Management of Type 2 Diabetes Mellitus by Traditional Medicine Practitioners in Kenya--Key Informant Interviews

Indigenous Medicinal Plants Used in the Management of Diabetes in Africa: 5 Years (2019-2024) in Perspective

(1) Background: The utilization of medicinal plants in the management of diabetes is of great importance to the health of the indigenous population on the African continent. The high cost of orthodox conventional medicines coupled with the perceived side effects encourages the high patronage of indigenous medicinal plants in the management of this metabolic disorder. We conducted a review on the indigenous African medicinal plants that could be useful in preclinical and clinical trials in the field of diabetes mellitus research. (2) Methods: Data were mined from research articles published and associated with the use of medicinal plants in the management of diabetes on the African continent (from January 2019 to March 2024). Literature from ethnobotanical studies on the African continent was searched from the Google Scholar, SCOPUS, Medline, Web of Science and PubMed databases. We employed the following keywords: "indigenous plants", "diabetes in Africa" and "antidiabetic effect of medicinal plants". (3) Results: A total of 52 medicinal plants belonging to 31 families were recorded in this study. Amaryllidaceae (14.28%), Fabaceae (9.52%) and Asteraceae (9.52%) were the most cited plant families. The frequently used indigenous medicinal plants on the African continent were Allium sativum L. (n = 6), Olea europaea L. (n = 6), Azadirachta indica A. Juss (n = 5), Allium cepa L. (n = 5) and Moringa oleifera Lam. (n = 5). The highly cited parts of the plant used in the management of diabetes were the leaves (45.55%), bark (14.44%) and bulbs (12.22%). The preferred methods of the preparation of herbal medicines were decoction (45.23%) and infusion (25%). Oral (52.32%) was the preferred route of the administration of herbal medicine on the African continent. (4) Conclusions: The data revealed some similarities in the way countries on the African continent manage diabetes. This interesting observation will assist in our quest towards obtaining a standardized protocol using indigenous medicinal plants to combat diseases on the African continent.

Evaluation of antihyperglycemic activity of aqueous stem bark extract of Boswellia dalzielii in alloxan-induced diabetic Wistar rats

Background

Diabetes mellitus is one of the leading causes of morbidity and mortality globally. Although synthetic hypoglycemic agents are commonly used to manage this disorder, such medications, besides being unable to cure the disease, are expensive and associated with side effects. Conversely, medicinal plants have emerged as effective, safe and affordable alternative treatments. Boswellia dalzielii plant has been reported to possess ethnomedicinal properties for the treatment of various health conditions; however, scientific studies exploring this plant as antihyperglycemic agent are still limited. Thus, this study evaluated the antihyperglycemic activity of aqueous stem bark extract (ASBE) of B. dalzielii in alloxan-induced diabetic Wistar albino rats.

Methods

Phytochemical screening of the ASBE of B. dalzielii was conducted. Twenty male Wistar albino rats weighing 100–150 g divided into 4 groups (A–D) of five rats were used for the study. Group A served as the normal control and received neither ASBE of B. dalzielii nor glibenclamide. The treatment for the other three groups was as follows: Group B, 10 mg/kg of glibenclamide (diabetic control); Group C, 500 mg/kg ASBE of B. dalzielii; and Group D, 1000 mg/kg ASBE of B. dalzielii. Treatments were administered orally every 24 h for a period of 2 weeks. Blood glucose level and body weight were evaluated at weeks 0, 1 and 2. Histomorphological features of the rats’ pancreas in all the groups were compared.

Results

The phytochemical analysis revealed the presence of alkaloids, saponins, tannins, cardiac glycosides, flavonoids, carbohydrates, steroids and triterpenes. The two different doses of the plant extract significantly reduced blood glucose level at weeks 1 and 2 (all p < 0.05), with the 1000 mg/kg dose demonstrating a greater reduction compared with glibenclamide at week 2 (p = 0.014). However, only the 500 mg/kg dose led to restoration, albeit slight, of the pancreatic islet cells.

Conclusion

This study suggests that B. dalzielii plant exhibits a potent antihyperglycemic activity evidenced by reduced blood glucose levels and slight restoration of pancreatic islet cells. This plant could be, therefore, considered in the treatment of diabetes mellitus.

Graphical Abstract

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.

Therapeutic role of Azadirachta indica leaves ethanolic extract against diabetic nephropathy in rats neonatally induced by streptozotocin

Diabetic nephropathy (DN) is manifested by chronic loss of renal function due to damage of glomeruli and renal tubules. Therefore, this study is mainly designed to evaluate the therapeutic role of Azadiracta indica (neem) leaves extract as a novel approach for treatment of DN in rats neonatally induced by streptozotocin (STZ). For this study, 40 offspring were selected after parturition and categorized into four groups (n = 10). Group1: control group, group 2: neem leaves extract supplemented group, group 3: diabetic group that injected with a single dose of STZ and group 4: diabetic group treated with neem extract. The results revealed deleterious histological and ultrstructural changes in the renal tissues of diabetic rats. Such changes included atrophied glomeruli, dilated renal cortical tubules and scattered hemorrhage spots, thickening of glomerular basement membrane, expansion of mesangial matrix and pyknotic podocyte. Additionally, the proximal convoluted tubule and distal tubule showed cytoplasmic vacuolation, vacuolated mitochondria, scattered lipid droplets, lost microvilli and disrupted basal lamina and basal infoldings. Moreover, significant decreased levels of serum antioxidants (SOD&CAT) and significant increased levels of serum MDA, urea and creatinine were noticed in diabetic rats. Neem leaves extract successfully alleviated the histological and ultrastructural as well as biochemical changes induced by diabetes.

Antidiabetic effect of aqueous stem bark extract of Parinari macrophylla in alloxan-induced diabetic Wistar rats

Background

Diabetes is a major public health problem with increasing prevalence globally. Plant-based medicines for diabetes are gaining popularity across the world due to perceptions of efficacy, safety and cost-effectiveness. The plant, Parinari macrophylla, has been widely reported to possess potent ethnomedicinal properties especially in the northern part of Nigeria. However, there has been no scientific documentation of this plant to be used as an antidiabetic agent. The objective of this study was to investigate the antidiabetic effect of aqueous stem bark extract of P. macrophylla in alloxan-induced diabetic Wistar rats. Phytochemical screening and acute toxicity studies were conducted. Wistar rats weighing between 100 and 150 g were used for the study and diabetes was induced using alloxan monohydrate (150 mg/kg) intraperitoneally. The animals were treated with different doses of aqueous stem bark extract of P. macrophylla (1000 mg/kg and 2000 mg/kg) for 2 weeks. Blood glucose levels and body weight were then monitored. Histopathological investigation of pancreatic tissue was also conducted.

Results

The phytochemical analysis revealed the presence of alkaloids, saponins, tannins, cardiac glycosides, carbohydrates, steroids, and triterpenes as secondary metabolites. The acute toxicity test revealed no mortality with a median lethal dose determined to be above 5000 mg/kg. Although the two different doses of aqueous stem bark extract of P. macrophylla decreased blood glucose levels at weeks 1 and 2, a statistically significant difference (P < 0.05) was only observed for the group treated with 2000 mg/kg dose compared to the diabetic control group at week 2. The histological investigation revealed that the two different doses of aqueous stem bark extract of P. macrophylla caused regeneration of pancreatic islet cells, with the 2000 mg/kg dose being more evident.

Conclusion

This study suggests that the stem bark extract of P. macrophylla possesses a potent antidiabetic effect and may potentially be used to treat diabetes and associated complications.

Graphical Abstract

Utilization of traditional medicine in primary health care in low- and middle-income countries: a systematic review

This paper reports the findings from the first systematic review of the utilization of traditional medicine (TM) in primary health care (PHC) in low- and middle-income countries (LMICs). PHC is an important component of health care and essential for achieving universal health coverage (UHC). For countries where there is a gap in PHC, TM plays a vital role. It is widely used and has the potential to increase the coverage of PHC and UHC. Hence in situations where TM is recognized in a considerable magnitude, there are scarce evidence and minimal regulation on it and TM practitioners (TMPs). This study aims to identify the current situation in the utilization of TM in PHC or UHC in LMICs. A systematic review and thematic synthesis of qualitative and quantitative studies have been conducted. A total of 56 articles met the criteria and were included in the review. In all, 14 analytic themes have been developed including the current use of TM in PHC, higher accessibility of TM, medical pluralism, national health system, national health policy and national health insurance to include TM, including TMPs in the referral system, utilizing TMPs as community health workers, the needs of scientific research on TM and the need for training both TMPs and conventional medical staffs for better collaboration. The study concluded that it is necessary to further focus on TM in the macro level on strengthening the referral system by including TM to establish a comprehensive service delivery network under UHC and in the micro level to focus on training the TMPs and conventional medicine health workers on both areas to attain more in-depth understanding of each other, which can lead to better collaboration and quality patient care.

Knowledge and documentation of patient health information among traditional health practitioners in urban and peri-urban areas of eThekwini Municipality, KwaZulu-Natal Province, South Africa

BACKGROUND

Documentation of patient health information (PHI) is a regulatory requirement and hence a standard procedure in allopathic healthcare practice. The opposite is true for African traditional medicine (ATM) in most African countries, including South Africa, despite legal and policy frameworks that recognise and mandate the institutionalisation of ATM. Developing good practice standards for PHI documentation is an essential step in the institutionalisation of ATM.

OBJECTIVE

This study examined the knowledge and practices of documentation of PHI by traditional health practitioners (THPs) in Durban, eThekwini Municipality, KwaZulu-Natal Province, South Africa.

METHODS

In this quantitative cross-sectional study, snowball sampling was used to identify and recruit THPs. An interviewer-administered questionnaire was used to gather data. Chi-square tests and logistic regression were used to assess associations of knowledge and practice of documentation of PHI with potential predictors; age, gender, education, type of practitioner, experience, number of patients seen per day and location of the practice.

RESULTS

Of the 248 THPs who participated, 71.8% were female. Mean (SD) age was 47.4 (14.2), ranging 18-81 years. The majority (65.7%) were Izangoma (diviners). Overall, 42.9% of the THPs reported knowledge of patient medical records (PMRs). In logistic regression, only number of patients seen per day remained a significant predictor of knowledge about PMR. THPs who reported seeing 6-10 patients were five times more likely (Odds Ratio (OR): 5.164, 95% Confidence Interval (CI): 1.270-20.996; p = 0.022) to report knowledge of PMR than those seeing <6 patients per day. Overall, 25.0% of THPs reported that they were documenting some PHI. Documentation was associated with having knowledge of PMR (OR: 29.323, 95% CI: 10.455-82.241; p < 0.0001) and being an Isangoma (OR: 3.251, 95% CI: 1.092-9.679; p = 0.02). Not knowing what (56.5%) and how (50.5%) to record were the most commonly cited reasons for not documenting.

CONCLUSION

Knowledge of PMR is low, and the practice of documenting PHI is even lower among THPs in eThekwini. That knowledge of PMR was a strong predictor of documentation practice, and the most common reason for not documenting was lack of knowledge about what and how to document suggests that training could improve PHI documentation in traditional medicine practice.

The commercialization of traditional medicine in modern Cambodia

Globally, traditional medicine has long been used to address relatively common illness, mental ill health and during childbirth and post-natal care. However, traditional medicine is primarily provided by the private sector and it is unclear how far expenditures on traditional medicine contribute to household impoverishment. A life history method was used to understand the health seeking experience of 24 households over the last 60 years in Cambodia, a country with high out-of-pocket expenditures for health. The life histories suggest that traditional medicine in Cambodia has been undergoing a process of commercialization, with significant impacts on poor households. In the earlier lives of respondents, payments for traditional medicine were reported to have been flexible, voluntary or appropriate to patients’ financial means. In contrast, contemporary practitioners appear to seek immediate cash payments that have frequently led to considerable debt and asset sales by traditional medicine users. Given traditional medicine‘s popularity as a source of treatment in Cambodia and its potential to contribute to household impoverishment, we suggest that it needs to be included in a national conversation about achieving Universal Health Coverage in the country.

Renal biochemical and histopathological alterations of diabetic rats under treatment with hydro alcoholic Morus nigra extrac

Introduction: Morus nigra fruit is known to have antioxidant effects and used to control the blood sugar level in traditional medicine.

Objectives: This study was conducted to investigate the biochemical and histopathological changes in the serum and kidneys of diabetic rats treated with hydroalcoholic M. nigra extract.

Materials and Methods: In this study, 60 male Wistar rats were divided into five groups of 12 each. After induction of diabetes with alloxan, the diabetic rats were treated with hydroalcoholic extract of M. nigra at different concentrations. Then, the animals were anesthetized and the serum levels of glucose, creatinine, and urea as well as kidney tissue catalase level measured. The kidney tissue was also histopathologically examined.

Results: Milder glomerular damage was seen in the group treated with 800 mg/kg of the M. nigra extract compared with diabetic and positive controls, and no difference in the expansion of mesenchymal tissue into renal glomerular vessels observed between the group treated with 800 mg/kg of M. nigra extract and diabetic and positive controls. Furthermore, creatinine levels were significantly higher and urea levels significantly lower in the group treated with 800 mg/kg of M. nigra extract than healthy and positive control groups (P<0.05).

Conclusion: Administration of M. nigra extract at 800 mg/kg can prevent kidney tissue damage in diabetic rats and this fruit seems to be beneficial to patients with diabetes.

Medicinal plants used by traditional healers from South-West Algeria: An ethnobotanical study

Background/Aim:

This study aimed to document and analyzes the local knowledge of medicinal plants’ use by traditional healers in South-west Algeria.

Methods:

The ethnobotanical survey was conducted in two Saharian regions of South-west of Algeria: Adrar and Bechar. In total, 22 local traditional healers were interviewed using semi-structured questionnaire and open questions. Use value (UV), fidelity level (FL), and informant consensus factor (FIC) were used to analyze the obtained data.

Results:

Our results showed that 83 medicinal plants species belonging to 38 families are used by traditional healers from South-west of Algeria to treat several ailments. Lamiaceae, Asteraceae, Apiaceae, and Fabaceae were the most dominant families with 13, 8, 6, and 4 species, respectively. Leaves were the plant parts mostly used (36%), followed by seeds (18%), aerial parts (17%) and roots (12%). Furthermore, a decoction was the major mode of preparation (49%), and oral administration was the most preferred (80%). Thymus vulgaris L. (UV = 1.045), Zingiber officinale Roscoe (UV = 0.863), Trigonella foenum-graecum L. (UV=0.590), Rosmarinus officinalis L. (UV = 0.545), and Ruta chalepensis L. (UV = 0.5) were the most frequently species used by local healers. A great informant consensus has been demonstrated for kidney (0.727), cancer (0.687), digestive (0.603), and respiratory diseases.

Conclusion:

This study revealed rich ethnomedicinal knowledge in South-west Algeria. The reported species with high UV, FL, and FIC could be of great interest for further pharmacological studies.