Ethnobotanical Study of Medicinal Plants used by Traditional Health Practitioners to Manage Diabetes Mellitus in Safi and Essaouira Provinces (Central-Western Morocco)

Abstract

The diabetes prevalence ranges between 4.4 % and 9 % in rural and urban areas, respectively. 8 Many complications are resulting from both types of diabetes and are considered as a leading cause of premature mortality. 9,10 Diabetic patients with prolonged uncontrolled hyperglycemia run the risk of developing macrovascular and microvascular angiopathy, 9 cancers, cardiovascular and Alzheimer's diseases. 2,11 Furthermore, untreated diabetic patients are prone to develop bladder, skin, and sexual dysfunctions. 12-14 Chronic exposure of diabetics to an irregular metabolic environment disturbs the immune system and lung physiology, aggravates inflammation, and increases virus infectivity and virulence. 15 Diabetic patients should commit to a set of self-care behaviours, such as diets, physical activities, glycemia control, and appropriate medications. 16 Presently, the injection of exogenous insulin is still the basic treatment for type-1 diabetic patients as well as for some type-2 diabetic patients, who failed to keep their glycemia under control by other means. 3 Several antihyperglycemic agents are frequently used to manage diabetes mellitus. These include sulfonylureas, incretin mimetics, meglitinides, thiazolidinediones, biguanides, α-glucosidase inhibitors, dipeptidyl peptidase-IV inhibitors, and sodium/glucose cotransporter 2 inhibitors. 17 Though the antihyperglycemic drugs have shown promising results, they are not devoid of side effects. 18 For instance, biguanides such as metformin are known to cause anorexia, transient nausea, diarrhea, renal hypoperfusion and lactic acidosis with severe renal damage. Sulfonylureas can cause mild headaches, gastrointestinal disorders, increased food intake, weight gain, and cardiovascular mortality. Thiazolidinediones lead to anemia, insomnia, headache, dizziness, gastrointestinal disorders, weight gain, haematuria, proteinuria, impotence, and, less commonly, fatigue, vertigo and hypoglycemia. 18 In low and middle-income countries, poor quality of