The Use of Natural Products in the Management of Diabetes: The Current Trends
Natural products have played and continue to play a great role in the management of different diseases. Natural products are usually believed to be safer, cheaper, easily available and sometimes more efficacious than purely synthetic drugs. Diabetes mellitus is a major health problem in the world. There is no cure for diabetes. With the increase in a number of newer drugs for diabetes, there is the possibility of a wide range of side effects that vary from one drug to another. It is, therefore, essential to practice effective methods of the treatment and management of diabetes. Hence, the need to explore antidiabetic drugs of natural origin with minimal side effects is highly essential. This review provides a scientific perspective on the usage and research of natural traditional remedies in the management of diabetes. The aim of the present review is to provide a comprehensive and concise overview of the previously reported clinical trials of antioxidative natural products in the management of diabetes.
Keywords: Diabetes, Natural products, Hyperglycemia, Diabetic complications,
 Joseph B, Jini D, Insight into the hypoglycaemic effect of traditional Indian herbs used in the treatment of diabetes. Res J Med Plant, 2011; 5(4): 352-376.
 Piero MN, Nzaro GM, Njagi JM, Diabetes mellitus-a devas-tating metabolic disorder. Asian journal of biomedical and pharmaceutical sciences, 2015; 5(40):1.
 Nasar MK, Prevention and management of diabetes and its complications by unani herbal medicine - a review. Endocrinol Metb Int J. 2017; 4 (4):101‒105. DOI: 10.15406/emij.2017.04.00094
 Khare CP. Indian Medicinal Plants. (1st edn), Springer (India) private limited, India, 2007; pp. 587.
 CCRUM. Unani Pharmacopoeia of India. 2007.
 Dey L, Attele AS, Yuan CS. Alternative therapies for type 2 diabetes. Altern Med Rev. 2002; 7 (1): 45–58.
 Kar A, Choudhary BK, Bandyopadhyay NG, Comparative evaluation of hypoglycaemic activity of some Indian medicinal plants in alloxan diabetic rats. J Ethnopharmacol. 2003; 84(1):105–108.
 Karen Sanders, Aloe Vera juice helps lowers blood sugar and cholester¬ol. Natural Health. 2013; 365(4): 122–127.
 Rajnandan Patnaik, International journal of innovative research & de¬velopment. 2014; 3(12): 401–407.
 Devaraj S, Yimam M, Brownell LA, Jialal I, Singh S, Jia Q, Effects of Aloe vera supplementation in subjects with prediabetes/metabolic syndrome, Metabolic Syndrome and Related Disorders, 2013; 11(1): 35–40.
 Mahmoud F, Haines D, Al-Ozairi E, Dashti A, Effect of black tea consumption on intracellular cytokines, regulatory T cells and metabolic biomarkers in type 2 diabetes patients, Phytotherapy Research, 2016; 30(3): 454– 462.
 Zemestani M, Rafraf M, Asghari-Jafarabadi M, Chamomile tea improves glycemic indices and antioxidants status in patients with type 2 diabetes mellitus, Nutrition, 2016; 32(1): 66–72.
 Kaatabi H, Bamosa AO, Badar A, Al-Elq A, Abou-Hozaifa B, Lebda F, Al-Khadra A, Al-Almaie S, Nigella sativa improves glycemic control and ameliorates oxidative stress in patients with type 2 diabetes mellitus: placebo controlled participant blinded clinical trial, 2015; PLoS One, 10(2): article e0113486.
 Fatima N, Pingali U, Muralidhar N, Study of pharmacodynamics interaction of Phyllanthus emblica extract with Clopidogrel and ecosprin in patients with type II diabetes mellitus, Phytomedicine, 2014; 21(5) 579–585.
 Ahmad MS, Ahmed N, Antiglycation properties of aged garlic extract: possible role in prevention of diabetic complications, The Journal of Nutrition, 2006; 136(3): 796S–799S.
 Shiju TM, Rajesh NG, Viswanathan P, Renoprotective effect of aged garlic extract in streptozotocin-induced diabetic rats, Indian Journal of Pharmacology, 2013; 45(1): 18–23.
 Thomson M, Al-Qattan KK, Divya JS, Ali M, Antidiabetic and anti-oxidant potential of aged garlic extract (AGE) in streptozotocin-induced diabetic rats, BMC Complementary and Alternative Medicine, 2016; 16: 17.
 Dillon SA, Lowe GM, Billington D, Rahman K, Dietary supplementation with aged garlic extract reduces plasma and urine concentrations of 8-iso-prostaglandin F(2 alpha) in smoking and nonsmoking men and women, The Journal of Nutrition, 2002; 132(2): 168–171.
 Weiss N, Ide N, Abahji T, Nill L, Keller C, Hoffmann U, “Aged garlic extract improves homocysteine induced endothelial dysfunction in macro- and microcirculation,” The Journal of Nutrition, 2006; 136(3): 750S–754S.
 Atkin M, Laight, D, and Cummings MH, The effects of garlic extract upon endothelial function, vascular inflammation, oxidative stress and insulin resistance in adults with type 2 diabetes at high cardiovascular risk. A pilot double blind randomized placebo controlled trial, Journal of Diabetes and its Complications, 2016; 30(4): 723–727.
 Qian Q, Qian S, Fan P, Huo D, Wang S, Effect of Salvia miltiorrhiza hydrophilic extract on antioxidant enzymes in diabetic patients with chronic heart disease: a randomized controlled trial, Phytotherapy Research, 2012; 26(1): 60–66.
 Singh R, Kaur N, Kishore L, Gupta GK, Management of diabetic complications: a chemical constituents based approach, Journal of Ethnopharmacology, 2013; 150(1): 51–70.
 Bai Y, Cui W, Xin, Y., et al., “Prevention by sulforaphane of diabetic cardiomyopathy is associated with up-regulation of Nrf2 expression and transcription activation,” Journal of Molecular and Cellular Cardiology, vol. 57, pp. 82–95, 2013.
 Zhang Z, Chen J, Jiang X, Wang J, Yan X, Zheng Y, Conklin DJ, Kim K, Kim KH, Tan Y, Kim YH, Cai L, The magnolia bioactive constituent 4-O-methylhonokiol protects against high-fat diet-induced obesity and systemic insulin resistance in mice, Oxidative Medicine and Cellular Longevity, 2014; Article ID 965954, 10 pages.
 Gu J, Cheng Y, Wuet H, al., Metallothionein is downstream of Nrf2 and partially mediates sulforaphane prevention of diabetic cardiomyopathy, Diabetes, 2017; 66(2): 529–542.
 Wu H, Kong L, Zhou S, Cui W, Xu F, Luo M, Li X, Tan Y, Miao L, The role of microRNAs in diabetic nephropathy, Journal of Diabetes Research, 2014; Article ID 920134, 12 pages.
 Wu H, Kong L, Cheng Y, Zhang Z, Wang Y, Lou M, Tan Y, Chen X, Miao L, Cai L, Metallothionein plays a prominent role in the prevention of diabetic nephropathy by sulforaphane via up-regulation of Nrf2, Free Radical Biology & Medicine, 2015; 89: 431–442.
 Bahadoran Z, Tohidi M, Nazeri P, Mehran M, Azizi F, Mirmiran P, Effect of broccoli sprouts on insulin resistance in type 2 diabetic patients: a randomized double-blind clinical trial, International Journal of Food Sciences and Nutrition, 2012; 63(7): 767–771.
 Abo-Salem OM, Harisa GI, Ali TM, El- Sayed e-SM, Abou-Elnour FM, Curcumin ameliorates streptozotocin-induced heart injury in rats, Journal of Biochemical and Molecular Toxicology, 2014; 28(6):263–270.
 Yu W, Wu J, Cai F, Xiang J, Zha W, Fan D, Guo S, Ming Z, Liu C, Curcumin alleviates diabetic cardiomyopathy in experimental diabetic rats, PLoS One, 2012; 7(12): article e52013.
 Soetikno V, Sari FR, Sukumaran V, Lakshmanan AP, Mito S, Harima M, Thandavarayan RA, Suzuki K, Nagata M, Takagi R, Watanabe K, Curcumin prevents diabetic cardiomyopathy in streptozotocin-induced diabetic rats: possible involvement of PKC-MAPK signaling pathway, European Journal of Pharmaceutical Sciences, 2012; 47(3): 604–614.
 Aziz MT, El Ibrashy IN, Mikhailidis DP, Rezq AM, Wassef MA, Fouad HH, Ahmed HH, Sabry DA, Shawky HM, Hussein RE, Signaling mechanisms of a water soluble curcumin derivative in experimental type 1 diabetes with cardiomyopathy, Diabetology and Metabolic Syndrome, 2013; 5(1): 13.
 Yu W, Zha W, Ke Z, Min Q, Li C, Sun H, Liu C, Curcumin protects neonatal rat cardiomyocytes against high glucose-induced apoptosis via PI3K/Akt signalling pathway, Journal of Diabetes Research, 2016; Article ID 4158591, 11 pages.
 Wu H, Kong L, Tan Y, Epstein PN, Zeng J, Gu J, Liang G, Kong M, Chen X, Miao L, Cai L, C66 ameliorates diabetic nephropathy in mice by both upregulating NRF2 function via increase in miR-200a and inhibiting miR-21, Diabetologia, 2016; 59(7): 1558–1568.
 Pan Y, Wang Y, Zhao Y, Peng K, Li W, Wang Y, Zhang J, Zhou S, Liu Q, Li X, Cai L, Liang G, Inhibition of JNK phosphorylation by a novel curcumin analog prevents high glucose induced inflammation and apoptosis in cardiomyocytes and the development of diabetic cardiomyopathy, Diabetes, 2014; 63(10): 3497–3511.
 Liu Y, Wang Y, Miao X, Zhou S, Tan Y, Liang G, Zheng Y, Liu Q, Sun J, Cai L, Inhibition of JNK by compound C66 prevents pathological changes of the aorta in STZ-induced diabetes, Journal of Cellular and Molecular Medicine,2014; 18(6): 1203–1212.
 Bao H, Chen L, Icariin reduces mitochondrial oxidative stress injury in diabetic rat hearts, Zhongguo Zhong Yao Za Zhi, 2011; 36(11): 1503–1507.
 Yu W, Zha W, Guo S, Cheng H, Wu J, Liu C, Flos Puerariae extract prevents myocardial apoptosis via attenuation oxidative stress in streptozotocin-induced diabetic mice, PLoS One, 2014; 9(5): article e98044.
 Han J, Tan C, Wang Y, Yang S, Tan D, Betanin reduces the accumulation and cross-links of collagen in high fructose- fed rat heart through inhibiting non-enzymatic glycation, Chemico-Biological Interactions, 2015; 227: 37– 44.
 Bi L, Tian X, Dou F, Hong L, Tang H, Wang S, New antioxidant and antiglycation active triterpenoid saponins from the root bark of Aralia taibaiensis, Fitoterapia, 2012; 83(1): 234–240.
 Weng Y, Yu L, Cui J, Zhu Y, Guo C, Wei G, Duan J, Yin Y, Guan Y, Wang Y, Yang Z, Xi M, Wen A, Antihyperglycemic, hypolipidemic and antioxidant activities of total saponins extracted from Aralia taibaiensis in experimental type 2 diabetic rats, Journal of Ethnopharmacology, 2014; 152(3): 553–560.
 Xi M, Hai C, Tang H, Wen A, Chen H, Liu R, Liang X, Chen M, Antioxidant and antiglycation properties of triterpenoid saponins from Aralia taibaiensis traditionally used for treating diabetes mellitus, Redox Report, 2010; 15(1): 20–28.
 Duan J, Wei G, Guo C, Cui J, Yan J, Yin Y, Guan Y, Weng Y, Zhu Y, Wu X, Wang Y, Xi M, Wen A, Aralia taibaiensis protects cardiac myocytes against high glucose-induced oxidative stress and apoptosis, The American Journal of Chinese Medicine, 2015; 43(6): 1159–1175.
 Sun W, Zhang Z, Chen Q, Yin X, Fu Y, Zheng Y, Cai L, Kim KH, Tan Y, Kim YH, Magnolia extract (BL153) protection of heart from lipid accumulation caused cardiac oxidative damage, inflammation, and cell death in high-fat diet fed mice, Oxidative Medicine and Cellular Longevity, 2014; Article ID 205849, 13 pages.
 Chang WC, Yu YM, Hsu YM, Wu CH, Yin PL, Chiang SY, Hung JS, Inhibitory effect of Magnolia officinalis and lovastatin on aortic oxidative stress and apoptosis in hyperlipidemic rabbits, Journal of Cardiovascular Pharmacology, 2006; 47(3): 463–468.
 Zhang Z, Chen J, Zhou S, Wang S, Cai X, Conklin DJ, Kim KS, Kim KH, Tan Y, Zheng Y, Kim YH, Cai L, Magnolia bioactive constituent 4-O-methylhonokiol prevents the impairment of cardiac insulin signaling and the cardiac pathogenesis in high-fat diet-induced obese mice, International Journal of Biological Sciences, 2015; 11(8): 879–891.
 Khanra R, Dewanjee S, Dua TK, Sahu R, Gangopadhyay M, De Feo V, Zia-UI-Haq M, Abroma augusta L. (Malvaceae) leaf extract attenuates diabetes induced nephropathy and cardiomyopathy via inhibition of oxidative stress and inflammatory response, Journal of Translational Medicine, 2015; 13(6) DOI: 10.1186/s12967-014-0364-1.
 Bhatti R, Sharma S, Singh J, Ishar MP, Ameliorative effect of Aegle marmelos leaf extract on early stage alloxaninduced diabetic cardiomyopathy in rats, Pharmaceutical Biology, 2011; 49(11): 1137–1143.
 Zhang Z, Zhang D, Dou M, Li Z, Zhang J, Zhao X, Dendrobium officinale Kimura et Migo attenuates diabetic cardiomyopathy through inhibiting oxidative stress, inflammation and fibrosis in streptozotocin-induced mice, Biomedicine & Pharmacotherapy, 2016; 84: 1350–1358.
 Dludla PV, Muller CJ, Louw J, Joubert E, Salie R, Opoku AR, Johnson R, The cardioprotective effect of an aqueous extract of fermented rooibos (Aspalathus linearis) on cultured cardiomyocytes derived 12 Journal of Diabetes Research from diabetic rats, Phytomedicine, 2014; 21(5): 595– 601.
 Joshi H, Vaishnav D, Sanghvi G, Rabadia S, Airao V, Sharma T, Parmar S, Sheth N, Ficus recemosa bark extract attenuates diabetic complications and oxidative stress in STZ-induced diabetic rats,” Pharmaceutical Biology, 2016; 54(9) 1586–1595.
 Fitzl G, Martin R, Dettmer D, Hermsdorf V, Drews H, Welt K, Protective effects of Gingko biloba extract EGb 761 on myocardium of experimentally diabetic rats. I: ultrastructural and biochemical investigation on cardiomyocytes, Experimental and Toxicologic Pathology, 1999; 51(3): 189–198.
 Latha R, Shanthi P, Sachdanandam, P, Kalpaamruthaa ameliorates myocardial and aortic damage in cardiovascular complications associated with type 2 diabetes mellitus, Canadian Journal of Physiology and Pharmacology, 2013; 91(2): 116–123.
 Latha R, Shanthi P, Sachdanandam, P, Kalpaamruthaa modulates oxidative stress in cardiovascular complication associated with type 2 diabetes mellitus through PKC-beta/ Akt signaling, Canadian Journal of Physiology and Pharmacology, 2013; 91(11): 901–912.
 Latha R, Shanthi P, Sachdanandam P, Protective role of Kalpaamruthaa in type II diabetes mellitus-induced cardiovascular disease through the modulation of protease activated receptor-1, Pharmacognosy Magazine, 2015; 11(1): S209–S216.
 Sen S, Chen S, Wu Y, Feng B, Lui EK, Chakrabarti S, Preventive effects of North American ginseng (Panax quinquefolius) on diabetic retinopathy and cardiomyopathy, Phytotherapy Research, 2013; 27(2): 290– 298.
 Badole SL, Chaudhari SM, Jangam GB, Kandhare AD, Bodhankar SL, Cardioprotective activity of Pongamia pinnata in streptozotocin-nicotinamide induced diabetic rats, BioMed Research International, 2015; Article ID 403291, 8 pages.
 Atale N, Chakraborty M, Mohanty S, Bhattacharya S, Nigam D, Sharma M, Rani V, Cardioprotective role of Syzygium cumini against glucose-induced oxidative stress in H9C2 cardiac myocytes, Cardiovascular Toxicology, 2013, 13(3): 278–289.
 Ban CR, Twigg SM, Fibrosis in diabetes complications: pathogenic mechanisms and circulating and urinary markers, Vascular Health and Risk Management, 2008; 4(3): 575–596.
 Asbun J, Villarreal FJ, The pathogenesis of myocardial fibrosis in the setting of diabetic cardiomyopathy, Journal of the American College of Cardiology, 2006; 47(4): 693–700.
 Modak M, Dixit P, Londhe J, Ghaskadbi S, Paul T, Devasagayam A, Serial review indian herbs and herbal drugs used for the treatment of diabetes, J Clin Biochem Nutr, 2007; 40:163-173.
 Maninder Kaur VV, Diabetes and antidiabetic herbal formulations: an alternative to Allopathy, Int J Pharmacogn, 2014; 1(10): 614-626. https://doi.org/10.13040/IJPSR.0975-8232.
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 Sridharan K, Mohan R, Ramaratnam S, Panneerselvam D, Ayurvedic treatments for diabetes mellitus. In: Sridharan K, ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2011. https://doi.org/10.1002/14651858.CD008288.pub2.
 Thakkar NV, Patel JA, Pharmacological evaluation of "Glyoherb": a polyherbal formulation on streptozotocin-induced diabetic rats, Int J Diabetes Dev Ctries, 2010; 30(1): 1-7.
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