 days significantly delayed
insulin resistance in fructose fed experimental mice (Reddy
et al., 2008). The alcoholic extract and other organic solvent fractions
extract has been found to stimulate insulin secretion from perfused rat pancreas,
isolated islets and clonal pancreatic β-cells. The proposed mechanism of
action for the secretion of insulin is that, O. sanctum extract is able
to stimulate adenylate cyclase/ cAMP or the phosphatidylinositol or direct effect
on exocytosis that induce mobilization of intracellular Ca++ as well
as promoting Ca++ entry (Hannan et al.,
In one of the initial randomized controlled clinical trails, anti-diabetic
properties have been studied in 40 noninsulin dependent diabetes mellitus (NIDDM)
patients. It was observed that taking dried O. sanctum leaf powder made
from 2.5 g fresh leaves per day orally on empty stomach could reduce the fasting
glucose level up to 21 mg dL-1 and postprandial blood glucose by
15.8 mg dL-1 (Agrawal et al., 1996).
In another trial on 27 NIDDM patients, it was observed that supplementation
of O. sanctum powder along with hypoglycaemic drugs for one month could
significantly decrease the blood glucose, glycosylated proteins, total amino
acids, uronic acid, triglycerides, Low Density Lipoprotein (LDL) and very Low
Density Lipoprotein (VLDL), compared to control group on similar hypoglycaemic
drugs. However, there was no significant change in High Density Lipoprotein
(HDL) level (Rai et al., 1997b).
Periwinkle (Catharanthus roseus): Catharanthus roseus Linn.
(Apocyanaceae) is known with various names (Madagascar periwinkle; Vinca
rosea; Lochnera rosea) in all over the world. Water decoction of
the leaves and/or the whole plant is used as household remedy for diabetes in
several countries (Don, 1999). Several animal studies
showed the antidiabetic activity of various types organic extracts of C.
roseus (Swanston-Flatt et al., 1989; Chattopadhyay
et al., 1991; Singh et al., 2001).
As water decoction or fresh juice of leaves are used traditionally as antidiabetic,
some animal studies also done with the juice of fresh leaves. In two animal
studies researchers showed the hypoglycemic effect of the juice of fresh leaves
of C. roseus in streptozotocin-induced (Ahmed et
al., 2007) and alloxen induced (Nammi et al.,
2003) diabetic animals. Moreover, the hypoglycemic effect of the powder
of C. roseus leaves has also been proved clinically (Banakar
et al., 2007).
Ivy Gourd (Coccinia indica): Coccina indica Wight and
Am. has been used since ancient times as an antidiabetic drug by physicians
who practice the Indian system of medicine known as Ayurveda. For this some
researchers concentrate themselves to proof the antidiabetic effect of this
plant. One animal study showed hypoglycemic effect of 95% ethanol extract of
the leaves of C. indica. This effect was due in part to the inhibition
of the key gluconeogenic enzyme glucose-6-phosphatase (Hossain
et al., 1992). In another animal study showed that the oral administration
of the isolated pectin from the fruit of the C. indica at a dose of 200
mg/100 g BW/day produced a reduction in glycaemia and an increase in liver glycogen.
Glycogen synthetase activity was significantly increased. Incorporation of labeled
glucose into hepatic glycogen was also found to be higher. A significant reduction
in phosphorylase activity was noted in the pectin-administered groups (Kumar
et al., 1993).
Garlic (Allium sativum L.) and Onion (Allium cepa L.):
These two herbs are extensively used in many ethnic cuisines. Both garlic and
onion belong to the genus Allium of the family Liliaceae. Garlic and
onion have been shown to produce significant decreases in blood glucose concentrations
in experimental animals. Healthy Wistar adult male rats showed significant decreases
in blood glucose levels after they were fed a one-month diet containing 2% (wt/wt)
garlic (Ahmed and Sharma, 1997). In healthy rabbits,
the maximum glucose concentration following a subcutaneous glucose tolerance
test was lower after oral treatment with garlic or onion (Roman-Ramos
et al., 1995). Components in garlic and onion, S-allyl cysteine sulfoxide
in garlic and S-Methyl Cysteine Sulfoxide (SMCS) in onion, were shown to cause
the glucose-lowering effect seen in diabetic animals (Sheela
et al., 1995; Kumari et al., 1995;
Augusti and Sheela, 1996). SMCS was shown to improve
the use of glucose as a result of an increase in insulin secretion by the pancreas
(Kumari and Augusti, 2002).
Around 100 years ago infectious diseases, like cholera, small pox, TB, typhoid,
malaria and so on, were the main causes of mortality. With the subsequent developments
in medical science these infectious diseases are less of a problem. In the mean
time chronic, noncommunicable diseases and complications have surpassed infectious
diseases as the main cause of death and disability. Among the noncommunicable
diseases diabetes is increasing at an alarming rate. If diabetes is not controlled
then a lot of complication like coronary artery disease, cerebrovascular disease,
peripheral vascular disease, retinopathy, nephropathy and neuropathy arise in
diabetic patients and causes morbidity and/or mortality (Wingard
et al., 1993; Meigs et al., 1997;
UK Prospective Diabetes Study Group, 1998). By analyzing
the recently collected data it is estimated that in near future more than 1.2%
increase (from 6.6 to 7.8%) in prevalence of diabetes will take place worldwide.
Moreover, the largest increases will take place in the regions dominated by
developing economies (International Diabetes Federation, 2009).
So, it will be a great social and economical burden to developing countries
as well as the developed.
We always say that prevention is better than cure. The role of diet in maintenance
and prevention of diabetes has been supported by several studies (Kalergis
et al., 2005; Ghattas et al., 2008).
For this, it is necessary for us to be aware about our diet and lifestyle that
play a vital role in prevalence of diabetes and diabetes related morbidity and
mortality (Yach et al., 2006; Haque
and Nargis, 2010). We should take calorie restricted, well planned low-fat
and/or low carbohydrate diet and have to increase physical activities to prevent
or manage diabetes. Besides changing diet habit and lifestyle the patient should
take oral herbal preparations as these are with fewer side effects (Verspohl,
With the development of modern technology a lot of animal and clinical trials
on antidiabetic properties of medicinal plants have been conducted. In this
study we included few of them. Among these herbs the antidiabetic properties
of Trigonella foenum-graecum (Sharma et al.,
1990; Gupta et al., 2001; Yadav
et al., 2008), Momordica charantia (Leatherdale
et al., 1981), Gymnema sylvestre (Hirata
et al., 1992), Lagerstroemia speciosa (Judy
et al., 2003), Ocimum sanctum (Agrawal
et al., 1996; Rai et al., 1997a),
Catharanthus roseus (Banakar et al., 2007)
have been proved by both animal and clinical trials. Moreover, through animal
studies researchers are trying to prove the antidiabetic properties of traditionally
used plants and their usefulness in the ethnotherapy of type 2 diabetes (Sugiwati
et al., 2006; Eseyin et al., 2007;
Palsamy and Malathi, 2007; Anthony
and Adebimpe, 2009; Anreddy et al., 2010;
Radhika et al., 2010). On the other hand, the
preparations of herbal antidiabetic medicine are cheap and economically feasible
to low or middle income people also. So, it might play a significant role in
prevention and maintenance of diabetes.
As maintenance of blood sugar level and reduction of morbidity and mortality due to diabetes is our main concern so beside proper diet and exercise we should take safer herbal preparation and should encourage the researchers to find out more effective antidiabetic herbal plants to reduce the economic burden of a country.
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