Diabetes

A study of ancient literature indicates that diabetes was fairly well known and well conceived as an entity in India. Plant-based drugs have been used against various diseases since a long time. The nature has provided abundant plant wealth for all the living creatures, which possess medicinal virtues. The essential values of some plants have long been published, but a large number of them have remained unexplored to date. Therefore, there is a necessity to explore their uses and to conduct Pharmacognostic and pharmacological studies to ascertain their therapeutic properties. In fact, nowadays, diabetes is a global problem. Tridax procumbens, is a weed extensively used in traditional medicine as anticoagulant, antifungal and insect repellent. Water extract of leaf and flower contained more proteins when compared to its methanolic counterpart. The same was observed in case of total free phenol present wherein among the methanolic extracts, leaf showed good result when compared to flower. Hydroxyl free radical scavenging assay is an assay to determine the antioxidant property of the sample.

Studies had shown that hydromethanolic leaf extract of Cnidoscolus aconitifolius (CA) caused dose-dependent antihyperglycaemic or hypoglycaemic effects. Its adverse effects were reportedly lesser compared to some currently used pharmaceuticals. Nuclear Magnetic Resonance (1H NMR-Spectrometry) had been used to analyze the chloroform fraction of this CA extract in order to identify the major and minor phytochemicals responsible for its activities. The presence of the bioactive flavonoids possibly has molecular mechanisms of lowering the diabetic glucose levels and complications. The antidiabetic compounds identified in plant extracts included: isoquercetin, eupafolin, hispidulin, oleanolic acid, β sitosterol and campesterol. These phyto-compounds work through different mechanisms, including the interference of glucose and lipid absorptions, regeneration of pancreatic islets or by increasing the insulin release by beta cells. These phyto-constituents could synergistically lower persistent hyperglycaemia and its complications. The plant leaves of CA are readily available in most residential areas as a vegetable or herb (‘Ogwu-obara’ in Igbo) with reported minimal side effects compared to more costly synthetic antidiabetic drugs. This review calls for the advancement of ethno-pharmaceutical technology in poorer African countries in order to carry out purposeful ethno-pharmacological researches and develop affordable phytotherapy for diabetes.

Complementary and alternative medicine (CAM) refers to a wide range of clinical therapies outside of conventional medicine the term “complementary “ refers to  the therapy that are used in conjunction with conventional medicine where as alternative medicine includes therapy that are used in place of conventional medicine. The term “integrative medicine that has been advocated by some CAM providers More than one-third of patients with diabetes in the united state use some type of complementary and alternative medicine herbs, dietary   supplements and mind body medicine are the most commonly used studies and CAM modalities to treat diabetes including proposed mechanisms a summary of evidence and adverse effect. It also offers recommendation for counseling patient regarding CAM use. The use of CAM for patients with diabetes was reported to be common in almost all parts of the world However, different definitions were used for CAM, which was one of the reasons for a wide range of prevalence of CAM use ranging from 17% to 73% CAM use prevalence in the USA ranged from 31% to 57% among diabetes patients , 63% in Bahrain 62% in Mexico 7% in UK  and 25% in Canada  China had a long tradition of use of herbal medicine for diabetes The findings of a systematic review reported that Chinese herbal medicines were reported to be more effective for diabetes compared with lifestyle modification alone  In China, traditional medicines accounts for 40% of all healthcare.

The present work deals with the use of folklore medicine by tribal and non-tribal communities of Nalgonda district, Telangana state, India for controlling diabetes, a chronic disease. Here it is focused on the use of plant species as folklore medicine to cure diabetes by the ethnic groups. Preliminary phytochemical analysis was carried out with different extracts like distill water, petroleum ether, chloroform and methanol of folk medicine samples and their constituent plant parts from Nalgonda district. The folk medicine and the individual plant parts present in the sample showed the presence of similar kind of phytochemicals with various screening tests for the control of diabetes.

Over the past years it has been recognized that women are more susceptible to coronary heart disease than men and it should be acknowledged in the management and assessment of coronary heart disease. Then there is a remarkable progress in the knowledge of cardiovascular risk factors related to gender. Triglycerides, high density lipoproteins levels, diabetes have been found to have greater Influence on coronary heart disease in women than men. But certain evidence showing that lipoprotein is a stronger cardiovascular risk factor in men compared to women. Risk factor control in patient with CHD remains poor, especially for obesity, smoking, and blood pressure in spite of guidelines. Patient should initiate or maintain lifestyle modification- weight control, increased physical activity, moderation of alcohol intake, limited sodium consumption, maintenance of a diet high in fresh fruits, low fat dairy products etc. Long acting drugs also minimize blood pressure variability and this may offer protection against progression of target organ damage and cardiovascular events. This review article addresses the impact of cardiovascular risk factors on both men and women and management of coronary heart disease.

Diabetes, the world largest metabolic disorder has become a serious threat to public health. The management of diabetes by synthetic drugs causes many unwanted complications. Hence this study was designed to explore the root Salep of Gymnadenia orchidis Lindl against type-2 diabetes to achieve a complications free herbal treatment for the disease. The Streptozotocin (STZ) induced-diabetic rats were supplemented with root Salep orally daily at an effective dose (200 mg/ g of body weight). The body weights and fasting blood glucose levels were measured periodically for 32 days.  After treatment period, the animals were sacrificed and glycosylated haemoglobin, lipid profiles, antioxidant enzymes levels, liver function enzymes etc. were determined. Phytochemically determined terpenoids was extracted from the root and orally supplemented (4 mg/g body weight) to the induced-diabetic animals. Normalization of fasting blood glucose levels, significant (P<0.001) decrement of glycosylated haemoglobin percentage, liver enzymes activities and increase body weights and anti-oxidants levels were noted for the Salep supplemented diabetic rats. Terpenoids played the key role in such observations. The root Salep of Gymnadenia orchidis Lindl or its terpenoids may be used as potentially herbal therapeutic agent for long term and effective solution against type-2 diabetes mellitus.

The evaluation of plant products on the basis of medicinal and therapeutic properties forms a platform for the discovery of newer drug molecules from different plant sources. To compare anti-diabetic effect between two ethanolic extracts of selected plants locally available in Bobbili region, Vizianagaram district, Andhra Pradesh, India on Streptozotocin induced diabetic rats. To compare anti-diabetic study, experimental rats were divided into five groups viz. Group I (Control), Group II (Diabetic, Streptozotocin, 50mg/kg bwt, i.p.), Group III (Diabetic with Glibenclamide(4mg/kg)), Group IV (Diabetic with Origanum majorana) and Group V (Diabetic with Indigofera linnaei Ali). Both plants extracts were supplemented with same dose i.e. 100mg/kg b.wt, orally. The blood glucose levels, lipid profile, body weight were evaluated in all above experimental groups before and after diabetes induction in 21 days pharmacological evaluation. Significantly decreased blood glucose level and simultaneously improved lipid profile and body weight in Group IV rats after oral administration of ethanol extract whereas in Group V rats are showing less effect compare to Group IV rats. Both the plant extracts effect compare with Group II and Group III rats statistically. Origanum majorana shows better antidiabetic activity because the leaf contain huge amount of antidiabetic phytoconstituents like rutin and quercetin flavonoids. In Indigofera linnaei Ali whole plant ethanol extract also shows antidiabetic activity because it contains kaempferol like important antidiabetic active constituents. Origanum majorana and Indigofera linnaei Ali plants may be used as a dietary supplement in diabetic patients. Further study is required to evaluate the antidiabetic activity.

Depression is commonly found as a co-morbid condition in patients with diabetes. The co-existence of depression is associated with poor glycaemic control and low medication adherence. The objective of this study was to assess and compare the severity of depression in patients with Type II diabetes taking OHA versus Insulin. A prospective observational study conducted  among  200 diabetic patients for a period of 6 months in the general medicine department of a tertiary care hospital, with established T2DM  satisfying inclusion and exclusion criteria were evaluated for depression by  using Hamilton Depression Rating scale (HAMD) with the help of physician. Finally comparing the severity of depression among patients  taking OHA versus Insulin. Out of 200 diabetic patients, 124 (62%) patients were depressed. About 22% patients shows moderate depression  ,followed by mild depression (20%), severe (10.5%) and very severe(9.5%). Mild-Moderate level of depression is more prevalent in diabetics than in general population. Majority of the patient taking OHA had no depression ( normal, 51%) followed by mild depression (19.6%), moderate (17.6%), and only 11.8% shows severe/ very severe depression. Patients on insulin showed that 27.5% have severe or very severe depression followed by moderate (26.3%), mild (22.5%), and 23.8% have no depression. Depression is more common in patients with diabetes mellitus. Study shows that depression is more prevalent in patients taking Insulin as compared to those using OHA.

Depression is commonly found as a co-morbid condition in diabetes. The relationship between the diabetes and depression is bidirectional. Coexistence of diabetes and depression is associated with poor symptom control, increased suffering, health care expenditure, disability, decreased quality of life and greater risk of death. Depression in diabetes is under diagnosed and undertreated. Depression adversely effect on both psychological well being and diabetic outcomes. Management of depression in diabetes should be directed toward improving psychological and medical outcomes, and quality of life. Pharmacologic and psychotherapeutic interventions shown to be effective in the management of depression in diabetes, which improve the glycaemic control and reduce the risk of short term complications. Selective serotonin reuptake inhibitors(SSRI), Serotonin norepinephrine reuptake inhibitors, and atypical antidepressants (eg. Buproprion) are preferred pharmacologic interventions for patients with diabetes and depression.

Metformin HCl is an oral anti-diabetic drug used in the treatment of type-2 diabetes but has been linked with gastrointestinal disturbances and lactic acidosis. The aim of this study is to improve the efficacy and achieve dose reduction of metformin HCl by entrapping the drug in solid lipid nanoparticles (SLN). Solid lipid nanoparticles of metformin were prepared by hot homogenization method at different stearic acid and polysorbate 20 ratios. The formulated particles were characterized by particle size, time-dependent pH, differential scanning calorimetry, drug entrapment efficiency (EE) and loading capacity, and in vivo hypoglycaemic activity in mice. P-values less than 0.05 were considered statistically significant. Formulations prepared with lipid-surfactant ratios of 1:5 and 1:2 formed nanoparticles with sizes of 474 and 617 nm, respectively, with moderate entrapment efficiencies and loading capacities, while time-resolved pH showed dependence on surfactant proportion. The size and entrapment efficiency-optimized metformin HCl nanoparticles (1:2 lipid-surfactant ratio) showed faster, higher and sustained reduction of blood glucose in mice than pure metformin HCl powder. Metformin SLN improved the delivery of metformin and may reduce the occurrence of side effects associated with metformin. Solid lipid nanoparticles of metformin HCl may therefore be recommended for effective management of type-2 diabetes mellitus.