Department of Pharmacy, Shivajirao Pawar College of Pharmacy, Pachegaon, Ahilyanagar-413725
Diabetes mellitus is a group of metabolic diseases in which there are high blood sugar levels over a continuous period. Diabetes mellitus is widely recognised as one of the leading causes of death and disability. According to W.H.O. 415 million people are suffering from Diabetes mellitus worldwide, which may go up to 435 million in 2030 and may go to 592 million by 2035. Several mechanisms have been proposed to be responsible for insulin resistance, including increased non-esterified fatty acids, inflammatory cytokines, adipokines and mitochondrial dysfunction as well as glucotoxicity, lipotoxicity and amyloid formation of ?. cell dysfunction. Diabetic management includes diet, exercise and combinations of antihyperglycemic drug treatment with lipid-lowering, antihypertensive and antiplated therapy. Traditionally, there are some medicinal plants believed to treat diabetes as they have been proven in research studies to possess anti-diabetic properties. This review focused on types, Diagnosis, Pathophysiology and the medicinal plants used for the treatment /management of the diabetes mellitus.
As per Ayurveda diabetes also known as Madhumeha is a disease in which improper functioning of Insulin and as a result sugar level in blood increases.[1] As per W.H.O DM is characterised by common features of chronic hyperglycemia with disturbance of carbohydrate, fat and protein metabolism. [2] At this point it is also important to understand another related term, metabolic syndrome (also called syndrome X or insulin resistance syndrome) Consisting of a combination of metabolic abnormalities which increases the risk of developing diabetes mellitus and the cardiovascular disease. Major features of the metabolic syndrome are central obesity hyperglyceridaemia, low HDL cholesterol, hyperglycemia and hypertension. DM is a leading cause of morbidity and mortality world over. It is expected to continue as a major health problem owing to its serious complications especially end-stage renal disease.IHD. Gangrene of the lower extremities and blindness in adults. China, India and the US are the countries with highest number of the diabetic population. In India, its incidence is estimated at 7% of adult population largely due to genetic susceptibility combined with changing lifestyle of low-activity and high calorie diet in the growing Indian middle class.Not only biological factors but also psychosocial factors are responsible for diabetes risk.(3) Evidence indicates that diabetes and its complications are strongly related to the psychological and psychiatrically problems.[4] various types of psychosocial factors include depression, poor eating habits, poor exercise and fear of hypoglycaemia. Patients with diabetes from high level of diabetes-specific emotional stress associated with poor adherence to exercise, diet, medications, inadequate glycaemic control, obesity, hereditary, lifestyle includes alcohol consumption, smoking.[5] There are mainly 2 types of diabetes. Type 1 diabetes mellitus (T1DM) which is more common in children and type 2 diabetes mellitus (T2DM) most commonly observed in adults. DM is suspected mainly based on its symptoms. The high blood glucose produces the sign of frequent urination (polyurea) increased thirst (polydipsia) and increased thirst(polydipsia) and increased hunger (polyphagia).[6] According to the International Diabetes Federation (IDF) 9.1 of the 4.15 millions patients with DM have Type 2 DM.(7) Type 1 DM stems from the lymphocyte-mediated destruction of pancreatic ?-islet cells, involving human leukocyte antigen associated particularly with a strong linkage to DQA and DQB agents. The place at which ?-cell deterioration occurs differs among individual of different age groups limiting the body’s ability to maintain physiological glucose level.(8) Patients with DM may present with various symptoms like Polyuria, polydisphia and weight loss. DM is diagnosed through criteria such as Fasting blood glucose levels and oral glucose tolerance test. The pathophysiology of DM involves Inulin resistance and pancreatic ?-cell dysfunction leading to elevated blood glucose levels.(9)
The causes of DM includes:
Prevalence
The number of people with diabetes is increasing due to population growth, aging, urbanization, and the increasing prevalence of obesity and physical inactivity. The prevalence of diabetes for all age groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than wo iimen, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030.[11] The prevalence estimates of Diabetes in India ranges from 5.6% to 12.4% in Urban area and 2.4% to 2.7% in rural area. This difference not only exist across the Indian states because different states India are at diverse stages of demographic transition. [12] Diabetes is chronic disease that occurs either when pancreas does not produce enough Insulin or when the body cannot effectively use the Insulin it produces. The Insulin hormone that produces /regulate blood glucose. Hyperglycemia also called as raised blood glucose /raised blood sugar is a common effect of uncontrolled Diabetes and over time leads to serious damage to many of the body system specially nerves and blood vessels. In 2014 8.5% of adult ,18-year-old and elder persons has Diabetes. In 2019 Diabetes was directly caused 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years.[13]
The firstly accepted classification of Diabetes Mellitus was published by W.H. O in the year 1980. [ ] and was modified in the year 1985.it must be different from secondary Diabetes Mellitus which include from Hyperglycemia associated with identifiable causes in which destruction pancreatic islet is reduced by inflammatory disease. (14)
Type 2 DM (NIDDM): It is non-Insulin dependent Diabetes Mellitus. It is also known as Maturity onset diabetes since it occurs in the middle age group (usually more than 40 years of age. Body does not produce enough Insulin for proper function or the cell in the body do not reacts to insulin (Insulin-resistance).[17)
3) Gestational Diabetes: This type affects female during the pregnancy. Some women have very high levels of glucose in their blood.(18) In pregnacy hormonal changes occurs which are responsible for the body to use Insulin which results in development of carbohydrate in tolerance. Gestational Diabetes Mellitus disappears after the childbirth.[19)
4) Other specific type (Monogenic types)
The most common form of monogenic types of diabetes is developed with mutations on chromosome 12 in a hepatic transcription factor referred to as hepatocyte nuclear factor (HNF)la. They also referred to as genetic defects of beta cells(20). These forms of diabetes are frequently characterized by onset of hyperglycemia at an early age (generally before age of 25 years). They are also referred to as maturity onset diabetes of the young (MODY), 181 maturity- onset diabetes in youth or with defects of insulin action; persons with diseases of the exocrine pancreas, such as pancreatitis or cystic fibrosis; persons with dysfunction associated with other endocrinopathies (e.g., acromegaly); and persons with pancreatic dysfunction caused by drugs, chemicals or infections. Some drugs also used in the combination with the treatment of HIV/ AIDS or after organ transplantation. Genetic abnormalities that result in the inability to convert proinsulin to insulin have been identified in a few families, and such traits are inherited in an autosomal dominant pattern. They comprise less than 10% of DM cases.
Causes of diabetes mellitus: Disturbances or abnormality in gluco-receptor of B cell so that they respond to higher glucose concentration or relative B cell deficiency. In either way, insulin secretion is impaired; may progress to B cell failure. 1251 The theory of principal in micro vascular disease leading to neural hypoxia, and the direct effects of hyperglycemia on neuronal metabolism. [21)
Current treatments for Diabetes Mellitus and their side effects.25
Sr. No. |
Drug |
Action |
Side effect |
1) |
Metformin
|
Lowering glucose production in the liver improve body sensitivity to insulin. |
Nausea, bloating and abdominal pain.
|
2) |
Sulfonylureas |
Help to body secrete more insulin. |
Low blood sugar level and weight gain |
3) |
Thiazolidinediones (Glitanide) |
Make body tissues more sensitive to insulin. |
Risk of CHF, bladder cancer, bone fracture, cholesterol. |
4) |
Glinides (Biguanide ) |
stimulate pancreas to secrete more insulin. |
Low blood sugar level and weight gain. |
5) |
DPP 4 inhibitors |
Help to reduce sugar level. |
Risk of pancreatitis and joint pain. |
6) |
SGLT 2 inhibitors |
Inhibit the return of glucose is excreted in the urine. |
Risk of amputation, bone fracture, vaginal yeast function, high cholesterol and urinary tract infection. |
Medicinal plants used for the treatment and management of Diabetes mellitus.[26)
CONCLUSION
Diabetes mellitus is a complicated health condition with multiple causes and many treatment options. Various myths may influence diabetics’ health-seeking behaviour, and they may use traditional medicines, which include normal foods and herbs, for primary health care. The synthetic formulation against the diabetes mellitus is available in market. They are showing excellent clinical and pharmacological activity in diabetic patients, but they have significant adverse effect. So, it is necessary to aware the people who are suffered from type 2 diabetes mellitus to treat this disorder by using herbal/medicinal preparation which is showing antidiabetic action. In this article we have provided the information of Diabetes Mellitus and some medicinal plants which are safe and helpful in the treatment and management of Diabetes Mellitus.
REFERENCES
Kailas Gore, Pratik Bhange, Dr. Megha Salve, A Brief Review on Diabetes Mellitus and Role of Medicinal Plants in The Management of Diabetes Mellitus, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 11, 1567-1573. https://doi.org/Kailas Gore, Pratik Bhange, Dr. Megha Salve, A Brief Review on Diabetes Mellitus and Role of Medicinal Plants in The Management of Diabetes Mellitus, Int. J. of Pharm. Sci., 2024, Vol 2, Issue 11, 1567-1573. https://doi.org/10.5281/zenodo.14236446