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IJBPAS, May, 2023, 12(5): 1877-1890
ISSN: 2277–4998
1877
IJBPAS, May, 2023, 12(5)
ROLE OF HERBAL MEDICINES IN MANAGEMENT OF DIABETES: AN
UPDATED OVERVIEW
SYED SM*1, HOLKAR A2, THORE P3, NAUSHHEN QN4, MORE K5 AND PATAVE T6
1: Associate Professor, Dayanand College of Pharmacy Latur MS, India
2: Research Scholar, Dr. Vedprakash Patil Pharmacy College, Aurangabad, MS, India
3: Lecturer, SDMVM’s Diploma in Pharmacy Institute, Aurangabad, MS, India
4: Y B Chavan College of Pharmacy, Aurangabad, MS, India
5: Research Scholar, Dr. Vedprakash Patil Pharmacy College, Aurangabad, MS, India
6: Loknete Dr. J D Pawar College of Pharmacy, Kalwan, Nashik, MS, India
*Corresponding Author: Dr. Shoaeb Mohammad Syed: E Mail: ybccpsh@gmail.com
https://doi.org/10.31032/IJBPAS/2023/12.5.7091
ABSTRACT
Introduction:
Diabetes is a serious metabolic complaint affecting millions of people today. The allopathic drugs used
for treatment suffer numerous complications. Many herbal remedies can be used to treat diabetes. These
herbs have no side effects and numerous drugs are deduced from the herbal sources. The purpose of this
methodical review is to study diabetes and to epitomize the available herbal drugs with superiority over
allopathic drugs for this complaint.
Methods:
The current review was structured by studying papers in the context of diabetes and effective herbal
treatment from the databases, including Scopus, Wiley, Springer, Science Direct, and PubMed.
Results:
Diabetes is substantially caused due to a high quantum of reactive oxygen oxidative stress and an increase
in reactive oxygen species that can have major goods. Herbal drugs contain a variety of natural
antioxidants, similar to tannins, flavonoids, Vitamin C, and Vitamin E that can maintain β- cells
performance and drop glucose situations in the blood.
Received 10
th
June 2022; Revised 15
th
July 2022; Accepted 15
th
Sept. 2022; Available online 1
st
May 2023
Syed SM et al Review Article
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IJBPAS, May, 2023, 12(5)
Conclusion:
According to published results, it can be concluded that herbal drugs are more affordable and have lower
side goods in comparison to synthetic medicines, and are more effective in the operation of diabetes.
Keywords: Diabetes, Types, Treatment, Herbal medicines, Role of herbal drugs
INTRODUCTION
Diabetes mellitus could be a cluster of
metabolic conditions characterized by blights
in hormone stashing, hormone action, or both.
The habitual symptom of the polygenic
complaint is related to long injury,
dysfunction, and failure of colorful organs,
particularly the eyes, kidneys, liver, heart,
and blood vessels. The pathogenic process
may vary from response destruction of the β-
cells of the duct gland with resulting
hormone deficiency to abnormalities that
lead to resistance to hormone action. The
abnormalities in sugar, fat, and
macromolecule metabolism in polygenic
disease are due to the deficient action of
hormones on course tissues. Deficient
hormone action results from inadequate
hormone secretion or diminished tissue
response to hormone [1-3].
Defects in insulin secretion and defects in
insulin action frequently coexist in the same
patient, and it is often unclear which
abnormality, if either alone, is the primary
cause of hyperglycemia. Hyperglycemia is
marked by symptoms of polyuria (increasing
urine frequency), polydipsia (excess thirst),
weight loss, sometimes polyphagia (excess
hunger), and blurred vision. Acute, life-
threatening consequences of uncontrolled
diabetes are hyperglycemia with ketoacidosis
or non-ketoacidosis hyperosmolar syndrome.
Long-term complications of diabetes suffer
from retinopathy with a potential loss of
vision; nephropathy leading to renal failure;
peripheral neuropathy with risk of foot
ulcers, amputations, and Charcot joints [1-3].
According to statistics, 2.8% of the world’s
population suffers from this disease and it is
expected to increase to more than 5.4% by
2025. Diabetes is taken into account and can
be treated easily by early diagnosis, treatment,
and lifestyle changes. At the current time,
different treatments, similar to insulin
remedy, pharmacotherapy, and diet remedy,
are prevailing to control diabetes. Several
types of glucose-lowering medicines that ply
anti-diabetic effects through different
mechanisms are present. These mechanisms
include enhancing insulin stashing by
sulfonylurea and meglitinides medicines,
rising supplemental immersion of glucose by
biguanides and thiazolidinediones, and
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IJBPAS, May, 2023, 12(5)
delaying the immersion of carbohydrates
from the intestine by nascence-glucosidase,
and reduction of hepatic gluconeogenesis by
some medicines. In the once three decades,
despite the significant exploration made in
the treatment of diabetes, the results of
treatment in cases are still not perfect. These
treatments have some disadvantages like
medicine resistance (reduction of
effectiveness), side goods, and toxins. For
illustration, sulfonylureas lose their
effectiveness after 6 years of treatment in 44
cases. It's also observed that the glucose-
lowering drugs aren't suitable to control
hyperlipidemia to the extent hence further
addition of antihyperlipidemic is needed in
remedy. In addition, the side effects of drugs
and their relations with each other further
may increase complications. At the moment
the intelligence of the public is shifting
further toward natural sources for diabetes.
Major contents of natural or herbal drugs
include carotenoids, flavonoids, terpenoids,
alkaloids, glycosides, and antioxidants that
exhibit anti-diabetic effects. The anti-
hyperglycemic property of herbal medicines
is frequently due to their capability to
ameliorate the performance of pancreatic
towels, which might be due to adding insulin
concealment or reducing the intestinal
immersion of glucose. The number of people
with diabetes moment has been rising and
causing enterprises in the medical
community and the public. The main purpose
of this composition is to introduce and
suggest several effective herbal drugs or
plants based remedy used for treating or
managing diabetes [2-4].
History - According to Egyptians Diabetes
was first identified and measured by the
symptoms of polyuria and weight loss. The
greek physician “Aertaeus" has given the
term Diabetes. Diabetes is called
‘Madhumeha’ by ancient Hindu physicians.
Types of Diabetes Mellitus: [1-4]
Type 1 Diabetes (Insulin-dependent).
Type 2 Diabetes (Non-insulin Dependent).
Cause -
Type 1 diabetes is an autoimmune disorder.
It's believed that a combination of genetic
predisposition and additional environmental
factors provoke the immune system into
attacking and killing the insulin-producing
cells in the pancreas [1-4].
Obesity is a leading cause of insulin
resistance – about 90% of people with type 2
diabetes are overweight or obese. Genetic
factors may be more likely involved in the
cause of type 2 diabetes. Genetic history of
the disease increases the risk of causing
diabetes [1-4].
Signs and symptoms:
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IJBPAS, May, 2023, 12(5)
Some common signs & symptoms associated
with diabetes include excessive thirst, weight
loss, fatigue, nausea, retarded wound healing,
skin infections, hunger problems, etc. [4].
MATERIALS & METHODS
The current review was structured by
detailing the papers about diabetes and
effective herbal treatment amongst the
databases, including Scopus, Wiley, Springer,
Science Direct, and PubMed as far as
possible only the justified results were taken
into consideration. The attempt was made to
bring the most recent work performed in the
reviewed area.
RESULTS & DISCUSSION
Why do we need Herbal Drugs? As
currently available antidiabetic drugs are
harmful and have critical side effects in
various aspects. It's reported that over to72.8%
of people with diabetes are switching to
herbal drugs, salutary supplements, and other
complimentary indispensable drug curatives.
Some common examples of the currently
available synthetic drug include: Pioglitazone
associated with Liver toxicity and weight
gain, Acarbose results in gastrointestinal
disturbances, and Tolbutamide & Glyburide
cause hypoglycemia & weight gain,
Sitagliptin, Saxagliptin, & Linagliptin causes
nasopharyngitis, headache, & nausea [3-7].
Role of Herbal Drugs:
Medicinal plants constitute the natural wealth
of the country. These medicinal plants
provide primary health care services to the
rural populations. According to ancient
literature, more than 800 plants contain anti-
diabetic properties. To date back, herbal
formulations exist and are still widely
consumed all over the world. In recent years,
a prominent number of natural product-
derived agents, such as lovastatin, pravastatin,
and FK-506, have been discovered by
employing mechanism-based screening
approaches involving the cellular or
biochemical targets. In their assay design, in
addition, a large number of natural products,
especially plant-derived drugs are
continuously discovered based on traditional
medical practices. It was estimated that
nearly 80% of the world population depends
on traditional herbal drugs for primary health
care [3-7].
Herbs or Plants Possessing Antidiabetic
Effects:
Veritably High figures of medicinal shops
are being used to treat diabetes and affiliated
conditions. The recent NAPRALERT
database shows 1300 species of plants
representing further than 750 rubrics within
190 families, covering lower plants like algae
and fungi to nearly all types of advanced
plants. Numerous of these plants have been
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IJBPAS, May, 2023, 12(5)
used ethnopharmacologically in the operation
of diabetes. Although numerous of these
plants have been studied experimentally to
validate their physiological exertion,
chemical, and pharmacological parcels
having the anti-diabetic effects are less well
studied. A high number of potentially bio-
active motes are insulated and linked, which
include complex carbohydrates, alkaloids,
glycopeptides, terpenoids, peptides, amines,
steroids, flavonoids, lipids, coumarins, sulfur
composites, and inorganic ions [3-7].
Common herb-drug relations in diabetes:
The co-administration of antidiabetic herbs
and pharmaceutical agents may affect in
HDIs leading to enhanced effects (which
may be desirable clinically), dropped
pharmacological effects, or adverse medicine
events, similar to hypoglycemia. The
following section provides a brief discussion
of common antidiabetic sauces and their
implicit relations with antidiabetic agents.
Literature quests were conducted with the
standard databases to date.
Aloe vera: (Aloe barbadensis)
Aloe Vera belongs to the family Liliaceae,
one of further than 400 species of the rubric
Aloe. Carbohydrates and galacturonic acid
are the major factors of Aloe. Traditional
literature reveals a large range of clinical
uses of this factory from cosmeceuticals to
immunity and organ care. In diabetes, aloe
vera shows a reduction in blood glucose
situations [4-7].
Karela—Momordica charantia
Momordica charantia, karela, or bitter melon.
Several chemical ingredients are present in
its juice, including sterols, glucoside fusions,
and charantin polypeptides. Karela has been
subordinated to expansive clinical studies in
combination with common antidiabetics.
High efficacity has been reported when used
together with metformin, glymidine, and
glibenclamide. In one clinical trial, 400 mg
of chloroform/ benzene karela extract was
combined with 50% of the full clinical doses
of either metformin or glibenclamide in
NIDDM cases. Results showed that the
combined interventions inspired a lesser
hypoglycemic effect when compared to that
of full doses of metformin or glibenclaminde
alone, indicating a possible cumulative effect.
Analogous results have also been attained in
beast studies whereby combined treatments
of karela fruit juice/extract and metformin
have been shown to produce a lesser
hypoglycemic effect than either treatment
alone in rat models of diabetes [4-7].
Ginger—Zingiber Officinale:
Ginger is generally used as a spice as well as
a drug numerous times. Crude ginger
contains nearly 9 percent lipids or glycolipids
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and 5 – 8 percent oleoresin. The pungent
principles, which account for 25 percent of
the oleoresins, correspond substantially to
gingerols and related phenolic composites.
The aqueous extract is antidiabetic in
numerous countries. It's assumed that the
antidiabetic effect of ginger is due to
antioxidant and anti-glycation properties, and
its capability to express the glucose
transporter Glut 4. In a study in a rat model
of streptozotocin (STZ) convinced diabetes,
concurrent treatment of ginger extract (25 or
50 mg/ kg) and glibenclamide (5 mg/ kg)
significantly dropped non-fasting blood
glucose situations by 26 and 25%,
independently, compared to7.9 % reduction
when only glibenclamide was used [4-7].
Azadirachta indica: (Neem)
Neem is a tropical plant that's native to India
and Asia. Every part of the plant is full of
antiseptic and medicinal properties. Neem
has been an integral part of Indian and
Chinese drugs since ancient times. Nearly all
corridors of the neem tree- leaves, flowers,
seeds, fruits, roots, and dinghy have been
consumed traditionally for a variety of
treatments. Some Clinical studies have
suggested that some composites of
Azadirachta indica (Neem) could be useful in
diabetes mellitus in controlling blood sugar.
Alcoholic extract from neem reported anti-
hyperglycemic activity in streptozotocin-
treated rats and this effect is because of the
increase in glucose uptake and glycogen
deposit in insulated rat hemidiaphragm [7-
11].
Eugenia jambolana: (Indian gooseberry/
Jamun)
Jamun (Eugenia jambolana) is used as one of
the common remedies for diabetes. The
aqueous extract, alcoholic extract, and
lyophilized powder exhibited a reduction in
blood glucose position. The extract of
Eugenia jambolana pulp displayed a
hypoglycemic effect in streptozotocin
convinced diabetic mice within 30 min of
administration, whereas the seed of the
jambolana fruit took 24 hrs. The oral
administration of the extract showed an
acceptable rise in serum insulin situations in
diabetic rats [7-11].
Ocimum sanctum: (holy basil)
It's notorious by the name tulsi. Since ancient
times, this plant is known for its medicinal
property. Holy basil is a relative of the
further familiar species used in cooking
known to the ayurvedic medical tradition as
tulsi, it has been called the" Queen of
Sauces" since the times of ancient
civilization in India. The aqueous extract of
leaves of Ocimum sanctum redounded in the
significant reduction in blood sugar position
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in both normal as well as alloxan convinced
diabetic rats. Oral administration of the
aqueous extract (200 mg/ kg) for 30 days
results in a drop in the tube glucose position
by roughly 9.06 and 26.4% on 15 and 30
days of the trial independently. Renal
glycogen content raised by 10 fold while
cadaverous muscle and hepatic glycogen
situations were reduced by 68 and 75%
independently, in diabetic rats, compared to
control.
[12].
Tinospora cordifolia: (Guduchi)
Guduchi is a large, rough, evanescent
climbing shrub. A largely potent condiment
used in Ayurveda for the operation of
diabetes and keeps the function of various
organs in harmony, belonging to the family
Menispermaceae. It's abundantly planted
throughout India and is generally known as
Guduchi. Oral administration of the extract
of Tinospora cordifolia (T.cordifolia) roots
for 6 weeks displayed a significant reduction
in blood and urine glucose and lipids in
serum in alloxan convinced diabetic rats. The
extract also defended a drop in body weight
[13].
Cinnamon
It is a fragrant spice obtained from the bark
of a tree Cinnamonum Zylanicum. It is a
popular ingredient in food preparations. A
study found in humans that cinnamon may
improve levels of glucose, insulin and insulin
sensitivity, lipids, or fats, in the blood, it also
acts as an antioxidant another study
suggested that taking a cinnamon supplement
might lead to lower fasting blood glucose
levels less total cholesterol and “bad” low-
density lipoprotein cholesterol higher levels
of “good” high-density lipoprotein
cholesterol reduction in triglycerides, or fat,
in the blood increased insulin sensitivity [14].
Curry leaves (Murraya koenigii)
It controls diabetes so is one of the important
home remedies for diabetes. Hereditary
diabetic patients also get the best benefit
from its intake. Chewing (8-10) curry leaves
on an empty stomach is very effective for
bringing sugar levels in urine and blood to
normal [15-18].
Allium-cepa: (Onion)
Various ether soluble fractions, as well as
insoluble fractions of dried onion powder,
showed anti-hyperglycemic activity in
diabetic rabbits. Administration of a sulfur-
containing amino acid from Allium cepa, S-
methyl cysteine sulphoxide (SMCS) (200
mg/kg for 45 days) to alloxan convinced
diabetic rats significantly controlled blood
glucose as well as lipids in serum and tissues
with normalization of the activities of liver
hexokinase, glucose 6-phosphatase, and
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HMG Co-A reductase. When diabetic
patients were given a single oral dose of 50 g
of onion juice, it significantly controlled
post-pardinal glucose levels [16-18].
Green tea (Camellia sinensis) consumption
has been used traditionally to control blood
sugar in the body. It is associated with the
prevention of type 2 diabetes, lowering
fasting blood levels of glucose, reducing
triglyceride and free fatty acids, and
enhancing the ability of adipocytes to
respond to insulin and absorb blood sugar. Its
consumption also increases the body’s ability
to utilize blood sugar. Green tea polyphenols
regulate the expression of genes involved in
glucose uptake and insulin signaling [16-18].
Gurmar (Gymnema sylvestre)
This plant contains gymnemic acid as a chief
constituent effective against obesity which
probably slows down the glucose absorption
in the blood. Gymnema Sylvester also helps
in the excretion of cholesterol through feces
[16-18].
Ispaghula husk (Plantago ovata) is
naturally safe for the treatment of diabetes;
the main effect is on reducing constipation
thereby supporting the reduction of glucose
levels [16-18].
Leucas-lavandulifolia:
The plant of Leucas lavandulifolia Sm. of
family Labiatae has been estimated for its
antidiabetic exertion in alloxan convinced
diabetic rats as well as for its in vitro
antioxidant property. It was observed that
methanolic extract of L. lavandulifolia
displayed significant antidiabetic effects in
dose dependant manner, but the effect was
not more promising than glibenclamide [19].
Shilajit :
Shilajit is a herbal medicine that is used in
diabetes to improve the lipid profile & lower
blood glucose levels, it is an herbal booster
for the overall health of the body. Shilajit is
the safest herbal drug for the long-term
treatment of diabetes but not for heart
patients, in a hypertensive patient, it induces
blood pressure [20].
Fenugreek:
Fenugreek is an annual herb that belongs to
the Leguminosae family. The leaves, as well
as seeds, are used as an antidiabetic herb. It is
a rich source of proteins, vitamins, and
minerals. Fenugreek purifies the blood &
regulates the lipid profile which exhibits the
antidiabetic Property. Administration of
fenugreek increases glucose metabolism &
normalizes kinase activity [20].
Black Seeds:
Black seeds are taken in the whole form or in
the form of the cold-pressed oil that is
extracted from the seeds. The most important
property is the use of black seed or black
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IJBPAS, May, 2023, 12(5)
seed oil for regulating blood sugar levels in
diabetics. The oil may be especially
beneficial for Type-2 diabetics as it can
benefit them in multiple ways primarily due
to its antioxidant properties. The powerful
antioxidant property of black seeds
or kalonji has a positive impact in several
ways on the overall health of Type-2
diabetics [24].
Rauwolfia serpentina:
Commonly known as ‘snakeroot’, is an
important medicinal plant familiar to the
Indian subcontinent and South-East Asian
countries. The plant contains therapeutically
important indole alkaloids. It has also been
reported that extracts of the roots from R.
serpentina possess hypoglycemic and
hypolipidemic activity in animal models.
Based on the data, we hypothesize that
extracts of Rauwolfia serpentina may contain
molecules that are active against diabetes and
its related complications, primarily through
aldose reductase inhibition [26-31].
Acacia Arabica:
The animal study was conducted in King
Fahd Research Center, King Abdulaziz
University Jeddah Kingdom of Saudi Arabia
from December 2012 to January 2013.
Thirty-six female albino rats were divided
into 2 equal groups; the first group was the
control, and the second was the
streptozotocin-induced diabetic group. Each
group was further divided into 3 subgroups,
each of 6 rats; the first was left untreated, and
the second and the third were treated with
Acacia Arabica extract orally for 21 days
(100 mg/kg and 200 mg/kg for the second
and third group respectively). On the 21st
day, blood samples were taken through the
retro-orbital plexus of overnight fasted rats
under ether as an anesthetic for determination
of serum glucose, insulin, ), triglycerides
(TG), total cholesterol (TC low-density
lipoprotein cholesterol (LDL-C), high-
density lipoprotein cholesterol (HDL-C),
malondialdehyde (MDA), and coenzyme
Q10 (Co-Q10). It was found that there was a
significant decrease in levels of insulin
resistance, serum glucose, TC, TG, LDL-C,
and MDA, and a significant rise in HDL-C
and Co-Q10 was observed in the treated
diabetic groups when matched to the
untreated diabetic group. Acacia Arabica
extract was having hypoglycemic,
hypolipidemic, and antioxidant properties,
therefore, it can be further studied for the
treatment of diabetes in humans [30-33].
Phyllanthus amarus:
Phyllanthus amarus is a medicinal plant that
is used substantially in central and southern
India as a Hypoglycemic Factor. Oral
administration of an extract from the leaves
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(400 mg/ kg/ BW) for 6 weeks caused a
significant reduction in blood glucose
situations in alloxan-convinced diabetic mice
and led to a significant enhancement in the
weight of diabetic mice. Also, there was a
reduction in Robison Ester and fructose 1, 6-
diphosphatase conditioning in the liver. The
glucokinase exertion, in comparison with the
control group, rises during treatment in the
liver of the diabetic rats [30-33].
Eucalyptus Camaldulensis:
The study was based on the determination of
the composition of the essential oil
of Eucalyptus camaldulensis leaves and the
evaluation of its in vitro antioxidant and
antidiabetic properties. The composition of
the essential oil from Eucalyptus
camaldulensis leaves was analyzed by Mass
Spectrometric detection around 29
compounds representing 99.10% of the total
oil were identified. The components of the
oil were p-cymene, 8-cineole, 1-(S)-α-
pinene, and R-(+)- limonene. The
antidiabetic effects of the essential oil were
evaluated using inhibition of 2,2-diphenyl-1-
picrylhydrazyl, hydroxyl, and superoxide
radicals, inhibition of hydrogen peroxide, and
lipid peroxidase assays [30-33].
Table 1: Herb–antidiabetic drug co-administration studies [33]
CONCLUSION
All over the world, herbal medications are
being helpful and widely used for the
treatment of diabetes. Herbs are used to
manage various types of diabetes and their
complications. Various medicinal plants have
been considered for their probable
hypoglycemic actions and the researchers
have carried out some preliminary
investigations. Scientific authentication of
several Indian plant species has proved the
efficacy of the botanicals in reducing the
sugar level could be considered of possible
therapeutic value. Thus, many different
plants have been used individually or in
formulations for the treatment of diabetes.
Interactions of antidiabetic drugs and herbs
may result in antagonistic or enhancement
effects. The enhancement of glucose-
lowering has the possibility of causing
hypoglycemia, hence monitoring of potential
adverse effects is required and hence it is
Herb Co-administered Anti-Diabetic Drug Findings
Aloe-vera Glibenclamide Improved effect on lowering the blood glucose.
Bitter Melon Metformin A decrease in serum glucose was found in the combination
with fruit juice extract at half the normal dose of metformin.
Ginger Glibenclamide The Synergistic effect with ginger extract reduces blood
glucose levels greater than glibenclamide as single
Sesame oil Glibenclamide Improved anti-hyperglycemic effect in combination
Garlic Metformin garlic is capable of affecting the pharmacokinetics of
Metformin resulting in decreased blood glucose level
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when combining the two compounds.
Despite the potential for adverse effects, the
combination of these herbs and antidiabetic
medications has been more commonly shown
to have positive clinical implications as it
could lead to enhanced antidiabetic effects,
potentially enabling a reduction in the dose
of antidiabetic agents, thereby minimizing
their side effects. Herbal medicines might be
a promising therapy in the management of
diabetes.
FUNDING:
The current work did not receive any funding
CONFLICT OF INTEREST:
None
ACKNOWLEDGEMENT:
We are thankful to Dr. V K Patil, Dr. U V
Patil, and Dr. Vedprakash Patil Pharmacy
College Aurangabad for providing facilities
for carrying out the work.
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