Review Article Treating Type 2 Diabetes Mellitus with Traditional Chinese and Indian Medicinal Herbs
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Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2013, Article ID 343594, 17 pages http://dx.doi.org/10.1155/2013/343594 Review Article Treating Type 2 Diabetes Mellitus with Traditional Chinese and Indian Medicinal Herbs Zhijun Wang,1 Jeffrey Wang,1,2 and Patrick Chan3 1 Center for Advancement of Drug Research and Evaluation, College of Pharmacy, Western University of Health Sciences, 309E.SecondStreet,Pomona,CA91766,USA 2 Department of Pharmaceutical Sciences, College of Pharmacy, Western University of Health Sciences, 309 E. Second Street, Pomona,CA91766,USA 3 Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, 309E.SecondStreet,Pomona,CA91766,USA Correspondence should be addressed to Jeffrey Wang; [email protected] and Patrick Chan; [email protected] Received 1 February 2013; Accepted 1 April 2013 Academic Editor: Weena Jiratchariyakul Copyright © 2013 Zhijun Wang 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. Type II diabetes mellitus (T2DM) is a fast-growing epidemic affecting people globally. Furthermore, multiple complications and comorbidities are associated with T2DM. Lifestyle modifications along with pharmacotherapy and patient education are the mainstay of therapy for patients afflicted with T2DM. Western medications are frequently associated with severe adverse drug reactions and high costs of treatment. Herbal medications have long been used in the treatment and prevention of T2DM in both traditional Chinese medicine (TCM) and traditional Indian medicine (TIM). This review examines in vivo, in vitro,and clinical evidence supporting the use of various herbs used in TCM and TIM. The problems, challenges, and opportunities for the incorporation of herbal frequently used in TCM and TIM into Western therapy are presented and discussed. 1. Introduction In the United States, T2DM is quickly becoming an epidemic. The Center for Disease Control (CDC) estimates Type2diabetesmellitus(T2DM)isachronicillnessdueto that in the United States alone, 25.8 million Americans, or endocrine dysfunction. Uncontrolled, diabetes is associated 8.3% of the population, suffer from DM, with 7 millions with various acute and chronic comorbidities. T2DM is currently undiagnosed [5]. DM is higher, 26.9%, in the elderly a rapidly growing health concern in both developed and (65 years or older). But it is also rapidly becoming a disease developing nations. T2DM accounts for over 90% of cases observed in younger patients with almost 2 millions over the globally [1, 2]. According to the World Health Organization age of 20 being newly diagnosed with DM in 2010. More (WHO), in 2011, approximately 364 million people globally alarmingly, 35% of adults over the age of 20 and 50% of elderly suffer from diabetes (DM), with projections that DM-related had prediabetes. This equates to 79 million people in the deaths will double from 2005 to 2030 [3]. In 2004, 3.4 million US. DM is the primary cause of renal failure, non-traumatic people died directly from the consequences of high blood lower-limb amputations, and newly diagnosed retinopathy. glucose. The prevalence of DM worldwide was calculated as DM is the 7th leading cause of mortality of Americans. 2.8% in 2000. This is expected to increase to 4.4% by 2030 [4]. The growing concern is the epidemic growth in obesity and increase in the elderly population, which will continue 1.1. Current Pharmacological Agents in the Treatment of to increase the prevalence of DM. Another study, using data T2DM. T2DM is a chronic disease that affects millions of from 91 countries, estimates that the prevalence can be as people globally and is associated with multiple comorbidities high as 7.7% (439 million adults) by 2030 [2]. Other estimates and complications. DM education, prevention, and care are includea70%increaseinDMindevelopingcountriesand complex and should be designed to be patient specific. 20% increase in developed nations. Physicians, nurses (and nurse practitioners), pharmacists, 2 Evidence-Based Complementary and Alternative Medicine and dieticians are often recruited as a balanced health-care work primarily in the gut by inhibiting -glucosidase team in managing a patient’sdiabetes. The American Diabetes enzymes on the intestinal brush border. -Glucosidase is a Association (ADA) promotes diabetes self-management edu- key enzyme for breaking down carbohydrates such as starch, cation,aprocessinwhichthepatientisequippedwith dextrin, and disaccharides for absorption [17]. -Glucosidase theknowledgeandskillstoprovideself-care,managecrisis inhibitors may also stimulate GLP-1 secretion. Dipeptidyl (severe hyperglycemia and hypoglycemia), and make lifestyle peptidase-4 (DPP-4) is a protease enzyme responsible changes [6, 7]. for the inactivation of hormones GLP-1 and GIP (gastric Primary non-pharmacological interventions include ap- inhibitory peptide) [18]. Inhibition of DPP-4 by inhibitors propriate diet and exercise. Diet should be balanced and (sitagliptin, saxagliptin, linagliptin) increases endogenous aimed to reduce weight. At least thirty minutes of moderate to levels of GLP-1. Endogenous amylin and its analogues intenseexercisecanimproveT2DMandweightmanagement. (pramlintide) bind to amylin receptors in the brain [19]. Intense lifestyle modifications (LSMs) are the mainstay of all Endogenous amylin is secreted along with insulin from treatment modalities and should be encouraged in both pop- pancreatic -islet cells. Pramlintide delays gastric emptying, ulations who are at risk for developing diabetes and patients reducing postprandial glucose levels [20]. who are suffering from diabetes. For patients requiring phar- macological interventions of T2DM, metformin, a biguanide, is first-line treatment for most patients who are unable 1.2. Pharmacological Prevention of T2DM. The prevention of to achieve their glycemic goals with LSM. Used for years, T2DM in patients primarily focuses on education, diet, and metformin increases glucose uptake by the skeletal mus- exercise. While the use of pharmacological approaches for cles [8], inhibits hepatic gluconeogenesis [9], and increases prevention is not routinely practiced, the ADA recommends insulin sensitivity [10] (summarized in Table 1). Not only is that health-care practitioners consider the use of metformin metformin the first-line recommendation for the treatment of in patients who are at high risk for developing diabetes. In the T2DM, but there is also evidence of metformin being a useful Diabetes Prevention Program (DPP) trial, metformin 850 mg agent in preventing T2DM in high-risk populations [11]. twice daily was given to female patients considered at risk for Sulfonylureas are a commonly used second-line class developing DM [11]. One group was administered metformin, of antidiabetic drugs which increases insulin secretion by another group underwent intensive LSM, the last group binding to KATP (potassium) channels of the -islet cells was given placebo medication. After a four-year study, the in the pancreas [12]. Second-generation sulfonylureas are incidence of DM was decreased by 58% ( < 0.001) with the largely used due to their potency, fewer drug interactions, LSM group and 31% ( < 0.001) with the metformin-treated and less severe adverse reactions [6]. Insulin, which has long population when compared to placebo. As such, metformin been considered last-line therapy in the treatment of T2DM is the only current medication that has been advocated to be and is the primary treatment of Type 1 Diabetes Mellitus used in the prevention of diabetes in high-risk populations (T1DM, insulin-dependent DM), is now a viable addition such as those with a history of gestational diabetes, morbidly to metformin as a second-line agent in lieu of sulfonylureas obese, and those with progressive hyperglycemia [6, 21]. [6, 7].Insuliniseffectiveinreducingbloodglucoseand The Troglitazone in Prevention of Diabetes (TRIPOD) HbA1C. Insulin regimens are patient-specific and can involve study demonstrates preservation of pancreatic -islet cell various combinations. function [22]. TZD (troglitazone) was administered in high- Other less validated classes of medications that can risk Hispanic women as identified with the development of be added to metformin include the thiazolidinediones gestational diabetes within the previous four years. In women (TZDs) and GLP-1 agonists (glucagon-like peptide-1). TZDs receiving 400 mg troglitazone for 30 months, the cumulative (pioglitazone, rosiglitazone) act by modulating peroxisome incidence of diabetes was reduced significantly in treated proliferator-activated receptor (PPAR), a nuclear receptor women (5.4%) compared to placebo (12.1%; < 0.01). involved in the regulation of glucose and lipid metabolism. Troglitazone was discontinued in the USA in 1998 due to Activation of PPAR leads to increased insulin sensitivity potential liver damage associated with the drug. primarily in adipose tissue but has also shown to have an Over 1300 patients with impaired glucose tolerance in a effect on skeletal muscle and liver [13]. In the United States, multi-center study were selected for the STOP-NIDDM trial TZDs carry a black box warning of increased cardiovascular and given either acarbose three times daily or placebo [23]. events due to a trial that demonstrated an increased