Prevalence and associated factors of herbal medicine use among adult diabetes mellitus patients at government hospital, Ethiopia: An institutional-based cross-sectional study

Applying Network Pharmacology and Molecular Docking in the Screening for Molecular Mechanisms of Ampalaya (Momordica charantia L.) and Banaba (Lagerstroemia speciosa L.) against Type 2 Diabetes Mellitus

Background and Objectives

Type 2 diabetes mellitus (T2DM) is a global health concern affecting more than 400 million people worldwide. Diabetic neuropathy, nephropathy, retinopathy, and cardiovascular complications lead to debilitating effects to patients. To prevent these, the treatment goal is to lower the blood sugar levels and maintain at a normal range which is achieved through conventional treatments like insulin and oral hypoglycemic agents. However, the high cost of these medications implicates patient treatment outcomes. Hence, alternatives are sought for including the use of herbal medicines. Momordica charantia (MC) and Lagerstroemia speciosa (LS) are common herbal medicines used to manage T2DM. In the Philippines, these herbal preparations are validated for their glucose lowering effects and are commonly found in combination in food supplements. The study aims to screen the possible mechanisms of compounds present in these herbal medicines which can offer possible explanations for their synergistic effects and rationalization of their combination in preparations.

Methods

Network pharmacology was employed to determine pivotal proteins that are targeted by MC and LS compounds. Molecular docking was then done to evaluate the favorability of the binding of these compounds toward their target proteins.

Results

Our results showed that TNF, HSP90AA1, MAPK3, ALDH2, GCK, AKR1B1, TTR and RBP4 are the possible pivotal targets of MC and LS compounds in T2DM.

Conclusion

Terpenoids from MC and decanoic acid from LS are the compounds which showed favorable binding towards pivotal protein targets in T2DM. By binding towards the different key proteins in T2DM, they may exhibit their synergistic effects. However, the results of this study are bound to the limitations of computational methods and experimental validation are needed to verify our findings.

Prevalence and predictors of traditional medicine use among persons with diabetes in Africa: a systematic review

The utilization of traditional medicine (TM) is prevalent among the general population in Africa; however, its use among individuals with diabetes in the region remains underdocumented. This review aimed to synthesize the available literature to identify the prevalence and predictors of TM use among persons with diabetes in Africa. A systematic search was conducted across multiple databases, including MEDLINE, Embase, CINAHL, and AMED, covering studies published from 2000 to April 2023. Of 1560 records identified, 24 articles met the inclusion criteria. The prevalence of TM use varied significantly, ranging from 12.4% to 77.1%, with a median prevalence of 50%. TM was commonly used concurrently with conventional medicine (CM) (35.4-88.4%), with a majority (63.8-91.3%) not disclosing TM use to healthcare providers. Female gender, long diabetes duration, use of oral antiglycaemic medication and family history of diabetes emerged as the most common factors that predicted the use of TM. This review highlights the widespread use of TM among individuals with diabetes in Africa, often in conjunction with CM. The high prevalence of undisclosed TM use emphasizes the urgent need for healthcare providers to actively inquire about TM use during clinical consultations to address potential herb-drug interactions and adverse effects.

Prevalence and associated factors of herbal medicine use among patients living with chronic disease in Ethiopia: A systematic review and meta-analysis

Background

Complementary use of medicinal plants with prescribed drugs is becoming more widespread concern among people with chronic disease like cancer, HIV/AIDS, diabetes and hypertension. Consequently, the purpose of this review was to determine the prevalence and associated factors of herbal medicine use among patients suffering from chronic disease.

Methods

This systematic review and meta-analysis was conducted by searching articles from Cochrane library, Google scholar, PubMed and African journal online. Data was extracted using Microsoft excel format and imported in to Stata software version 11 (Stata Corp LLC, TX, USA) for analysis. Statistical heterogeneity across the studies was investigated using Cochran's Q chi-square test at the significance level of <0.05 and the I2 index. A random-effects model was used to estimate the pooled prevalence of herbal medicine use.

Results

Our systematic search yielded a total of 17,665 records from four databases (Google scholar (12,800), PubMed (3835), Cochrane library (30) and African journal online (12). The pooled estimate of herbal medicine use among patients with chronic disease in Ethiopia is found to be 56.94% (95% CI: 49.75, 64.12, P < 0.001). Being female (POR = 2.06, 95% CI = 1.55, 2.75, I2 = 10.0%), rural residence (POR = 2.80, 95% CI = 1.42, 5.52, I2 = 89.1%), duration of the disease greater than 5 years (POR = 6.42, 95% CI = 4.188, 9.84, I2 = 48.3%) and having complication (POR = 4.65, 95% CI = 3.75, 5.77, I2 = 0.0%) were factors associated with herbal medicine use among patients living with chronic disease.

Conclusion

The study found a high prevalence of herbal medicine use among patients living with chronic disease. Being female, rural residence, duration of disease greater than 5 years and having complication were factors that are significantly associated with herbal medicine use. The prevalence of herbal medicine use among persons with chronic disease in Ethiopia presents significant implications for healthcare practice. Healthcare professionals need to adopt a patient-centered strategy that promotes open, judgment-free discussions about herbal medicine usage.

Prospero registration

CRD42024498817.

Study of the spread of medicinal herbs use among patients suffering from chronic diseases in Iraq

OBJECTIVE

Aim: To assess the prevalence of medicinal plants, use among Iraqi patients with chronic disease and compare it with another study in same or different countries.

PATIENTS AND METHODS

Materials and Methods: A randomized Internet and social media questionnaire was used. In this cross-sectional study, peoples with chronic diseases from different age group were recruited. Participants had an internet questionnaire to answer. This questionnaire embraced age, gender, occupation, marital status, education level and some lifestyle details as demographic data, a large proportion of the questionnaire was related to herbs, both prescribed and OTC ones.

RESULTS

Results: Gender distribution: about 70% of patients were female and 30% male. Education level: uneducated - 35%, primary school - 30%, secondary school - 25%, academic - 10%. Place of residence: 30% lived in urban and 70% in rural areas. Diseases distribution: 30% hypertension, 20% diabetes, 10% asthma, 10% migraine, 15% hyperlipidemia and 15% rheumatoid arthritis. Medicinal plants: 10% green tea, 5%fish oil, 15% anise 25% castor oil and 15% spirulina.

CONCLUSION

Conclusions: The study reported a high prevalence of medicinal herbs use among patients with chronic disease in Iraq. Several factors (rural residence, education, age, multiple chronic conditions and low quality of life) associated with medicinal herbs use. This knowledge will help policy makers and health care providers for decision making on the safe use of herbal medicine.

Managing Diabetic Complications with Alternative Therapeutic Strategies

Diabetes is a chronic metabolic disease affecting millions worldwide. It is characterized by a lack of insulin production or impaired insulin function, leading to elevated blood glucose levels. Conventional treatment methods for diabetes management typically include lifestyle changes and medications. However, alternative therapies have gained attention in recent years, including traditional medicine containing bioactive compounds, supplements like vitamin D and Omega-3 fatty acids, aromatherapy, and homeopathy. Diabetic complications are common in patients with uncontrolled diabetes and can lead to serious health problems, including diabetic retinopathy, impaired wound healing, kidney disease, nerve damage, and cardiovascular disease. Alternative remedies, such as traditional medicine containing bioactive compounds, supplements, and aromatherapy, have been studied for their potential benefits in managing these complications. Traditional medicines like bitter melon, cinnamon, and fenugreek have been shown to have anti-diabetic effects due to their bioactive compounds. Similarly, supplements like vitamin D and Omega-3 fatty acids have been found to improve glycemic control in patients with diabetes. Aromatherapy, which involves the use of essential oils, has also been explored for its potential benefits in diabetes management. Homeopathy, which uses highly diluted substances to stimulate the body's natural healing abilities, has been used to treat diabetes-related symptoms like neuropathy and wounds. Personalized care is essential in natural diabetes management because each person's body and health needs are unique. A holistic approach that addresses the individual's physical, emotional, and spiritual well-being is essential. As research in this field continues to expand, a more comprehensive understanding of diabetes management will lead to improved outcomes for those living with this condition.

Prevalence of herbal and traditional medicine in Ethiopia: a systematic review and meta-analysis of 20-year studies

BACKGROUND

The widely accepted prevalence of traditional medicine (TM) in Ethiopia was about 80 %, of which 95 % were sourced from plants. The purpose of this study was to update knowledge of the prevalence of herbal medicine or TM in Ethiopia and describe the characteristics of the population mostly relying on herbal medicine or TM to inform health policy-makers.

METHODS

PubMed, Google Scholar, Hinari, Scopus, and the Directory of Open Access Journals (DOAJ) were searched. The methodological quality of each included study was assessed using the quality assessment checklist for prevalence studies. Meta-analysis was conducted using STATA version 17, and the heterogeneity between studies was assessed using I2 test statistics based on the random effect model. Forest and funnel plots were used to present the data. Subgroup analysis was done by the study population, region, and setting.

RESULTS

Thirty-six studies with a total of 16,288 participants met the inclusion criteria. Meta-analysis of the study revealed that the prevalence of herbal medicine use in Ethiopia is 46 % (95 % CI, 37-54 %), with significant heterogeneity among the studies (I2 = 99.19 %). Egger's test for publication bias of herbal medicine use revealed significant results (Egger, P = 0.002) which indicates possible missing of small sample size studies. The prevalence of TM use in Ethiopia is 65 % (95 % CI, 52-77 %) with significant heterogeneity among the studies (I2 = 99.18 %). Egger's test for publication bias of TM use revealed non-significant results (Egger, P = 0.275). The subgroup analysis by the study setting and the region revealed variability amongst the studies. Community-based studies and Oromia National Regional State showed higher prevalence. By population type, a higher prevalence of TM use was observed amongst children and lowest amongst malaria suspects.

CONCLUSIONS

The current study revealed that TM/herbal medicine utilization remained an important source of primary healthcare in Ethiopia. In comparison to the commonly reported prevalence of TM/herbal medicine, there is a considerable decline in TM/herbal medicine prevalence. High TM/herbal medicine use tendency during pregnancy necessitates safety studies to optimize the utilization.

Use of herbal medicines for the management of type 2 diabetes: A systematic review of qualitative studies

BACKGROUND

Many people with Type 2 Diabetes Mellitus (T2DM) use herbal medicines, some of which can improve glycaemic control. Providing evidence-based advice on herbal medicines could be an effective intervention to improve control of diabetes, if it is designed to address key needs and concerns of T2DM patients.

AIM

To understand the views and experiences of patients and health professionals on herbal treatments for self-management of T2DM.

METHOD

MEDLINE, EMBASE, CINAHL, SOCIOFILE and Google Scholar were searched for qualitative studies in T2DM patients about their views on herbal medicines. Included papers were analysed using thematic synthesis.

RESULTS

Thirty-one papers (about 30 studies) were included: 20 from low-and-middle income countries, 10 from high income countries, and 1 internet-based study. Almost all studies from high income countries focussed on ethnic minorities. Many people with T2DM wanted a "cure", and often took advice from friends and family, but also traditional healers and mass media. However, they were reluctant to discuss herbal medicines with health professionals, whom they perceived as "closed-minded". They based their treatment decisions on personal experience (from "trial-and-error"), availability, cost and convenience of both herbal and conventional medicines. Most health professionals were reluctant to discuss herbal medicines, or recommended against their use, because of lack of knowledge and concerns about their quality, efficacy and potential interactions.

CONCLUSION

Evidence-based information could help to overcome the current lack of communication about herbal medicines between people with T2DM and health professionals.

In Vivo Hypolipidemic, Hypoglycemic, Antihyperglycemic, and In Vitro Antioxidant Effects of Podocarpus gracilis Leaf Extract and Fractions in Diabetic Mice

Background

Podocarpus gracilis is an evergreen, dioecious tree found in Ethiopia and other African nations. It can reach a height of 60 meters. Without any scientific validation, ethnobotanical studies conducted in Ethiopia revealed that the Podocarpus gracilis plant's leaf is consumed orally to treat diabetes mellitus. Hence, this study aims to evaluate the in vivo blood glucose level lowering, lipid-lowering, and in vitro-free radical scavenging responses of Podocarpus gracilis leaf extract and fractions on experimental mice induced with diabetes.

Methods

The in vitro antioxidant activity of PGC (Podocarpus gracilis) leaf extract was assessed by using a diphenyl-2-picrylhydrazyl (DPPH) assay. The oral glucose-loaded, normoglycemic, and streptozotocin- (STZ-) induced diabetic mouse models were employed. In the STZ-induced mice model, the leaf extract and solvent fractions activity on serum lipid and weight were also measured. The extract and fractions were tested at 100, 200, and 400 mg/kg dosages. One-way ANOVA was used to determine the statistical significance of BGL (blood glucose level) changes within and between groups, and Tukey's post hoc multiple comparisons were then performed.

Results

In the acute toxicity study of Podocarpus gracilis leaf extract and fractions, there was no evidence of animal mortality at the maximum dose of 2 g/kg during the observation period. The extract-treated group with normoglycemia revealed a significant lowering in BGL at the 4-hour mark of 27.4% (p < 0.001) and 25.2% (p < 0.01) at doses of 200 mg/kg and 400 mg/kg, respectively, compared to that in negative control. In the oral glucose tolerance test (OGTT) model, only 400 mg/kg treated groups at 120 min after exposure showed a BGL reduction of 31.17% which was statistically significant (p < 0.05) in comparison to the negative control. In the single-dose STZ-induced model, eighth-hour BGL measurements from CE 100, CE 200, CE 400, and GLC5 showed drops in BGL of 43.1%, 44.1%, 45%, and 47.3% from baseline fasting BGL values. In the repeated streptozotocin (STZ)-induced model, at all doses of leaf extract and fractions, the fasting BGL was significantly (p < 0.001) reduced. Moreover, the leaf extract and solvent fractions have shown a significant (p < 0.001) reduction of serum lipids such as LDL, TC, and VLDL, and at the same time, it increases HDL at 14 days with body weight gained. In the test for antioxidant activity, the half-maximal inhibitory concentrations (IC50) for leaf extract and the standard medication (ascorbic acid) were 8.2 μg/ml and 3.3 μg/ml, respectively. The IC50 value denotes the concentration of the sample required to scavenge 50% DPPH radicals.

Conclusion

The 80% hydromethanolic leaf extract and fractions of Podocarpus gracilis exhibited blood glucose lowering, lipid-lowering activity in normoglycemic, oral glucose tolerance test (OGTT) mode, and STZ-induced diabetic mice with weight gains. There is scientific support for the alleged traditional use as an antidiabetic, lipid-lowering, and antioxidant activity. The results need to be confirmed by future studies.

Treatment on Nature’s lap: Use of herbal products in the management of hyperglycemia

Diabetes mellitus (DM) is characterized by persistently elevated blood glucose concentration that lead to multisystem complications. There are about 400 medicinal plants cited to have a beneficial effect on DM. We must choose products wisely based on data derived from scientific studies. However, a major obstacle in the amalgamation of herbal medicine in modern medical practices is the lack of clinical data on its safety, efficacy and drug interaction. Trials of these herbal products often underreport the side effects and other crucial intervention steps deviating from the standards set by Consolidated Standards of Reporting Trials. Due to a lack of knowledge of the active compounds present in most herbal medicines, product standardization is difficult. Cost-effectiveness is another issue that needs to be kept in mind. In this mini-review, we focus on the anti-hyperglycemic effect of herbal products that are commonly used, along with the concerns stated above.

The effects of aqueous and ethanolic extracts of Rheum ribes on insulin-resistance and apolipoproteins in patients with type 2 diabetes mellitus: a randomized controlled trial

BACKGROUND AND AIM

Previous studies have shown that Rheum ribes (R. ribes) could be effective in controlling the blood glucose levels. This study was conducted to determine the effects of R. ribes supplementation on glycemic indices and apolipoproteins in patients with type 2 diabetes mellitus (T2DM).

METHODS

In the present randomized double-blind controlled trial, 60 type 2 diabetic patients aged 30-60 years with a body mass index (BMI) of 20-30 kg/m² and hemoglobin A1c (HbA1c) of 6-8% were enrolled. Patients were randomly assigned to receive 450 mg of aqueous R. ribes extract (AG), 450 mg of ethanolic R. ribes extract (EG), or placebo (PG) three times daily for 6 weeks. At the baseline and at the end of the study, blood glucose levels, homeostatic model assessment of insulin resistance (HOMA-IR) and the homeostatic model assessment of β-cell dysfunction (HOMA-B), as well as apolipoprotein A-I (ApoA1) and apolipoprotein B (ApoB) were measured.

RESULTS

There was a significant decrease in the serum levels of insulin in AG and EG groups (P = 0.003 and P = 0.001, respectively), HOMA-IR (P = 0.01 and P = 0.001, respectively), HOMA-B (P = 0.002 and P = 0.001, respectively), ApoB (P = 0.006 and P = 0.03, respectively), ApoB/ApoA1 ratio (P = 0.016 and P = 0.04, respectively). However, a significant increase in ApoA1 (P = 0.08 and P = 0.05, respectively) with no significant changes in blood glucose, at the end of study compared to beginning values, were observed. None of the variables showed a significant change in PG. At the end of the study; while there were significant differences in insulin (P = 0.04), HOMA-IR (P = 0.03), HOMA-B (P = 0.01), ApoB (P = 0.02), and ApoB/ApoA1 ratio (P = 0.03) among the groups but ApoA1 had no significant change.

CONCLUSION

Consumption of R. ribes intake could have beneficial effects on insulin resistance and apolipoproteins in type 2 diabetic patients. (Registered at en.irct.ir, identification number: IRCT201410142709N31).

The Effect of Herbal Product Use on BMI and HbA1c in Patients with Diabetes

Aim: Patients with diabetes can use herbal products to better manage the disease. The aim of this study is to examine the rate of herbal product use and the effect of herbal product use on Body Mass Index (BMI) and hemoglobin A1c (HbA1c) values in patients with diabetes.Method: The descriptive and cross-sectional study was conducted in the diabetes outpatient clinic of a hospital in Istanbul with a total of 104 patients with diabetes. The data were collected using a data collection form, which questioned the patients' socio-demographic characteristics, disease information and herbal product use. Data analysis was performed using Chi-square, One-Sample Kolmogorov-Smirnov test and Mann Whitney U test in computer environment.Results: The mean age of patients with diabetes was 61,08±9,3 years, the mean BMI was 26,3±5,4kg/m², and the mean HbA1c value was 6,9%±1,8%. The BMI and HbA1c values of the patients using herbal products were lower than the patients not using herbal products (respectively; p=,002; p=,047). It was determined that the duration of herbal product use did not affect BMI and HbA1c values (p&gt;,05).Conclusion: The use of herbal products was high in patients with diabetes. It was determined that olive leaf, cinnamon leaf, thyme juice, garlic, black sesame, blueberry, fenugreek seeds, French lavender and bitter almond were used as herbal products. Herbal product use decreased BMI and HbA1c values.

The Prevalence and Pattern of Using Complementary and Alternative Medicine in Saudi Patients With Diabetes: A Cross-Sectional Study

Background Diabetes mellitus is a common disease in Saudi Arabia. Patients with chronic diseases, such as diabetes, tend to use complementary and alternative medicine (CAM) either as an addition or alternative to their medical therapy. Many studies have evaluated the CAM herbal products used by patients with diabetes; however, there have been few and inconsistent studies on other types of CAM, and most studies on CAM have focused on their use in type 2 diabetes. Objective This study aimed to determine the prevalence and patterns of CAM use among patients with type 1 or type 2 diabetes in Riyadh, Kingdom of Saudi Arabia. Methods This cross-sectional study was conducted in an adult Saudi population at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. Data were collected from December 2019 to February 2020 using a data collection form and patient interviews. Results We included 332 patients, 43% of whom had type 1 diabetes; 26% of the patients had previously used one or more types of CAM. Approximately 53% of CAM users had glycated hemoglobin (HbA1c) level of ≥9%. Among CAM users, 51% mentioned that their blood sugar readings were improved with CAM treatments. Mind-body therapy was the most commonly used CAM (54%), followed by biologically based CAM, including herbs (46%). The most commonly used herbal supplements were black cumin (42%), followed by fenugreek (28%), myrrh (24%), frankincense (22%), cinnamon (15%), garlic (15%), and onion (15%). Older age and employment status were predictors of CAM use in Saudi patients with diabetes. The main sources of knowledge about CAM were from family and friends. Conclusions CAM use is common among Saudi Arabian patients with diabetes. Patients with diabetes who are aged >65 years and employment status were the main predictor of CAM use. Assessing CAM use is an important aspect of clinical encounters with Saudi patients, especially patients with type 1 diabetes.

Traditional Medicine Use among Type 2 Diabetes Patients in KZN

Background. Traditional medicine (TM) is widely used in both developing and developed countries to assist in the attempt to curtail the prevalence and increase in diabetes mellitus. Approximately 53% of South Africans use TM to prevent and treat their diseases. There is no conclusive evidence regarding the safety and effectiveness of TM versus prescribed medicine. The most common therapies used by diabetics in Africa include herbal treatments, nutritional products, spiritual healing, and relaxation techniques. Therefore, this study aimed to evaluate the use of TM in patients with T2DM who are on chronic therapy and living in KwaZulu-Natal. Method. This cross-sectional study was conducted at a district hospital, in which purposive sampling was used to recruit participants and data were collected using a structured questionnaire. Information collected included demographic data, information pertaining to home remedies/TM, and self-care practices employed by participants while using TM. Data were analyzed using Pearson’s chi-squared test, t-test, and multivariate logistic regressions to determine predictors of TM usage. Results. Only 92 (27%) of 340 participants reported using TM, with Indians being the most frequent users (58.24%). Approximately, 83.72% (n = 72) used TM in conjunction with prescribed medication. Most participants (56.32%) acquired TM knowledge from family. The most frequently used TM was lemon and honey, Aloe vera, bitter gourd, green tea, and cinnamon. Traditional medicine use among African participants was 0.56 times (OR = 0.56, 95% CI = 0.34, 0.93) lower than Indian participants. There were no significant predictors for TM usage among the variables tested. Conclusion. A low prevalence rate of TM usage in T2DM patients was found. A significant correlation was noted between ethnicity and TM use. Large-scale studies are required to determine the additive and synergistic effects of TM in health care. Consideration should also be given to integrating TM into mainstream health care.