Role of Ayurveda in the Management of Diabetes Mellitus:

A Comprehensive Review to explore the awareness

Vinit Kumar Sharma*, Madan Kaushik, Deepika Rani

Adarsh Vijendra Institute of Pharmaceutical Sciences, Shobhit University, Gangoh, Saharanpur.

*Corresponding Author E-mail: vinit50.89@gmail.com

ABSTRACT:

Diabetes mellitus (DM) is very oldest and common metabolic disease, characterized by a chronic hyperglycemic condition over a prolong extent of time. The disease is resulting due to insufficient insulin secretion or defects in insulin action or both. Diabetes is classified under non communicable disease (NCD) and it is referred as fourth most common among all NCDs. Diabetes is one of the leading causes of mortality in India and near about one million patients are died every year due to diabetes. The prevalence of diabetic is increasing rapidly worldwide and WHO (world health organization) has predicted that by the end of 2030, the number of adults with diabetes would have almost doubled, from 177 million in 2000 to 370 million Diabetes is mainly classified under two classes Type-1 and Type-2 DM. In the late 1936, a distinction between Type-1 and Type-2 DM was clearly made. Type-1 diabetes is a result of an autoimmune reaction to proteins of islets cells of pancreas and Type-2 is result of impaired insulin resistance. Genetic and some environmental factors such as overeating, stress, obesity and lack of physical exercise, smoking may also play a key role in development of DM. There are various treatment approach are being used to reduce the burden of DM worldwide. These approaches include modern medicines (allopathic), Ayurvedic therapies and gene therapy. Ayurvedic system of treatment is a holistic science which is discovered several years ago and plays a very important role in the management of DM. Ayurvedic therapies are able to provide permanent cure of certain chronic disease are, which remains incurable in allopathic systems. Present review article aims to highlight the role of ayurveda in management of DM.

KEYWORDS: Diabetes mellitus, Prevalence, Treatment, Epidemiology, Insulin.

INTRODUCTION:

Diabetes mellitus (DM) is very oldest and common disease. It was first recognized in the Egyptian manuscript approximately 3000 years ago¹. Diabetes is a group of metabolic disorder characterized by a chronic hyperglycemic condition resulting insufficient insulin secretion or defects in insulin action or both². The first clear description of diabetes was given by a famous Greek physician named Aretaeus of Cappadocia^3,4. Some study also revealed that Apollonius of Memphis, named diabetes to this disease, which means ‘to go though’ on the basis of its top most symptoms, i.e. excessive passing of urine⁵.

The term mellitus was given b a British surgeon, John Rollo in 1798, which means honey or sugar. John Rollo distinguished the term DM from Diabetes insipidus⁶. In ancient time, Indian physicians ‘Sushrutra and Charaka’ referred it to ‘Prameha/madhumeha’ because they noticed that the urine of affected patient attract ants⁷. Therefore, they use ant for the diagnosis of DM. Sushruta and Charaka Classified the Prameha/ madhumeha’ in to two categories based on symptoms, Sahaja Prameha and Apathayanimittaja Prameha, out of these two, second one is closely resembled to Type 2 DM⁸.

The defective insulin action or secretion may arise due to disturbance in body’s natural regulatory system for storage and circulation of metabolic fluids⁹. Basically DM is an endocrine disorder, which is depended on the activity of two hormones i.e. Insulin and glucagon both are secreted by different islets cells of pancreas. Insulin works to decrease the blood glucose level through glycogenesis and transfer the glucose in different tissues. Glucagon maintains the blood sugar level and increases it when desired through glycogenolysis¹⁰. Glucose is a main fuel in human body, which used as energy by different cells. In normal metabolic conditions it is converted in to glucagon and stored in different tissues or used for synthesis of fats. Under some abnormal conditions cells resists insulin action which leads to remarkable decrease in glucose and glucagon synthase activity in body’s peripheral tissues, hence leads to DM¹¹.

The prevalence of diabetes is increasing day by day due to bad life style, urbanization and aging. United Nations identifies this disease as one of the fourth NCDs with high mortality rate. Therefore, WHO and United Nations developed targets to control the prevalence of the DM¹². In 2020, a report is published by International Diabetes Federation (IDF), which states that near about 463 peoples in the world are affected from diabetes and out of which 77 millions are belong to India. According to this statistics India became the second most affected country in the world, after China¹³. IDF predicted that the numbers can be growing up to 134 million by the end of 2045, which is a worrisome data. Hence, some measures should be taken up to manage the prevalence of the disease.

Treatment approaches for diabetes mellitus:

The various therapies are being used for the treatment of diabetes mellitus which may include Allopathic system, AYUSH or traditional Indian system and gene therapy. Allopathic medicines or conventional system provides quick symptomatic relief but unable to provide permanent cure. Allopathic medicines have their own side effects which limited the safety and efficacy of the treatment¹⁴. Therefore over the pharmacological approaches, the ayurvedic system of medicines is quite more effective to manage the disease^15,16 Now a day the researcher has trust area to develop the anti diabetic drugs which cure the diabetic mellitus. The objective of this review article is to introduce the various therapy used for the treatment of diabetes mellitus.

Role of ayurveda to manage DM:

Ayurveda is an ancient Indian system of medicine, which is emerging now days as complementary and alternative treatment ton allopathic system of medicines. The first objective of ayurveda is to make balance between five natural elements (Mahabhootas) of earth, water, fire, air, and space within an individual through the theory of three doshas. These three doshas consist of vata, which corresponds to space and air, pitta, which corresponds to fire, and kapha, which maintain equilibrium between the elements of earth and water¹⁷. Primary ayurveda therapies mainly include appropriate nutritional diet, regular physical exercise and smoking cessation and reduction of stress to maintain the balance between three doshas. The lifestyle intervention is a proven strategy for reducing diabetes incidence. The diet and regular exercise from moderate to intense can improve glucose levels in patients with Type-2 Diabetes Mellitus¹⁸. Principally in ayurveda medicines are derived from plant source although it also derived from plant, mineral, animal, marine and metal source. The most commonly used plants along with mechanism of action, are mentioned in table 1.

Table 2: Plants and their active constituents for diabetes

Botanical Name	Active Constituent	Mechanism of action	References
Aronia melanocarpa	Anthocynins	Decrease of hepatic and intestinal absorption of glucose by reducing alpha glycosidase activity	19
Aloe vera Mill.	Anthraquinones,	It effectively inhibited the glycation reaction of proteins in the BSA/glucose system, possibly due to the oxidative degradation of fructosamine	20
Areca catechu Linn	Arecoline, guvacine, arecaidine	It works by regeneration of βcells of pancreas and potentiate insulin secretion from surviving β cells.	21
Adhatoda vasica	Vasicine, quinazoline	By inhibiting α-Glucosidase- activity.	22
Bombox ceiba	Mangiferin	It potentiates the regeneration of β cells of pancreas and stimulates insulin secretion.	23
Camellia sinesis	Epigallocatechin-3-gallate	By decreasing the expression of genes that control gluconeogenesis.	24
Ceratonia siliqua	Polyphenolic compounds	Decrease of hepatic and intestinal absorption of glucose by reducing alpha glycosidase activity.	25
Cornus officinalis	Morroniside, loganin, ursolic acid	Decrease of hepatic and intestinal absorption of glucose by reducing alpha glycosidase activity	26
Cajanus cajan (L)	Myrigalone-B, Saponins, Tanins	It stimulates insulin secretion from pancreatic beta cells increasing the utilization of peripheral glucose; inhibit alpha-glucosidase and alpha-amylase activity.	27
Daucus carrota L	Cyanidin 3-xylosyl galactoside	Decrease of hepatic and intestinal absorption of glucose by reducing alpha glycosidase activity	28

Role of Marine algae in diabetes:

Marine algae are an alternative to herbal and synthetic drugs in the management of diabetes mellitus. Marine algae are a potent source of bioactive metabolites which have positive effects on human health. Among all seaweed red and brown algae is huge source of bioactives with antidiabetic potential²⁹. Bromophemols and phlorotannins present in red and brown algae are quietly responsible for their antidiabetic potential. The possible mechanism of their antidiabetic activity may includes, inhibition of alpha glycosidase, alpha amylase, α-glukosidase, potent protein tyrosine phosphatase 1B (PTP1B) and aldose reductase. Apart from that they also diminish insulin resistance, and enhance pancreatic β-cell function, with the result that pancreatic β-cell release more insulin³⁰. Some of the marine algae are presented in table 2.

Table 2: Marine algae and their active constituents for diabetes

Biological source	Active Constituent	Mechanism of action	References
Symphyocladia latiuscula	2, 3, 6-tribromo-4, 5-dihydroxybenzyl derivatives	Works by α-glucosidase inhibition activities.	31
Bryothamnion seaforthii	lectin	It stimulates the β-cells of islets of Langerhans to produce insulin.	32
Halymenia durvilae	Saponin, flavanoids	Works by α-glucosidase inhibition activities.	33
Gracilaria edulis	1H-Indole-2-carboxylic acid,6-(4-ethoxyphenyl)-3-methyl-4-oxo-4,5,6,7-tetrahydro-isopropyl ester	Works by α-glucosidase inhibition activities.	34
Rhodomela confervoides	Bromophenol	Works by potent protein tyrosine phosphatase 1B (PTP1B) inhibition	35
Sargassum serratifolium	plastoquinones	Works by α-Glucosidase and Protein Tyrosine Phosphatase 1B Inhibitory Activity	36
Padina tenuis	Phenol and Flavanoid	β-cells/islet of Langerhans, enzymatic inhibition of alpha-glucosidase	37
Sargassum muticum (Yendo) Fensholt	polyphenolic	Works by inhibiting the activity of human aldose reductase, a key-enzyme in glucose metabolism.	38
Dictyopteris hoytii	(ethyl methyl 2-bromobenzene 1,4-dioate, 1), one new natural metabolite (diethyl-2-bromobenzene 1,4-dioate, 2)	Works by α-glucosidase inhibition activities.	39
Enteromorpha prolifera	oligosaccharide	By interfering glucose metabolism.	40

CONCLUSION:

Diabetes mellitus is very common and oldest disease in human beings which is characterized by a chronic hyperglycemic condition over a prolong extent of time. The disease is resulting due to insufficient insulin secretion or defects in insulin action or both. There are various treatment approach are being used to reduce the burden of DM worldwide. These approaches include modern medicines (allopathic), Ayurvedic therapies and gene therapy. Ayurveda is an ancient Indian system of medicine, which is emerging now days as complementary and alternative treatment ton allopathic system of medicines. Primary ayurveda therapies mainly include appropriate nutritional diet, regular physical exercise and smoking cessation and reduction of stress to maintain the balance between three doshas (vata, pitta and kapha). Principally in ayurveda medicines are derived from plant source although it also derived from plant, mineral, animal, marine and metal source. The review aims to highlight the role of plant, marine and mineral derived medicines in the management of diabetes.

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Received on 15.09.2022 Modified on 28.04.2023

Research J. Pharm. and Tech 2023; 16(11):5528-5531.

DOI: 10.52711/0974-360X.2023.00894