INTRODUCTION:

Chronic metabolic disease known as diabetes mellitus is typified by persistently high blood sugar levels brought on by deficiencies in either insulin secretion, insulin action, or both. It can be broadly divided into two categories: Type 1, in which the body is unable to manufacture insulin, and Type 2, in which insulin resistance predominates¹. The World Health Organization (WHO) predicts an increase in diabetes-related morbidity and mortality, indicating that the global burden of diabetes has reached alarming proportions². Effective management measures are essential for diabetes since uncontrolled diabetes can result in serious consequences such as retinopathy, nephropathy, neuropathy, and cardiovascular illnesses³. Even with the availability of numerous pharmaceutical treatments, diabetes management is still difficult. Instead of treating the underlying causes, many traditional therapies concentrate on providing symptomatic alleviation. Moreover, taking synthetic antidiabetic medications over an extended period of time might result in unwanted side effects like weight gain, hypoglycemia, and gastrointestinal problems⁴. Diabetes management is made more difficult by the high cost of medications and their limited accessibility, especially in environments with minimal resources. These difficulties highlight the need for additional or alternative strategies that are both practical and affordable⁵.

There's been a resurgence of interest in using medicinal plants to manage diabetes because of the shortcomings of traditional medications. Herbs have been used to treat illnesses since ancient times, when plants served as the main source of medicinal knowledge. Herbal treatments are an essential part of traditional Chinese medicine and Ayurveda in India, helping to treat a wide range of illnesses⁶. The continued use of medicinal plants is evidence of their therapeutic value, especially in the treatment of long-term illnesses like diabetes⁷. Traditional plant-based medicines are becoming more and more valued as modern medicine progresses, particularly for illnesses where conventional treatments might not be effective⁸.

Numerous bioactive substances found in plants, including as phenolic acids, alkaloids, flavonoids, and terpenoids, have been shown to have hypoglycemic properties. Compared to medications made of a single molecule, plant-based therapies have a distinct advantage due to their holistic character, which frequently involves numerous modes of action⁹. Medicinal herbs are also a desirable alternative for long-term therapy because they are typically well-tolerated and have a decreased risk of side effects. With an emphasis on their mechanisms of action, effectiveness, and potential for integration into contemporary healthcare systems, this review seeks to investigate the potential of diverse plants in the management of diabetes.

Common Plants Used In Diabetes Management^10,11,12

1. Momordica charantia (Bitter melon):

The plant known as Momordica charantia, or bitter melon, is well known for having strong anti-diabetic qualities. Bitter melon has been utilized traditionally in many Asian, African, and Caribbean civilizations. Its potential to control blood sugar levels has been thoroughly researched. The main bioactive components of bitter melon, such as vicine, charantin, and polypeptide-p, an insulin-like polypeptide, are responsible for the fruit's antidiabetic properties. These substances exert their hypoglycemic effects through a variety of routes. Bitter melon helps reduce blood glucose levels by stimulating the pancreas to secrete more insulin. It also lessens postprandial blood sugar rises by enhancing tissue uptake of glucose and blocking intestinal absorption of glucose¹³. The plant's ability to mimic insulin, especially through polypeptide-p, adds to its ability to reduce blood sugar levels. Research indicates that consuming bitter melon on a regular basis—as juice, powder, or as part of a diet—can significantly lower fasting blood glucose levels and HbA1c, making it a potentially effective natural treatment for diabetes¹⁴.

2. Trigonella foenum-graecum (Fenugreek):

Fenugreek, or Trigonella foenum-graecum, is a well-known medicinal herb that has been used historically for a variety of health purposes, including the treatment of diabetes. The main bioactive ingredients in fenugreek seeds, which give it its antidiabetic effects, are 4-hydroxyisoleucine, trigonelline, and galactomannan. Fenugreek primarily lowers blood sugar levels via increasing insulin sensitivity, which in turn increases cells' absorption of glucose. Another important factor is the soluble fiber galactomannan, which is included in fenugreek seeds¹⁵. It slows down the breakdown and absorption of carbs, causing blood sugar levels to rise more gradually after meals. Furthermore, 4-hydroxyisoleucine directly increases insulin secretion, which aids in better blood glucose regulation. Furthermore, supporting their function in diabetes control, the seeds' antioxidant qualities help shield pancreatic β-cells from oxidative damage¹⁶. Fenugreek is a useful natural medicine in the battle against diabetes because of its dual action of enhancing insulin activity and decreasing glucose absorption.

3. Syzygium cumini (Jambolan):

The medicinal herb jambolan, sometimes referred to as black plum or Indian blackberry, is well known for having antidiabetic qualities. Its hypoglycemic benefits are attributed to the abundance of bioactive chemicals found in the seeds, specifically flavonoids, ellagic acid, and jambosine. Jambolan helps control blood sugar levels by increasing insulin secretion and raising cell sensitivity to the hormone. It also prevents the enzymes that convert starch to sugar from active, which lessens the amount of blood glucose increases that occur after a meal. Clinical research has shown that using jambolan seed powder on a regular basis can help people with Type 2 diabetes improve their glycemic control and dramatically reduce their fasting blood glucose levels^17,18. Additionally shielding pancreatic β-cells from oxidative damage are its antioxidant qualities.

4. Aloe vera:

Aloe Vera is well known for its strong antidiabetic qualities in addition to its advantages for skincare. Aloin, barbaloin, and polysaccharides are just a few of the bioactive substances found in aloe vera gel that help to control blood sugar levels. Aloe Vera functions by increasing the sensitivity of cells to insulin, which facilitates the uptake of glucose from the bloodstream. Moreover, it prompts the pancreas to release insulin, which is essential for preserving appropriate blood glucose levels¹⁹. Furthermore, the potent antioxidant qualities of aloe vera aid in shielding pancreatic β-cells from oxidative damage, a typical problem associated with diabetes. It has been demonstrated that using aloe vera on a regular basis—in juice or supplement form—significantly lowers fasting blood glucose levels²⁰.

5. Gymnema sylvestre (Gymnema):

Because of its exceptional capacity to lessen cravings and the absorption of sugar, Gymnema sylvestre is frequently referred to as the "sugar destroyer". Gymnemic acids, the plant's active ingredients, are essential for managing diabetes. These acids work by attaching themselves to the taste buds' sugar receptors, which lessens sweetness perception and helps reduce sugar cravings—a benefit that is especially advantageous for diabetics. Furthermore, Gymnema sylvestre reduces postprandial blood sugar levels by blocking the intestinal absorption of sugar. In addition, it promotes insulin secretion and pancreatic β-cell regeneration, which help to further assist in blood glucose regulation²¹.

6. Ocimum sanctum (Holy Basil):

In Ayurvedic medicine, holy basil (Ocimum sanctum), popularly referred to as tulsi, is a highly valued herb that has numerous medicinal benefits, one of which is its ability to control diabetes. Holy basil's antidiabetic properties are facilitated by the presence of bioactive substances such rosmarinic acid, ursolic acid, and eugenol. These substances function by raising insulin sensitivity, stimulating improved insulin production from the pancreas, and facilitating improved glucose metabolism in the body. Additionally, holy basil has potent anti-inflammatory and antioxidant qualities that lessen insulin resistance and shield pancreatic β-cells from oxidative damage. Holy basil's adaptogenic qualities, which aid the body in adjusting to stress—a factor that can adversely affect blood sugar levels—provide more evidence for its application in the treatment of diabetes^22,23.

7. Cinnamomum verum (Cinnamon):

The common spice cinnamon (Cinnamomum verum) has been the subject of much research regarding its potential to prevent diabetes. Cinnamaldehyde, cinnamic acid, and catechins are some of the main bioactive substances in cinnamon that help control blood sugar levels. Cinnamon acts by increasing sensitivity to insulin, which makes it possible for cells to absorb glucose more effectively²⁴. Additionally, it lessens the quantity of glucose that enters the bloodstream after a meal by slowing down the digestion of carbohydrates in the digestive tract. Cinnamon has also been demonstrated to enhance the activity of insulin receptors on cells, which lends additional credence to its involvement in controlling blood sugar.

8. Allium sativum (Garlic):

Although the health advantages of garlic (Allium sativum) have long been known, it also has a big impact on diabetes control. Garlic's hypoglycemic properties are caused by sulfur-containing chemicals, specifically allicin, S-allyl cysteine, and allyl propyl disulfide. Blood glucose levels are lowered by garlic's improved insulin sensitivity and increased production of insulin²⁵. Additionally, it prevents the liver from producing glucose, which lowers the blood's total glucose burden. Garlic also contains antioxidants that shield pancreatic β-cells from oxidative damage, a typical problem in diabetes. Garlic has several cardiovascular benefits, including decreasing blood pressure and improving lipid profiles. These benefits are especially crucial for diabetics, as they increase the risk of heart disease²⁶.

9. Curcuma longa (Turmeric):

The yellow spice turmeric (Curcuma longa) is well known for its antioxidant and anti-inflammatory qualities, but it also has a lot of promise for managing diabetes. Curcumin, the main bioactive ingredient in turmeric, is essential for controlling blood sugar levels. Curcumin stimulates the pancreas to produce more insulin and improves insulin sensitivity, which helps the body use insulin more efficiently. Moreover, curcumin has been demonstrated to inhibit inflammatory pathways that support insulin resistance, a key component of Type 2 diabetes. Curcumin enhances the pancreas' overall function and improves blood sugar management by shielding pancreatic β-cells from oxidative stress and damage. Improved glycemic control has been linked to consuming supplements containing curcumin or adding turmeric to one's diet^27,28.

10. Panax ginseng (Ginseng):

Because it contains bioactive molecules called ginsenosides, ginseng—especially Panax ginseng—is well known for having antidiabetic qualities. It has been demonstrated that these substances increase insulin sensitivity, stimulate insulin secretion, and enhance glucose metabolism. Ginseng increases the uptake of glucose by cells and controls the creation of glucose in the liver, which lowers blood sugar levels. Its ability to prevent oxidative damage to pancreatic β-cells is another benefit of its antioxidant qualities, which reinforce its function in diabetes management^29,30. Clinical research has shown that supplementing with ginseng can significantly lower HbA1c and fasting blood glucose levels in people with Type 2 diabetes. Because of its adaptogenic properties, which support the body's ability to cope with stress, and its capacity to enhance overall glycemic control, ginseng is a useful supplementary treatment for diabetes management. Figure 1 depicts the various herbs used in the management of diabetes along with main phytoconstituent responsible for antidiabetic action and their mechanism of action.

MECHANISMS OF ACTION:

Enhancing Insulin Secretion:

Plants that encourage the pancreas to produce more insulin include ginseng (Panax ginseng) and bitter melon (Momordica charantia). Polypeptide-p and charantin, two substances found in bitter melon, imitate insulin and increase its secretion. Also, the ginsenosides in ginseng encourage the release of insulin from pancreatic β-cells³¹. These plants assist reduce blood glucose levels by improving the body's ability to use glucose more efficiently through an increase in insulin production.

Improving insulin Sensitivity:

Holy basil (Ocimum sanctum) and fenugreek (Trigonella foenum-graecum) increase insulin sensitivity, increasing cell reactivity to insulin. 4-hydroxyisoleucine, found in fenugreek seeds, improves insulin sensitivity and aids in the absorption of glucose. Bioactive substances found in holy basil, such eugenol, improve insulin sensitivity and assist in controlling glucose metabolism³². Higher insulin sensitivity enables cells to absorb glucose more effectively, which lowers blood sugar levels.

Reducing Blood Glucose Production:

Certain plants also lessen the amount of glucose produced by the liver. For instance, ginseng lowers blood glucose levels during fasting by regulating the liver's production of glucose. Better blood glucose regulation is supported by this activity, which lowers the total amount of glucose in the bloodstream³³.

Modulating Carbohydrate Metabolism:

The digestion and absorption of carbohydrates are inhibited by Gymnema sylvestre and cinnamon (Cinnamomum verum). Gymnemic acids, found in Gymnema Sylvestre, inhibit enzymes that break down carbohydrates, such as α-glucosidase and α-amylase, and block sugar receptors. In a similar vein, cinnamon slows down the digestion of carbs, which causes blood sugar levels to gradually rise³⁴. These herbs aid in the reduction of postprandial blood sugar rises by decreasing the absorption of glucose from the digestive system.

Protecting Pancreatic β-Cells:

Garlic (Allium sativum) and turmeric (Curcuma longa) guard against oxidative damage to pancreatic β-cells. Strong antioxidants like curcumin from turmeric and allicin from garlic protect β-cells from oxidative stress, which is a major problem in diabetes³⁵. These plants help maintain prolonged insulin production and glucose management by maintaining β-cell function, which lowers blood glucose levels.

Integration of Herbal Remedies Into Conventional Diabetes Management:

Combining herbal medicines with traditional diabetes care provides an additional strategy that can improve overall glucose control. Additional strategies for controlling blood glucose levels include increased insulin sensitivity, increased insulin secretion, and decreased absorption of carbohydrates via herbal medicines such fenugreek, gymnema sylvestre, and cinnamon. These herbs can assist in addressing some of the drawbacks of traditional therapy, such as insufficient glucose control or unpleasant side effects, when used in conjunction with conventional treatments. By combining the traditional knowledge and potential benefits of herbal interventions with the rigorous clinical evidence that supports pharmaceutical treatments, this integrative approach leverages the strengths of both conventional medicine and herbal remedies, potentially improving patient outcomes³⁶. However, cautious thought and cooperation with healthcare professionals are necessary for the effective integration of herbal therapies into traditional diabetic therapy. It's crucial to be sure herbal remedies don't negatively interact or conflict with prescription drugs. To guarantee safety and effectiveness, clinical studies and scientific research ought to inform the choice and dose of herbal treatments³⁷. Patients can gain from a more comprehensive approach to diabetes management by integrating evidence-based herbal treatments into a customized treatment plan, which will ultimately improve their general health and quality of life³⁸.

CHALLENGES AND CONSIDERATIONS:

In order to guarantee the safety and effectiveness of herbal therapies, there are a number of important criteria that need to be taken into account when incorporating them into diabetes therapy. A significant issue is the possibility of drug-herb interactions, in which herbal therapies could interfere with prescription diabetic drugs and change their efficacy or have unfavorable effects. Standardization is essential to guarantee constant potency and safety because there is variation in the quality and content of herbal medicines, which presents additional obstacles. Herbal medicines' efficacy and safety might be uncertain in the absence of standardized formulations, which makes it more difficult to include them into conventional treatment plans.

The process of integration is significantly influenced by regulatory factors as well. Because many herbal treatments are not subject to the same stringent clearance procedures as pharmaceutical pharmaceuticals, questions have been raised over their regulatory monitoring and quality control. Herbal products must adhere to established safety and efficacy requirements in order to be accepted and used in traditional diabetic care. By addressing these issues with thorough clinical research, appropriate standardization, and regulatory frameworks, herbal treatments can be effectively integrated into complete diabetes care plans while maximizing their benefits and limiting their hazards.

CONCLUSION:

To sum up, incorporating herbal treatments into diabetes treatment is a viable and comprehensive strategy for improving glycemic control. Plants with distinct processes, such Fenugreek, Gymnema Sylvestre, Cinnamon, and others, can provide substantial advantages like increased insulin sensitivity, increased insulin secretion, and inhibition of the breakdown of carbohydrates. Their anti-inflammatory and antioxidant qualities also aid in the control of diabetes and the avoidance of its consequences. Although there is a lot of promise for these herbal medicines, in order to assure safety and effectiveness, their usage should be guided by clinical evidence and integrated with conventional treatments. A more thorough and successful approach to managing diabetes can be obtained by fusing the benefits of contemporary medicine with ancient herbal remedies. This will ultimately enhance patient outcomes and quality of life.

ACKNOWLEDGEMENT:

The authors are highly thankful to the Management of Sanskar Educational Group for constant support.

CONFLICT OF INTEREST:

None.

REFERENCES:

1. Sharma Priya, Malik Sujeeta. Knowledge on Management of Diabetes Mellitus among Patients with type II Diabetes Mellitus in a Selected Community Health Centre of Dadra and Nagar Haveli Area. Asian J. Nursing Education and Research. 2019; 9(1): 109-112.

2. Roglic G. WHO Global report on diabetes: A summary. International Journal of Noncommunicable Diseases. 2016; Apr 1; 1(1): 3-8.

3. Mohd. Yaqub Khan, Poonam Gupta, Bipin Bihari, Vikas Kumar Verma. A Review on Diabetes and Its Management. Asian J. Pharm. Res. 2013; 3(1): Jan.-Mar. 27-32.

4. Kaul K, Tarr JM, Ahmad SI, Kohner EM, Chibber R. Introduction to diabetes mellitus. Diabetes: An Old Disease, A New Insight. 2013: 1-1.

5. Kavita Chandramore. Review on Dipeptidyl Peptidase IV Inhibitors as a Newer Target for Diabetes Mellitus Treatment. Asian J. Pharm. Res. 2017; 7(4): 230-238.

6. Garg A. Herbs in cosmetics: An overview. Research Journal of Topical and Cosmetic Sciences. 2023; 14(1): 45-9.

7. Mohd. Yaqub Khan, Irfan Aziz, Bipin Bihari, Hemant Kumar, Maryada Roy, Vikas Kumar Verma. A Review- Phytomedicines Used in Treatment of Diabetes. Asian J. Pharm. Res. 2014; 4(3): 135-154.

8. P. Jaya Preethi. Herbal Medicine for Diabetes Mellitus: A Review. Asian J. Pharm. Res. 2013; 3(2): 57-70.

9. Dharmesh Sharma, Deepak Prashar, Sanjay Saklani. Bird’s Eye View on Herbal Treatment of Diabetes. Asian J. Pharm. Res. 2012; 2(1): 01-06.

10. Aditya Mathur, Shweta Asthana, Samir Patra, Pulak Jana. A Review on Current Type-2 Diabetes Mellitus Treatment by selected Phytoconstituents. Research Journal of Pharmacology and Pharmacodynamics. 2023; 15(4): 205-1.

11. Bhutkar MA, Bhise SB. Spices and Condiments in the management of Diabetes mellitus. Research J. Pharm. and Tech. 2011; 4 (1): 37-42.

12. Rajiv Rai. Ethnobotanical studies on plants used in folk medicines in cure of Diabetes in Gondwana Region of Madhya Pradesh. Asian J. Pharm. Res. 2016; 6(2): 72-78.

13. Leung L, Birtwhistle R, Kotecha J, Hannah S, Cuthbertson S. Anti-diabetic and hypoglycaemic effects of Momordica charantia (bitter melon): a mini review. British Journal of Nutrition. 2009; Dec; 102(12): 1703-8.

14. Basch E, Gabardi S, Ulbricht C. Bitter melon (Momordica charantia): a review of efficacy and safety. American Journal of Health-System Pharmacy. 2003; Feb 15; 60(4): 356-9.

15. Haber SL, Keonavong J. Fenugreek use in patients with diabetes mellitus. American Journal of Health-System Pharmacy. 2013; Jul 15; 70(14): 1196-203.

16. Losso JN, Holliday DL, Finley JW, Martin RJ, Rood JC, Yu Y, Greenway FL. Fenugreek bread: a treatment for diabetes mellitus. Journal of Medicinal Food. 2009; Oct 1; 12(5): 1046-9.

17. Jagetia GC. A review on the role of jamun, syzygium cumini skeels in the treatment of diabetes. Int J Complement Alt Med. 2018; 11(2): 91-5.

18. Rather GJ, Hamidudin M, Ikram M, Zaman R. Antidiabetic potential and related activity of Jamun (Syzygium cumini Linn.) and its utilization in Unani medicine: An overview. International Journal of Herbal Medicine. 2019; 7(5): 07-11.

19. Ngo MQ, Nguyen NN, Shah SA. Oral aloe vera for treatment of diabetes mellitus and dyslipidemia. American Journal of Health-System Pharmacy. 2010; Nov 1; 67(21): 1804-11.

20. Araya-Quintanilla F, Gutiérrez-Espinoza H, Cuyul-Vásquez I, Pavez L. Effectiveness of aloe vera in patients with type 2 Diabetes Mellitus and pre-diabetes: An overview of systematic reviews. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2021; Nov 1; 15(6): 102292.

21. Leach MJ. Gymnema sylvestre for diabetes mellitus: a systematic review. The Journal of Alternative and Complementary Medicine. 2007 Nov 1; 13(9):977-83.

22. Singh D, Chaudhuri PK. A review on phytochemical and pharmacological properties of Holy basil (Ocimum sanctum L.). Industrial Crops and Products. 2018; Aug 1; 118: 367-82.

23. Kaur S, Sabharwal S, Anand N, Singh S, Baghel DS, Mittal A. An overview of Tulsi (Holy basil). European Journal of Molecular and Clinical Medicine. 2020; 7(7): 2833-9.

24. Bandara T, Uluwaduge I, Jansz ER. Bioactivity of cinnamon with special emphasis on diabetes mellitus: a review. International Journal of Food Sciences and Nutrition. 2012; May 1; 63(3): 380-6.

25. Ashraf R, Aamir K, Shaikh AR, Ahmed T. Effects of garlic on dyslipidemia in patients with type 2 diabetes mellitus. J Ayub Med Coll Abbottabad. 2005; Jul;17(3):60-4.

26. Phil RA, Khan RA, Ashraf I. Effects of garlic on blood glucose levels and HbA1c in patients with type 2 diabetes mellitus. Journal of Medicinal Plants Research. 2011; Jul 4; 5(13): 2922-8.

27. Bozkurt O, Kocaadam-Bozkurt B, Yildiran H. Effects of curcumin, a bioactive component of turmeric, on type 2 diabetes mellitus and its complications: An updated review. Food and Function. 2022; 13(23): 11999-2010.

28. Maithili Karpaga Selvi N, Sridhar MG, Swaminathan RP, Sripradha R. Efficacy of turmeric as adjuvant therapy in type 2 diabetic patients. Indian Journal of Clinical Biochemistry. 2015; Apr; 30: 180-6.

29. Li KK, Gong XJ. A review on the medicinal potential of Panax ginseng saponins in diabetes mellitus. Rsc Advances. 2015; 5(59): 47353-66.

30. Vuksan V, Sievenpiper JL. Herbal remedies in the management of diabetes: lessons learned from the study of ginseng. Nutrition, Metabolism and Cardiovascular Diseases. 2005; Jun 1; 15(3): 149-60.

31. Prabhakar PK, Doble M. Mechanism of action of natural products used in the treatment of diabetes mellitus. Chinese Journal of Integrative Medicine. 2011; Aug; 17: 563-74.

32. Subramoniam A. Anti-diabetes mellitus plants: active principles, mechanisms of action and sustainable utilization. CRC Press; 2016 Oct 3.

33. Shukia R, Sharma SB, Puri D, Prabhu KM, Murthy PS. Medicinal plants for treatment of diabetes mellitus. Indian Journal of Clinical Biochemistry. 2000; Aug; 15: 169-77.

34. Bathaie SZ, Mokarizade N, Shirali S. An overview of the mechanisms of plant ingredients in the treatment of diabetes mellitus. Journal of Medicinal Plants. 2012; Nov 10; 11(44): 1-24.

35. Bhushan MS, Rao CH, Ojha SK, Vijayakumar M, Verma A. An analytical review of plants for anti diabetic activity with their phytoconstituent and mechanism of action. Int J Pharm Sci Res. 2010; 1(1):2 9-46.

36. Dham S, Shah V, Hirsch S, Banerji MA. The role of complementary and alternative medicine in diabetes. Current Diabetes Reports. 2006; May; 6(3): 251-8.

37. Chang HY, Wallis M, Tiralongo E. Use of complementary and alternative medicine among people living with diabetes: literature review. Journal of Advanced Nursing. 2007; May; 58(4): 307-19.

38. Prabhakar PK, Kumar A, Doble M. Combination therapy: a new strategy to manage diabetes and its complications. Phytomedicine. 2014; Jan 15; 21(2): 123-30.

Received on 31.08.2024 Revised on 18.11.2024

Accepted on 23.01.2025 Published on 05.03.2025

Available online from March 11, 2025

Res. J. Pharmacognosy and Phytochem. 2025; 17(1):69-74.

DOI: 10.52711/0975-4385.2025.00012

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.