Diabetes also called diabetesmellitus (DM), is a group of chronic metabolic diseases that result in high blood sugar glucose levels. Our body has a hormone called insulin that lowers the blood sugar levels. In diabetesmellitus, the body either doesn't make enough insulin or is unable to effectively use it, resulting in an increase in the blood levels of glucose, if untreated, this can cause damage to nerves, eyes, kidneys, and other organs. An organ in the abdomen called the pancreas produces a hormone called insulin, which is essential to helping glucose get into the body's cell's. In a person without diabetes, the pancreas produces more insulin whenever blood levels of glucose rise (for example, after a meal), and the insulin signals the body's cell's to take in the glucose. In diabetes, either the pancreas’s ability to produce insulin or the cells response to insulin is altered. The two most common are called type 1 diabetes and type 2 diabetes.
afterwards. In 1910, Sir Edward Albert Sharpey-Schafer of Edinburgh in Scotland suggested that diabetics lacked a single chemical which was normally produced by the pancreas. Name of this chemical was later proposed to be insulin (Himsworth, 1936). In 1921, Frederick Grant Banting and Charles Herbert Best repeated the work of Von Mering and Minkowski but went a step further and managed to show that they could reverse the induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs. Plant derived medications have also found immense use in the management of diabetesmellitus. Notes that there is a new trend in the world to turn to phytodrugs to avoid the adverse effects associated with conventional hypoglycemic agents. Many plant species have been used to treat life- threatening diseases including diabetesmellitus. A World Health Organization (WHO) study shows that 80% of the world population solely relies on medicinal plants for their primary health care needs. To date, the catalogue of antidiabetic medicinal plants is growing at a pleasantly high rate particularly in the African continent. Perhaps this is advised by the economic situation in African, which has driven African diabetics to seek cheaper treatment and management options. This overreliance on antidiabetic medicinal plants has probably invoked scientists to bioassay these plants in an effort to elucidate more hypoglycemic medicinal plants. The antidiabetic potential of some medicinal plants extracts has been demonstrated in human and animal models of type II diabetes. However, more detailed research on the antidiabetic plants is inevitable to ameliorate the concerns of in vivo safety and efficacy 5,6
In view of the increasing demand by patients to use herbal preparations with antidiabetic effects in the management of diabetesmellitus worldwide especially in developing countries. Also considering the economic resource constraints of diabetics in developing countries and given the cheapness of these herbal products which are readily available to rural dwellers, this present review was undertaken to search for some of the herbs used around the world with antidiabetic effects which may be pursued for their clinical usefulness in the management of diabetesmellitus and other associated complications. The search used keywords such as herbal medicine, hypoglycaemic and hypolipidaemic herbs each crossed with the term diabetesmellitus with particular emphasis on experimental animal models, effective dosage and hypoglycaemic/or hypolipidaemic effects of these herbs. The search result revealed fifteen of some of the antidiabetic herbs which are Vernonia amygdalina, Tapinanthus butungii, Nauclea latifolia, Sarcocephalus latifolus, Benincasa hispida, Azadirachta indica, Momordica charantia, Aloe vera, Ocimum gratissimum, Gongronema latifolium, Gymnema sylvestre, Trigonella foenum graecum, Allium cepa, Zingiber officinale, Allium sativum. Further research may be necessary to elucidate the pharmacological principle of these herbs which will stimulate future pharmaceutical development of therapeutically beneficial antidiabetic herbal drugs.
Maintaining most favorable blood sugar levels with minimal risk of hypoglycemic episodes is the goal for successful management of diabetesmellitus. Greater attention should be directed in the research in the utilization of herbal medicines of natural origin with minimal side effects in the management of diabetes (Kumar et al. 2015).Health care providers should be aware that clients may make choices about the use of herbal medicines without proper guidance. Most of these choices came from the advice given by their family, friends, and some of these herbs used by participants were not indicated for the treatment of diabetes. (Poss et al. 2003). METHODOLOGY
Type 2 diabetesmellitus (T2DM) is a major public health concern, accounting for more than 90% of all diabetes cases. The deceptive and asymptomatic nature of the disease may result in patients not looking for early medical attention. This disease is comprised of a range of dysfunctions characterised by an increase in glucose levels in the body, and resulting from a combination of resistance to the actions of insulin, inadequate insulin secretion and excessive or inappropriate glucagon secretion. Genetic factors related to impaired insulin secretion, insulin resistance, social influences (e.g. obesity, overeating and aging), and environmental factors form part of the pathophysiology. Classic symptoms of T2DM include polydipsia, polyuria, polyphagia, and weight loss. The treatment approach is a combination of non-pharmacological measures, such as diet and exercise, and using pharmacological measures in the form of different medicines, including the biguanides, sulphonylureas, thiazolidinediones, alpha-glucosidase inhibitors, insulin, DPP4-inhibitors, GLP-1 agonists and SGLT2-inhibitors. Good control of glycaemia, blood pressure and dyslipidaemia, combined with frequent examinations for microvascular and macrovascular complications, with appropriate and timely interventions, is the only way to reduce morbidity and mortality associated with this disease. This article provides an overview of diabetesmellitus type 2 and the management thereof.
Background: Diabetesmellitus (DM) has been regarded as a disease of urbanisation and industrialisation, and one that is still rare or unknown in the world. Diabetesmellitus is an endocrinological and/or metabolic disorder with an increasing global prevalence and incidence. The prevalence of diabetes and its complications has been a major problem worldwide. The control of the diabetes and its complications can be achieved by the education of the patient regarding the disease and the causes that worsen the disease ant its complications. The lifestyle modifications, such as proper diet and regular exercise, also play a major role in prevention of diabetic complications. The chemotherapy of diabetes has the major role in maintaining the plasma glucose levels near to normal that can reduce the incidence of worsening of the disease. The drugs like Sulfonylureas, Biguanides, Thiazolidinediones, Meglitinides, Aldose Reductase Inhibitors, Alpha Glucosidase Inhibitors and insulin are used in the management of diabetes and its complications.
Abstract: Globally, Diabetesmellitus (DM) prevalence has created menace, being a major culprit of increased mortality and morbidity and health care expenditures. India is the 2 nd country with maximum number of diabetic patients, with an estimated prevalence of around 10%. Comprehensive Diabetes Care (CDC) is a combination of Panchakarma and Diet management. This study was conducted to evaluate the effect of CDC on glycosylated haemoglobin (HbA1c), body mass index (BMI), body weight, abdominal girth and dependency on conventional therapy in DM Patients. This retrospective study was conducted from July 2017 to January 2018, wherein the data of elderly male type 2 DM patients (HbA1c >6.5%) who attended Madhavbaug clinics in Maharashtra, India were identified. Data of patients who were administered CDC (60-75 minutes) with minimum 6 sittings over 90 days (± 15 days) were considered. Variables were compared between day 1 and day 90 of CDC. Out of 48 enrolled elderly male patients, 34 were included for analysis. CDC showed significant improvement in HbA1c from 8.27 ± 0.96to 7.1 ± 1.30; p=0.0001), BMI from 27.65 ± 3.20 to 25.91 ± 3.29, p< 0.0001), weight from 73.75 ± 10.76to 69.46 ± 10.39, p<0.0001). Abdominal girth (from 100.0 ± 9.08 to 95.36 ± 9.10; p<0.0001), also showed significant reduction. Dependency on concomitant medicines was reduced, with number of patients on no concomitant medicines increasing from 3% to 15%. CDC and allopathy both are found to be efficacious; but CDC acts dually, by reducing HbA1c, as well as reducing dependency on allopathic medications.
various ways. There are four pillars of management to prevent complications of diabetesmellitus, namely education, medical nutrition therapy, physical exercise and pharmacological interventions (Al Khawaldeh, 2009). Programs that have been implemented in Indonesia today are specifically health programs in health centers in dealing with diabetesmellitus, namely Chronic Disease Management program, Development Post Integrated, and Healthy Living Community Movement. But the application is considered to be still not optimal in preventing an increase in diabetesmellitus.
Abstract: The incidence of gestational diabetesmellitus (GDM) is on the increase and, if not diagnosed, managed and treated adequately, can have unfavorable maternal and fetal outcomes. Several studies have shown that glycemic values considered as adequate in the past when monitoring GDM failed to contain these adverse outcomes and randomized trials are needed to ascertain whether these targets should be lowered. Dietary restrictions remain the mainstay of GDM management and suitable physical exercise can help too. The use of rapid-acting insulin analogues (lispro and aspart) are novel treatments for improving metabolic control by reducing postprandial glycemia, while long-acting insulin analogues need to be evaluated by further studies for safety in clinical use before they can be prescribed. Numerous studies have found glyburide and metformin safe in women with GDM but more randomized controlled trials are needed, with a long-term follow-up of mother and child, to confirm these results.
The classic symptoms of diabetes are polyuria, polydipsia and unexplained weight loss. These are sometimes associated with polyphagia and blurred vision. Pruritus valvae or balanitis is a common presenting symptom since the external genitalia are especially prone to infection by fungi which flourish on skin and mucous membranes contaminated by glucose. Acute, life threatening consequence of diabetes are hyperglycemia with ketoacidosis or the nonketoic hypersmolar syndrome. Long term complications of diabetes include retinopathy with potential loss of vision, nephropathy leading to renal failure, peripheral neuropathy with risk of foot ulcers, ampulation and charcot joints and autonomic neuropathy causing gastro intestinal, genitourinary and cardiovascular symptoms and sexual dysfunction.
Diabetes is due to the reason the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. These includes three main types of diabetesmellitus which are as such: Type 1 DM results from the pancreas’ failure to produce enough insulin. This form was previously referred to as “insulin- dependent diabetesmellitus” (IDDM) or “juvenile diabetes.” The cause is unknown. Usually Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses lack of insulin may also develop.
Diabetes and hypertension are most common lifestyle disorders now a day. India is likely to become global capital of diabetes in next few years. Yoga practiced by Lord Shiva and other sages is gift to Indian culture and heritage of it. Basically it is meant for “Yogah Chittavrutti Nirodhah” but it has great role in upholding of our body health. Among Ashtang Yoga described by ‘Patanjali’ Aasana and Pranayama are being widely accepted globally. Indian physicians Sushruta and Charaka in 400-500 BC were well known that the type 1 diabetes is associated with youth and type 2 with obesity. Diabetesmellitus is a disease that averts the body from proper utilization of the energy from the diet. So to find out the beneficial effects of Aasana and Pranayama for diabetic patient this study was initiated and thorough literature related to topic was reviewed from all available sources. Aasanas and Pranayama have great prospective to alter pathophysiology of our body. Both can increase the blood and oxygen supply to various organs which also increase the efficiency and functioning of them. Diabetes is chiefly associated with malfunction of endocrine part of pancreas. So the Aasanas like Halasana, Sarvangasana, Matsyasana, Ardhamatsyendrasana, Shirshasana, Vajrasana, Dhanurasna, Chakrasana and Ushtrasana are very effective for stimulating the functions of pancreas. Similarly Pranayama like Bhrastrika, Bhramari, Kapalbhati and Nadishodhan are effective in cases of diabetesmellitus. The Aasanas and Pranayama effectively relieve physical and mental body stress. Bhrasrika is revitalizing Pranayama which increases oxygen levels and reduces carbon dioxide levels in the blood. The Aasana which create some pressure over pancreas and abdominal viscera by anatomical view are more helpful in controlling of blood sugar. Physical and mental stress is relieved by Pranayama helps to correct the pathology of diabetes.
There is a global epidemic of diabetes with its prevalence expected to increase from 5.1% in 2003 to 6.3% in 2025. This increase in diabetes is occurring in all nations, however, developing nations are particularly at risk. It spares no group and affects men, women, the elderly, young and people from very racial and socio- economic background. Nevertheless, certain ethnic groups including Asians are affected more than Caucasians. Large randomized clini- cal trials have shown that improvement in gly- caemic control, together with management of diabetes-related risk factors like blood pressure and lipid control significantly reduce the micro and macro complications in individuals with type 1 and type 2 diabetes. Patient education plays a crucial role in the prevention of diabetic fool problems. In Geneva, the rate of lower limb amputations was reduced by almost 75% after an educational intervention. People with diabe- tes must acquire the knowledge and skills through education to provide daily self-care in diabetesmanagement which involves mainte- nance of healthy living, recognition and man- agement of diabetes problems when they arise and taking preventive measures. Some factors include patients’ biomedical variables, the psy- chosocial environment, the knowledge, attitudes and beliefs of patients themselves, home ca- reers and health care providers, healthcare systems’ accessibility and availability and even the national political context may influence these self-care behaviors.
Although there was no definite information on pre- pregnancy counseling in our patients, it is pertinent to state that 49.2% of the patients were admitted in the first trimester (8–12 weeks) for careful control of diabetes, which usually included blood glucose monitoring and addition of insulin injections as required, a finding that tends to exclude any sig- nificant pre-pregnancy counseling/control of blood glucose. In all, 88.5% of the patients were admitted during pregnancy for blood glucose monitoring and diabetic control, includ- ing monitoring of glycosylated hemoglobin A 1c levels and ensuring that they were maintained in the normal range. The mean weight gained all through the pregnancy was signifi- cantly lower in the study population (P,0.009); this trend was also demonstrated in the subgroups of diabetesmellitus (GDM and type 1 diabetesmellitus), as reflected in Table 2, subsequent to further analysis of the study population. This indicates a positive effect of the treatment measures intro- duced in the care of the patients, which placed great emphasis on the reduction of weight gained in pregnancy.
Minkowski, Opie Schafer, and Oyhers conducted a study and observed that diabetes is caused due to lack of hormone secreted by pancreatic cells known as islets of Langerhans and later Schafer named this hormone as insulin. Based on insulin sensitivity, Hinsword classified diabetes as two types, Type-I (insulin sensitivity) and Type–II (insulin resistant). Eli Lilly and company is first to produce large quantity of purified insulin which is obtained from animal sources. In 1960 Dorothy frank developed urine strips to check the sugar levels in urine, and Dr. Richard Bernstein developed the first portable glucometer in 1969 . For Type-I diabetesmellitus (DM), insulin is the only medication as it is insulin-dependent, but type-II is non-insulin dependent so, many drugs such as oral hypoglycemic agents, glucagon-like peptide-I receptor agonists, and insulin are available. Some drugs such as metformin, glimepiride, repaglinide, and pioglitazone are commonly used oral hypoglycemic agents in treatment of DM. Sometimes combinations of two or more drugs are used in uncontrolled DM .
DM is currently the fifth leading cause of mortality worldwide by increasing the risk of cardiovascular dis- ease when compared to populations without diabetes [4,5]. Besides that, microvascular complications markedly deteriorate their quality of life. Tight plasma glucose con- trol, either with the use of insulin or oral glucose lowering agents, and the control of other cardiovascular risk factors, such as hypertension and dyslipidemia, are recommended nowadays in order to reduce morbidity and mortality asso- ciated with DM [6-14]. In addition to correcting glycemia, the combination of medications such as statins, anti- platelet agents and angiotensin-converting enzymes inhibi- tors is crucial in the treatment of patients affected by the disease.
Madhumeha is foremost in life style disorders and it was described as one among the Astamahagadas in Ayurvedic classics. Madhumeha (Diabetesmellitus) is becoming fastest considerable diseases in the world. It is a metabolic disorder may result in deficiency or dysfunction of the insulin production. The main causative factors is said to be sedentary lifestyle, stressful mental conditions and food ha- bits are running down to Madhumeha. In Ayurveda it is described in Vataja pramehas, which can be managed conservatively with Yoga, Exercise, Diet and Internal medication.
In 1674, Thomas Willis, a Physician, Anatomist and a professor of Natural philosophy at Oxford discovered by tasting that the urine of diabetic persons was “wonderfully sweet as if imbued with honey or sugar”. Willis could not explain the chemical nature of the sweet substance. It was Mathew Dobson of Manchester, England who in 1776 demonstrated that diabetics actually excrete sugar in urine. It was John Rollo, surgeon general of Royal artillery who first applied the discovery of glycosuria by Dobson to the quantitative metabolic study of diabetes.
Alternative Medicine for Diabetes Therapy Traditional medicine is used for management of diabetes in many countries. The herbs used in traditional medicine are readily available, cost effective and have very low side effects unlike drugs used in conventional medicine. More than 800 medicinal plants used in Ayurveda and other Indian medicine practices possess antidiabetic activity. These plants exert their antidiabetic potential by inhibiting enzymes involved in glucose generation or by promoting secretion of insulin. 6,7 The antidiabetic
(Tenepure; Teneza) at relatively affordable price. This is a positive step toward the management of T2DM in developing countries, where the cost of medicine is out-of-pocket expenditure and is a limiting factor for health care. This review evaluates the efficacy and safety of teneligliptin in the management of T2DM. Teneligliptin has been systematically evaluated in T2DM as mono- therapy with diet and exercise and in combination with metformin, glimepiride, pioglitazone, and insulin in short-term (12 weeks) and long-term (52 weeks) studies. These studies have reported a reduction in HbA1c of 0.8%–0.9% within 12 weeks of therapy. Two 52-week studies reported sustained improvement in glycemic control with teneligliptin. Teneligliptin has been found to be well tolerated, and the safety profile is similar to other dipeptidyl peptidase 4 inhibitors. Hypoglycemia and constipation are the main adverse events. Teneligliptin can be administered safely to patients with mild, moderate, or severe renal impairment or end-stage renal disease without dose adjustment. Similarly, it can be used in patients with mild-to-moderate hepatic impairment. Teneligliptin is effective and well tolerated and may have an important role in the management of T2DM.