Blood sugar lowering effect of Coccinia grandis (L.) J. Voigt: path for a new drug for diabetes mellitus

Gelatine nanoparticles encapsulating three edible plant extracts as potential nanonutraceutical agents against type 2 diabetes mellitus

AIM

To optimise, and characterise gelatine nanoparticles (GNPs) encapsulating plant extracts and evaluate the glucose-lowering potential.

METHODS

GNPs encapsulating plant extracts were prepared by desolvation method followed by adsorption. The GNPs were characterised by loading efficiency, loading capacity, particle size, zeta potential, SEM and FTIR. The glucose-lowering activity of GNPs was determined using oral glucose tolerance test in high-fat diet fed streptozotocin-induced Wistar rats.

RESULTS

Loading efficiency and capacity, particle mean diameter, and zeta potential of optimised GNPs 72.45 ± 13.03% w/w, 53.05 ± 26.16% w/w, 517 ± 48 nm and (-)23.43 ± 9.96 mV respectively. GNPs encapsulating aqueous extracts of C. grandis, S. auriculata, and ethanol 70% v/v extracts of M. koenigii showed glucose-lowering activity by 17.62%, 11.96% and 13.73% (p < 0.05) compared to the non-encapsulated extracts. FTIR analysis confirmed the encapsulation of phytoconstituents into GNPs. SEM imaging showed spherical GNPs (174 ± 46 nm).

CONCLUSION

GNPs encapsulating plant extracts show promising potential to be developed as nanonutraceuticals against diabetes.

Synthesis and bioactivity assessment of Coccinia grandis L. extract encapsulated alginate nanoparticles as an antidiabetic drug lead

AIM

This study aimed to prepare, characterise, and evaluate the antidiabetic activity of Coccinia grandis (L.) extracts encapsulated alginate nanoparticles.

METHODS

Alginate nanoparticles were prepared using the ionic gelation method and characterised by encapsulation efficiency %w/w, loading capacity %w/w, particle size analysis, zeta potential, Fourier transform infra-red spectroscopy (FTIR), and scanning electron microscopy (SEM). In vitro antidiabetic activity was also evaluated.

RESULTS

Encapsulation efficiency %w/w, loading capacity %w/w, mean diameter, zeta potential of C. grandis encapsulated alginate nanoparticles ranged from 10.51 ± 0.51 to 62.01 ± 1.28%w/w, 0.39 ± 0.04 to 3.12 ± 0.11%w/w, 191.9 ± 76.7 to 298.9 ± 89.6 nm, -21.3 ± 3.3 to -28.4 ± 3.4 mV, respectively. SEM and FTIR confirmed that particles were in nano range with spherical shape and successful encapsulation of plant extracts into an alginate matrix. The antidiabetic potential of aqueous extract of C. grandis encapsulated alginate nanoparticles (AqCG-ANP) exhibited inhibition in α-amylase, α-glucosidase and dipeptidyl peptidase IV enzymes of 60.8%c/c, 19.1%c/c, and 30.3%c/c, respectively, compared to the AqCG.

CONCLUSION

The AqCG-ANP exerted promising antidiabetic potential as an antidiabetic drug lead.

Selection and optimisation of extraction technique for the preparation of phenolic- and flavonoid-rich extract of leafy vegetable, Coccinia grandis (Linn.) Voigt

Coccinia grandis (L.) Voigt (family: Cucurbitaceae) is a popular leafy vegetable in Sri Lankan diet. C. grandis is high in phenolics and flavonoids. The present work attempted to determine a suitable extraction technique, and further optimise it to obtain phenolic- and flavonoid-rich extract from C. grandis leaves, with an aim at developing a nutraceutical targeting the dietary management of diabetes mellitus. Acetone extraction (AE), methanol extraction (ME), pre-warmed water extraction (PWE), electric shake extraction (ESE), reflux extraction (RE), ultrasonication with water (UEw), ultrasonication with ethanol (UEe), ultrasonic assisted-reflux extraction (URE), and reflux assisted-ultrasonic extraction (RUE) were chosen as the extraction techniques. URE was selected as a satisfactory extraction technique for further optimisation for the preparation of phenolic- and flavonoid-rich extract based on the contents of phenolics (32.97 ± 0.41 mg of equivalent gallic acid/g of extract) and flavonoids (4.50 ± 0.04 mg equivalent quercetin/g of extract). The highest yield of 32.8% was obtained by the URE technique. The optimal extraction conditions for URE were determined with an ultrasonic time of 19 min, refluxing time of 168 min, and liquid:solid ratio of 16.4 mL/g. This is the first attempt to investigate the selection and optimisation of an extraction technique for obtaining phenolic- and flavonoid-rich extract from C. grandis leaves. The present findings would be useful in the development of a commercially viable nutraceutical using a phenolic- and flavonoid-rich extract of C. grandis.

Mucilage of Coccinia grandis as an Efficient Natural Polymer-Based Pharmaceutical Excipient

Natural eco-friendly materials are recently employed in products to replace synthetic materials due to their superior benefits in preserving the environment. The herb Coccinia grandis is widely distributed in continents like Asia and Africa and used traditionally to treat fever, leprosy, asthma, jaundice, and bronchitis. Mucilage of Coccinia grandis was accordingly extracted, isolated by a maceration technique, and precipitated. The mucilage was evaluated for its physicochemical, binding, and disintegrant properties in tablets using paracetamol as a model drug. The crucial physicochemical properties such as flow properties, solubility, swelling index, loss on drying, viscosity, pH, microbial load, cytotoxicity was evaluated and the compatibility was analyzed using sophisticated instrumental methods (TGA, DTA, DSC, and FTIR). The binding properties of the mucilage was used at three different concentrations and compared with starch and PVP as examples of standard binders. The disintegrant properties of mucilage were used at two different concentrations and compared with standard disintegrants MCCP, SSG, and CCS. The tablets were punched and evaluated for their hardness, friability, assay, disintegration time, in vitro dissolution profiles. In vitro cytotoxicity studies of the mucilage were performed in a human embryonic kidney (HEK) cell line. The outcome of the study indicated that the mucilage had good performance compared with starch and PVP. Further, the mucilage acts as a better disintegrant than MCCP, SSG and CCS for paracetamol tablets. Use of a concentration of 3% or less demonstrated the ability of the mucilage to act as a super disintegrating agent and showed faster disintegration and dissolution, which makes it as an attractive, promising disintegrant in formulating solid dosage forms to improve the therapeutic efficacy and patient compliance. Moreover, the in vitro cytotoxicity evaluation results demonstrated that the mucilage is non-cytotoxic to human cells and is safe.

Antidiabetic Activity of Widely Used Medicinal Plants in the Sri Lankan Traditional Healthcare System: New Insight to Medicinal Flora in Sri Lanka

The use of medicinal plant extracts and their isolated bioactive compounds for the management of diabetes mellitus has been tremendously increased in recent decades. The present study aimed at providing in-depth information on medicinal flora that has been widely used in the Sri Lankan traditional healthcare system for the management of diabetes mellitus. The data of this review article were obtained from published articles from January 2000 to September 2020 in scientific databases of PubMed, Web of Science, and Google Scholar. In this review, a total number of 18 medicinal plants with the antidiabetic activity were expressed, and their isolated antidiabetic active compounds were highlighted as new drug leads. Results of the reported studies revealed that medicinal plants exert a potent antidiabetic activity via both in vitro and in vivo study settings. However, bioactive compounds and antidiabetic mechanism (s) of action of many of the reported medicinal plants have not been isolated/elucidated the structure in detail, to date. Reported antidiabetic medicinal plants with other properties such as antioxidant and antihyperlipidemic activities deliver new entities for the development of antidiabetic agents with multiple therapeutic targets. This is a comprehensive review on potential antidiabetic activities of the Sri Lankan medicinal plants that have been widely used in the traditional healthcare system. The information presented here would fill the gap between the use of them by traditional healers in the traditional medicine healthcare system in Sri Lanka and their potency for development of new drug entities in future.

Efficacy and safety of a herbal drug of Coccinia grandis (Linn.) Voigt in patients with type 2 diabetes mellitus: A double blind randomized placebo controlled clinical trial

BACKGROUND

Several lines of preclinical studies have shown promising antidiabetic effects of the aqueous leaves extract of Coccinia grandis (Linn.) Voigt (Cucurbitaceae) in vivo and in vitro.

PURPOSE

The present study was conducted to evaluate the efficacy and safety of a newly developed herbal formulation of C. grandis in newly diagnosed patients with type 2 diabetes mellitus (T2DM).

STUDY DESIGN

A three months long, randomized, double blind, placebo controlled clinical trial in patients with newly diagnosed T2DM.

METHOD

Based on fasting plasma glucose (FPG) concentration, a total number of 158 newly diagnosed patients with T2DM (45 ± 15 years age) were recruited for the present trial from the University Medical Clinic, Teaching Hospital, Karapitiya, Galle, Sri Lanka. They were randomly assigned to the test or placebo group to receive 500 mg of herbal drug (n = 79) or placebo drug (n = 79) once daily for three months. Patients and investigators were blinded for the treatment. Percentage of glycated hemoglobin (HbA_1C %), insulin and lipid profile parameters were estimated at the base line and at the end of the intervention. Serum concentration of fructosamine was assessed at every other visit of the trial. The homeostatic model assessment for insulin resistance (HOMA-IR), atherogenic index (AI), cardio-protective index (CPI) and coronary risk index (CRI) were calculated. Furthermore, fasting plasma glucose concentration, renal and liver toxicity parameters, hematological parameters, blood pressure (BP) were assessed throughout the study in two weekly intervals till the end of three months.

RESULTS

Out of 158, a total number of 145 patients completed the entire clinical trial period successfully. Mean (SD) changes of variables from the baseline to the end of the intervention in test and placebo groups were 0.65 (0.54) and 0.08 (0.66) for HbA_1C % (p < 0.001), 1.91 (3.07) and -1.28 (9.77) for insulin (p < 0.001), 0.02 (0.03) and -0.01 (0.04) for frucosamine (p < 0.001), 1.51 (0.49) and 0.05 (0.50) for FPG (p < 0.001), 1.73 (1.36) and -0.37 (3.38) for HOMA-IR (p < 0.001), 0.16 (0.18) and -0.04 (0.42) for TG (p < 0.001), 0.07 (0.08) and -0.02 (0.19) for VLDL-C (p < 0.001), respectively. However, the herbal drug of C. grandis was unable to change other outcome variables significantly when compared to the placebo (p > 0.05). All the renal, liver and toxicity parameters, hematological parameters and BP were within the normal physiological reference ranges at each visit.

CONCLUSION

Treatment with herbal drug of C. grandis (500 mg per day) for three months for patients with newly diagnosed T2DM significantly improved their glycemic and selected lipid profile parameters with well tolerated safety.

Medicinal plants utilized in Thai Traditional Medicine for diabetes treatment: Ethnobotanical surveys, scientific evidence and phytochemicals

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetes mellitus remains the most lethal metabolic disease of contemporaneous times and despite the therapeutic arsenal currently available, research on new antidiabetic agents remains a priority. In recent years, the revitalization of Thai Traditional Medicine (TTM) became a clear priority for the Thai government, and many efforts have been undertaken to accelerate research on herbal medicines and their use in medical services in various hospitals. Additionally, and particularly in rural areas, treatment of diabetes and associated symptomatology frequently relies on herbal preparations recommended by practitioners of TTM. In the current work, medicinal plants used in Thailand for treating diabetes, as well as their hypoglycaemic pharmacological evidences and potential therapeutic use for diabetes-related complications were reviewed.

MATERIALS AND METHODS

Ethnopharmacological information on the plant materials used in TTM for diabetes treatment was collected through literature search in a range of scientific databases using the search terms: diabetes, folk medicine, Thailand medicinal plants, traditional medicine. Information regarding scientific evidence on the antidiabetic effects of surveyed species was obtained considering not only the most common taxonomic designation, but also taxonomic synonyms, and including the keywords 'diabetes' and 'hypoglycaemic effect'.

RESULTS

A total of 183 species known to be used for diabetes management in TTM were reviewed, with 30% of them still lacking experimental evidences to support claims regarding the mechanisms and phytochemicals underlying their antidiabetic properties. Moreover, a total of 46 bioactives displaying effective antidiabetic effects have been isolated from 24 species, their underlying mechanism(s) of action being fully or partially disclosed.

CONCLUSIONS

We deliver the most extensive survey dealing with the ethnomedicinal knowledge of Thai medicinal plants utilized on diabetes management. We are certain that the current review will spark further research on Thai plants for the development of new standardized phytomedicines through drug discovery programmes.

Synergistic Antimicrobial and Antioxidant Properties of Coccinia grandis (L.) Voigt, Clerodendrum inerme (L.) Gaertn. and Acanthus ebracteatus Vahl. Extracts and Their Potential as a Treatment for Xerosis Cutis

BACKGROUND

A common health condition among older persons is xerosis cutis. Topical corticosteroid treatments are -associated with side effects. There is an unmet need for her-bal treatment alternatives. Coccinia grandis, Clerodendrum inerme and Acanthus ebracteatus are used to treat skin con-ditions in Thai traditional medicine. This study aimed to investigate their antimicrobial and antioxidant properties, synergistic properties as well as their cytotoxicity.

METHODS

-Ethanolic herbal extracts were used to perform minimal -inhibitory (MIC) and minimal bactericidal concentration (MBC) assays on common skin pathogens. Synergistic anti-microbial activity was evaluated by a chequerboard assay. Antioxidant and synergistic properties were assessed by a 1,1-diphenyl-2-picrylhydrazyl assay. Cytotoxicity was tested on normal adult human primary epidermal keratinocytes.

RESULTS

All extracts showed an inhibitory effect on growth of all microorganisms tested. MIC and MBC values ranged from 0.0625 to 32 mg/mL and from 0.0625 to >256 mg/mL, respectively. A. ebracteatus extract markedly demonstrated bactericidal activity against an methicillin-resistant Staphylococcus aureus strain. Additive antimicrobial activity was observed (fractional inhibitory concentration index values: 0.75-1). All extracts possessed antioxidant properties (IC50 values: 0.12-0.25 mg/L). However, antagonism was observed with paired extract combinations (combination index values: 1.025-1.455). The cell viability assay confirmed that herbal extracts were not cytotoxic.

CONCLUSIONS

Our results provide early findings of pharmacological activities to support a novel choice of herbal combinations as potential local skin treatment options for xerosis cutis.

Natural Hydrogen Sulfide Donors from Allium sp. as a Nutraceutical Approach in Type 2 Diabetes Prevention and Therapy

Type 2 diabetes mellitus (DM) is a socially relevant chronic disease with high prevalence worldwide. DM may lead to several vascular, macrovascular, and microvascular complications (cerebrovascular, coronary artery, and peripheral arterial diseases, retinopathy, neuropathy, and nephropathy), often accelerating the progression of atherosclerosis. Dietary therapy is generally considered to be the first step in the treatment of diabetic patients. Among the current therapeutic options, such as insulin therapy and hypoglycemic drugs, in recent years, attention has been shifting to the effects and properties-that are still not completely known-of medicinal plants as valid and inexpensive therapeutic supports with limited side effects. In this review, we report the relevant effects of medicinal plants and nutraceuticals in diabetes. In particular, we paid attention to the organosulfur compounds (OSCs) present in plant extracts that due to their antioxidant, hypoglycemic, anti-inflammatory, and immunomodulatory effects, can contribute as cardioprotective agents in type 2 DM. OSCs derived from garlic (Allium sp.), due to their properties, can represent a valuable support to the diet in type 2 DM, as outlined in this manuscript based on both in vitro and in vivo studies. Moreover, a relevant characteristic of garlic OSCs is their ability to produce the gasotransmitter H₂S, and many of their effects can be explained by this property. Indeed, in recent years, several studies have demonstrated the relevant effects of endogenous and exogenous H₂S in human DM, including by in vitro and in vivo experiments and clinical trials; therefore, here, we summarize the effects and the underlying molecular mechanisms of H₂S and natural H₂S donors.

A study on food-medicine continuum among the non-institutionally trained siddha practitioners of Tiruvallur district, Tamil Nadu, India

BACKGROUND

Medicinal properties of the food species are one of the poorly documented and important areas of ethnopharmacology. The present survey quantitatively documented the medicinal foods prescribed by the non-institutionally trained siddha practitioners of Tiruvallur district of Tamil Nadu.

METHODS

Field work was carried out between December 2014 and April 2017 using a questionnaire. The illnesses mentioned by the informants were grouped as illness categories on the basis of emic perceptions. Sufficiency of sampling of this survey was assessed by plotting the cumulative number of UR and Shannon-Wiener's index. The indices such as informant consensus factor (FIC), Index of Agreement on Remedies (IAR), and Cultural Food Significance Index (CFSI) were calculated.

RESULTS

This study documented 165 medicinal foods used by 82 non-institutionally trained siddha practitioners of Tiruvallur district, and 73.93% of these preparations were plant based. Among the animal taxa, 82.05% were represented by fish taxa. The illness category gastrointestinal ailments is the majorly cited illness category treated with plant-based formulations. The illness categories viz., gastrointestinal ailments, hemorrhoids, and neural ailments had high consensus under the group of plant-based medicinal foods. In animal-based medicinal foods, kapha ailments had gained 23.07% of UR. The illness categories such as bone fractures, male reproductive ailments, blood ailments, and anabolic had high FIC values.

CONCLUSIONS

Deeper studies on different dietary cultures of India may help to derive better interpretations on food-medicine continuum. This study identified some important claims such as the use of citron, pomegranate and Solanum americanum (gastrointestinal ailments), Abutilon indicum, onions and elephant foot yam (hemorrhoids), Boerhavia diffusa (urinary ailments), Moringa oleifera (anemia), Aloe vera (gynecological ailments), Eclipta prostrata (liver ailments), ivy gourd (diabetes), citron (hypertension), Centella asiatica (psychological ailments), spade nose shark (lactogogue), reticulate whipray (wheezing and bronchitis), Katelysia opima (impotence), Indian squid (anemia), and Indian oil sardine (anabolic). More studies on these claims will help identify novel functional foods to add to the field of medical nutrition therapy, with traditional brand identity. Robust studies on the documentation of the traditional knowledge on marine resources will yield a good database for various stakeholders and policy makers.

An Overview of Herbal Products and Secondary Metabolites Used for Management of Type Two Diabetes

Diabetes mellitus is a common effect of uncontrolled high blood sugar and it is associated with long-term damage, dysfunction, and failure of various organs. In the adult population, the global prevalence of diabetes has nearly doubled since 1980. Without effective prevention and management programs, the continuing significant rise in diabetes will have grave consequences on the health and lifespan of the world population, and also on the world economy. Supplements can be used to correct nutritional deficiencies or to maintain an adequate intake of certain nutrients. These are often used as treatments for diabetes, sometimes because they have lower costs, or are more accessible or "natural" compared to prescribed medications. Several vitamins, minerals, botanicals, and secondary metabolites have been reported to elicit beneficial effects in hypoglycemic actions in vivo and in vitro; however, the data remain conflicting. Many pharmaceuticals commonly used today are structurally derived from natural compounds from traditional medicinal plants. Botanicals that are most frequently used to help manage blood glucose include: bitter melon (Momordica charantia), fenugreek (Trigonella foenum graecum), gurmar (Gymnema sylvestre), ivy gourd (Coccinia indica), nopal (Opuntia spp.), ginseng, Russian tarragon (Artemisia dracunculus), cinnamon (Cinnamomum cassia), psyllium (Plantago ovata), and garlic (Allium sativum). In majority of the herbal products and secondary metabolites used in treating diabetes, the mechanisms of action involve regulation of insulin signaling pathways, translocation of GLUT-4 receptor and/or activation the PPARγ. Several flavonoids inhibit glucose absorption by inhibiting intestinal α-amylase and α-glucosidase. In-depth studies to validate the efficacies and safeties of extracts of these traditional medicinal plants are needed, and large, well designed, clinical studies need to be carried out before the use of such preparations can be recommended for treatment and/or prevention of diabetes. The main focus of this review is to describe what we know to date of the active compounds in these, along with their glucose-lowering mechanisms, which are either through insulin-mimicking activity or enhanced glucose uptake.

Evaluation of Larvicidal Activity of Essential Oil from Leaves of Coccinia grandis against Three Mosquito Species

BACKGROUND

To study the chemical constituents and larvicidal activity of essential oil extracted from the leaves of Coccinia grandis against three mosquito species.

METHODS

Essential oil was extracted by hydro distillation using clevenger apparatus and was analyzed for chemical constituents by gas chromatography-mass spectrophotometry (GC-MS). Larvicidal activity was recorded after 12 and 24h of post-exposure against three mosquito species, Anopheles stephensi, Aedes aegypti and Culex quinquefasciatus. Dead larvae were identified when they failed to move after probing with a needle in the siphon or cervical region. The LC₅₀ and LC₉₀ values for three mosquito larvae were calculated by Probit analysis.

RESULTS

The GC-MS analysis revealed that essential oil contains 23 different constituents. Out of these 23 constituents, major constituents identified were n-tetracosane (39.18%), n-eicosane (30.04%), tetratriacotane (2.97%), 7-octadecanal (2.81%), and tricosane (2.31%). Essential oil from leaves of Coccinia grandis exhibited significant larvicidal activity against An. stephensi with LC₅₀ and LC₉₀ values 39.41ppm and 123.24ppm, respectively. This was followed by Ae. aegypti and Cx. quinquefasciatus with LC₅₀ and LC₉₀ values of 48.20ppm, 131.84ppm and 52.80ppm, 135.48ppm, respectively after 24h of exposure.

CONCLUSION

The results could be useful in developing a cost effective, ecofriendly, region specific and practical strategy for the control of mosquito vectors.

Biomolecular Characterization of Putative Antidiabetic Herbal Extracts

Induction of GLUT4 translocation in the absence of insulin is considered a key concept to decrease elevated blood glucose levels in diabetics. Due to the lack of pharmaceuticals that specifically increase the uptake of glucose from the blood circuit, application of natural compounds might be an alternative strategy. However, the effects and mechanisms of action remain unknown for many of those substances. For this study we investigated extracts prepared from seven different plants, which have been reported to exhibit anti-diabetic effects, for their GLUT4 translocation inducing properties. Quantitation of GLUT4 translocation was determined by total internal reflection fluorescence (TIRF) microscopy in insulin sensitive CHO-K1 cells and adipocytes. Two extracts prepared from purslane (Portulaca oleracea) and tindora (Coccinia grandis) were found to induce GLUT4 translocation, accompanied by an increase of intracellular glucose concentrations. Our results indicate that the PI3K pathway is mainly responsible for the respective translocation process. Atomic force microscopy was used to prove complete plasma membrane insertion. Furthermore, this approach suggested a compound mediated distribution of GLUT4 molecules in the plasma membrane similar to insulin stimulated conditions. Utilizing a fluorescent actin marker, TIRF measurements indicated an impact of purslane and tindora on actin remodeling as observed in insulin treated cells. Finally, in-ovo experiments suggested a significant reduction of blood glucose levels under tindora and purslane treated conditions in a living organism. In conclusion, this study confirms the anti-diabetic properties of tindora and purslane, which stimulate GLUT4 translocation in an insulin-like manner.

Traditional management of diabetes in Pakistan: Ethnobotanical investigation from Traditional Health Practitioners

ETHNOPHARMACOLOGICAL RELEVANCE

The uses of anti-diabetic plants are well anchored in the traditional health care system of Pakistan. To the best of our knowledge, this is the first ethno-botanical study about the uses of plants for the treatment of diabetes. The aim of the study is to record indigenous knowledge on anti-diabetic plants from Traditional Health Practitioners (THPs) and diabetic patients. In addition, it is aimed to ascertain and validate the traditional uses of anti-diabetic plants by citing pharmacological activities and phytochemical constitutes from previously published literature.

MATERIALS AND METHODS

The ethno-medicinal data was documented during 14 field surveys, each comprising of 10 days, from 3 regions of Pakistan (Islamabad, Khyber Pukhtoonkhwa and Deserts of Sindh). In total, 113 THPs and 44 diabetic patients were interviewed using open-ended and semi-structured questionnaires. Quantitative indices, including Relative Frequency of Citation percentage (RFC %) and Disease Consensus Index (DCI) were calculated. The documented data is authenticated by comparing with 28 published articles on ethno-botanical aspects and many pharmacological studies.

RESULTS

In total, 120 plant species belonging to 50 families were reported. The ethno-botanical results indicated that Moraceae (11 species); herb (56 reports) is dominant life form; the leaves (56 reports) are the most used plant part and decoction (24%) is the preferred mode of preparation. The quantitative analysis shows that RFC% ranges from 14 to 42 and DCI varies from 0.15 to 0.74. By comparing to previous studies, 64 species are reported new in traditional treatment of DM; 40 species are new to pharmacological evidence and 3 species are new to phytochemical studies.

CONCLUSIONS

This study recoded the significant indigenous knowledge about anti-diabetic plants among the THPs and diabetic patients in Pakistan. This type of ethno-botanical knowledge on traditional use of anti-diabetic plants is an important step in designing detailed pharmacological and clinical trials for Diabetes Miletus treatment. It is recommended that further pharmacological and phytochemical analysis should be conducted on those species which lack previous references in literature and have highest Frequency of Citation (FC), Disease Consensus Index (DCI) and Relative Frequency of Citation percentage (RFC%).

Use of household ingredients as complementary medicines for perceived hypoglycemic benefit among Sri Lankan diabetic patients; a cross-sectional survey

Background:

Biologic based therapies are frequently used as complementary medicines in diabetes. The aim of this study was to identify the commonly used herbal remedies and their preparations in Sri Lankan patients with Type 2 diabetes.

Methods:

This is a descriptive, cross-sectional study on 220 diabetic patients using herbal remedies for perceived glycemic benefit.

Results:

All the patients used their regular conventional medications together with herbal remedies. The most commonly used medication was metformin (91.4%). Ivy gourd (Coccinia grandis) was the most commonly used herbal remedy (32%), followed by crepe ginger (Costus speciosus) (25%) and bitter gourd (Momordica charantia) (20%). Herbal remedies used less frequently were finger millet (Eleusine corocana) (5%), anguna leaves (Wattakaka volubilis) (5%), goat weed (Scoparia dulcis) (4%), Salacia reticulata (4%), fenugreek (Trigonella foenum-graecum) (3%) and tree turmeric (Coscinium fenestratum) (0.5%). None of the patients used commercially available over-the-counter herbal products. The common preparations were salads (72.8%), curries (12.8%), herbal tea (6%), and herbal porridges (6%).

Conclusion:

The practice of using household ingredients as complementary medicines is common in Sri Lanka. Few herbal remedies and their methods of preparation have limited evidence for efficacy. In view of the frequent use by diabetic patients each needs to be documented for reference and scientifically explored about their hypoglycemic potential.

Monograph of Coccinia (Cucurbitaceae)

This monograph deals with all 95 names described in the Cucurbitaceae genus Coccinia and recognizes 25 species. Taxonomic novelties are Cocciniaadoensisvar.aurantiaca (C.Jeffrey) Holstein, stat. nov., Cocciniasessilifoliavar.variifolia (A.Meeuse) Holstein, stat. nov., and Cocciniaadoensisvar.jeffreyana Holstein, var. nov. For the 25 species 3157 collections were examined, of which 2024 were georeferenced to produce distribution maps. All species are distributed in sub-Saharan Africa with one species, Cocciniagrandis, extending from Senegal in West Africa east to Indonesia and being naturalized on Pacific Islands, in Australia, the Caribbean, and South America. Coccinia species are dioecious creepers or climbers with simple or bifid tendrils that occupy a range of habitats from arid scrubland, woodlands to lowland rainforest and mist forest. The corolla of Coccinia species is sympetalous, usually pale yellow to orange, and 1 to 4.5 cm long. Pollination is by bees foraging for pollen or nectar. After pollination, the developing ovary often exhibits longitudinal mottling, which usually disappears during maturation. All species produce berries with a pericarp in reddish colors (orange-red through to scarlet red), hence the generic name. The globose to cylindrical fruits contain numerous grayish-beige flat to lenticular seeds. Chromosome numbers are 2n = 20, 24, and 22 + XX/XY. Many Coccinia species are used for food, either as roasted tubers, greens as spinach, or the fruits as vegetables. Medicinal value is established in Cocciniagrandis, of which leaves and sap are used against diabetes.

The use of complementary and alternative medicines (CAMs) in the treatment of diabetes mellitus: is continued use safe and effective?

INTRODUCTION

Diabetes mellitus is a major cause of morbidity and mortality worldwide, with a prevalence of 347 million in 2013. Complementary and Alternative Medicines (CAM) are a group of remedies that is fast gaining acceptance among individuals. Cinnamon, Bitter gourd (Momordica charantia) and Fenugreek (Trigonella foenum-graecum) are 3 widely used CAMs used worldwide for the treatment of diabetes. Data on safety and efficacy is limited, but the consumption is wide. Crepe ginger (Costus speciosus) and Ivy gourd (Coccinia grandis) are 2 plants used widely in the Asian region for their presumed hypoglycaemic properties.

OBJECTIVE

In this review, we analyzed the available evidence for the 5 CAMs mentioned above in terms of in-vitro studies, animal studies sand clinical trials. We also describe the mechanisms of hypoglycaemia and safety concerns where there is available evidence.

RESULTS AND CONCLUSIONS

Clinical trials that studied the hypoglycaemic effects of Cinnamon, bitter gourd, fenugreek and ivy gourd showed conflicting results. Direct comparison between studies remains a challenge in view of the baseline heterogeneity of subjects, differences in substrate preparation, variable end points and poor trial design. Short durations of study and small number of subjects studied is universal. Crepe ginger has not been studied adequately in humans to draw conclusions.In view of the high prevalence of use and safety and efficacy issues, there is an urgent need to study their hypoglycaemic and adverse effects in well-designed long-term clinical trials.

Use of Complementary and Alternative Medicines (CAMs) among type 2 diabetes patients in Sri Lanka: a cross sectional survey

BACKGROUND

The incidence of chronic illnesses has increased worldwide. Diabetes is one such illness and 80% of the diabetic population lives in the developing world. There is a rapidly growing trend towards the use of Complementary and Alternative Medical practices in Diabetes. Sri Lanka is a developing Asian nation with a rich culture of Ayurvedic and native medical culture. The objective of this study was to find the prevalence of use of CAMs in a diabetic population attending a large multiethnic diabetes facility in a University unit and to assess whether there is an increase in the incidence of hypoglycaemic episodes among users of CAMs.

METHODS

A cross sectional study was performed at Teaching Hospital Peradeniya between April and August 2012. Following verbal consent, 254 type 2 adult diabetic patients attending the diabetes facility were interviewed regarding the use of CAM and hypoglycaemia using an interviewer-administered questionnaire.

RESULTS

Of the 252 valid results, 192 patients (76%) admitted to the use of a CAM to reduce blood glucose. Bitter gourd, ivy gourd and crepe ginger were used by 128, 113 and 92 individuals. While 19% used a single agent, 34%, 21% and 2.4% used 2,3 and more than 3 agents. The incidence of hypoglycaemia in CAM users was 21% and 16.6% in non-users. The difference was statistically not significant. (p = 0.57) Ingestion of Costus speciosus (Crepe ginger) was associated with higher incidence of hypoglycaemia (P = 0.01).Female gender was significantly associated with CAM use (p = 0.01), while the age, duration of diabetes, presence of co-morbidities and complications of diabetes failed to show a significant association.

CONCLUSION

Sri Lanka has a very high use of herbal supplementation in type 2 diabetes patients. Although the overall incidence of hypoglycaemia is not increased among CAM users, crepe ginger is associated with significant hypoglycaemia and warrants further research.