Diabetes Melitus and Herbal Medicine

Kelompok 10

Definition

• a group of common metabolic disorders that share the phenotype of hyperglycemia

DM type I :Complete Insulin Deficiency DM Type II:heterogeneous group of disorders characterized by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production

Longo Dl, Kasper DL, Jameson JL, et al. Harrison’s Principles of Internal Medicine. 18th ed. US: McGraww Hill Companies, Inc. 2012

Classification

DM type I :Complete Insulin Deficiency

DM Type II:heterogeneous group of disorders characterized by variable degrees of :

insulin resistance, impaired insulin secretion, increased glucose production

Longo Dl, Kasper DL, Jameson JL, et al. Harrison’s Principles of Internal Medicine. 18th ed. US: McGraww Hill Companies, Inc. 2012

Pathophysiology DM Type II

Insulin Resistance

Glucose tolerance ≈

normal

Compensatory : ↗ Insulin

Hyperinsulinemia

The Islets unable to sustain

hyperinsulinemic state

IGT Develops

↗PPBG

↙Insulin Secretion

↗ Hepatic Glucose

Production

Overt Diabetes with fasting

hyperglycemia

Β cell failure

Longo Dl, Kasper DL, Jameson JL, et al. Harrison’s Principles of Internal Medicine. 18th ed. US: McGraww Hill Companies, Inc. 2012

• Clinical Studies potential links between herbal therapies and improved blood glucose control

• Plants have anti-diabetic properties include: – Aloe vera– Bilberry extract– Bitter melon– Cinnamon– Fenugreek– Ginger

The Global Diabetes Community. Herbal and Natural Therapies. http://www.diabetes.co.uk/Diabetes-herbal.html

Classification of Herbal Medicine

Herbal medicine can be broadly classified into the following categories according to their mode of action:a)Drugs acting like insulinb)Drugs acting on insulin secreting beta cellsc)Drugs modifying glucose utilizationd)Drugs showing adrenomimeticisme)repairing pancreatic beta cellsf) cAMP (2nd messenger) stimulatorsthe beta-cells

g

g) renal glucose resorption inhibitorsh) herbal drugs providing certain necessary elements like calcium, zinc, magnesium, manganese and copper for the beta cellsi) drugs regenerating and/or repairing pancreatic beta cellsj) effectors of size and number of cells in the islets of langerhans,k) glycogenesis and hepatic glycolysis stimulators,l) drugs preventing pathological conversion of starch to glucose by inhibition of β –galactosidase, α–glycosidase & alpha-amylase, m) drugs preventing oxidative stress that is possibly involved in pancreatic ß-cell dysfunction found in diabetes

Herbal alternatives and management for diabetes, Evidence based herbal drug standardization approach in coping with challenges of holistic management of diabetes: a dreadful lifestyle disorder of 21st century http://www.jdmdonline.com/content/12/1/35

The various contraindications of herbal medicines

a) Being self prescribed, quality assurance is not guaranteed and also may interact with other drugs b) contraindications of herbal drugs and associated unusual beliefs c) contain powerful, pharmacologically active compounds that needs to be evaluated for drug-drug interactions d) usually cause hepatic and renal problems if taken in excess; due to lack of pharmacodynamics and pharmacokinetics data and slow clearance rate from the body

e) difficulty in identification of the causative agent associated with the adverse reactions encountered as these often contain multiple ingredientsf) lack of standardization while the formulation of herbal drug i.e. delivery system for particular target is generally not validated g) mode of action of herbal plant constituents is not clear enough to support therapeutic utility.

Contraindications of herbal alternatives, Evidence based herbal drug standardization approach in coping with challenges of holistic management of diabetes: a dreadful lifestyle disorder of 21st century century http://www.jdmdonline.com/content/12/1/35

Controversy Use of Herbal Medicine

• ayurvedic and oriental medicine treating serious conditions such as diabetes, • health experts in the west sceptical about their reported medical benefits.

Argument : Herbal Med ↗ Hypoglicemic effect Herbal Med + Diabetes Med

↗dangerously low levels of Glucose ↗the risk of other diabetes complications

The Global Diabetes Community. Herbal and Natural Therapies. http://www.diabetes.co.uk/Diabetes-herbal.html

Anti Diabetic Herbs in Indonesia, Sambiloto (Andrographis paniculata)

• "Andrografolid with the main fitochemical can decrease glucose level in blood and can express the GLUT-4 in DM 1,” dosen Fakultas Farmasi UGM in paralel session of the 4th Riset Industri Indonesia

• Purified Isolat andrografolid (sambiloto extract) that given to the mice shows the hypoglicemic activities in DM mice with insulin resistence. It is effective to decrease LDL and Triglycerides level in blood, but has no effect in cholesterol and weight.

• Combination between purified extract and metformin (biguanide) shows less effectiveness than using single using of sambiloto.

• Andrografolid decreases blood glucose level in DM type 2 with insulin resistence by increasing expression of GLUT 4 protein in muscle tissues

Sambiloto, Obat Herbal Anti Diabetes Mellitus http://www.suaramerdeka.com/v1/index.php/read/sehat/2012/12/09/887/Sambiloto-Obat-

Herbal-Anti-Diabetes-Melitus .

Fenugreek (Type 1 and 2 diabetes)

• Helps lower blood glucose by slowing down digestion and absorption of carbohydrates.

• Study research :1.Adding 100 grams to the daily diet of patients with type 1

diabetes significantly reduce fasting blood glucose, improved glucose tolerance, lowered total cholesterol, LDL, and TG.

2.Adding 15 grams into meal of patients with type 2 diabetes reduced post meal blood glucose.

Cassia Cinnamon (Cinnamon bark)

• Research :• Daily intake 1, 3, or 6 grams after 40 days shown reduce

serum glucose, TG, LDL, total cholester among 60 middle-aged patients.

• Consuming 1 gram perday can increase insulin sensivity.• Consuming 6 gram shown slows stomach emptying and

significantly reduces post prandial blood glucose

Bitter melon (In type 2 diabetes)

• The fruit contains :• Charantin blood glucose lowering effect• Vicine• Polypeptide-p• Lectin reduce blood glucose and supressing appetite.

Bilberry (Vaccinium myrtillus)extract

• Effect :• Retinopathy strengthening of blood vessels in the retina

and reduced hemorrhaging.

Preventive and Protective Properties of Zingiber officinale (Ginger) in Diabetes Mellitus, Diabetic Complications, and Associated Lipid and Other Metabolic

Disorders: A Brief Review.

• Zingiber officinale (ginger) has been used as herbal medicine to treat various ailments (penyakit) worldwide since antiquity (zaman purbakala). Recent evidence revealed the potential of ginger for treatment of diabetes mellitus. Data from in vitro, in vivo, and clinical trials has demonstrated the antihyperglycaemic effect of ginger. The mechanisms underlying these actions are associated with insulin release and action, and improved carbohydrate and lipid metabolism. The most active ingredients in ginger are the pungent(tajam) principles, gingerols, and shogaol. Ginger has shown prominent(mencolok) protective effects on diabetic liver, kidney, eye, and neural system complications. The pharmacokinetics, bioavailability, and the safety issues of ginger are also discussed in this update.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519348/

GINGER

Ginger

• Function :1.Gingerols - the major active component - can increase uptake

of glucose into muscle cells without using insulin.2.Led to a 35 % drop in blood glucose level and 10 % increase in

plasma insulin level

Evaluation of the Nutritional and Metabolic Effects of Aloe vera

Aloe vera has a long history of popular and traditional use. It is used in traditional Indian medicine for constipation, colic, skin diseases, worm infestation, and infections (Heber 2007). It is also used in Trinidad and Tobago for hypertension (Lans 2006) and among Mexican Americans for the treatment of type 2 diabetes mellitus (DM; Coronado et al. 2004). In Chinese medicine, it is often recommended in the treatment of fungal diseases (Heber 2007). In Western society, Aloe vera is one of the few herbal medicines in common usage, and it has found widespread use in the cosmetic, pharmaceutical, and food industries. The conditions for which clinical trials of Aloe vera have been conducted include skin conditions, management of burn and wound healing, constipation, DM, and gastrointestinal disorders.

http://www.ncbi.nlm.nih.gov/books/NBK92765/

Herbal Medicine: Biomolecular and Clinical Aspects. 2nd edition.Benzie IFF, Wachtel-Galor S, editors.Boca Raton (FL): CRC Press; 2011.

Penggunaan Obat Herbal dan Konvesional secara bersamaan

Penelitian yang dilakukan di 11 Puskesmas, Kecamatan Kota Depok, dari bulan Maret sampai Mei 2012, pada pasien DM tipe 2.

Responden 10152,47% pengguna antidiabetes herbal71,70% dari pengguna antidiabetes herbal masih menggunakan ADODengan daun sirsak, daun salam, dan kulit manggis tiga terbanyak

antidiabetes herbal yang digunakan.Adhitia. Efek Perseptif Antidiabetes Herbal bersamaan dengan Obat Antidiabets Oral Pada Pasien Diabetes elitus Tipe 2

Di Puskesmas Kotamadya Depok. Universitas IndonesiaI; 2012.

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