Comparative study of allopathy and ayurveda for treatment of diabetes mellitus

Abstract

These days, one of the most prevalent non-communicable diseases is diabetes mellitus. It has an impact on people worldwide of all ages and their families, and it heavily strains national budgets and healthcare systems. In the short term, implementing a comprehensive healthcare management program for individuals with diabetes can result in significant improvements in clinical outcomes and costs. Millions of people throughout the world suffer from diabetes mellitus, a chronic metabolic illness. To avoid complications and enhance the quality of life for those with diabetes, management is crucial. The two main methods used to treat diabetes are Ayurveda, an ancient system of traditional medicine, and Allopathy, a conventional medical system. The purpose of this study is to compare and contrast these two methods for treating diabetes. The study includes a thorough analysis of the research on diabetes treatment in allopathy and ayurveda, as well as clinical studies and expert opinions.

Full text

 Corresponding author: Yogesh N Sonawane.
Copyright © 2024 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0.
Comparative study of allopathy and ayurveda for treatment of diabetes mellitus
Yogesh N Sonawane *, Megha P Yeole, Piyush V Wagh, Mayuri A Sarode, Sagar A Sarode and Parag R Patil
KYDSCT’s College of Pharmacy, Sakegaon, Bhusawal, 425 201, Dist. Jalgaon, MS, India.
GSC Biological and Pharmaceutical Sciences, 2024, 26(01), 253–267
Publication history: Received on 09 December 2023; revised on 18 January 2024; accepted on 20 January 2024
Article DOI: https://doi.org/10.30574/gscbps.2024.26.1.0023
Abstract
These days, one of the most prevalent non-communicable diseases is diabetes mellitus. It has an impact on people
worldwide of all ages and their families, and it heavily strains national budgets and healthcare systems. In the short
term, implementing a comprehensive healthcare management program for individuals with diabetes can result in
significant improvements in clinical outcomes and costs. Millions of people throughout the world suffer from diabetes
mellitus, a chronic metabolic illness. To avoid complications and enhance the quality of life for those with diabetes,
management is crucial. The two main methods used to treat diabetes are Ayurveda, an ancient system of traditional
medicine, and Allopathy, a conventional medical system. The purpose of this study is to compare and contrast these two
methods for treating diabetes. The study includes a thorough analysis of the research on diabetes treatment in allopathy
and ayurveda, as well as clinical studies and expert opinions.
Keywords: Diabetes; Allopathy; Ayurveda; Treatment
1. Introduction
The current study compares the use of natural herbs versus allopathic medications in the management of diabetes
mellitus. The aim of the research was to evaluate the effectiveness of a current Sulfonylurea-Gliclazide drug against a
polyhedral drug that is commercially available in the Indian market [1]. The medications used in the allopathic system
are intended to treat a specific ailment, but they can also have an impact on other serious or fatal illnesses. Ayurveda is
a traditional medical system that uses natural therapies to treat and prevent illness. It has a number of potential positive
effects. When these two systems work together, they create a unique and amazing combination that makes the most of
both and helps to build a healthy society [1-2].
Diabetes can be treated in many different ways, but full recovery might not be achievable [2]. In addition, adverse
reactions to allopathic medications include kidney damage, poor absorption, gas, diarrhoea, and bloating in the
abdomen. Anti-Diabetes plant-based therapies are less expensive and have fewer side effects than allopathic treatments
while having a similar mode of action [2-3].
1.1. What Is Allopathy?
This is most likely one of the most widely used methods of medical care. The term "allopathic medicine" describes a
medical practise in which physicians attempt to treat patients using medication, radiation, or surgery [3]. Doctors are
able to prescribe a wide range of drugs, such as blood pressure, chemotherapy, Diabetes medications, antibiotics, and
migraine remedies.

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Due to the fact that scientists and clinical researchers create medications, allopathy is a common therapeutic approach.
It is an extremely genuine and successful modern medical practise that focuses on highly technological treatments [3-
4].
Figure 1 Allopathy Medicines
1.2. What Is Ayurveda?
Figure 2 Ayurvedic Medicines
One of the ancient, conventional Indian treatment modalities is ayurvedic medicine and treatment. In this treatment,
the mind, body, and spirit are seen as intimately connected. Rather than combating particular illnesses, this type of
therapy aims to improve general health. Nonetheless, the treatment is taken into consideration to treat specific ailments
[4].
It's possible that the technology or research behind this kind of medication is not scientific. Nonetheless, the fact that it
is composed of natural ingredients lowers the possibility of adverse effects [4-5].

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1.3. What Are the Differences Between Allopathy and Ayurveda?
Figure 3 Difference between Allopathy and Ayurveda
Table 1 Difference between Allopathy and Ayurveda
Parameters
Allopathy
Ayurveda
Meaning and
Concept
The term comes from the Green word állos,
which means other, and the word pathos, which
means disease or suffering.
Ayurveda has its origin in India. It is derived
from the Sanskrit word Ayus, which means life,
and Veda, which means knowledge.
Treatment
Doctors usually concentrate on the symptoms of
a disease instead of looking into its causes.
This treatment focuses more on the causes,
trying to destroy them by creating a balance
between the five areas.
Individuality of
Patients
There is a lack of individualisation, as there is a
specific treatment procedure for a disease. Two
people suffering will receive similar treatment
for a disease.
This treatment considers specific attributes of
an individual’s body, looking into their
constitution (Vata, Pitta, and Kapha). The
therapy, therefore, differs on an individual level.
Side Effects
Allopathy has possibilities of side effects, which
is a major drawback here. There can be
reactions to the components or side effects.
Ayurveda uses only natural ingredients and
herbs to create medicines. This reduces the
chances of having side effects.
Speed to show
results
Allopathic treatments and medicines start
showing actions within a day or two. So it is
much faster than other types of treatment.
Ayurveda treatment takes a long time to start
showing action. It can take about 2-3 months of
treatment, which can be a drawback.
2. Diabetes mellitus
A series of metabolic illnesses collectively referred to as diabetes mellitus, or simply diabetes, are marked by
persistently high blood sugar (hyperglycemia). Increased thirst, appetite, and frequency of urination are common
symptoms [5]. Numerous health issues can arise from diabetes if it is not treated. Death, hyperosmolar hyperglycemia
state, and Diabetes ketoacidosis are examples of acute complications. Severe long-term consequences can include nerve
and eye damage, stroke, chronic kidney disease, foot ulcers, cardiovascular disease, and cognitive decline. Either
insufficient insulin production by the pancreas or improper insulin cellular response are the causes of diabetes. Insulin
is a hormone that facilitates the uptake of glucose from food into cells for energy production [5-6].
2.1. Type-1 Diabetes
Because of the loss of beta cells, the pancreas is unable to produce enough insulin, which leads to type 1 diabetes. Earlier
terms for this condition included "insulin dependent diabetes mellitus" and "juvenile diabetes". The autoimmune

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response is what leads to the loss of beta cells. It is unknown what is causing this autoimmune reaction [6]. Type 1
diabetes can strike adults even though it typically first manifests in childhood or adolescence.
2.2. Type-2 Diabetes
Insulin resistance is the first stage of type 2 diabetes, a disorder in which cells do not react to insulin as they should [6-
7]. Lack of insulin may also develop as the disease worsens. Previously, this type of diabetes was known as "adult-onset
diabetes" or "non-insulin-dependent diabetes mellitus". Although type 2 diabetes is more common in older adults, there
has been a notable rise in type 2 diabetes cases in younger people due to the high prevalence of obesity among children.
Excessive body weight combined with inadequate exercise is the most common cause [7].
2.2.1. Signs and Symptoms
Objective evidence of a disease such as a rash or cough is a sign. Doctors, family members, and anyone experiencing
signs can identify them. However, less noticeable disruption of normal functioning, such as abdominal pain, back pain,
and malaise, is a symptom and can only be recognized by the affected individual [7-8]. Symptoms are subjective. That
is, others can only know the symptoms when told by the affected person. This MNT Knowledge Center article describes
the effects of signs and symptoms, and their history. The play also introduces different types of signs and symptoms, as
well as their medical use [8].
Figure 4 Main symptoms of Diabetes mellitus
2.2.2. Pathophysiology
A Diabetes patient may experience hyperglycemia. Since multiple factors can frequently contribute to the disease, the
pathology of diabetes mellitus may be unclear [8-9]. Even on its own, hyperglycemia can damage insulin secretion and
pancreatic beta-cell function. As a result, hyperglycemia creates a vicious cycle that impairs metabolic function. In this
context, blood glucose levels greater than 180 mg/dl are frequently regarded as hyperglycemic; however, there's no
precise cutoff point because there are so many different mechanisms.[9]. Higher blood glucose levels cause the
nephron's glucose transporters to become saturated, which causes osmotic diuresis in patients 9-10. Serum glucose
levels above 250 mg/dl are likely to result in polyuria and polydipsia symptoms, though the impact varies.

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Excess fatty acids and proinflammatory cytokines cause insulin resistance by impairing glucose transport and speeding
up the breakdown of fat. The body reacts to insufficient insulin response or production by mistakenly raising glucagon
levels, which exacerbates hyperglycemia. Although insulin resistance is a part of type 2 diabetes, the disease's full impact
occurs when the patient's insulin production is insufficient to offset their insulin resistance.[10]
2.2.3. Complications
Whatever the particular form of diabetes, complications include neuropathic, macrovascular, and microvascular
problems. Nephropathy, retinopathy, neuropathy, and ASCVD events are examples of microvascular and macrovascular
complications that vary depending on the severity and length of poorly controlled diabetes, particularly if it is
accompanied by other comorbidities like dyslipidemia and hypertension.[10-11] Heart disease (ASCVD) is one of the
most severe effects of diabetes mellitus (DM). A myocardial infarction or stroke will claim the lives of about two thirds
of people with diabetes.[11] More than 100 mg/dl of fasting glucose increases the risk of ASCVD in people with type 2
diabetes; however, cardiovascular risk can appear before frank hyperglycemia.
In the US, diabetes is also the primary cause of amputations of limbs. This is mostly because of the neuropathy and
angiopathy associated with DM. 48 Frequent foot exams are necessary for many patients who develop neuropathy in
order to prevent infection from wounds that are missed.[11-12] The most significant risk factor for the development of
Diabetes retinopathy is the length of diabetes. It typically appears in individuals with type 1 diabetes five years after the
disease first manifests.[12] Consequently, it is advised that retinal exams begin in these patients about five years after
diagnosis.
2.2.4. Treatment
A range of interventions are necessary for the effective management of diabetes due to its complex physiology and
management. Patient participation and diabetes awareness are crucial for management. [12-13] If patients are able to
independently monitor their blood glucose, regular exercise (more than 150 minutes per week), and diet (low carbs
and general calorie restriction), they will see better outcomes.[13] Often, lifelong care is necessary to prevent
unintended consequences. Blood glucose levels should ideally be kept between 90 and 130 mg/dl, and hba1c levels
should be kept below 7%. Although controlling blood sugar is crucial, doing so too firmly can result in hypoglycemia,
which can have dangerous or even fatal effects. Since insulin deficiency is the primary cause of T1DM, daily injections
or insulin pump delivery are essential components of the treatment plan.[13-14]
Exercise and diet may be suitable therapies, particularly for type 2 diabetes in its early stages. Other therapies might
focus on improving insulin sensitivity or raising the pancreas' production of insulin. Biguanide (metformin),
sulfonylurea, meglitinide, α-glucosidase inhibitor, thiazolidinedione, glucagon-like peptide-1 agonist, dipeptidyl
peptidase IV inhibitor (DPP-4), selective, and amilopril are some examples of particular drug subclasses.[14] SGLT-2
(sodium glucose transporter-2) inhibitors and peptides. The primary prescription medication for diabetes, metformin,
lowers basal and postprandial plasma glucose levels. Patients with type 2 diabetes may also require insulin, particularly
if their condition is advanced and their glucose control is inadequate.[14-15] Obesity surgery may be an option for
patients with morbid obesity to return their blood sugar levels to normal. Suggested for patients with severe
comorbidity who have not responded to previous treatments.[15]
3. Comparative study of Diabetes treatment allopathy vs ayurveda
Diabetes mellitus has emerged as a major global health concern that has substantial socioeconomic ramifications for
both individuals and the community at large.[15-16] Diabetes mellitus is a chronic condition influenced by daily dietary
modifications, physical activity, infections, and stress.[16] The illness known as diabetes mellitus, or diabetes, is
characterised by the loss of muscle mass and sweet urine.
Insulin is a hormone secreted by the pancreas that regulates blood glucose levels. When blood glucose levels rise, the
pancreas produces more insulin to keep blood glucose levels stable in patients with low or absent insulin production, a
condition known as hyperglycemia.[16-17] Diabetes can be divided into two categories. While type-2, or non-insulin
dependent diabetes mellitus, is characterised by varying degrees of insulin resistance, impaired insulin secretion, and
increased glucose production, type-1, or insulin dependent diabetes mellitus (IDDM), is characterised by complete or
nearly total insulin deficiency.[17]

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Figure 5 Ayurveda vs Allopathy
Glucose, which is present in foods like breads, fruits, starchy vegetables, legumes, milk, yoghurt, and sweets, causes the
body to produce insulin, which is necessary for converting glucose into energy in Diabetess.[17-18]
The body either stops producing insulin altogether or stops producing it in sufficient quantities. High blood glucose
levels are the result of glucose remaining in the blood because it cannot be transformed into energy.[18] Diabetes
mellitus can cause long-term harm, malfunction, and failure of several organs, such as the kidneys, nerves, and
gastrointestinal system. Lack of safe and effective drugs and the incapacity to offer long-term clinical, biochemical, and
histological care complicate the treatment of diabetes.[18-19]
3.1. Classification of diabetes mellitus
Figure 6 Classification of Diabetes mellitus
 Β- cell destruction (Type 1 diabetes - IDDM)
o Immune mediated (autoimmune type)
o Idiopathic
 Insulin resistance or insulin deficiency (Type 2 diabetes - NIDDM)
 Hybrid forms of diabetes
o Slowly evolving immune-mediated diabetes of adults
o Ketosis prone type 2 diabetes
 Other specific types
o Monogenic diabetes

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 -Monogenic defects of β-cell function
 -Monogenic defects in insulin action
o Disease of exocrine pancreas
o Endocrine disorders
o Drug –or chemical-induced
o Infections
o Uncommon specific forms of immune-mediated diabetes
o Other genetic syndromes sometimes associated with diabetes
 Unclassified diabetes
o This category should be used temporarily when there is not a clear diagnostic category especially close
to the time of diagnosis of diabetes
 Hyperglycemia first detected during pregnancy
o Diabetes mellitus in pregnancy
o Gestational diabetes mellitus.
3.2. Type 1 diabetes mellitus
Insulin-dependent or juvenile diabetes are other names for type 1 diabetes. When the pancreatic beta cells are damaged
to the point where the body is unable to produce enough insulin, diabetes results.[19] A hormone called insulin is in
charge of controlling blood glucose, or blood sugar.
3.2.1. Symptoms
Vision problems, an increase in appetite, increased weariness, increased or intense thirst, fruity breath or odour,
Abnormal reduction in weight, frequent and increased urination.[19-20]
3.2.2. Pathophysiology of type 1 diabetes mellitus
Glycogen levels are limited in type 1 diabetes, despite the liver's potential to produce glucose. Blood glucose levels rise
and gluconeogenesis becomes uncontrollable in the absence of insulin.[20]
Muscle and fat cells cannot absorb available blood glucose at the same time due to the presence of glucosetransporter
4 (GLUT4). Extremely high blood glucose levels cause the body to be unable to expel it, starving adipose tissue and
peripheral muscles of glucose.
Blood glucose levels have no bearing on glucagon secretion. Since insulin controls glucagon secretion, glycogen
synthesis is suppressed when glucagon is in opposition to a counter-regulatory hormone like growth hormone, cortisol,
or catecholamine.
Lipolysis, glycogenolysis, and glucoseneogenesis are all induced. Free fatty acids in the blood rise as a result of increased
lipolysis.[20-21]
Some of the fatty acid molecules are absorbed by the liver and then integrated into lipoproteins, increasing levels of LDL
and VLDL, two lipoproteins that are associated with an increased risk of heart disease.
Ketone bodies are produced by excessive lipolysis and cannot be suppressed without insulin. An extremely serious
condition known as ketoacidosis may arise from excessively high ketone levels.[21]
Injecting the body with exogenous insulin is the only available treatment option.
Unfortunately, elevated blood glucose and cholesterol levels damage tissues and have negative medical effects even
with the best of intentions.

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3.2.3. Allopathic treatment of type 1 diabetes
Figure 7 Allopathic treatment of Type-1 Diabetes
Treatment for type 1 diabetes
 Taking insulin
 Frequent blood sugar monitoring
 Eating healthy foods
 Protein, fat and carbohydrate counting
 Exercising regularly and maintaining a healthy weight
Examples of insulin includes
 Short-acting (regular) insulin include – Humulin R and Novolin R.
 Rapid-acting insulin include – Insulin glulisine (Aphidra), Insulin and insulinaspart (Novolog).
 Intermediate- acting (NPH) insulin include – Novolin N, Humulin N
 Long- acting insulin include – Insulin glargine (Lantus, Toujeo Solostar), insulin
 Detemir(Levemir) andinsulin degludec(Tresiba)
Insulin
One can use insulin on its own or in conjunction with oral hypoglycemic medications. If some beta cell function is still
present, basal insulin augmentation therapy can be beneficial. Swapping out the basal-bolus.[21-22] In the event of beta
cell exhaustion, insulin becomes required. In cases of glucose toxicity, replacement therapy—which aims to replicate
the regular release of insulin by the pancreatic beta cells—is required for rescue therapy. There are four injectable forms
of insulin: long acting, intermediate acting, short acting, and rapid acting. Compared to the short acting forms, the long
acting forms have a lower risk of causing hypoglycemia.[22]
Insulin analogue
The capacity of insulin therapy to replicate typical physiological insulin secretion was found to be restricted. The peaks
of action of traditional intermediate- and long-acting insulins, such as NPH insulin, lente insulin, and ultralente insulin,
can cause hypoglycemia due to their uneven absorption.[22-23] The new insulin analogues have different
pharmacokinetic profiles from regular insulins, and they have varying rates of onset and durations of action. There is
currently one long-acting insulin analog, insulin glargine, and two rapid-acting insulin analogs, insulin lispro and insulin
aspart.[23]

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3.2.4. Herbal treatment of type 1 diabetes mellitus
Figure 8 Herbal Treatment
Table 2 Herbs used for treatment of diabetes with their mechanism of action
Sr.no
Scientific Name
Common Name
Family
Mechanism of Action
1.
Trigonella
foenum-
graecum[24]
Fenugreek
Fabaceae
Stimulate the secretion of insulin, reduce
insulin resistance and
Decrease blood sugar levels.
2.
Aloe barbadensis
Miller[33]
Aloe vera
Asphodelacea
e
Improvement in impaired glucose
Tolerance.
3.
Gemnema sylvestre[26]
Gurmar
Apocynaceae
Prevent the absorption of excess glucose.
Increase secretion of insulin, it promotes
regeneration of
Islet cells.
4.
Tinospora
cordifolia[5,27]
Guduchi
Menispermac
eae
Lower blood glucose level.
5.
Coriandrum
sativum[28]
Coriander
Apiaceae
Improving and regenerating the β cell in
pancreas and inhibiting the α-
Glucosidase enzyme in small
intestine

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6.
Indian ginseng or
Winter cherry[29]
Ashwagandha
Araliaceae
Decrease the blood glucose and body
weight; increased the immune cell
population and GLUT1 expression.
Enhance beta-cell proliferation and
Glucose tolerance
3.3. Type 2 diabetes mellitus
Diabetes type 2 is also referred to as adult-onset diabetes or non-insulin-dependent diabetes. A long-term illness that
influences how the body uses glucose, or blood sugar.[23-24]
One of the most prevalent metabolic diseases in the world, type 2 diabetes mellitus (T2DM) is mainly brought on by a
combination of two main factors: the pancreatic β-cells' impaired ability to secrete insulin and the tissues' incapacity to
react to insulin.[24]
3.3.1. Symptoms:
Heightened desire, urinating frequently, Constantly feeling peckish, blurry vision, extreme fatigue, Wounds and cuts
heal slowly.[24-25]
3.3.2. Pathophysiology of type 2 diabetes mellitus
In type 2 diabetes, insulin resistance causes the body to respond as though it doesn't have enough insulin, even though
it does.
This type of diabetes is similar to type 1 diabetes in many ways, but it is different in that insulin controls lipolysis and
the liver can still produce glycogen.
Insulin, which is synthesised as pre-proinsulin, is produced by β-cells. Β-cell death has historically been linked to β-cell
dysfunction.
As previously mentioned, insulin secretion needs to be precisely regulated to meet metabolic demand. Consequently,
the maintenance of islet integrity is necessary for β-cells to react to metabolic demands.[25]
The mechanism mentioned above has the potential to compromise pancreatic islet integrity and organisation under
pathogenic conditions. This could lead to poor regulation of insulin and glucagon release, impair optimal cell-to-cell
communication within the islets, and ultimately exacerbate hyperglycemia.
The primary cause of β-cell failure and a key feature of type 2 diabetes is insulin secretory dysfunction, which can be
brought on by errors in the synthesis of insulin or its precursors, as well as problems with the secretion mechanism.
For instance, a decrease in the GLUT2 glucose transporter's expression would impact the downstream signalling
pathway, and its failure would do the same. Obesity and poor diet often result in elevated plasma lipoprotein levels.
Type 2 diabetes is not typically associated with ketoacidosis, although it can occur as a result of other metabolic
stressors. The production and secretion of insulin are decreased in the event of pancreatic failure. An unhealthy
condition known as hyperosmolar hyperglycemic nonkitotic syndrome can arise in elderly individuals with type 2
diabetes.
Urine is the body's method of trying to get rid of excess sugar. Usually, a medical infection or other factors cause this
illness.
3.3.3. Diabetes prevention
As of right now, there is no known way to prevent type 1 diabetes. On the other hand, type 2 diabetes is preventable in
certain situations.[25-26]
 Consume a wholesome diet rich in fibre and low in fat to keep your weight at or near normal.
 Exercise on a regular basis is crucial for preventing type 2 diabetes.

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 Minimise the amount of alcohol you consume.
 Decide not to smoke.
 If a person has high blood pressure or high blood fat levels (e.g., high cholesterol), take all prescribed
medications as directed.
 People with prediabetes can prevent diabetes by changing their lifestyle and taking certain medications.
 Give up smoking.
 Brush and floss your teeth every day.
 Consume plant-based foods.
3.3.4. Allopathic treatment of type 2 diabetes mellitus
Table 3 Allopathic preparations, mechanism of actions and their benefits and adverse effects.
Sr.no
.
Drug class
Available
formulations
Mechanism
Benefits
Adverse effects and
cautions
1.
Biguanides
Metformin
Insulin sensitizers.
Inhibition of hepatic
glucose production and
promotion of
Skeletal muscle glucose
uptake.
Weight loss
Decreased
progression from
prediabetis
Gastrointestinal
upset(diarrhoea) Lactic
acidosis (higher risk with
chronic kidney failure) B12
or folate deficiency
2.
Thiazolidine
diones
Pioglitazone
Rosiglitazone
Increase in Glucose
uptake
And utilization.
Activation of
Decreased
progression
From prediabetes
to
Weight gain (fluidand
adipose)Fluidretention
Chronic heart failure
exacerbation
Biguanides
Biguanides, of which metformin is the most often prescribed medication for patients who are overweight or obese,
improve glucose absorption, boost insulin sensitivity, and inhibit the production of glucose by the liver. Through
phosphorylating GLUT-enhancer factor, which also raises fatty acid oxidation and lowers gastrointestinal absorption of
glucose.39 A 2008 study reveals another way that metformin works: it activates AMP-activated protein kinase, an
enzyme involved in the expression of hepatic gluconeogenic genes.[26]
Sulfonylureas
These are usually well tolerated, but there is a chance of hypoglycemia because they increase the body's natural
production of insulin. Compared to younger patients, elderly DM patients receiving sulfonylurea treatment have a 36%
higher risk of hypoglycemia. When glipizide is used instead of glycoride, hypoglycemia rates are higher with glycoride.
Age-related impaired renal function, using insulin or insulin sensitizers simultaneously, being older than 60, having
recently been released from the hospital, abusing alcohol, restricting calories, taking multiple medications, or taking
medications that intensify the effects of sulfonylureas are some risk factors for hypoglycemia.
Repaglinide
Similar to sulfonylurea, but with a different binding site, repaglinide and nateglinide are non-sulfonylurea secretagogues
that stimulate the release of insulin from pancreatic beta cells by acting on the ATP-dependent K-channel. Meglitinides
reduce the risk of hypoglycemia because of their quick onset and brief (4-6 hours) duration of action. Before meals,
meglitinides are administered to control blood glucose levels after a meal. In the event that a meal is missed, preprandial
administration permits flexibility without raising the risk of hypoglycemia. With the exception of patients with end-
stage renal disease, repaglinide is mostly metabolized in the liver and only very little is eliminated through the kidneys.
As a result, dose adjustments are not required in patients with renal insufficiency.[26-27]
Thiazolidinediones
Insulin sensitivity is exhibited by thiazolidinedione, which selectively binds to transcription factors, peroxisomes, and
proliferator-activated gamma. These medications are the first to address the fundamental issue of insulin resistance in
patients with type 2 diabetes. The class of these medications currently consists primarily of pioglitazone, as the F ood
and Drug Administration (FDA) recently advised against the restricted use of rosiglitazone due to an increase in

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cardiovascular events associated with the medication. Because pioglitazone is well tolerated by older adults and does
not cause hypoglycemia, it can be used in cases of renal impairment. On the other hand, its use in older adults with DM
may be restricted due to worries about peripheral edema, fluid retention, and fracture risk in women. Pioglitazone is
contraindicated in patients with congestive heart failure and should be avoided in older patients.
Dipeptidyl-Peptidase IV Inhibitors
Dipeptidyl peptidase IV (DPP) inhibitors block DPP-4, a widely distributed enzyme that quickly deactivates GLP-1 and
GIP, raising the active concentrations of these hormones and, enhances islet function and glycemic control in type 2
diabetes as a result.A novel class of anti-diabetogenic medications called 50 DPP-4 inhibitors has efficacy levels
comparable to those of existing therapies. When combined with metformin, thiazolidinediones, and insulin, they can be
used as adjuvant therapy or as monotherapy for patients whose diabetes is not well controlled by diet and exercise. The
DPP-4 inhibitors are weight neutral, well tolerated, and have a minimal chance of causing hypoglycemia.[27]
Herbal treatment of type 2 diabetes mellitus
Table 4 Herbs used for treatment of diabetes with their mechanism of action.
Sr.no
Scientific name
Common
name
Family
Mechanism of action
1.
Allium
sativum[10,37]
Garlic
Liliaceae
Improve plasma lipid metabolism and plasma
antioxidant activity.
Decreased serum triglycerides and cholesterol.
2.
Allium cepa[25, 33]
Onion
Liliaceae
Stimulating the effectson glucose utilizationand
Antioxidant enzyme.
3.
Zingiber
officinalis[38]
Sunth
Zingiberaceae
Increases the insulin level.
4.
Eugenia
jambolana[5, 39]
Jamun
Myrataceae
Inhibited insulinase activity from liver and kidney.
Increase ininsulin level. Control blood sugar level.
5.
Cinnamomum
cassia[40]
Cinnamon
Lauraceae
Increases the sensitivityof insulin receptor.Decreased
the
Glucose level.
6.
Brassica juncea[41]
Mustard
Brassicaceae
Increased activity of
Glycogen synthetase.
7.
Momordica
charantia[42]
Bitter gourd,
melon
Cucurbitaceae
Reduce plasma glucose concentrations and improve
response to an oral glucose load.Lower blood glucose
Level.
8.
Ocimum
sanctum[34]
Holy basil,
tulsi
Lamiaceae
Increased insulin release.
9.
Mangifera
indica[43]
Mango
Anacardiaceae
Reduction in the intestinal absorption of glucose.
Improve beta cell regenerat on.
10.
Azadirachta
indica[44]
Neem
Meliaceae
Reduce blood sugar level.

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4. Some marketed herbal formulations and their uses :-
 Pancreatic Tonic (Ayurvedic supplement): Currently marketed as a food supplement, pancreas tonic is a
concoction of traditional Ayurvedic herbs.
 Diabetes, an Ayurvedic remedy marketed as a capsule containing immune modulator, antidiabetogenic, anti-
stress, anti-hyperlipidemic, and heptoprotective plant-based ingredients.
 Himalaya's Diabetescon is said to improve glucose uptake, encourage B-cell resturtion, and raise C-peptide
levels. Additionally, it protects beta cells from oxidative damage.[27-28]
 Episulin produced using a Swastika formula. Through an increase in cathepsin activity, it contributes to the
conversion of proinsulin to insulin. It is a treatment for diabetes type 1 and type 2.
 Med. Lab Pvt. Ltd.'s Sharang Dyab-Tea Plant. Encourage the production of insulin.
 Jambu made from herbal hills by Isha Agro Developers. Lower the level of blood and urine sugar.
 Vitalize Herbs Pvt. Ltd. Produces Stevia-33. Encourage pancreatic β cells.
 Herbal FIT produces Diab-FIT. Keep your blood sugar levels within normal range.
4.1. Advantages of herbal drugs
 The goal of Ayurvedic medicine is to treat a patient's ailment effectively and permanently. It also suggests a
healthy lifestyle for us to enhance our general well-being. On the other hand, the aim of allopathic treatment is
to eradicate the pathogens, bacteria, viruses, and other microorganisms that caused the illness in order to
provide quick relief. It does not, however, ensure that the condition will be cured.[28]
 Because ayurvedic remedies are made from a wide range of readily available plants and herbs, they are typically
less expensive.
 3 3. Natural herbs and fruit, vegetable, spice, and other plant extracts are the main ingredients of Ayurvedic
medications, which help treat illnesses without having any negative side effects. All allopathic drugs have some
adverse effect, even though most of them are synthetic.[28-29]
 The allopathy industry is very profitable. The development of a healthy lifestyle, however, is the selfless service
provided by Ayurvedic medicine.[29]
 Because Ayurvedic treatments use organic ingredients, they are safe for the environment and help prevent
harmful chemical contamination of the forest and atmosphere.
 Whereas certain allopathic medications only partially cleanse our bodies, Ayurvedic remedies detoxify them.
 Ayurvedic treatments aim to treat the root cause of an issue in order to heal a particular body system and
prolong our excellent health. Conversely, allopathy focuses more on the symptoms than the underlying cause.
 Ayurvedic medicines are incredibly effective in treating chronic diseases, especially liver ailments, when
compared to allopathic treatment. This is because certain Ayurvedic medications include compounds that help
to rejuvenate our livers.
 Allopathic medicines are artificially produced in laboratories and may contain chemicals, even though some of
them are made with natural ingredients. In contrast, all of the ingredients in ayurvedic medications are natural,
and none of them contain chemicals.[30]
 Allopathy is a relatively new kind of medicine that treats certain illnesses quickly but only temporarily. For
instance, they are unable to offer a long-term cure for serious conditions like arthritis, jaundice, piles, and so
forth. Conversely, Ayurveda has the ability to treat a wide range of diseases. The effects of ayurvedic
medications come on gradually but steadily.
4.2. Future prospectives
Because diabetes affects a large portion of the population, it is expensive for both the people who have the condition
and our healthcare system. There is ongoing discussion about an attempt, but with the increasing number of people
going undetected, it's also critical to consider the prevalence of the condition, how it affects patients' quality of life, and
how much diabetes costs the healthcare system overall. Given the severe effects of diabetes, it is imperative that
preventive and therapeutic measures be implemented in every nation. This could entail asking eateries to disclose the
number of calories shown on their menus and limiting the availability of high-calorie, high-fat meals in school cafeterias.
The final solution to the diabetes problem will surely involve changing one's lifestyle, and more substantial remedies
will depend on basic science's capacity to steer prevention and treatment in new ways.
5. Conclusion
This study suggests that prevention is better than treatment. Allopathic medications used to treat diabetes, including
metformin, sulphonylurea, insulin and its analogues, and tzds, have a number of side effects and have been linked to

GSC Biological and Pharmaceutical Sciences, 2024, 26(01), 253–267
266
some of the most serious illnesses, including cancer. It has been found that natural compounds produced by plants can
help treat conditions like diabetes and cancer. Vegetables, fruits, grains, and spices are examples of plant-based foods
that contain a wide range of phytochemicals that may provide health benefits beyond basic nutrition, like reducing the
risk of various chronic diseases. The fact that herbal medicines don't have any adverse effects is their best feature. Thus,
always eat for your health in order to maintain it.
Compliance with ethical standards
Disclosure of conflict of interest
No conflict of interest to be disclosed.
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