Management of diabetic complications: a chemical constituents based approach

Abstract

Ethnopharmacological relevance: Long term hyperglycemia leads to development of complications associated with diabetes. Diabetic complications are now a global health problem without effective therapeutic approach. Hyperglycemia and oxidative stress are important components for the development of diabetic complications. Over the past few decades, herbal medicines have attracted much attention as potential therapeutic agents in the prevention and treatment of diabetic complications due to their multiple targets and less toxic side effects. This review aims to assess the current available knowledge of medicinal herbs for attenuation and management of diabetic complications and their underlying mechanisms.

Material and methods: Bibliographic investigation was carried out by scrutinizing classical text books and peer reviewed papers, consulting worldwide accepted scientific databases (SCOPUS, PUBMED, SCIELO, NISCAIR, Google Scholar) to retrieve available published literature. The inclusion criteria for the selection of plants were based upon all medicinal herbs and their active compounds with attributed potentials in relieving diabetic complications. Moreover, plants which have potential effect in ameliorating oxidative stress in diabetic animals have been included.

Results: Overall, 238 articles were reviewed for plant literature and out of the reviewed literature, 127 articles were selected for the study. Various medicinal plants/plant extracts containing flavonoids, alkaloids, phenolic compounds, terpenoids, saponins and phytosterol type chemical constituents were found to be effective in the management of diabetic complications. This effect might be attributed to amelioration of persistent hyperglycemia, oxidative stress and modulation of various metabolic pathways involved in the pathogenesis of diabetic complications.

Conclusion: Screening chemical candidate from herbal medicine might be a promising approach for new drug discovery to treat the diabetic complications. There is still a dire need to explore the mechanism of action of various plant extracts and their toxicity profile and to determine their role in therapy of diabetic complications. Moreover, a perfect rodent model which completely mimics human diabetic complications should be developed.

Keywords: AGE; BB rats; BB/Wor rats; BBZDR/Wor rats; BioBreeding Zucker Diabetic rats; BioBreeding rats; BioBreeding/Worcester rats; Body weight; DAG; DPN; DRG; Diabetic complications; FOS; G-6-P; GK rats; GLP-1; GPx; GSH; Goto-Kakizaki rats; HDL; HbA1c; High-density lipoprotein; IGF; IU; LBP-4; LDL; Lycium barbarum Polysaccharides-4; MAPK; MNCV; Medicinal plants; NCV; NF-κB; NGF; NO; NOD; OLETF rats; Otsuka Long Evans Tokushima Fatty rats; Oxidative stress; PKC; PPAR α; PPAR γ; RNS; ROS; SNCV; STZ; Streptozotocin; TBARS; TGF-β; TNF-α; VEGF; WBN/Kob rats; Wistar Bonn/Kobori rats; ZDF rats; Zucker Diabetic Fatty rats; advanced glycation end products; b.d.; b.w.; diabetic peripheral neuropathy; diacyl glycerol; dorsal root ganglion; fructooligosaccharides; glucagon like peptide-1; glucose-6-phosphate; glutathione; glutathione peroxidase; glycosylated hemoglobin A1c; i.g.; i.p.; insulin-like growth factor; international units; intragastric route; intraperitoneal injection; low-density lipoprotein; mitogen activated protein kinase; motor nerve conduction velocity; nerve conduction velocity; nerve growth factor; nitric oxide; non-obese diabetic mice; nuclear factor kappa B; o.d.; once daily dose; p.o.; per os (oral administration); peroxisome proliferators-activated receptor α; peroxisome proliferators-activated receptor γ; protein kinase C; reactive nitrogen species; reactive oxygen species; sensory nerve conduction velocity; thiobarbituric acid reactive substances; transforming growth factor-β; tumor necrosis factor-α; twice daily dose; v/v; vascular endothelial growth factor; volume by volume; w/w; weight by weight.