Herbal medicine from the perspective of type II diabetic patients and physicians: what is the relationship?

Enhancing glycaemic control and promoting cardiovascular health: the therapeutic potential of Trigonella foenumgraecum in diabetic patients - a systematic review and meta-analysis

Background

The antidiabetic potential of fenugreek has been highlighted in past literature, and various in-vitro and in-vivo studies have validated its glucose-lowering effects; however, very limited data are available on its effects on diabetic patients.

Objective

An updated systematic review and meta-analysis of randomized control trials that assessed patients who were administered fenugreek.

Methods

The PRISMA guidelines (Supplemental Digital Content 1, http://links.lww.com/MS9/A361) were followed when conducting this meta-analysis. PubMed, Scopus, Google Scholar and MEDLINE were searched from inception until June 2023, for randomized control trials that compared fenugreek with control in patients with type 2 diabetes mellitus (DM) and reported the following outcomes of interest: fasting blood glucose, glycated haemoglobin A1c (HbA1c) and postprandial glucose levels. The findings were presented as mean difference (MD) with 95% confidence intervals (CIs) and were pooled using a random effects model.

Results

Fenugreek significantly (P<0.001) reduced the fasting blood sugar (FBS), HbA1c levels and postprandial glucose levels in diabetic patients when compared to the control.

Conclusion

Among patients with type 2 DM, our comparisons demonstrated a reduction in FBS, HbA1c levels and postprandial glucose levels with the administration of fenugreek seed at 2-5 mg dose in powder form.

Knowledge levels of doctors and nurses working in surgical clinics about nutrients and food supplements, a multicentre descriptive study

PURPOSE

The use of nutrients and food supplements is increasing worldwide. Nutrients and food supplements frequently used in the surgical period may cause complications and side effects. This study was conducted to determine the level of knowledge about sixty-one nutrients and food supplements among doctors and nurses working in surgical clinics.

DESIGN

A multicentre descriptive, quantitative, cross-sectional study.

METHODS

The study was conducted between 15 February and 31 May 2022 with a total of 410 participants, including 143 doctors and 267 nurses, working in the surgical clinics of 8 hospitals, including public, university and private hospitals, within the borders of one province in Turkey. Data were collected face-to-face using a questionnaire developed by the researchers, which included descriptive characteristics of the doctors and nurses and questions about sixty-one nutrients and food supplements.

RESULTS

The median overall success score of the doctors and nurses participating in the study regarding the use of nutrients and food supplements was 3.20 out of 100 points, the median success score of complications and side effects of nutrients and food supplements in the surgical period was 7.06 out of 33 points, the median success score for discontinuation of nutrients and food supplements prior to surgery was 0.21 out of 16 points, and the median success score for drug interactions of nutrients and food supplements was 1.70 out of 51 points. In addition, it was found that the overall success scores of doctors and nurses regarding nutrients and food supplements increased statistically significantly with increasing age and working years. The total success score of doctors and nurses who received training in nutrients and food supplements was statistically significantly higher than that of doctors and nurses who did not receive training.

CONCLUSION

In conclusion, it was found that the level of knowledge of nutrients and food supplements among doctors and nurses working in surgical clinics was less than half or even close to zero. Therefore, it is recommended that training on nutrients and food supplements should be included in the undergraduate and postgraduate education of doctors and nurses in order to prevent complications, side effects, drug interactions and patient safety related to the use of nutrients and food supplements in the surgical period.

Views of healthcare professionals on complementary and alternative medicine use by patients with diabetes: a qualitative study

BACKGROUND

Recent estimates indicate that a significant proportion of diabetic patients globally, up to 51%, are utilizing complementary and alternative medicine (CAM). To improve patient-provider communication and optimize prescribed treatments, healthcare professionals (HCPs) must understand the factors associated with CAM use among diabetic patients. There is a dearth of literature on HCPs perspectives on CAM use by diabetic patients. This study explored HCPs knowledge, perspective, and views on their diabetic patients' use of CAM.

METHODS

Qualitative study using one-to-one semi-structured interviews conducted with 22 HCPs involved in the care of diabetic patients (6 endocrinologists, 4 general practitioners, 4 nurses and 8 pharmacists). Participants were recruited through general practices, community pharmacies and a diabetic centre in Saudi Arabia. Data were analyzed using thematic analysis.

RESULTS

Five key themes resulted from the analysis. HCPs generally demonstrated negative perceptions toward CAM, particularly regarding their evidence-based effectiveness and safety. Participants described having limited interactions with diabetic patients regarding CAM use due to HCPs' lack of knowledge about CAM, limited consultation time and strict consultation protocols. Participants perceived convenience as the reason why patients use CAM. They believed many users lacked patience with prescribed medications to deliver favourable clinical outcomes and resorted to CAM use.

CONCLUSIONS

HCPs have noted inadequate engagement with diabetic patients regarding CAM due to a lack of knowledge and resources. To ensure the safe use of CAM in diabetes and optimize prescribed treatment outcomes, one must address the communication gap by implementing a flexible consultation protocol and duration. Additionally, culturally sensitive, and evidence-based information should be available to HCPs and diabetic patients.

Beliefs, awareness, use, and factors associated with herbal supplements usage among patients with chronic diseases-A cross-sectional insight from Alkharj, Saudi Arabia

BACKGROUND

Herbal supplements (HSs) are used to treat a variety of diseases and ailments. Individuals with chronic diseases are at a higher risk of having adverse events and drug interactions from the use of HSs.

AIM

This study determined the beliefs, awareness, use, and factors associated with HSs usage among patients with chronic diseases in Alkharj, Saudi Arabia.

METHOD

A cross-sectional study was conducted among patients with chronic diseases between February and June 2019. Face-to-face interviews were conducted at various out-patient clinics in different hospitals. Patients diagnosed with chronic diseases were included in the study. Data were analyzed by descriptive, comparative, and inferential statistics using SAS ver. 9.4.

RESULTS

The study participants were consisted of 533 patients, with mean age 53.6 ±12.9 years. The most prevalent chronic diseases were diabetes mellitus (67.7%), followed by hypertension (54.8%), and hyperlipidemia (53.8%). Among the studied participants, 336 (63%) had used at least one HS, whereby the most commonly used HSs were ginger (74.7%), mint (72%), and cumin (66.7%). Almost 78% of HSs users did not consult any healthcare provider about their use. HSs use varied significantly between female and male participants (p<0.05), whereby 61.5% of female participants used HSs in comparison to the male participants (38.5%). Gender (AOR 0.328; 95% CI 0.139-0.772; p = 0.0107), number of chronic diseases (AOR 1.585; 95% CI 1.084-2.318; p = 0.0312), and hyperlipidemia (AOR 2.818; 95% CI 1.507-5.269; p = 0.0.0012) were the pure factors of HSs use among the studied patients.

CONCLUSION

The results of this study showed that HSs usage was high among patients with chronic diseases in Saudi Arabia. Concurrent usage of HSs with drugs should be well-discussed with healthcare providers to avoid potential adverse events or drug interactions especially among patients with chronic diseases.

A comparative analysis of complementary therapies use among patients attending diabetic clinics in Taiwan: 2007 vs. 2023

BACKGROUND

We conducted a comparative study to examine the differences in the use of complementary therapies (CT) among patients who attended diabetic clinics for follow-up treatment between 2007 and 2023 in Taiwan.

METHODS

This study employed a cross-sectional survey design to recruit individuals with diabetes from two regions (northern and southern) of Taiwan. A total of 183 and 307 participants were included in the surveys of 2007 and 2023, respectively. The data were analyzed using IBM SPSS Statistics version 28.0 to compare the survey results between the two time periods.

RESULTS

Among the various CTs, nutritional supplements remained the most prevalent, with a significant increase in usage from 68.3% in 2007 to 89.9% in 2023. Conversely, other therapies, such as Chinese herbal medicines, manipulative-based therapies, supernatural healings, and bioelectromagnetic-based therapies, demonstrated a significant decrease in usage between the two time periods. Furthermore, the disclosure rate of CT use to healthcare professionals remained persistently low, with only 24.6% in 2007 and a slight increase to 30.3% in 2023.

CONCLUSION

The significant rise in the use of nutritional supplements in conjunction with conventional medicine, without adequate monitoring and guidance from healthcare professionals, poses a substantial risk of unregulated blood sugar control, compromised diabetes management, and potential harm to health outcomes.

Use of Traditional Remedies for Treatment of Diabetic Foot Ulcers: A Cross-Sectional Study at a Tertiary Center in Saudi Arabia

Patients with diabetic foot ulcer (DFU) are prone to major complications including amputations. Traditional remedies (TR) have been used to treat DFU around the world. This study aims to identify the prevalence of TR among patients with DFU in our local cohort and its effect on DFU. 1408 patients were included in the analysis. Data were collected retrospectively from patients' medical records. DFU characteristics include grading ulcers using the Wagner scale (WG) and infections (cellulitis and osteomyelitis). Ulcer management (UM) includes medical treatment, self-medical treatment, traditional treatment, and medical-traditional treatment. The mean age of the cohort was 60 years (SD = 12.4). The mean duration of diabetes was 18.6 years (SD = 9.3) and the mean duration of open wounds was 206.9 days (SD = 545.6). The majority were males (71%) and had type 2 diabetes (96%, SD = .204). Forty-three percent of patients were treated with TR (29% were self-prescribed and 14% prescribed by a physician) while 48% had medical treatment and 10% were self-treated using medical treatment. More than two-thirds of the cohort had cellulitis and/or osteomyelitis at the time of presentation. The use of traditional treatment was significantly associated with higher WG (WG 4 OR =  1.936, 95% CI: 1.338-2.800; WG 5 OR =  2.937, 95% CI:1.614-5.346; P < 0.05). Moreover, osteomyelitis was associated with medical-traditional treatment (OR = 1.608, 95% CI: 1.006-2.572; P < 0.05) and increased wound depth (WG 3 OR =  1.969, 95% CI: 1.193-3.250; WG 4 OR =  1.874, 95% CI: 1.115-3.15; P < 0.05). There is high use of TR for the treatment of DFU in our cohort. High Wagner-grade of foot ulcers and the presence of osteomyelitis were highly associated with DFU. This study showed for the first time the use of traditional potions by medical physicians. Both physicians and patients need to be made aware of the detrimental effects of using traditional methods on DFU.

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.

A descriptive survey study in endocrinology clinic: evaluation of the use of natural products

OBJECTIVE

The use of herbal products/dietary supplements (HP/DS) in endocrinal chronic diseases is growing. However, no studies have evaluated their use in patients who present to endocrinology and metabolic diseases clinics. This descriptive study aims to investigate the rate of HP/DS use and the factors affecting this in patients who presented to Karadeniz Technical University (KTU) Farabi Hospital Endocrinology and Metabolic Diseases Clinic, Türkiye between 01.11.2021 and 01.05.2022.

METHODS

Five hundred six questionnaires with acceptable data quality were included this investigation. The data were analyzed on SPSS version 23.0 software. The factors with the greatest effect on the use of HP/DS were determined using binary logistic regression analysis.

RESULTS

Analysis showed that 49.4% of the participants used HP/DS. The main factors affecting the use of herbal products were age, diagnosis of the disease, and treatment compliance problems. The most frequently used products were lemon, cinnamon, black cumin, ginger, turmeric, and dill. The participants main sources of information about HP/DS were friends/relatives, the internet/social media, and television, respectively. 74.8% of the participants using HP/DS did not inform their physcisian/pharmacist about such use, although 81.8% of these nevertheless wished to receive information from these occupational groups.

CONCLUSION

Herbal product monitoring in patients should be performed in collaboration with pharmacists, herbal product use should be investigated, and counseling services should be made available in order to maintain and promote public health.

Investigation of the relationship between the attitudes of patients with type 2 diabetes toward insulin therapy and complementary alternative medicine

AIM

This study aimed to determine the attitudes of patients with type 2 diabetes toward insulin treatment and complementary alternative medicine and to examine the relationship between them.

METHOD

A cross-sectional design was used in the study. A total of 293 patients with type 2 diabetes were included in the study. The study data were collected by using a Descriptive Information Form, Complementary, Alternative and Conventional Medicine Attitude Scale (CACMAS), and the Insulin Treatment Appraisal Scale (ITAS). The factors related to the attitudes of patients with type 2 diabetes toward insulin were examined by using multiple linear regression analysis.

RESULTS

It was determined that 36.5% of the patients used CAM, 49.8% received insulin therapy, and that 38.6% received oral antidiabetic treatment. Patients' mean score on the total CACMAS was 106.8 ± 19.7, indicating a moderately positive attitude. Their mean score on the total ITAS was 57.1 ± 11.6, suggesting that they had a negative attitude toward insulin therapy. In regular drug use, negative attitudes toward insulin decreased (β = -0.151, p < 0.001), and when dissatisfaction with conventional medicine increased, negative attitudes toward insulin increased, as well (β = -0.432p<0.05).

CONCLUSION

While almost all of the patients (93.9%) had a negative attitude toward insulin, they had a moderately positive attitude toward the use of CAM. A significant portion of them (36.5%) stated that they used CAM. There was a weak positive correlation between attitude toward CAM and negative attitude toward insulin.

Comparative effectiveness of six herbs in the management of glycemic status of type 2 diabetes mellitus patients: A systematic review and network meta-analysis of randomized controlled trials

BACKGROUND AND AIMS

There are several herbal formulations for type 2 diabetes (T2D), but many of them have never been directly compared to establish the most effective methods. Therefore, the present systematic review and network meta-analysis aimed to compare and rank the effects of herbal formulations by combining direct and indirect evidence on the management of type 2 diabetes.

METHODS

From five electronic databases, relevant studies on the effectiveness of herbal formulations for glycemic status for people with type 2 diabetes were retrieved. Only randomized controlled trials that were published in English and looked at how herbal formulations affected adults' (>18-year-old) glycemic levels were included. A systematic review and network meta-analysis design with the random-effects model was used.

RESULTS

A total of 44 trials included 3130 participants on six herbs were included in the final analysis. Apple cider vinegar (ACV) (standardized mean difference (SMD) = -28.99), cinnamon (-9.73), curcumin (-13.15), and fenugreek (-19.64) significantly reduced fasting blood glucose (FBG) compared with placebo (all p < 0.05). Notably, only ACV (SMD = -2.10) and fenugreek seeds (0.84) were found significantly effective in reducing HbA1C. ACV was most effective herb to reduce FBG comparison with other herbs.

CONCLUSIONS

Several herbs could be considered as a valuable adjuvant therapy regarding glycemic control of type 2 diabetes patients. Health professionals should be encouraged to incorporate these herbs for the management of type 2 diabetes as part of their standard care.

Endoplasmic reticulum as a therapeutic target in type 2 diabetes: Role of phytochemicals

Type 2 diabetes mellitus (T2DM) is a metabolic disorders characterized by insulin resistance and β-cell dysfunction with an increasing worldwide incidence. Several studies have revealed that long-term glucotoxicity results in β-cell failure and death through induction of endoplasmic reticulum (ER) stress. Owing to the chronic progression of T2DM and the low effectiveness of antidiabetic drugs in long-term use, medicinal plants and their secondary metabolites seem to be the promising alternatives. Here we have provided a comprehensive review regarding the role of phytochemicals to alleviate ER stress in T2DM. Ginsenoside compound K, baicalein, quercetin, isopulegol, kaempferol, liquiritigenin, aspalathin, and tyrosol have demonstrated remarkable improvement of T2DM via modulation of ER stress. Arctigenin and total glycosides of peony have been shown to be effective in the treatment of diabetic retinopathy through modulation of ER stress. The effectiveness of grape seed proanthocyanidins and wolfberry is also shown in the relief of diabetic neuropathy and retinopathy. Resveratrol is involved in the prevention of atherosclerosis via ER stress modulation. Taken together, the data described herein revealed the capability of herbal constituents to prevent different complications of T2DM via a decrease in ER stress which open new doors to the treatment of diabetes.

Antidiabetic effects of Eryngium billardieri hydrosol in the treatment of type 2 diabetic patients: A double-blind randomized clinical trial

Objective

Medicinal plants with fewer side effects and low cost than synthetic medicines are increasingly advised to treat diseases. The present study aimed to identify Eryngium billardieri compounds and evaluate the plant's effects on hyperglycemic and hyperlipidemia indices, and liver, and kidney function.

Materials and Methods

Following identification of Eryngium billardieri using GC/MS method, 72 participants were randomly divided into two groups (n=36 per group), receiving oral hypoglycemic medication (metformin) with or without 50 ml hydrosol twice a day for three months as intervention and placebo control, respectively. Body mass index (BMI), systolic and diastolic blood pressure, fasting blood sugar (FBS), glycosylated hemoglobin (HbA1c), total cholesterol, triglyceride, HDL-C, and LDL-C levels were measured at the beginning and end of the experiment. Also, aspartate transaminase, alanine transaminase, blood urea nitrogen, and creatinine levels were measured to assess adverse effects on liver and kidney functions.

Results

The main components were terpenes with 46.69% of the total ingredients of E. billardieri essential oil. Other prominent compounds identified included octanoic acid (12.14 %) and isoxazole (6.72 %). Intergroup changes in blood parameters showed that E. billardieri hydrosol for three months could significantly reduce HbA1C and blood cholesterol levels but did not affect other measured parameters. Also, there were no adverse effects on kidney or liver function.

Conclusion

The present findings showed that the consumption of 50 ml of E. billardieri hydrosol as a complementary treatment in diabetic patients reduced HbA1C and cholesterol levels without adverse effects on the liver or kidneys functions.

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.

Habits, Traditions, and Beliefs Associated With the Use of Complementary and Alternative Medicine Among Diabetic Patients in Al-Qassim Region, Saudi Arabia

Background Since diabetes mellitus (DM) affects every aspect of a person's being, more and more people are using complementary and alternative therapies such as ingesting ginger and cinnamon in addition to conventional medical care and lifestyle changes to manage their condition and enhance their well-being. Although this population uses complementary and alternative medicine (CAM) at a high rate, it is unclear what causes this use. Objective We aim to know the habits, traditions, and beliefs associated with the use of complementary and alternative medicine among type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients in the Al-Qassim region of Saudi Arabia. Methods This is an observational cross-sectional study conducted among diabetes patients in Al-Qassim, Saudi Arabia, in 2022. Participants were selected via a non-probability sampling technique. Patients were interviewed in the diabetic clinics using validated questionnaires. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY, USA). Results A total of 444 validated responses were received in this study. The average age was 50 ± 16.9 years, and females represented the highest proportion (58.6%). Moreover, we found that most of the participants had type 2 diabetes (79.1%) and 93 (20.9%) had type 1 diabetes. Hypertension was the most reported chronic disease. Our results revealed that the prevalence of CAM usage was 29.1%. Regarding the sources of information on herbal medicines, we found that more than half of the respondents (57.4%) obtained information from friends, relatives, and neighbors. Ginger, vitamins and minerals, and cinnamon were the most frequently used herbals among our participants. Our results found that 38% of CAM users used herbal products on a regular basis. As regards the frequency of using herbal products, 29.5% of the respondents used herbal medicine weekly and 21.7% used it daily. In addition, we found that gender, marital status, and monthly income were significantly associated with the use of CAM (P value = 0.008, 0.011, and 0.011, respectively). The significantly higher CAM use was associated with females, married participants, and participants with a monthly income of 10,000-15,000 Saudi riyal (SAR). Conclusion According to our research, CAM use among diabetes patients in the Al-Qassim region was found to be relatively common. The prevalence of type 2 diabetes mellitus was higher (79.1%) in comparison to type 1 diabetes mellitus (20.9%). Also, the most commonly used herb was ginger (47.66%), followed by vitamins and minerals (44.53%), and cinnamon (42.19%). Patients with diabetes need to be informed of the significance of telling their doctors about their use of CAM.

Evidence-Based Anti-Diabetic Properties of Plant from the Occitan Valleys of the Piedmont Alps

Data on urban and rural diabetes prevalence ratios show a significantly lower presence of diabetes in rural areas. Several bioactive compounds of plant origin are known to exert anti-diabetic properties. Interestingly, most of them naturally occur in different plants present in mountainous areas and are linked to traditions of herbal use. This review will aim to evaluate the last 10 years of evidence-based data on the potential anti-diabetic properties of 9 plants used in the Piedmont Alps (North-Western Italy) and identified through an ethnobotanical approach, based on the Occitan language minority of the Cuneo province (Sambucus nigra L., Achillea millefolium L., Cornus mas L., Vaccinium myrtillus L., Fragaria vesca L., Rosa canina L., Rubus idaeus L., Rubus fruticosus/ulmifolius L., Urtica dioica L.), where there is a long history of herbal remedies. The mechanism underlying the anti-hyperglycemic effects and the clinical evidence available are discussed. Overall, this review points to the possible use of these plants as preventive or add-on therapy in treating diabetes. However, studies of a single variety grown in the geographical area, with strict standardization and titration of all the active ingredients, are warranted before applying the WHO strategy 2014-2023.

Effects of Portulaca oleracea L. (purslane) on the metabolic syndrome: A review

Metabolic syndrome (MetS) is defined as a disorder with multiple abnormalities, including obesity, high blood pressure, dyslipidemia, and high blood glucose. MetS is the best-known risk factor for type 2 diabetes mellitus (T2DM), cardiovascular disease (CVD), and obesity. With the globally increasing prevalence of MetS and its related abnormalities, attention to safe and effective prevention and treatment of this complex disorder has been increased. In particular, most treatments have been devoted to using natural agents that could provide more reliable and effective medicinal products with fewer side effects. Portulaca oleracea L. (purslane) is an herb whose therapeutic properties could be found in some ancient medical books. Purslane has shown analgesic, antispasmodic, skeletal muscle relaxant, bronchodilator, antiasthmatic, anti-inflammatory, antiseptic, diuretic, antibacterial, antipyretic, and wound-healing properties. In addition, purslane's hypoglycemic and hypolipidemic properties have been reported in different studies. The positive effects of this plant include reducing stress oxidative and inflammation along with the atherogenic index, improving insulin level and glucose uptake, decreasing lipid profiles, and ameliorating weight gain. These activities could reduce MetS complications. This review aims to provide a comprehensive overview of various in vitro, animal, and human studies regarding the effect of Portulaca oleracea on metabolic syndrome to better understand the underlying mechanisms of action for designing more effective treatments.

Narratives of Herbal Medicine Utilisation in the United Kingdom: Scoping Literature Review

Using thematic analysis of existing literature, this scoping review aims to explore the narratives of people using herbal medicine (HM) in the United Kingdom. Understanding who is using HM and why will enable better ways of facilitating the use of HM, as well as assist in designing future research. Ethnic groups were found to be primary users of HM in the United Kingdom. A sense of heritage continues to be important for these participants as it allows tradition and culture to stay alive within communities, as well as the ritualistic purposes of these plants. For women, another key demographic, concepts surrounding the naturalness of HMs are associated with the idea of femineity and self-healing. A reoccurring theme in the literature focusing on both ethnic groups and women’s perceptions is the judgement from healthcare practitioners/professionals (HCPs) when addressing the use of HM. However, studies that investigated the perceptions of HCPs on HM confirmed that they often were supportive of using HM where standard treatments had been unsuccessful, and if a patient had anecdotal evidence of a herb having been effective. Delving deeper into public narratives of HM usage will allow conventional healthcare systems to effectively integrate alternative approaches, as well as ensuring that future research into the benefits of HMs is relevant to how people use them.

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.

Is mental health co-morbidity an influencing factor in the health service utilisation of women with diabetes mellitus?

Diabetes Mellitus, affecting nearly half a billion people worldwide, is a substantial global public health issue. Although diabetes predominantly affects men, women with diabetes have specific risks and self-management characteristics. Women have a higher risk of either presenting with or developing depression or anxiety, as well as being high users of complementary medicine which can create clinical governance issues. In spite of these known gender differences, limited research has explored gender-specific diabetes care, especially health service use patterns. As increasing attention has turned to supporting people with diabetes to successfully self-manage their diabetes, it is important that we understand how women with diabetes are using health services, and if their specific risk profile is influencing their health care choices. Our study sought to examine the relationship between mental health status and the patterns of conventional and complementary medicine health service use by women diagnosed with diabetes mellitus. Our results showed that women with diabetes and any mental health co-morbidity were more likely to visit their general practitioner more frequently or use herbal medicine than those without a mental health co-morbidity. Women with depression and anxiety were also less likely to consult a physiotherapist and those with anxiety less likely to consult a podiatrist over time when compared to the other mental health groups.

Functional Yogurt Fortified with Honey Produced by Feeding Bees Natural Plant Extracts for Controlling Human Blood Sugar Level

The human blood sugar level is important and should be controlled to avoid any damage to nerves and blood vessels which could lead to heart disease and many other problems. Several market-available treatments for diabetes could be used, such as insulin therapy, synthetic drugs, herbal drugs, and transdermal patches, to help control blood sugar. In a double-blind human study, four kinds of honey from bees fed on acacia, sea buckthorn, chlorella alga, and green walnut extracts were used in fortifying yogurt for controlling human blood sugar. The impact of a previously fortified honey was investigated on blood levels and other parameters of healthy individuals in a human study with 60 participants. The participants received 150 mL of yogurt mixed with 30 g of honey every morning for 21 days. Before and after the study period, the basic blood parameters were tested, and the participants filled out standardized self-report questionnaires. Acacia honey was the traditional honey used as a control; the special honey products were produced by the patented technology. The consumption of green walnut honey had a significant effect on the morning blood sugar level, which decreased for every participant in the group (15 people). The average blood sugar level at the beginning in the walnut group was 4.81 mmol L⁻¹, whereas the value after 21 days was 3.73 mmol L⁻¹. The total decrease level of the individuals was about 22.45% (1.08 mmol L⁻¹). Concerning the sea buckthorn and chlorella alga-based honey product groups, there was no significant change in the blood sugar level, which were recorded at 4.91 and 5.28 mmol L⁻¹ before treatment and 5.28 and 5.07 mmol L⁻¹ after, respectively. In the case of the acacia honey group, there was a slight significant decrease as well, it was 4.77 mmol L⁻¹ at the beginning and 4.27 mmol L⁻¹ at the end with a total decrease rate of 10.48%. It could thus be concluded that the active ingredients of green walnut can significantly decrease the blood sugar level in humans. This study, as a first report, is not only a new innovative process to add herbs or healthy active ingredients to honey but also shows how these beneficial ingredients aid the honey in controlling the human blood sugar level.

Assessment of Knowledge about Traditional Medicine Reveals Overuse as a Potential Risk for Aggravating COVID-19 and Underlying Diseases in Geriatrics and Women’s Health in the Saudi Population

The devastating COVID-19 pandemic has created several gaps in the management of viral infections, leaving biocontainment and supportive measures as the only resorts for control. As such, there has been a dramatic increase in the use of dietary supplementations and herbal medicine for COVID-19. However, serious concerns regarding the efficacy, safety, and recommended doses of these medicines have been raised. In this study, we aimed to assess the population knowledge about alternative medicine administration for COVID-19 and the associated factors. Using a self-administered cross-sectional survey, we analyzed a total of 2042 valid responses. Most of the included participants were females (69.7%), with an overall mean age of 20.8 ± 11.8 years. Most respondents (62.8%) obtained their knowledge from social media while only 16.6% received knowledge from the health care workers. Half of the participants (50.6%) correctly identified all COVID-19 symptoms, where fever (18.5%) and loss of smell and taste (17.1%) were the most frequent answers. On the use of traditional medicines and supplements for COVID-19, 57.8% did not answer, 23.7% admitted regular use, and 18.5% used sometimes. Family members or friends suggested the use of traditional medicines and dietary supplements to 28.0% of the participants while only 14.7% were advised by a nutritionist, physician, pharmacist, nurse, or a health worker. Moreover, seniors and illiterate portions of society had lower knowledge scores and increased utilization of alternative medicine. Marital status, income, and previous COVID-19 were all significant predictors of the awareness and knowledge score. Thus, this study has identified overuse of unregulated medicinal products in the region, which potentially aggravates COVID-19 or other underlying risks of the disease, making clinical management challenging, particularly in geriatrics and women’s health. Regulation of medicinal products and establishment of educational campaigns about the disease have become imperative.

Antidiabetic Activity of Hydromethanolic Extract of Crude Dorstenia barnimiana Root: Validation of In Vitro and In Vivo Antidiabetic and Antidyslipidemic Activity

Background

Despite modern therapeutic armamentaria, DM remains a 21st-century public health menace. Novel phytomedicines are a rapidly expanding focus of research. The juice of Dorstenia barnimiana roots has long been used for the treatment of diabetes mellitus in traditional Ethiopian medicine, but its efficacy has not been supported by in vitro or in vivo scientific study. To investigate this, the present work was performed.

Methods

In this experimental study, simple random sampling was applied. Healthy male mice were used in normoglycemic and oral glucose-tolerance test (OGTT) models. Streptozotocin (IP, 150 mg/kg)–administered diabetic male mice were utilized. Animals were randomly divided into five groups of six each. Group I received 10 mL/kg distilled water, groups II–IV received 100 (DB100), 200 (DB200), and 400 (DB400) mg/kg crude extract, respectively, and group V received glibenclamide 5 mg/kg. A sham group (group VI) was added that received 10 mL/kg distilled water. All treatments were given orally. FBG, serum-lipid profiles, and body-weight changes were then measured. In vitro α-amylase inhibitory activity was also evaluated.

Results

The doses were atoxic up to 2,000 mg/kg. There was α-amylase inhibition activity of 67.52% at 500 μg/mL with an IC₅₀ of 4.595 μg/mL. The OGTT revealed an antihyperglycemic effect of the crude extract. This was not attributed to a hypoglycemic side effect. In the diabetic mouse model, it shrank FBG levels remarkably. There were also significant reductions in serum TC, TGs, VLDL-C, and LDL-C. Nevertheless, HDL-C and body-weight levels returned.

Conclusion

The present study confirmed the safety and promising in vivo antidiabetic and antidyslipidemic activity of D. barnimiana, thus corroborating the traditional claim.

Effectiveness of Medicinal Plants for Glycaemic Control in Type 2 Diabetes: An Overview of Meta-Analyses of Clinical Trials

Aims: To rank the effectiveness of medicinal plants for glycaemic control in Type 2 Diabetes (T2DM).

Methods: MEDLINE, EMBASE, CINAHL and Cochrane Central were searched in October 2020. We included meta-analyses of randomised controlled clinical trials measuring the effectiveness of medicinal plants on HbA1c and/or Fasting Plasma Glucose (FPG) in patients with T2DM.

Results: Twenty five meta-analyses reported the effects of 18 plant-based remedies. Aloe vera leaf gel, Psyllium fibre and Fenugreek seeds had the largest effects on HbA1c: mean difference –0.99% [95% CI−1.75, −0.23], −0.97% [95% CI −1.94, −0.01] and −0.85% [95% CI −1.49, −0.22] respectively. Four other remedies reduced HbA1c by at least 0.5%: Nigellasativa, Astragalus membranaceus, and the traditional Chinese formulae Jinqi Jiangtang and Gegen Qinlian. No serious adverse effects were reported. Several other herbal medicines significantly reduced FPG. Tea and tea extracts (Camellia sinensis) were ineffective. However, in some trials duration of follow-up was insufficient to measure the full effect on HbA1c (<8 weeks). Many herbal remedies had not been evaluated in a meta-analysis.

Conclusion: Several medicinal plants appear to be as effective as conventional antidiabetic treatments for reducing HbA1c. Rigorous trials with at least 3 months’ follow-up are needed to ascertain the effects of promising plant-based preparations on diabetes.

Analysis of Metformin and Five Gliptins in Counterfeit Herbal Products: Designs of Experiment Screening and Optimization

BACKGROUND

Drug counterfeiting is a rising problem due to difficulties with identifying counterfeit drugs and the lack of regulations and legislation in developing countries.

OBJECTIVE

This study aims to develop a robust and economic reversed phase high performance liquid chromatography (LC) method for simultaneously determining metformin HCl, vildagliptin, saxagliptin, alogliptin benzoate, sitagliptin phosphate monohydrate, and linagliptin to target counterfeiting.

METHODS

Plackett-Burman (PB) and Box-Behnken (BB) designs were used to screen and optimize the mobile phase composition. Chromatographic separation was carried out on an Inertsil® ODS-3 C18 column with isocratic elution mode and the mobile phase was a mixture of acetonitrile-methanol-ammonium formate buffer, pH 3.5 (25:10:65, v/v/v). This method was applied to analyze synthetic drugs in three traditional Chinese and Indian herbal medicines. To identify the adulterants, thin-layer chromatography (TLC), nuclear magnetic resonance (NMR), and mass spectrometry (MS) were used on counterfeit herbal medicines.

RESULTS

The developed method is sensitive, simple, rapid, economical, accurate, and highly robust. Student's t-test and variance ratio (F-test at P < 0.05) were used to compare the results statistically with the reference methods.

CONCLUSION

The study found that the analyzed herbal medicines were adulterated with metformin and the quantification of anti-diabetic counterfeits was therefore applied.

HIGHLIGHTS

This study determined counterfeited anti-diabetic drugs in Indian and Chinese traditional herbal medicines(THMs). Design-of-experiment, PB, and BB designs were used. Method validation was also performed in accordance with the International Conference on Harmonization guidelines.

Antidiabetic Activity of Nigella Sativa (Black Seeds) and Its Active Constituent (Thymoquinone): A Review of Human and Experimental Animal Studies

The use of herbal medicine to manage chronic conditions including diabetes has become a recent global trend. Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia. The present review is aimed to analyze the antidiabetic activity of N. sativa as many type 2 diabetic patients use it as a complementary therapy along with their modern allopathic medications or as an alternative therapy. The literature was reviewed in databases like Medline/PubMed Central/PubMed, Google Scholar, Science Direct, EBSCO, Scopus, Web of science, EMBASE, Directory of open access journals (DOAJ), and reference lists to identify relevant articles supporting the use of N. sativa in diabetes management. Numerous clinical and animal studies have demonstrated the antidiabetic efficacy of black seeds (N. sativa) and its major bioactive constituent thymoquinone. Based on these findings patients with diabetes may use N. sativa as an adjuvant therapy, which may help to reduce the dose and incidence of adverse effects of modern antidiabetic medicines.

Vinpocetine Effect on the Juncture of Diabetes and Aging: An in-vitro study

BACKGROUND

The rapid-growing population of diabetic patients and the elderly are among the direst challenges that the science of medicine is facing today. Targeting these two challenges can shed light on new means to control and ideally reverse this trend. In this experiment, Vinpocetine's effect on aged pancreatic beta-cell functions in correlation with oxidative stress was studied.

METHODS

Islet cells were isolated from the pancreas of aged rats and exposed to Vinpocetine, dissolved in acetone and RPMI, for 48 h. Then, senescence-associated molecular parameters, including P16 and P38 gene expressions and β-galactosidase activity, were investigated along with diabetic and inflammation markers.

RESULTS

Experimental results showed that Vinpocetine could significantly increase aged islets insulin secretion and also make a meaningful reduction in oxidative stress markers. This drug can also decrease expression levels of P16 and P38, the primary genes responsible for the aging pathway. TNF-α, IL-6, and NF-κB expressions were also reduced noticeably after treatment with Vinpocetine.

CONCLUSION

The current study showed that Vinpocetine, a derivative of the secondary plant metabolite called Vincamine, could break this vicious cycle of oxidative stress and aging by reducing oxidative stress and inflammation, thus inhibiting cellular aging.

Prescription, over-the-counter (OTC), herbal, and other treatments and preventive uses for COVID-19

The current COVID-19 pandemic has spread rapidly worldwide and has challenged fragile health care systems, vulnerable socioeconomic conditions, and population risk factors, and has led to an overwhelming tendency to misuse prescription drugs and self-medication with prescription drugs, over-the-counter (OTC) drugs, herbals products, and unproven chemicals as a desperate preventive or curative measure for COVID-19. In this chapter, we present the legislative differences between prescription drugs, OTC drugs, and herbals. Various approved and nonapproved prescription and OTC drugs as symptomatic treatment for COVID-19 are listed and evaluated based on their reported efficacy, safety, and toxicological profile. We also present the various herbal products that are currently studied and used as treatment and preventive for COVID-19. The efficacy, toxicology profile, safety, and legal issues of some speculative preventive and treatment options against COVID-19, such as Miracle Mineral Solution (MMS), chlorine dioxide solution (CDS), colloidal silver, and hydrogen peroxide is presented. The chapter also emphasizes the specific strategies that need to be implemented to guide the population in the effective and safe use of prescribed medications, such as the Medication Therapy Management or Pharmaceutical Care process. Finally, this chapter aims to provide a deeper insight into the lack of health literacy in the population and the effect that drug utilization research (DUR) has in the decision making of health authorities and general public. We aim to provide the current information about the various treatment and preventive options used for COVID-19.

Bioactive Compounds in Anti-Diabetic Plants: From Herbal Medicine to Modern Drug Discovery

Natural products, including organisms (plants, animals, or microorganisms) have been shown to possess health benefits for animals and humans. According to the estimation of the World Health Organization, in developing countries, 80% of the population has still depended on traditional medicines or folk medicines which are mostly prepared from the plant for prevention or treatment diseases. Traditional medicine from plant extracts has proved to be more affordable, clinically effective and relatively less adverse effects than modern drugs. Literature shows that the attention on the application of phytochemical constituents of medicinal plants in the pharmaceutical industry has increased significantly. Plant-derived secondary metabolites are small molecules or macromolecules biosynthesized in plants including steroids, alkaloids, phenolic, lignans, carbohydrates and glycosides, etc. that possess a diversity of biological properties beneficial to humans, such as their antiallergic, anticancer, antimicrobial, anti-inflammatory, antidiabetic and antioxidant activities Diabetes mellitus is a chronic disease result of metabolic disorders in pancreas β-cells that have hyperglycemia. Hyperglycemia can be caused by a deficiency of insulin production by pancreatic (Type 1 diabetes mellitus) or insufficiency of insulin production in the face of insulin resistance (Type 2 diabetes mellitus). The current medications of diabetes mellitus focus on controlling and lowering blood glucose levels in the vessel to a normal level. However, most modern drugs have many side effects causing some serious medical problems during a period of treating. Therefore, traditional medicines have been used for a long time and play an important role as alternative medicines. Moreover, during the past few years, some of the new bioactive drugs isolated from plants showed antidiabetic activity with more efficacy than oral hypoglycemic agents used in clinical therapy. Traditional medicine performed a good clinical practice and is showing a bright future in the therapy of diabetes mellitus. World Health Organization has pointed out this prevention of diabetes and its complications is not only a major challenge for the future, but essential if health for all is to be attained. Therefore, this paper briefly reviews active compounds, and pharmacological effects of some popular plants which have been widely used in diabetic treatment. Morphological data from V-herb database of each species was also included for plant identification.