Phytotherapy in the Management of Diabetes and Hypertension

Type 2 diabetes mellitus (T2DM) is a metabolic disorder caused by the insufficient production of insulin and/or the development of resistance to insulin. The long-term management of T2DM with conventional oral hypoglycaemic drugs is a challenge as these drugs may worsen certain underlying comorbidities and complications, such as chronic kidney and cardiovascular diseases. Besides, because of the development of resistance to those drugs, it is difficult to control hyperglycemia for long term treatment of type 2 diabetes mellitus patients. This drawback of conventional medicines necessitates phytotherapy, herbal medicines, functional foods, nutraceuticals, and other forms of alternative medicines or the invention of new medicines for the effective and long term treatment of type 2 diabetes mellitus avoiding the major adverse-effects or minimising them. Plant-derived bioactive compounds are a great resource for the discovery of new medicines. Besides, phytomedicines in the forms of extracts, isolated compounds, combined herbal preparations or other forms can be used for the prevention and treatment of type 2 diabetes mellitus. This chapter contains updated panorama based on the evidences from clinical study reports on different forms of phytotherapy, including plant extracts, its fractions, isolated bioactive compounds, functional foods, nutraceuticals, herbal medicines formulations and other forms of plant-derived phytotherapy reported for the treatment of type 2 diabetes mellitus. The findings from clinical study reports were discussed with proper citations as well as presented in summarized form in a table. A total of 52 different types and forms of prospective phytomedicines, bioactive compounds, or formulation or extracts or fractions or decoctions or functional foods formulations having clinical study reports associated with type 2 diabetes mellitus were presented in this chapter. The molecular mechanisms involved along with the primary and secondary outcomes with phytotherapy on type 2 diabetes patients were also presented. Multiple clinical studies demonstrated very prospective and potential antidiabetic activities of Berberine, Bitter gourd, Cinnamon, Curcumin, Dia-BestTM, Fenugreek, Gegen Qinlian decoction, GlucoSupreme herbal, Gymnema sylvestre, Magnesium, Nigella sativa, Resveratrol, Tibetan medicine herb combination, TCM multiple herbal combination, Xiaoke pill, and vitamin C. Hence, at least, these phytoremedies are recommended for the management of type 2 diabetes mellitus which may have additional benefits in diabetes management compared to conventional Allopathic medicines considering the long-term safety and effectivity of the products. The updated clinical study reports on phytotherapy presented in this chapter will be helpful for the medical, biological and pharmaceutical researchers and complementary and alternative medicine users to use these plants extracts, its fractions, isolated biomolecules, herbal preparations, functional foods, nutraceuticals and other forms of phytomedicines for the prevention and treatment of diseases as well as for the discovery of modern medicines.

This chapter covers the beneficial effect of curcumin, a biphenolic active compound of turmeric in diabetes and hypertension. Curcumin as a dietary component plays an important role in diabetes and hypertension inhibition as well as to mediate its anti-inflammatory effect by regulating redox status, transcription factors, fatty acids composition and various enzymatic activities. The active involvement of curcumin in the activation of activating peroxisome proliferator-activated receptor γ while the reduction in thiobarbituric acid reactive substances and succinate dehydrogenase is well known and correspondingly the disregulated adiokine which are involved in insulin resistance and development of Type 2 diabetes may be recovered by curcumin. The reduction in insulin resistance is induced by curcumin via activation of various transcription factors such as lipoprotein lipase, NF-E2-related factor 2, and liver enzymes involved in metabolic processes. Consequently, the molecular interaction of curcumin with adiponectin and signal transduction in various metabolic processes hinder insulin resistance, diabetes acceleration factors and other inflammatory symptoms linked with diabetes and hypertension.

Olive leaves are used in Mediterranean folk medicine for the treatment of diabetes, hypertension, and hypercholesterolemia since ancient times. In the last decade, different authors have studied their chemical composition and ratified their pharmacological properties both in vitro and in vivo, and, more recently, clinical trials focusing on their effects on diabetes and hypertension have been developed. Oleuropein and hydroxytyrosol seem to emerge as promising bioactive phenolics responsible for these beneficial effects. In this chapter, information about recent studies on the olive leaf is compiled, including its effects on the specific subject of this chapter, but also its other potential pharmacological effects.

Diabetes is a chronic metabolic disorder characterized by a persistent increased level of glucose in the blood. The uncontrolled glucose level in the blood is associated with a defect in insulin secretion, insulin action, or both, which leads to the progression of oxidative stress. It also affects metabolic, genetic, and haemodynamic systems by activating the polyol pathway, protein kinase C pathway, and hexosamine pathway. According to the World Health Organization (WHO) report, globally, an estimated 422 million adults were living with diabetes in 2014, compared to 108 million in 1980.

Various medicinal plants, as well as phytochemicals like alkaloids, glycosides, terpenes, and polyphenols, have been thoroughly studied for their activity in the management of diabetes. Recent data showed that around 1200 traditional plants have been used for real or perceived benefit in the treatment of diabetes. Costus (Linn.) is an important genus belonging to the family ‘Costaceae’ containing approximately 200 species. The plants have spirally arranged leaves and rhizomes being free from aromatic essential oils and tropically distributed in nature. In Ayurveda, the rhizomes of plants are described to be astringent, acrid, cooling, aphrodisiac, purgative, anthelmintic, depurative, and expectorant. Aerial parts of the plants and rhizomes are an edible and good source of carbohydrate, starch, amylase, proteins, and lipids. Recent literature shows that many species of Costus like Costus pictus, Costus afer, Costus spirali, Costus speciosus, and Costus igneus possess a significant glucose-lowering capacity. They are commonly known as ‘insulin plants’. The chapter provides scientific information on plants from genus Costus focusing on phytochemistry, pharmacological effects specifically in diabetic conditions.

Herbal medicines have been in use since stone days as an alternative therapy for the treatment of number of diseases. In this chapter, medicinal application of Passiflora genus in the treatment of diabetes mellitus, hypertension and related anxiety disorders are discussed. Passiflora belongs to the genera of Passifloraceae family. Species of the Passiflora fruits are edible and other parts of the plant including leaves, seeds, flowers and fruit peel are used in traditional system of medicine. Phyto constituents namely, Flavonoids, glycosides, phenolic compounds, alkaloids and volatile constituents are reported. Various studies carried out in the recent years reported various biological activities in the genus, including antioxidant, diuretic, anxiolytic, anti-inflammatory, analgesic, and antiviral properties. They also exhibited hypoglycemic, antihypertensive and antianxiety properties. The focus of this review is to preset the current state of knowledge and research findings associated with the use of the Passiflora species in the treatment of hyperglycemia and hypertension. Co-presence of diabetes mellitus and hypertension increases the risk of many health problems. In this chapter, we reviewed the findings of various species viz. Passiflora edulis, Passiflora alata, Passiflora ligularis, Passiflora quadrangularis, Passiflora glandulosa, Passiflora incarnata, Passiflora nitida, Passiflora nepalensis with the above mentioned activities. This chapter also aims to provide latest information on the medicinal benefits of Passiflora species which can be helpful to prevent hyperglycemia and related manifestation of Type 2 diabetes and hypertension.

Anvillea radiata Coss. & Durieu (A. radiata) which belongs to the Asteraceae family is an aromatic and medicinal plant, endemic of Morocco and Algeria and usually used in the traditional medicines to treat obesity, hypertension and diabetes. The phytochemical analysis of A. radiata reveals the presence of a number of bioactive compounds such as germacranolids. The present chapter summarizes the most recent ethnobotanical, pharmacological and phytochemical studies conducted on this herb.