Editorial Herbal Medicine as an Alternative Medicine for...

EditorialHerbal Medicine as an Alternative Medicine forTreating Diabetes: The Global Burden

Geeta Watal,1 Preeti Dhar,2 Sharad Kr. Srivastava,3 and Bechan Sharma4

1 Department of Chemistry, University of Allahabad, Allahabad 211002, India2Department of Chemistry, 1 Hawk Drive, State University of New York, New Paltz, NY 12561, USA3National Botanical Research Institute, Lucknow 226001, India4Department of Biochemistry, University of Allahabad, Allahabad 211002, India

Correspondence should be addressed to Geeta Watal; [email protected]

Received 19 July 2014; Accepted 19 July 2014; Published 18 August 2014

Copyright © 2014 Geeta Watal et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Diabetes mellitus (DM) affects 150 million people worldwideincluding 50million in India.The incidence rate of the diseaseis expected to double by 2025.Diabetes emerges due to severalfactors such as inhibition of glucose absorption, increase inglucose uptake and upregulation of glucose transporters, acti-vation of the nuclear receptor PPAR𝛾, increase in adiponectinrelease, glycogen metabolism, absent or decreased insulinproduction and/or impaired function, insulin mimetic andinsulinotropic effect, elevation of D-Chloroinositol, incretinmimetics and incretin enhancers, and the role of endogenousopioids on glucose homeostasis and antioxidants. Based onthe pancreatic effect, DM is classified as type 1 (insulindependent diabetes mellitus (IDDM)) and type 2 (nonin-sulin dependent diabetes mellitus (NIDDM)). DM inducedhyperglycemia leads to many clinical complications eitherat the macrovascular level causing coronary artery andcerebrovascular diseases or at themicrovascular level causingrenal failure, blindness, limb amputation, neurological com-plications, and premature death [1, 2]. The symptoms of DMinclude severe hypoglycemia, lactic acidosis, idiosyncraticliver cell injury, permanent neurological deficit, digestivediscomfort, headache, and dizziness.

Existing therapeutics against DM mainly include syn-thetic hypoglycemic drugs and insulin.These anti-DM drugsusually target a single metabolic pathway to regulate hyper-glycemia and are laced with numerous side effects and theirefficacies are questionable. Therefore, it is imperative todevelop new therapeutic paradigms that can act on morethan one key metabolic pathway concerning carbohydrate,fat, or protein metabolism. Herbal preparations from over

200 traditional plants and their bioactive constituents areknown to possess antidiabetic property as demonstrated byvarious screening methods. The extracts or constituents ofsome plants may act at different levels such as inhibitingglucose absorption from intestines, increasing insulin secre-tion from the pancreas, enhancing glucose uptake by adiposeand muscle tissues, or inhibiting glucose production fromhepatocytes [2]. Accordingly, there are ample possibilities toexploit phytochemicals as effective alternativemedicineswithlimited or no side effects.

Given that limited information is available regardingthe evidence-based therapeutic usage of many antidiabeticplants, this special issue was proposed. It attracted manysubmissions; following a peer review, only seven submissionswere recommended for publication. These articles includereview articles and technical papers that provide comprehen-sive reports on antidiabetic plants and the mode of action oftheir active ingredients.

The review article “Botanical, pharmacological, phyto-chemical, and toxicological aspects of the antidiabetic plantBidens pilosa L.” written by W.-C. Yang provides up-to-date information on the pharmacology, phytochemistry, andtoxicology of Bidens pilosa in regard to type 1 and type 2diabetes. The author has highlighted medicinal properties ofingredients isolated from the plant, B. pilosa L., which is easy-to-grow, widespread, and a palatable perennial. The authorhas presented the structure and biosynthesis of B. pilosaand its polyynes in relation to their antidiabetic action andmechanism. In the article “Antidiabetic effect of oral borapetolB compound, isolated from the plant Tinospora crispa, by

Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2014, Article ID 596071, 2 pageshttp://dx.doi.org/10.1155/2014/596071

2 Evidence-Based Complementary and Alternative Medicine

stimulating insulin release,” F. E. Lokman et al. have presentedan evaluation of the antidiabetic property of a biologicallyactive small compound borapetol B (C1) isolated from T.crispa in normoglycemic control using Wistar (W) andspontaneously type 2 diabetic Goto-Kakizaki (GK) rats.Theyfound that an acute oral administration of the compoundsignificantly improves blood glucose levels in the treatedgroup in comparison to the placebo group. They observedthat plasma insulin levels were significantly enhanced by 2-fold in treatedW and GK rats compared to the placebo groupat 30 minutes. Their study provides evidence that borapetolB (C1)’s antidiabetic property is mainly due to stimulation ofinsulin release.

N. H. M.-Radzman et al. in the paper “Stevioside fromStevia rebaudiana Bertoni increases insulin sensitivity in 3T3-L1 adipocytes” have reported that stevioside from Steviarebaudianamay exert an antihyperglycemic effect on both ratand human subjects. Using methods such as the radioactiveglucose uptake assay, they have shown the improvementsin insulin sensitivity in 3T3-L1 cells by elevation of glucoseuptake as a result of stevioside treatments. They foundthat stevioside managed to increase uptake activities to amaximum of 2.08 times (𝑃 < 0.001) under normal condi-tions and up to 4.40 times (𝑃 < 0.001) in insulin-resistantstates. It was noncytotoxic to the 3T3-L1 cells. The authorshave shown that stevioside can have a direct effect on3T3-L1’s insulin sensitivity, by means of the glucose uptakeelevation and the increase in expression of proteins inthe insulin-signaling pathway. The article “Potential roles ofStevia rebaudiana Bertoni in abrogating insulin resistance anddiabetes: A review” by N. H. M.-Radzman et al. highlights themechanisms involving free fatty acids, adipocytokines suchas TNF𝛼 and PPAR𝛾 and serine kinases like JNK and IKK𝛽,asserted to be responsible for the development of insulinresistance.The review article “Use of laser-induced breakdownspectroscopy for the detection of glycemic elements in Indianmedicinal plants” by P. K. Rai et al. describes how a uniquecombination of physics, chemistry, and biological techniquescan be exploited to evaluate antidiabetic Indian medicinalplants. They show laser-induced breakdown spectroscopy(LIBS) as a sensitive optical technique being widely used forthe detection of glycemic elements from medicinal plants.

G. Sartore et al. in the article “Mediterranean diet andred yeast rice supplementation for the management of hyper-lipidemia in statin-intolerant patients with or without type2 diabetes” found that the lipid profile can be modifiedby consuming Mediterranean diet (MD) and red yeast rice(RYR).They indicate that MD counseling alone is effective inreducing low density lipoprotein (LDL) cholesterol levels inmoderately hypercholesterolemic statin-intolerant patientswith a presumably low cardiovascular risk, and combiningMD with the administration of RYR improves patients withLDL cholesterol levels considerably more than when thepatient is on MD only.

In a quest to cure many serious diseases using more cost-effective and safer drugs, there has been a paradigm shiftin drug discovery that involves using plant-based molecules.More effort, however, is required to explore newer andmore promising herbal ingredients that qualify absorption,

distribution, metabolism, and excretion (ADME) criteriawith a relatively larger therapeutic index.

Geeta WatalPreeti Dhar

Sharad Kr. SrivastavaBechan Sharma

References

[1] A. Lopez-Candales, “Metabolic syndrome X: a comprehensivereview of the pathophysiology and recommended therapy,”Journal of Medicine, vol. 32, no. 5-6, pp. 283–300, 2001.

[2] H. S. El-Abhar and F. Schaalan, “Phytotherapy in diabetes:review on potential mechanistic perspectives,”World Journal ofDiabetes, vol. 5, no. 2, pp. 176–197, 2014.

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