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An Overview of Complementary Therapies for Effective Diabetes Management

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Himangshu Deka1, Ananta Choudhury1, Jahnabi Sarmah2, Debgopal Ganguly3, Rosamund Jyrwa4, Dhiraj Baishya1 and Nurjamal Houque1
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1Faculty of Pharmaceutical Science, Assam Down Town University, Panikhaiti, Guwahati, Assam, INDIA

2NEPEDS College of Pharmaceutical Sciences , Beltola Tiniali, Guwahati, Assam, INDIA

3NSMS Institute of Pharmacy, Nachan Road, Kamalpur, Durgapur, Paschim Bardhaman, West Bengal, INDIA

4Pratiksha Institute of Pharmaceutical Sciences, Panikhaiti, Barchapari, Assam, INDIA

Corresponding author.

Correspondence: Dr. Ananta Choudhury Faculty of Pharmaceutical Science, Assam Down Town University, Assam-781026, INDIA. Email: [email protected]

Author Notes

Received August 23, 2023; Revised September 25, 2023; Accepted November 03, 2023.

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1.Deka H, Choudhury A, Sarmah J, Ganguly D, Jyrwa R, Baishya D, et al. An Overview of Complementary Therapies for Effective Diabetes Management. International Journal of Pharmaceutical Investigation [Internet]. 2023 Dec 27;14(1):16–22. Available from: http://dx.doi.org/10.5530/ijpi.14.1.3
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Published in: International Journal of Pharmaceutical Investigation, 2024; 14(1): 16-22.Published online: 15 December 2023DOI: 10.5530/ijpi.14.1.3

ABSTRACT

Diabetes mellitus is a global health concern resulting in significant morbidity and mortality. Till today there is no known cure available for the condition. The extended treatment schedule, unfavorable side effects of commercially available oral hypoglycemic medications, and heavy financial burden, enable patients towards exploring other forms of treatment. The integration of Complementary and Alternative Medicines (CAM) into treatment and management plans for diseases such as diabetes has grown in popularity in recent years. This form of medicine has been used for centuries and has been demonstrated to be effective when used in combination with more traditional therapies. However, there is limited evidence that CAM therapies can be disruptive to the pharmacokinetics and pharmacodynamics of medications or that they are ineffective. In this study primary focus has been given to summarize the effects of some of the common complementary alternative medicines and associated therapies in treatment and management of diabetes along with their possible mechanisms.

Keywords: Alternative medicine, Complementary medicines, Diabetes, Dietary supplements, Herbs, Herbal medicines

INTRODUCTION

Complementary and Alternative Medicine (CAM) is a broad term which includes a range of health-care practices, activities, and services which are increasingly accepted by mainstream medicine.1 According to a medical expenditure panel study, CAM is characterized as a caring approach that includes acupuncture, special diets, massage therapy, use of medicinal plants, biologic feedback, relaxation techniques, etc.2 Complementary medicine can also be defined as a group of diagnostic and therapeutic disciplines that are employed in conjugation with the conventional therapy for effective and comprehensive health care. In the 1970s and 1980s, these disciplines were mostly provided as an alternative to traditional medical care; therefore, the term “alternative medicine.” was given. As both the conventional and alternative therapy was started using alongside to complement the effect of the other, the term “complementary medicine” was coined.3 Complementary therapies are delivered by a diverse group of professional caregivers, each with their own set of educational qualifications, professional credentials, and regulatory oversight. Therefore the therapy varies based on geographic location, and cultural ethnicity.4 National Center of Complementary and Integrative Health (NCCIH) broadly classified complementary therapies based on their therapeutic input or by the way of administration to the patients namely

Nutritional and natural products based therapy.

  • Mind body practices.
  • Psychological such as meditation, hypnosis, music therapies, relaxation therapies.
  • Physical such as acupuncture, massage, spinal manipulation etc.

Combinations of psychological and physical

The increasing prevalence of diabetes mellitus has become a major global health concern, with serious implications for both mortality and morbidity, with no known cure yet. According to the International Diabetes Federation, there were 463 million people who were diagnosed with diabetes in 2019 and this figure is expected to rise to 700 million by 2045. The use of synthetic anti-diabetic medications has grown in recent years, with thiazolidinediones, meglitinides, biguanides, sulfonylureas, glucosidase inhibitors, GLP-1 analogues, and DPP-4 inhibitors all being used to help treat and manage diabetes. Many of these treatments, however, have substantial side effects, and 10-20% of diabetic patients stop taking them as a result of these side effects. Hypoglycemia, weight gain, gastrointestinal side effects (abdominal discomfort, nausea, vomiting, diarrhea, gassiness, and bloating), edema, and a rise in LDL-C are some of the common adverse effects of oral diabetic medications.5 Diabetes also comes with a significant financial burden for those who suffer from it. The annual medical expenditures T2DM is worth several billion dollars, including direct costs as well as indirect medical costs.6 Thus, there is an urgent requirement for effective substitutions to reduce the complications of diabetes with lower side effects. In recent times, the exploration of additional diabetic therapies has been an area of great interest. Substantial evidence from many research documents has revealed that Complementary and Alternative Medicine (CAM) can be used to treat and manage diabetes around the globe. The utilization CAM in diabetes is on the rise due to the reported drawbacks of conventional synthetic medications and the faith that many people have in traditional treatment.6,7 Complementary therapies such as taking nutritional supplements, using herbal medicines, obtaining nutritional guidance, and engaging in spiritual healing and relaxation practices are gaining popularity among diabetic patients.8 This review will summarize the research done on the use and limitations of complementary medicine to treat and manage diabetes.

MATERIALS AND METHODS

This study aimed to assess the efficacy of complementary medicine in handling diabetes. To this end, various databases such as PubMed, Google Scholar, Research Gate, Scopus, Medline and Science Direct were searched using keywords like ‘diabetes’, ‘herb-drug combination therapy’, ‘synergistic action’, ‘dietary supplements’ and ‘complementary therapy’. Only English-language articles published after 2010 and relevant to the study’s objective were included in the analysis and duplicate articles, abstracts, and articles unrelated to the objective were excluded (Figure 1).

RESULTS AND DISCUSSION

Herbal Complementary Medicine/Therapy

Natural products, particularly those derived from plants are serving as promising lead compounds. Plant-based preparations are the critical contributor in today’s field of medicine, due to their ease of use, low cost, and lack of side effects.9 As per as the recent study by Salehi et al. several medicinal plants that have been traditionally utilized in the treatment and management of diabetes.10 Table 1 outlines the results of recent studies on herbal complementary therapy, which demonstrate significant complementary effects after the co-administration or simultaneous administration of natural products such as isolated natural compounds and extracts from different parts of plants alongside commercially available drugs.

Recent studies have suggested that polysaccharides derived from natural sources may be beneficial in anti-diabetic therapy, due to their strong antioxidant properties.5,11,12 An investigation of anti-diabetic therapy in alloxan-induced diabetic rats found that a combination of polysaccharide isolated from the roots of Acanthopanax senticosus (200 mg/kg/BW) and metformin (2 mg/ kg/BW) was more effective than metformin alone in relieving diabetes symptoms and healing liver and kidney damage.13

One such example of plant namely Gymnema sylvestre was reported to have promising hypoglycemic and blood cholesterol-lowering properties.14 In a study, rats with induced diabetes were given a dose of 400 mg/kg of Gymnema Sylvestre leaf extract alongside 0.8 mg/kg of Glimepiride for a period of 28 days. The results showed a marked increase in anti-hyperglycemic and anti-hyperlipidemic activity. Further, concomitant administration of the leaf extract in conjunction with glimepiride produces a greater decrease in HbA1c levels in the blood and an increase in serum insulin levels compared to glimepiride taken alone.15

The use of Azadirachta indica (AZI) has been documented since ancient times for its ability to treat a range of illnesses. Recent evidence suggests that extracts from both the leaf and bark of this plant may reduce blood glucose levels and improve the lipid profile.16 However, when combining Glipizide (GZ) with AZI leaf extract, it is recommended to exercise caution. In a study involving streptozotocin-induced diabetic rats, administering either of two doses of AZI extract (250 mg/kg) or a combination of extract and GZ (5 mg/kg) decreased the bioavailability of GZ and its subsequent hypoglycemic effect.17

The use of garlic as a nutritional and medicinal supplement has been gaining recognition around the world.18 The study conducted by R. Kumar et al. revealed that a combination of garlic (250 mg) and metformin (500 mg) was more effective at decreasing the blood glucose level of obese diabetic patients than metformin alone. In addition, the participants in the study had a noticeable improvement in their lipid profiles. Additionally, Studies have found that combining garlic and metformin may help to reduce the nephrotoxicity associated with gentamycin.19,20

Further, Gliclazide is a common treatment for type 2 diabetes mellitus, yet it has been demonstrated that its efficacy declines with time. This is attributed to the progressive linear decline in β-cell function that occurs with the disease.21 Considering this issue several researches has been carried out to potentiate the efficiency of Gliclazide with combination of herbal drugs. In a study conducted by Vastavai et al., healthy rats and rabbits were co-administered gliclazide (100/200 mg/kg) and curcumin (2/4 mg/kg). Surprisingly, there was a marked decrease in the animals’ blood glucose levels after multiple doses, and the combination proved to be more effective than gliclazide alone in terms of overall therapeutic effects.22 Further a study states that when streptozotocin induced diabetic rats were administered gliclazide and quercetin together, their glucose homeostasis, lipid profile, and inflammatory status were improved. Additionally, insulin immunostaining in their beta cells returned to normal levels.24

Figure 1:
Flow Chart of the study selection process.

Studies have indicated that a combination of Annona squamosa leaf extract and various concentrations of Glipizide (300 mg/kg, 3.75 mg/kg, 2.5 mg/kg, 1.25 mg/kg) given to streptozocin-induced diabetic rats on a high-fat diet can lead to a reduction of their blood glucose levels by 25-50%. This could potentially decrease the need for Glipizide.24,25 Additionally, co-administering leaf extract of Brassica rapa (turnip) with metformin has been reported to improve hypoglycemic activity in diabetic rats.26,27

Limitation of herb drug combination therapy

Herbal medicines or supplements can be used in conjunction with conventional therapy for diabetic patients, but the potential effects of these components should be evaluated. This could have a positive or negative impact on how drugs work in the body.32 The absorption, distribution, metabolism, and/or excretion of conventional medications may be affected when taken with herbs or supplements. This could potentially lead to the inhibition or induction of metabolic enzymes, efflux proteins, and drug transporters.33 The use of herbs and drugs together can have varying effects, ranging from improved treatment results to the potential for dangerous toxicity and diminished drug efficacy, and even the possibility of rendering the treatment ineffective.34 Further, The presence of a bioactive component with medicinal activity can be impacted by factors such as the process of cultivation, collection time/season, growth conditions, and parts used. Because of this, the therapeutic potency of herbal medicines or supplements may be affected.35 Therefore, In order to maximize the effectiveness of complementary medicine, it is essential to have a thorough understanding of the patient’s clinical condition and the potential benefits and limitations of the therapy.

Dietary Supplement as Complementary Medicine

The use of CAM treatments, including dietary supplements, is growing in popularity for people with diabetes as a way to help manage the condition. Many people are turning to dietary supplements as an additional form of diabetes management. Most common dietary supplements used for diabetes include: herbs, vitamins, minerals, and other dietary components.36 Herbal supplements are the most widely used dietary supplements for diabetes. Herbs such as garlic, ginger, fenugreek, and cinnamon are believed to help manage diabetes symptoms by improving insulin sensitivity, decreasing blood glucose levels, and improving overall glycemic control.37 Table 2 outlines some study that were conducted to highlights the role of dietary supplements in diabetes management. A systematic review of the available literature has revealed that garlic and ginger are the only herbs which have shown a noteworthy reduction in blood glucose levels; however, the effectiveness of these herbs is not unanimous.38 Research has indicated that certain vitamins and minerals are often used as dietary supplements for those with diabetes. For example, Vitamin D and chromium have been studied for their ability to improve glycemic control. An analysis of existing studies demonstrated that the impact of chromium supplementation on glycemic control for individuals with type 2 diabetes was positive, while the outcomes of Vitamin D supplementation were more inconsistent.39 Further, Research indicates that omega-3 fatty acid supplementation might be useful in treating type 2 diabetes. Research indicates that omega-3 fatty acids may improve insulin sensitivity and reduce inflammation, which can result in better glycemic control.40 Again, probiotics are also thought to improve glycemic control due to their anti-inflammatory properties and ability to reduce body fat. Fiber is another useful supplement for diabetes, as it can help to increase feelings of fullness and slow down glucose absorption.41 Results from studies suggest that taking particular probiotic strains may help to improve glycemic control in people with type 2 diabetes. Evidence indicates that probiotics may also be beneficial for increasing insulin sensitivity42–44 Kumar et al. revealed that zinc supplementation in combination with oral hypoglycemic drugs could possibly decrease the likelihood of complications associated with diabetes, as evidenced by lower blood glucose, triglyceride, urinary albumin excretion, and inflammation levels in diabetic nephropathy patients.45 Finally, studies have shown that dietary supplements, such as Complementary and Alternative Medicine (CAM), may be beneficial in managing type 2 diabetes. However, further research is needed to assess the impact of these supplements on individuals with type 1 diabetes and to evaluate their long-term safety.

Herb/herbal supplement Dose Study subject Study period Observation References
Acanthopanax senticosus polysacchairde (ASP) ASP 200 mg/kg+ metformin 2 mg/ kg. Alloxan-induced diabetic rats. 28 days ļBlood glucose, ļ Blood lipid (TC and TG), TBARS, GSH, AST, ALT, ALP, total bilirubin, creatinine and urea levels î body weight, liver glycogen formation, and antioxidant enzyme (SOD and GPX) levels. 13
Turnip leaf Aqueous extract Extract 400 mg/ kg+50/100 mg/kg metformin. Streptozotocin-induced diabetic rats. 28 days Improved hypoglycemic activity ļ liver enzymes elevation(both AST and ALT) and histological damages. 27
Azadirachta indica aqueous extract of leaves Extract 250 mg/kg +GZ 5 mg/kg. Streptozotocin induced diabetic Sprague-Dawley rats. 14 days ļ hypoglycemic effect ļ Bioavailibity of Glipizide due to the induction of CYP3A activity. 17
Scutellaria baicalensis Extract 3.52 g/day+ 500 mg metformin. Human volunteer 20-75 years. 20 weeks Improve glucose tolerance 28
Gymnema sylvestre Leaf extract Extract 400 mg/ kg+ 0.8 mg/kg glimepiride Streptozotocin (STZ) induced diabetic rats 28 days No significant pharmacokinetic interaction. ļ Blood glucose 15
Curcumin Curcumin 200 /100mg/kg+ Gliclazide 2/4 mg/ kg Albino rats 21 days Significant reduction of blood glucose level was observed 22
Quercetin Quercetin 50 mg/ kg+10 mg/kg Gliclazide Streptozotocin (STZ) induced diabetic rats. 21 days ļ Blood glucose î c peptide î lipid profile 23
Aloe vera gel Aloe gel 300 mg/ kg+2 mg/kg Metformin. Male albino rats. 21 days ļ hyperlipidemia, improve pancreas and kidney integrity î HDL-cholesterol level. 29
Garlic extract Extract 20 mg/kg+metformin100 mg/kg Male wistar rats. 20 days Curative and protective activity against nephrotoxicity. 30
Annona squamosa aqueous leaf extract Extract 300 mg/ kg+3.75 mg,2.5 mg,1.25/kg glipizide Sprague-Dawley Rats. 25 days ļ Blood glucose 25
Garlic capsules Garlic capsule 250 mg+500 mg Metformin. 60 human volunteer of both sex. 12 weeks Greater fall in cholesterol, triglyceride, and low-density lipoprotein C-reactive protein was observed in combination. 19
Gymnema sylvestre leaf extract. Extract 500 mg/ kg+100 mg metformin. Wistar rats 21 days ļ Hypoglycemic effect of Metformin. 31
Table 1.
A list of some herbal complementary therapies.
Dietary supplement Study subject Doses Investigation Observation References
Chromium picolinate 78 diabetic patients 200 μg of chromium twice a day for 3 weeks. Fasting blood glucose (FBS), cholesterol, HDL, LDL triglycerides (TG), HbA1c, insulin levels. ļ FBS ļ HbA1c ļ cholesterol. 38
Chromium picolinate 52 diabetic patients 400 μg of chromium in a day for 8 weeks. FBS, cholesterol, lipoproteins, insulin level and Insulin resistance. ļ Cholesterol ļ LDL-C ļ Insulin resistance No significant improvement in FBS, triglycerides, HDL. 39
Omega-3 fatty acids 344 diabetic patients 1 g/day, 2 g/day, 4 g/day for 1.4 years (median). Blood glucose, lipid profiles. GFR, ACR. ļ Cholesterol ļ Triglycerides ļ ACR. 44
Magnesium (Mg) supplement 42 diabetic patients 250 mg/day for 3 months. FBS, HbA1c, insulin levels, C-peptide. î HbA1c, î Insulin levels, î C-peptide ļ FBS. 45
Oral magnesium 71 diabetic patients 300 mg/day for 3 months. HBA1c, lipid profile, and serum Mg. ļ HbA1c ļ Cholesterol ļ TG. 46
Zinc supplement 54 diabetic patients 50 mg/day for 12 weeks. Blood glucose, cholesterol, HDL, LDL triglycerides, HbA1c. ļ FBS ļ PPBS ļ HbA1c ļ Cholesterol ļ TG î HDL. 43
Alpha Lipoic Acid 25 diabetic patients 300 mg/day for 3 months. BMI FBS Cholesterol. ļ Insulin resistance ļ TG. 47
Table 2.
Some common dietary supplements in diabetic patients.

Mind-Body Practices

In recent years, mind-body practices have become increasingly popular as an important tool for diabetes management.46 Mind-body practices are defined as activities that involve both physical and psychological components. This includes practices such as yoga, tai chi, meditation, and biofeedback. These activities have been found to have a number of benefits for people living with diabetes.47 Mind-body practices are a potential solution for managing diabetes, as they can help to maintain a healthy blood sugar level by reduces stress level of person.48 Research has revealed that performing yoga and tai chi on a regular basis can lead to an increase in insulin sensitivity and reduced levels of HbA1c, which signifies sustained blood sugar levels. Additionally, engaging in mind-body practices can diminish the chances of developing diabetes-related medical issues, such as heart disease, stroke, and kidney disease.49 Further, Meditation is an exercise for the mind and body that has been proven to diminish stress, anxiety, and even help manage high blood pressure and diabetes. An investigation on 12 weeks of Buddhist-based walking meditation exercise on 23 diabetic patients reported a favorable decrease in the fasting blood glucose level.50 Finally, mind-body practices can also help to improve overall quality of life among people living with diabetes. These activities can help to reduce symptoms of depression and anxiety, as well as improve physical and emotional well-being and offer positive benefits in diabetic patients, However, the role of this kind of complementary therapy needs to be evaluated further to establish a liner relation in the treatment of diabetes mellitus.

CONCLUSION

The complementary medicine system and its associated therapies becoming popular day by day due to some of its unique features like lesser side effects, low cost, and patient acceptability. Based on the available literature, case study, and clinical application report it may be concluded that the potential of the complementary medicine system to provide an integrative, participatory approach to diabetes care is noteworthy. Yet, comprehensive research is necessary to ascertain the safety and effectiveness of complementary medicine treatments.

Cite this article

Deka H, Choudhury A, Sarmah J, Ganguly D, Jyrwa R, Baishya D, et al. An Overview of Complementary Therapies for Effective Diabetes Management. Int. J. Pharm. Investigation. 2024;14(1):16-22.

ACKNOWLEDGEMENT

The work is supported by the Assam Down Town University, Panikhaiti, Guwahati, Assam, India.

ABBREVIATIONS

CAM Complementary and Alternative Medicine
NCCIH National Center of Complementary and Integrative Health
GLP-1 Glucagon-like peptide 1
DPP 4 Dipeptidyl peptidase 4
LDL-C Low-density lipoprotein-cholesterol
mg Miligram
kg Kilogram
BW Body weight
TC total cholesterol
TG triglycerides
HDL high density lipoprotein
LDL low density lipoprotein
ALP Alkaline phosphatase
ALP Alanine transaminase
AST Aspartate aminotransferase
TBARS Thiobarbituric acid reactive substance
GSH Glutathione
FBS fasting blood sugar
HBA1c Hemoglobin A1C

References

  1. Sheikhrabori A, Dehghan M, Ghaedi F, Khademi GR. Complementary and alternative medicine usage and its determinant factors among diabetic patients: an Iranian case. J Evid Based Complementary Altern Med. 2017;22(3):449-54. [PubMed] | [CrossRef] | [Google Scholar]
  2. Hori S, Mihaylov I, Vasconcelos JC, McCoubrie M. Patterns of complementary and alternative medicine use amongst outpatients in Tokyo, Japan. BMC Complement Altern Med. 2008;23:8 [CrossRef] | [Google Scholar]
  3. Vickers A, Zollman C. ABC of complementary medicine: hypnosis and relaxation therapies. BMJ. 1999;319(7221):1346-9. [PubMed] | [CrossRef] | [Google Scholar]
  4. Koithan M. Introducing complementary and alternative therapies. J Nurse Pract. 2009;5(1):18-20. [PubMed] | [CrossRef] | [Google Scholar]
  5. Hu J, Pang W, chen J, Bai S, Zheng Z, Wu X, et al. Hypoglycemic effect of polysaccharides with different molecular weight of Pseudostellaria heterophylla. BMC Complement Altern Med. 2013;13(1):267 [PubMed] | [CrossRef] | [Google Scholar]
  6. Radwan H, Hasan H, Hamadeh R, Hashim M, Abdulwahid Z, Gerashi MH, et al. Complementary and alternative medicine use among patients with type 2 diabetes living in the United Arab Emirates. BMC Complement Ther. 2020;20(1):1-12. [CrossRef] | [Google Scholar]
  7. Vishnu N, Mini GK, Thankappan KR. Complementary and alternative medicine use by diabetes patients in Kerala, India. Glob Health Epidemiol Genomics. 2017;2:e6 [PubMed] | [CrossRef] | [Google Scholar]
  8. Cengiz Z, Budak F. Use of complementary medicine among people with diabetes in eastern Turkey: A descriptive study. Complement Ther Clin Pract. 2019;36(12):120-4. [PubMed] | [CrossRef] | [Google Scholar]
  9. Sharma R, Arya V. A review on fruits having antidiabetic potential. J Chem Pharm Res. 2011;3(2):204-12. [PubMed] | [CrossRef] | [Google Scholar]
  10. Salehi B, Ata A, Kumar VAN, Sharopov F, Ramirez-Alarcon K, Ruiz-Ortega A, et al. Antidiabetic potential of medicinal plants and their active components. Biomolecules. 2019;9(10):551 [CrossRef] | [Google Scholar]
  11. Luo Y, Peng B, Wei W, Tian X, Wu Z. Antioxidant and anti-diabetic activities of polysaccharides from guava leaves. Molecules. 2019;24(7) [PubMed] | [CrossRef] | [Google Scholar]
  12. Nayak AK, Pal D, Santra K. Screening of polysaccharides from tamarind, fenugreek and jackfruit seeds as pharmaceutical excipients. Int J Biol Macromol. 2015;79:756-60. [PubMed] | [CrossRef] | [Google Scholar]
  13. Fu J, Fu J, Yuan J, Zhang N, Gao B, Fu G, et al. Anti-diabetic activities of Acanthopanax senticosus polysaccharide (ASP) in combination with metformin. Int J Biol Macromol. 2012;50(3):619-23. [PubMed] | [CrossRef] | [Google Scholar]
  14. Kang MH, Lee MS, Choi MK, Min KS, Shibamoto T. Hypoglycemic activity of Gymnema sylvestre extracts on oxidative stress and antioxidant status in diabetic rats. J Agric Food Chem. 2012;60(10):2517-24. [PubMed] | [CrossRef] | [Google Scholar]
  15. Kamble B, Gupta A, Moothedath I, Khatal L, Janrao S, Jadhav A, et al. Effects of Gymnema sylvestre extract on the pharmacokinetics and pharmacodynamics of glimepiride in streptozotocin induced diabetic rats. Chem Biol Interact. 2016;245:30-8. [PubMed] | [CrossRef] | [Google Scholar]
  16. Satyanarayana K, Sravanthi K, Shaker IA, Ponnulakshmi R. Molecular approach to identify antidiabetic potential of Azadirachta indica. J Ayurveda Integr Med. 2015;6(3):165-74. [PubMed] | [CrossRef] | [Google Scholar]
  17. Chaudhari S, Zambad S, Ali M. Effect of aqueous extract of Azadirachta indica Leaves on Pharmacokineics and pharmacodynamics of glipizide. Drug Metab Lett. 2019;13(1):19-24. [PubMed] | [CrossRef] | [Google Scholar]
  18. Wang J, Zhang X, Lan H, Wang W. Effect of garlic supplement in the management of type 2 diabetes mellitus (T2DM): a meta-analysis of randomized controlled trials. Food Nutr Res. 2017;61(1):1377571 [PubMed] | [CrossRef] | [Google Scholar]
  19. Kumar R, Chhatwal S, Arora S, Sharma S, Singh J, Singh N, et al. Antihyperglycemic, antihyperlipidemic, anti-inflammatory and adenosine deaminase-lowering effects of garlic in patients with type 2 diabetes mellitus with obesity. Diabetes Metab Syndr Obes. 2013;6:49-56. [PubMed] | [CrossRef] | [Google Scholar]
  20. Rafieian-Kopaei M, Baradaran A, Merrikhi A, Nematbakhsh M, Madihi Y, Nasri H, et al. Efficacy of co-administration of garlic extract and metformin for prevention of gentamicin-renal toxicity in Wistar rats: A biochemical study. Int J Prev Med. 2013;4(3):258-64. [PubMed] | [Google Scholar]
  21. Rendell M. The role of sulphonylureas in the management of type 2 diabetes mellitus. Drugs. 2004;64(12):1339-58. [PubMed] | [CrossRef] | [Google Scholar]
  22. Vatsavai LK, Kilari EK. Influence of curcumin on the pharmacodynamics and pharmacokinetics of gliclazide in animal models. J Exp Pharmacol. 2016;8:69-76. [PubMed] | [CrossRef] | [Google Scholar]
  23. Abdelkader NF, Eitah HE, Maklad YA, Gamaleldin AA, Badawi MA, Kenawy SA, et al. New combination therapy of gliclazide and quercetin for protection against STZ-induced diabetic rats. Life Sci. 2020;247:117458 [PubMed] | [CrossRef] | [Google Scholar]
  24. Kotkar HM, Mendki PS, Sadan SVGS, Jha SR, Upasani SM, Maheshwari VL, et al. Antimicrobial and pesticidal activity of partially purified flavonoids of Annona squamosa. Pest Manag Sci. 2002;58(1):33-7. [PubMed] | [CrossRef] | [Google Scholar]
  25. Kaur R, Afzal M, Kazmi I, Ahamd I, Ahmed Z, Ali B, et al. Polypharmacy (herbal and synthetic drug combination): A novel approach in the treatment of type-2 diabetes and its complications in rats. J Nat Med. 2013;67(3):662-71. [PubMed] | [CrossRef] | [Google Scholar]
  26. Hassanpour Fard MH, Naseh G, Lotfi N, Hosseini SM, Hosseini M. Effects of aqueous extract of turnip leaf (Brassica rapa) in alloxan-induced diabetic rats. Avicenna J Phytomed. 2015;5(2):148-56. [PubMed] | [Google Scholar]
  27. Hassanzadeh-Taheri M, Hassanpour-Fard M, Doostabadi M, Moodi H, Vazifeshenas-Darmiyan K, Hosseini M, et al. Co-administration effects of aqueous extract of turnip leaf and metformin in diabetic rats. J Tradit Complement Med. 2018;8(1):178-83. [PubMed] | [CrossRef] | [Google Scholar]
  28. Shin NR, Gu N, Choi HS, Kim H. Combined effects of Scutellaria baicalensis with metformin on glucose tolerance of patients with type 2 diabetes via gut microbiota modulation. Am J Physiol Endocrinol Metab. 2020;318(1):E52-61. [PubMed] | [CrossRef] | [Google Scholar]
  29. Atanu FO, Avwioroko OJ, Momoh S. Anti-diabetic effect of combined treatment with Aloe vera gel and metformin on alloxan-induced diabetic rats. J Ayu Her Med. 2018;4(1):1-5. [CrossRef] | [Google Scholar]
  30. Rafieian-Kopaei M, Nasri H. Ginger and diabetic nephropathy. J Ren Inj Prev. 2013;2(1):9-10. [PubMed] | [CrossRef] | [Google Scholar]
  31. Kumar DS, Kannappan RR. effect of Gymnemasylvestre on thepharmacokinetics and pharmacodynamics of metformin in diabetic rats. J Pharm Res. 2013;6:657-4. [CrossRef] | [Google Scholar]
  32. Rehman SU, Choi MS, Choe K, Yoo HH. Interactions between herbs and antidiabetics: an overview of the mechanisms, evidence, importance, and management. Arch Pharm Res. 2015;38(7):1281-98. [PubMed] | [CrossRef] | [Google Scholar]
  33. Kesavadev J, Saboo B, Sadikot S, Das AK, Joshi S, Chawla R, et al. Unproven therapies for diabetes and their implications. Adv Ther. 2017;34(1):60-77. [PubMed] | [CrossRef] | [Google Scholar]
  34. Izzo AA, Ernst E. Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs. 2009;69(13):1777-98. [PubMed] | [CrossRef] | [Google Scholar]
  35. Shaw D, Graeme L, Pierre D, Elizabeth W, Kelvin C. Pharmacovigilance of herbal medicine. J Ethnopharmacol. 2012;140(3):513-8. [PubMed] | [CrossRef] | [Google Scholar]
  36. Rautiainen S, Manson JE, Lichtenstein AH, Sesso HD. Dietary supplements and disease prevention—a global overview. Nat Rev Endocrinol. 2016;12(7):407-20. [PubMed] | [CrossRef] | [Google Scholar]
  37. Jacob B, Narendhirakannan RT. Role of medicinal plants in the management of diabetes mellitus: a review. 3 Biotech. 2019;9(1):4 [PubMed] | [CrossRef] | [Google Scholar]
  38. Wang HP, Yang J, Qin LQ, Yang XJ. Effect of garlic on blood pressure: a meta-analysis. J Clin Hypertens (Greenwich). 2015;17(3):223-31. [PubMed] | [CrossRef] | [Google Scholar]
  39. Talab AT, Abdollahzad H, Nachvak SM, Pasdar Y, Eghtesadi S, Izadi A, et al. Effects of chromium picolinate supplementation on cardiometabolic biomarkers in patients with type 2 diabetes mellitus: a randomized clinical trial. Clin Nutr Res. 2020;9(2):97-106. [PubMed] | [CrossRef] | [Google Scholar]
  40. Chen C, Yu X, Shao S. Effects of omega-3 fatty acid supplementation on glucose control and lipid levels in type 2 diabetes: A meta-analysis. PLOS ONE. 2015;10(10):e0139565 [PubMed] | [CrossRef] | [Google Scholar]
  41. Gao L, Lin L, Shan N, Ren CY, Long X, Sun YH, et al. The impact of omega-3 fatty acid supplementation on glycemic control in patients with gestational diabetes: a systematic review and meta-analysis of randomized controlled studies. J Matern Fetal Neonatal Med. 2020;33(10):1767-73. [PubMed] | [CrossRef] | [Google Scholar]
  42. Hemarajata P, Versalovic J. Effects of probiotics on gut microbiota: mechanisms of intestinal immunomodulation and neuromodulation. Ther Adv Gastroenterol. 2013;6(1):39-51. [PubMed] | [CrossRef] | [Google Scholar]
  43. Yao B, Fang H, Xu W, Yan Y, Xu H, Liu Y, et al. Dietary fiber intake and risk of type 2 diabetes: a dose-response analysis of prospective studies. Eur J Epidemiol. 2014;29(2):79-88. [PubMed] | [CrossRef] | [Google Scholar]
  44. Saboo B, Misra A, Kalra S, Mohan V, Aravind SR, Joshi S, et al. Diabetes India ‘decode fiber’ expert consensus group. Role and importance of high fetsl. Diabetes Metab Syndr. 2022;16(5):102480 [PubMed] | [CrossRef] | [Google Scholar]
  45. Jayawardena R, Ranasinghe P, Galappatthy P, Malkanthi R, Constantine G, Katulanda P, et al. Effects of zinc supplementation on diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr. 2012;4(1):13 [PubMed] | [CrossRef] | [Google Scholar]
  46. Shahbah D, Hassan T, Morsy S, Saadany HE, Fathy M, Al-Ghobashy A, et al. Oral magnesium supplementation improves glycemic control and lipid profile in children with type 1 diabetes and hypomagnesaemia. Med (Baltim). 2017;96(11):e6352 [PubMed] | [CrossRef] | [Google Scholar]
  47. Udupa AS, Nahar PS, Shah SH, Kshirsagar MJ, Ghongane BB. Study of comparative effects of antioxidants on insulin sensitivity in type 2 diabetes mellitus. J Clin Diagn Res. 2012;6(9):1469-73. [PubMed] | [CrossRef] | [Google Scholar]
  48. Raveendran AV, Deshpandae A, Joshi SR. Therapeutic role of yoga in Type 2 diabetes. Endocrinol Metab (Seoul). 2018;33(3):307-17. [PubMed] | [CrossRef] | [Google Scholar]
  49. Innes KE, Selfe TK. Yoga for adults with type 2 diabetes: A systematic review of controlled trials. J Diabetes Res. 2016;2016:6979370 [PubMed] | [CrossRef] | [Google Scholar]
  50. Gainey A, Himathongkam T, Tanaka H, Suksom D. Effects of Buddhist walking meditation on glycemic control and vascular function in patients with type 2 diabetes. Complement Ther Med. 2016;26:92-7. [PubMed] | [CrossRef] | [Google Scholar]

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