Exploring Diabetes: Types, History, Prevelance and Role of Medicinal Plants in Management

Diabetes mellitus (DM), commonly referred to as diabetes, is a multifaceted metabolic disorder marked by hyperglycemia, an abnormal physiological state characterized by persistently elevated blood glucose levels. Hyperglycemia results from irregularities in insulin production, insulin action, or both, and manifests chronically and variably as dysfunctions in carbohydrate, lipid, and protein metabolism. Diabetes advances with intricate pathophysiology and many symptoms.[1]

Hyperglycemia and its related metabolic dysfunctions of carbohydrates, fats, and proteins impact various organs and impair their normal operations. These disturbances develop progressively and primarily result from the detrimental impacts of hyperglycemia and its related metabolic abnormalities on the normal architecture and function of micro- and macrovasculature, which are fundamental to organ structure and function throughout the body. Disruptions in the structure and function of organ system vasculature result in microvascular and macrovascular problems. These consequences are characterized by organ damage, dysfunction, and eventually, organ failure, impacting many body organs, particularly the eyes, kidneys, heart, and nerves. Cardiovascular repercussions encompass hypertension and coronary heart disease; renal complications lead to nephropathy and potential renal failure; and ocular issues result in retinopathy that may advance to blindness. Nerve-related complications result in neuropathy, characterized by autonomic and/or peripheral dysfunctions in cardiovascular, gastrointestinal, and genitourinary systems (including sexual dysfunction) in cases of autonomic neuropathy. In contrast, long-term peripheral neuropathy is frequently linked to foot infections, including ulcers that necessitate amputations and Charcot joint disease (osteoarthropathy). [2-3]

Diabetes is linked to reduced lifetime, small blood vessel dysfunction, increased risk of major blood vessel diseases (for example, heart disease, stroke), and lower quality of life. Many pathogenic causes cause diabetes. These treatments harm the pancreatic beta cells, hence causing insulin deficiency and generating insulin resistance as well. Insulin insensitivity or absence leads to difficulties with glucose, lipid and protein metabolism owing to the negative influence of insulin on tissue targets. Diabetes has been recognized for more than 2,000 years as a dangerous and fatal condition. Aretaeus, an ancient Greek physician from the 1st century A.D., emphasized the fatal qualities of the condition, which he dubbed “diabetes” after the Greek term for “siphon”. Ancient physicians, like Aretaeus, possessed understanding of the symptoms of diabetes but lacked the skills to successfully treat it. In the majority of developing nations, including China and India, diabetes has at some point been an epidemic.  The sector fitness organization argues that diabetes is spreading most swiftly in low- and middle-income countries.  The fundamental reason of the global surge in epidemic-like diabetes is rapid socioeconomic change mixed with industrial and developmental developments; other risk variables include population expansion, bad eating habits, and a sedentary lifestyle, all gambling key parts.[4-5]

Current Scenario of Diabetes Mellitus:

Pacific Islanders, Asian Indians, and Native Americans are more likely to develop type 2 diabetes than other individuals around the world. Around the year 2000, there was a notable increase in the number of people with type 2 diabetes. There are seven. With 8.8% of cases, diabetes is more common in males than in women.  Diabetes affects 463 million people globally, with 374 million suffering from poor glucose tolerance, a sort of prediabetes. The Western Pacific area comprises 163 million diabetics, followed by South East Asia European.[6]

Classification of Diabetes Mellitus:

According to this Classification, diabetes can be divided into four main types or categories: type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), gestational diabetes mellitus (GDM), and diabetes caused or associated with certain specific conditions, pathologies, and/or disorders.[7]

Type1 Diabetes Mellitus:

T1DM, also known as type 1A DM or as per the previous nomenclature as insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes, constitutes about 5–10% of all the cases of diabetes. It is an autoimmune illness defined by T-cell-mediated death of pancreatic β-cells, which results in insulin insufficiency and ultimately hyperglycemia.[8]

The variety in the rate at which the immune-mediated destruction of the pancreatic β-cells very often characterizes the future development of this disease. In some cases, children and teenagers, the β-cell breakdown and eventual failure occur rapidly, which can lead to diabetic ketoacidosis (DKA), commonly defined as the initial indication of the condition. In others, the disease progression is very slow with a mild increase in fasting blood glucose levels, which assumes a severe hyperglycemic form with or without ketoacidosis, only in the presence of physiological stress conditions such as severe infections or onset of other disorders. In some other cases, which include adults, β-cells may retain some degree of function to emit only that quantity of insulin, which is only sufficient to prevent ketoacidosis for many years. However, due to progressive insulin shortage, these individuals become insulin-dependent with the onset of severe hyperglycemia and subsequent ketoacidosis. Here’s a complete summary of the pathophysiology of diabetes[8,9].

Type 2 Diabetes Mellitus:

T2DM, also known as non-insulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes, as per the prior nomenclature, constitutes around 90–95% of all the cases of diabetes. This kind of diabetes is characterized by two primary insulin-related anomalies: insulin resistance and β-cell malfunction. Insulin resistance comes from disruption of several cellular pathways, which lead to a diminished response, or sensitivity of cells in the peripheral tissues, in particular the muscle, liver, and adipose tissue toward insulin. In the early stages of the disease, decreased insulin sensitivity causes β-cells hyperfunction to achieve a compensatory increase in insulin production to maintain normoglycemia. The greater levels of circulating insulin (hyperinsulinemia), thus, avoid hyperglycemia. However, gradually, the increased insulin release by β-cells is not able to compensate sufficiently for the decline in insulin sensitivity. Moreover, β-cell activity begins to deteriorate and B-cell malfunction finally leads to insulin shortage. As a result, normoglycemia can no longer be maintained and hyperglycemia develops. Although insulin levels are lowered, the release of insulin in most situations is sufficient to prevent the onset of DKA. But DKA may arise amid extreme stress circumstances such as those linked with infections or other pathophysiological scenarios.[10,11]

Gestational Diabetes Mellitus:

GDM is defined as any degree of glucose intolerance or diabetes identified at the onset or throughout pregnancy, usually the second or third trimester. This definition originally also includes any undiscovered T2DM which may begin prior to or occur at the time of pregnancy commencement. However, the latest recommendations of the International Association of the Diabetes and Pregnancy Study Groups exclude mellitus this definition diabetes diagnosed at the pregnancy onset or afterward in high-risk women such as with obesity where any degree of glucose intolerance is described as previously undiagnosed overt diabetes rather than GDM. GDM is different from any preexisting diabetes in women undergoing pregnancies and usually resolves soon after childbirth or termination of pregnancy.[12]

During early pregnancy, both the fasting and post-prandial blood glucose levels are usually lower than normal but the blood glucose levels increase during the third trimester of pregnancy, and in cases where this blood glucose level reaches the diabetic levels, the condition is described as GDM. More than 90% of all the instances of diabetes and related complications that occur during pregnancy can be linked to GDM. The incidence of GDM varies from 1% to 14% of all pregnancies and its prevalence is highly impacted by the populations under study. GDM occurs more commonly in certain racial or ethnic groups than others and this influence of ethnicity on risk of GDM is very important and has long been recognized. The prevalence of GDM is highest among Asian Indians, higher in aboriginal Australians, Middle Eastern (Lebanese, Syrian, Iranian, Iraqi, or Afghanistan), Filipina, Pacific Islanders, and Chinese, Japanese, Korean, and Mexican women. The incidence is lower in blacks and lowest among non-Hispanic white women.[13,14]

Other kinds of diabetes:

Besides T1DM, T2DM, and GDM, diabetes in different additional forms, though in smaller percentages with respect to overall diabetic incidence scenario, has been proven to be connected with some specific ailments including numerous pathologies and/or several disorders. The notable among these types of diabetes include diabetes arising from the monogenic errors in β-cell function and those owing to genetic abnormalities in insulin action, endocrinopathies exocrine pancreatic diseases, and several other specialized illnesses.

ASHWAGANDHA

Withania somnifera Dunal (ashwagandha, WS) is widely used in Ayurvedic medicine, the traditional medical system of India. It is an ingredient in many formulations prescribed for a variety of musculoskeletal conditions (e.g., arthritis, rheumatism), and as a general tonic to increase energy, improve overall health and longevity, and prevent disease in athletes, the elderly, and during pregnancy.1,2 Many pharmacological studies have been conducted to investigate the properties of ashwagandha in an attempt to authenticate its use as a multi-purpose medicinal agent. For example, anti-inflammatory properties have been investigated to validate somnifera, dunal, withaferin, Solanaceae, Indian Ginseng and winter cherry.[15,16]

Ashwagandha one of the most significant herbs in Ayurvedic medicine, a traditional system of healing that originated in India more than 3,000 years ago. The term "Ashwagandha" is derived from Sanskrit, meaning "smell of the horse," which relates both to the herb's characteristic smell and its traditional belief in imparting the power and vitality of a horse.

Belonging to the Solanaceae family, Ashwagandha is a tiny shrub with yellow blooms, and it is native to India, the Middle East, and portions of Africa. The root and leaves of the plant are mostly utilized for medical purposes.

Ashwagandha is a small, woody shrub known for its strong roots and oval leaves. It is one of the most revered herbs in Ayurveda for its revitalizing (rasayana) and adaptogenic effects.

Phytochemical Analysis:

Ashwagandha contain several active compounds responsible for its pharmacological effects. These compounds are primarily classified into Withanolides, Alkaloids, Saponins & Steroidal lactones.[20]

Ashwagandha (Withania somnifera), a well-known adaptogenic herb in Ayurvedic medicine, is available in various forms and dosages depending on the intended use.

1. Powder (Churna)-Traditional Ayurvedic form, Typically mixed with warm milk, ghee, or honey.
2. Capsules/Tablets- Standardized extracts for consistent dosing, Often used for convenience and precise dosage control.
3. Liquid Extracts/Tinctures- Alcohol or glycerin-based.
4. Tea/Infusions- Less common but used for general wellness.
5. Gummies and Functional Foods-Found in modern health supplements and beverages, Typically combined with other adaptogens or nutrients. [21,22,23,24]

Ayurvedic Use: In Ayurvedic pharmacology, Ashwagandha is characterized by distinct properties that define its therapeutic effects. Its Rasa (taste) is predominantly Tikta (bitter) and Kashaya (astringent), which contribute to its cleansing and detoxifying actions. The Guna (qualities) are Laghu (light) and Snigdha (unctuous), indicating that it is both easy to digest and nourishing. Ashwagandha possesses Ushna Virya (hot potency), which aids in stimulating metabolism and reducing cold-related imbalances. Upon digestion, its Vipaka (post-digestive effect) is Madhura (sweet), supporting tissue nourishment and anabolic activity. Overall, Ashwagandha is known to balance Vata and Kapha doshas, making it especially valuable in conditions involving nervous system imbalances and fatigue, where these doshas are typically aggravated. [27, 28].

Pharmacological Activities (Per Plant Part):

Medicinal Uses:

1. Adaptogen: Helps the body cope with stress and distress
2. Cognitive Enhancer: Supports memory, attention, and neuroprotection
3. Anti-inflammatory: Useful in arthritis and muscle pain
4. Reproductive Health: Improves strength, stamina, fertility in men and women
5. Anti-fatigue & Immunity Booster: Strengthens the immunological response and boosts energy,

MULETHI

Mulethi (Glycyrrhiza glabra), commonly known as Licorice, is a perennial herb belonging to the Fabaceae family. It is native to southern Europe and parts of Asia and is widely used in Ayurvedic, Unani, Chinese, and Western herbal medicine systems. It is recognized for its pleasant taste, healing powers, and wide range of medicinal effects. The name “Mulethi” is often used in India, where it has been a staple in herbal formulations for generations. The root of the plant is the most widely used portion and contains potent bioactive chemicals that contribute to its health benefits.

Common Names: It is obtained by plant parts used as primarily the root (dried or powdered) occasionally leaves and stems in certain formulations.[31]

Traditional Uses:

1. Respiratory health: Soothes sore throat, cough, and asthma
2. Digestive aid: Relieves ulcers, gastritis, and indigestion
3. Anti-inflammatory and immune support
4. Rejuvenative (Rasayana) in Ayurveda
5. Used as a flavoring agent in foods and pharmaceuticals

Active Constituents:

1. Glycyrrhizin – major sweet-tasting saponin glycoside, has anti-inflammatory and antiviral properties
2. Liquiritin and Isoliquiritigenin – flavonoids with antioxidant effects
3. Glabridin – a phytoestrogen and skin-lightening agent

Pharmacological Activities:

1. Anti-inflammatory,
2. Antiviral (incl. herpes and hepatitis viruses),
3. Antioxidant,
4. Gastroprotective,
5. Hepatoprotective,
6. Mild laxative and
7. Expectorant [32,33,34]

Forms and Dosage:

1. Powder (Churna)- Traditional Ayurvedic form, Taken with warm water, ghee, or honey, Commonly used for sore throat, cough, ulcers.
2. Capsules/Tablets- Standardized extracts for consistent dosage, Used in respiratory, gastrointestinal, and hormonal support supplements.
3. Decoction (Kashayam/Kwath)- Boiled root preparation, Used for bronchitis, asthma, and sore throat.
4. Syrup- Often used in cough syrups and throat soothers, Combined with honey, tulsi, or other herbs.
5. Tinctures or Liquid Extracts- Alcohol or glycerin-based extracts, Used for faster absorption and flexible dosing.
6. Lozenges/Pastilles- For local throat relief, often used in herbal cold or throat formulations.

Dosage Considerations:

1. Short-term use is generally safe.
2. Long-term high doses (>4 weeks or >100 mg/day glycyrrhizin) can cause: Hypertension, Hypokalemia, Fluid retention.[35,36,37]

Ayurvedic Properties:

Rasa (Taste): Madhura (Sweet), Guna (Qualities): Guru (Heavy), Snigdha (Unctuous), Virya (Potency): Shita (Cooling), Vipaka (Post-digestive effect): Madhura (Sweet)[38,39]

Phytochemical Analysis:

Pharmacological Activities (Per Plant Part) [41,42]:

 Medicinal Uses:

1. Respiratory Health: Acts as an expectorant, soothes sore throat, cough, and bronchitis
2. Digestive Aid: Helpful in gastritis, ulcers, and acid reflux due to its mucoprotective activity
3. Liver Tonic: Protects liver from toxins and boosts liver enzyme activity
4. Anti-inflammatory: Beneficial in arthritis, joint pain, and skin conditions
5. Immunomodulatory: Enhances immunity and supports adrenal gland function

GILOY:

Giloy, scientifically known as Tinospora cordifolia, is a highly valued medicinal plant in traditional Indian medicine, especially Ayurveda. Commonly referred to as “Guduchi” or “Amrita” (meaning “the root of immortality”), Giloy has been used for centuries due to its diverse therapeutic potential. It is a large, deciduous climbing shrub that belongs to the family Menispermaceae, and is native to the tropical regions of India, Sri Lanka, and Myanmar.[43,44]

In Ayurveda, Giloy is classified as a Rasayana, or rejuvenating herb, known to enhance longevity, immunity, and vitality. Its stem is the most commonly used part, although the root and leaves also have medicinal properties. Giloy is renowned for its immunomodulatory, anti-inflammatory, antipyretic, anti-diabetic, and antioxidant properties, making it useful in managing conditions such as fever, diabetes, infections, and inflammatory disorders.[44,45]

Modern pharmacological studies have validated many of Giloy’s traditional uses, showing that it contains bioactive compounds such as alkaloids, diterpenoid lactones, glycosides, steroids, and polysaccharides, which contribute to its wide-ranging health benefits.[46]

Phytochemical Analysis:

Giloy (Tinospora cordifolia) is rich in a wide range of bioactive phytochemicals that contribute to its medicinal properties. Various parts of the plant—stem, leaves, and roots—have been studied for their chemical composition. The stem is considered the most potent and is most frequently used in traditional medicine.

Phytochemicals:

Pharmacological Activities:

Medicinal Uses:

1. Anti-diabetic: Helps manage blood sugar by boosting insulin sensitivity
2. Immunomodulator: Enhances immune system function and white blood cell activity
3. Antipyretic: Effective in treating chronic and intermittent fevers
4. Hepatoprotective: Supports liver detox and enzyme function
5. Adaptogen: Reduces stress and increases overall vitality

JAMUN SEED

Jamun, scientifically known as Syzygium cumini, is a tropical evergreen tree native to the Indian subcontinent and Southeast Asia. Belonging to the Myrtaceae family, this tree is widely cultivated for its delicious, purplish-black fruits that are known for their sweet, slightly astringent flavor. Apart from being consumed fresh, jamun is also processed into juice, vinegar, wine, and other products due to its rich nutritional and medicinal properties.

The jamun fruit is a rich source of anthocyanins, flavonoids, and phenolic compounds, which contribute to its antioxidant, anti-inflammatory, and antidiabetic properties. Traditionally, various parts of the tree—such as the bark, seeds, and leaves—have been used in Ayurvedic and Unani systems of medicine to treat ailments like diabetes, diarrhea, and ulcers.

With increasing scientific interest in functional foods and natural remedies, jamun has gained prominence for its potential role in managing lifestyle-related diseases, particularly type 2 diabetes, due to the hypoglycemic effects of its seed extract.[49,50]

Active Compounds:

Jamun is utilized in various medicinal and nutraceutical forms, each offering unique health benefits. Different parts of the plant—particularly the fruit, seeds, leaves, and bark—are processed and administered depending on the therapeutic need.

Phytochemical Analysis:

Jamun seeds are rich in bioactive chemicals, including:

Jamboline: Helps decrease the conversion of starch to sugar, Ellagic acid: Antioxidant, anti-inflammatory, Tannins, Flavonoids, Alkaloids, Glycosides, Saponins, Terpenoids: Contribute to anti-diabetic characteristics

Pharmacological Activities (Seed Focused):

1. Seeds: Antidiabetic, antioxidant, anti-inflammatory, hepatoprotective
2. Bark: Astringent, Anti diarrheal, antibacterial
3. Leaf: Hyperglycemic, antioxidant
4. Fruit: Rich in vit c, iron, and antioxidants-boosts immunity

Key Medicinal Uses:

1. Diabetes Management: Reduces blood glucose levels by delaying carbohydrate metabolism,
2. Liver Protection: Enhances liver detox and reduces oxidative stress,
3. Antioxidant: Neutralizes free radicals and protects cellular damage,
4. Anti-inflammatory: Useful in treating inflammation-related problems,
5. Astringent: Helps control diarrhea, bleeding gums, and ulcers

KARELA

Karela, also known as bitter gourd or bitter melon, is a tropical and subtropical vine belonging to the Cucurbitaceae family. Botanically named Momordica charantia, it is widely cultivated in Asia, Africa, and the Caribbean for its edible fruit, which is characterized by its distinctive bitter taste. In India, Karela holds a prominent place in traditional medicine systems like Ayurveda and Unani due to its therapeutic potential.

Karela is rich in bioactive compounds such as charantin, vicine, and polypeptide-p—compounds that have been shown to exert hypoglycemic effects. These constituents contribute to its long-standing use in managing diabetes mellitus. Additionally, Karela is valued for its antioxidant, anti-inflammatory, antiviral, hepatoprotective, and anticancer properties.

Both the fruit and seeds of bitter gourd are used in various forms—fresh juice, extracts, powders, and capsules. It is commonly consumed as part of the diet or used as a supplement to regulate blood sugar levels and promote metabolic health.[53]

Forms and Dosage: