https://repository.uaeh.edu.mx/revistas/index.php./MJMR/issue/archive Mexican Journal of Medical Research ICSa Biannual Publication, Vol. 8, No. 16 (2020) 56-64 ISSN: 2007-5235 Evidence of the hypoglycemic capacity of some plant products as alternative treatment for type 2 diabetes Evidencias de la capacidad hipoglucemiante de algunos productos vegetales como tratamiento alternativo de diabetes mellitus tipo dos Pérez-Ávila Karla Guadalupe a, Vargas-De-León Cruz b, Morales-González José Antonio c, Madrigal-Santillán Eduardo d Abstract Type 2 diabetes is a disease characterized by the chronic presence of high glucose levels in blood caused by a defect in the secretion of insulin or in the action of said hormone in the body which must be treated integrally with a multidisciplinary approach. The alternative treatment of this disease with plants and their derivatives is a common practice around the world, especially in Latin America. There are several clinical studies, in vivo or in vitro that focus on assessing the hypoglycemic capacity of various plant products used empirically by the population for years for the phytotherapeutic treatment of the disease, as well as the chemicals related to the mechanism of action that produces this hypoglycemic effect. The aim of this article is to briefly review the evidence of the hypoglycemic capacity of some plant products for the alternative treatment of type 2 diabetes. Keywords: Hypoglycaemic capacity, phytochemicals, phytotherapy, type 2 diabetes Resumen: La diabetes tipo dos es una enfermedad que se caracteriza por la presencia crónica de niveles elevados de glucemia provocado por un defecto en la secreción de insulina o en la acción de dicha hormona en el organismo la cual debe ser tratada integralmente con un enfoque multidisciplinario. El tratamiento alternativo de esta enfermedad con plantas y sus derivados es una práctica común alrededor del mundo, especialmente en América Latina; existen diversos estudios de tipo clínico, in vivo o in vitro que se enfocan en evaluar la capacidad hipoglucemiante de diversos productos vegetales utilizados empíricamente por la población durante años para el tratamiento fitoterapéutico de la enfermedad, así como los químicos relacionados con el mecanismo de acción que produce dicho efecto hipoglucemiante. El presente artículo tiene como objetivo hacer una breve reseña de las evidencias de la capacidad hipoglucemiante de algunos productos vegetales para el tratamiento alternativo de la diabetes mellitus tipo 2. Palabras Clave: Capacidad hipoglucemiante, fitoquímicos, fitoterapia, diabetes mellitus tipo 2 INTRODUCTION the body.1 It is a condition with multiple risk factors such as Type 2 diabetes is defined as a group of metabolic disorders advanced age, obesity, sedentary lifestyle, family history with characterized by chronic increase in blood glucose levels diabetes and socioeconomic level among others; it is of caused by a defect in the insulin secretion or in the action in chronic and complex evolution.2,3 _____________________________________________________________________________________________________________________________ ____________________________ a Autor de Correspondencia, Escuela Superior de Medicina, Instituto Politécnico Nacional, "Unidad Casco de Santo Tomas". Plan de San Luis y Díaz Mirón s/n, Ciudad de México 11340. https://orcid.org/0000-0002-4492-5721, E-mail: [email protected]. b Escuela Superior de Medicina, Instituto Politécnico Nacional, "Unidad Casco de Santo Tomas". Plan de San Luis y Díaz Mirón s/n, Ciudad de México 11340. https://orcid.org/0000-0001-9428-3619. c Escuela Superior de Medicina, Instituto Politécnico Nacional, "Unidad Casco de Santo Tomas". Plan de San Luis y Díaz Mirón s/n, Ciudad de México 11340. https://orcid.org/0000-0002-5980-0980. d Escuela Superior de Medicina, Instituto Politécnico Nacional, "Unidad Casco de Santo Tomas". Plan de San Luis y Díaz Mirón s/n, Ciudad de México 11340. https://orcid.org/0000-0003-2264-4598. Received: 06/03/2019, Accepted: 12/11/2019, Published: 05/07/2020 Biannual Publication, Mexican Journal of Medical Research ICSa, Vol. 8, No. 16 (2020) 56-64 Currently, diabetes is classified according to its etiological • Occasional glucose > 200 mg/dl in patients with classic and pathophysiological characteristics, the most used is the symptoms of hyperglycemia.3 one established by the American Diabetes Association (ADA) which includes 4 categories4 that are described in If the clinical diagnosis is not clear, then it will be necessary Table 1. to confirm the diagnosis with a second analysis, if both In 2012, according to the World Health Organization, 90% of analyzes exceed the figures previously indicated, then cases were represented by type 2 diabetes and, in 2015, the diabetes can be diagnosed; however, in case the results are International Diabetes Federation determined around the incongruent, the test, whose results were altered, must be repeated.3 world there were 415 million people with diabetes; 5 million 5 died this year from diabetes in Mexico. According to the Patients affected by this condition have symptoms such as Halfway National Survey of Health and Nutrition unusual thirst, extreme hunger, constant need to urinate, (ENSANUT MC by its initials in Spanish) 2016, 9.4% of the unusual weight loss, extreme fatigue and irritability, as well population indicated having a previous medical diagnosis of as frequent infections, blurred vision, wounds that take time diabetes, with women being the most affected group of the to heal, tingling or numbness of hands and feet and recurrent population with a prevalence of 10.3% compared to the male infections in skin, gums and bladder; although sometimes prevalence of 8.4%; the majority of diabetics were between people with type 2 diabetes are asymptomatic.5 60 and 79 years old.6 PHARMACOLOGICAL CONTROL OF TYPE 2 Table 1. Diabetes mellitus classification. DIABETES DIABETES MELLITUS CLASIFICATION The treatment of diabetes should be comprehensive, adequate Type one diabetes Destruction of beta cells leading to and safe8; therefore, it is necessary to assess and guarantee absolute insulin deficiency medical treatment, and at the same time as it should be Type 2 diabetes Progressive defect in insulin complemented with a nutritional assessment and frequent secretion, associated with an increase medical check-ups with a multidisciplinary team to keep in insulin resistance adequate control and avoid the complications associated with Gestational Diagnosed in the 2nd and 3rd the disease.7 diabetes trimesters of pregnancy Other types Genetic defects in the function of With respect to the pharmacological treatment for type 2 (Diabetes beta cells diabetes, the Official Mexican Standard NOM-015-SSA2- MODY) Genetic defects in the action of 2010 for the prevention, treatment and control of diabetes insulin mellitus in primary care establishes that the treatment of Exocrine pancreas disease (cystic choice for patients with type 2 diabetes are sulfonylureas, fibrosis) biguanides, insulins or combinations thereof.9 Metformin is Induced by chemicals or medications established as the first-line medical treatment unless there is Source: Own elaboration with information from Barquilla a contraindication to its use, in which case the use of García, Brief Update on Diabetes for General Practitioners. sulfonylureas is suggested, according to the guidelines for the Rev. Esp. Sanid. Penit. 2017; 19: 57-65. treatment of type 2 diabetes.10 DIAGNOSTIC CRITERIA FOR DIABETES Due to the natural history of the disease, insulin is indicated at a specific time of diabetes mellitus type 2. For this, there Diagnosing the disease in a timely manner is important, must be the presence of several hyperglycemia, weight loss, controlling it as soon as possible will help reduce and prevent elevated blood glucose levels despite combined oral complications.7 treatment, decompensation due to ketoacidosis or The criteria used to establish a diagnosis of diabetes are the hyperosmolar state, infections with hyperglycemia, following: pregnancy, glucocorticoid therapy, use of markers as a predictor of a high probability of insulin need.11 • Hemoglobin glucose A1c fraction (HbA1c) > 6.5% PLANT PRODUCTS WITH HYPOGLYCEMIC • Fasting plasma glucose 8 hours > 126mg/dl CAPACITY • Plasmatic glucose two hours after applying a glucose Opuntia spp tolerance test by previously administering an anhydrous glucose load of 75 g dissolved in water > 200mg/dl The cactus (Opuntia spp.) belongs to the cacti. They grow wild in the American continent, primarily in Mexico. There 57 Biannual Publication, Mexican Journal of Medical Research ICSa, Vol. 8, No. 16 (2020) 56-64 are 10 of the 258 existing species of the genus.12 The The compounds that give stevia the potential to sweeten up to consumption of its stems, fruits and flowers precedes from 30 times more than conventional sugar17 are known as steviol the prehispanic time13, being Mexico the main producer and glucosides; which make up 15% of total composition. biggest consumer of this vegetable worldwide.14 Its Stevioside, steviolbioside, rebaudioside A, B, C, D, E, F and nutraceutical properties are of interest for the European and dulcoside have been isolated and identified. The content of Asian markets, it is an excellent source of vitamins (C and E), these phytochemicals varies according to the species and the minerals and soluble and insoluble fiber, as well as being culture conditions.18 beneficial in the natural treatment of various conditions13