Management of Diabetes with Medicinal plants and Dietary control (part 1)

It is predicted that by 2030, India, China and United States will have largest number of people with diabetes. The World Health Organization (WHO) estimates that more than 180 million people worldwide currently have diabetes and this figure is likely to more than double by 2030. In 2005, an estimated 1.1 million people died from diabetes and almost 80% of diabetes deaths occurred in low and middle-income countries.

Almost half of diabetes deaths occur in people under the age of 70 years; 55% of diabetes deaths are in women and the WHO projects that diabetes death will increase by more than 50% in the next 10 years without urgent action. Most notably, diabetes deaths are projected to increase by over 80% in upper-middle income countries between 2006 and 2015.

Plants have been the main source of medicines since ancient times. Despite tremendous advances in medicinal chemistry, synthetic drugs have not provided cures to many diseases due to their adverse side effects or diminution in response after prolonged use. As such, there is renewed interest in traditional medicines with the belief that plant-derived drugs are generally less toxic and safer than synthetic drugs. With respect to diabetes, numerous studies have indicated that plant-derived chemicals may be useful in the therapeutic treatment of diabetes.

However, before the development of therapeutic insulin, diet was (and still is) the main method of treatment and modern treatment focuses on a combination of drugs and diet. Dietary measures included the use of traditional medicines mainly derived from plants. While drugs will continue to be an important part of diabetes therapy, the mass of evidence available in the literature regarding the medicinal properties of vegetables, fruits and other herbs, suggests that diet (including herbal medicines) should not be ignored or neglected.

This article focuses on recent examples of traditional medicines and foods that have been validated by scientific evaluation as having promising activity for the prevention and/or treatment of diabetes. Intriguing questions that await further elucidation include how plants, plant-derived molecules and diet can be used in the future to complement current treatment strategies for diabetes. The increasing worldwide incidence of diabetes mellitus in adults constitutes a major global public health burden.

Types and the Effects of Diabetes on Humans
Diabetes is a metabolic syndrome resulting from low levels of insulin. Common symptoms are hyperglycemia, polyuria, polydipsia, blurred vision, lethargy and weight loss. Diabetes is categorized into: Type I – Insulin Dependent Diabetes Mellitus (IDDM), Type II – Non-Insulin Dependent Diabetes Mellitus (NIDDM) and gestational diabetes which occurs during pregnancy.

In Type I diabetes, there is loss of insulin secreting β cells of the Islets of Langerhans in the pancreas which causes deficiency of insulin. The main cause of β-cell loss is autoimmune attack of T-cells. The principal treatment is replacement of insulin.

Type II diabetes is caused by reduced insulin sensitivity due to increased glucose levels in the blood. Hyperglycemia can be rectified by medications that improve insulin sensitivity or decrease glucose production by the liver. This condition can be treated by increasing physical activity, decreasing carbohydrate intake, selection of proper diet, modification of life-style and losing weight.

Gestational diabetes, although temporary, increases the risk of developing Type II diabetes later in life. Although insulin injections are sometimes necessary, this type of diabetes is also commonly treated by life style changes such as moderate physical activity and diet.

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves. The major complications related to diabetes are diabetic retinopathy, a cause of blindness which results from long-term accumulated damage to the small blood vessels in the retina, and diabetic neuropathy, the destruction of nerves as a result of diabetes with common symptoms of tingling, pain, numbness, or weakness in the feet and hands. Combined with reduced blood flow, neuropathy in the feet increases the chance of foot ulcers and eventual limb amputation.

Diabetes is among the leading causes of kidney failure and increases the risk of heart disease and stroke. Ten to twenty percent of people with diabetes die of kidney failure and fifty percent of people with diabetes die of cardiovascular disease (primarily heart disease and stroke). The overall risk of dying among people with diabetes is at least double the risk of their peers without diabetes.

The current focus of drug discovery research in diabetes includes exploration of alternative medicines, discovery of new synthetic antidiabetic agents as well as isolation of active compounds from plants which have been the source of traditional herbal medicines. The WHO has recommended that alternative medicines should be investigated and explored for discovery of new drugs for the treatment of diabetes mellitus.

Current Therapies for Diabetes
Currently available therapies for diabetes include insulin and various oral antidiabetic agents such as sulfonylureas, biguanides (metformin), α-glucosidase inhibitors, α-amylase inhibitors and glinides, which are used as monotherapy or in combination to achieve better Glycemic regulation. However, the most common adverse effects of these drugs being gastrointestinal, weight gain, hypoglycaemia, gas production and gastrointestinal symptoms and fluid retention.

Thus, treatment of diabetes without any side effects is still a challenge. When selecting an appropriate therapy for Type II diabetes, then, factors such as other co-existing medical conditions (high blood pressure and elevated cholesterol), adverse effects of that therapy, contraindications to therapy, issues which may affect compliance (timing of medication, frequency of dosing) and cost to the patient and the healthcare system should be considered alongside the magnitude of change in blood sugar control that each medication will provide.

Moreover, the relatively complication-free option of diet and life style change should be considered.

By MH/Dr Ernest Aggrey, 0543999776/[email protected]

Reference:
Gulati, V., Harding, I., & Palombo, E. (2009), Medicinal Plants: Classification, Biosynthesis and Pharmacology, Management of Diabetes with Diet and Plant-Derived Drugs. Nova Science Publishers, Inc. New York.pg 167-182