Herb‐drug interactions in diabetes mellitus: A review based on pre‐clinical and clinical data

Abstract

Global diabetes epidemic is the major cause of fatality and lethality. As per IDF 2019 report, diabetes caused 4.2 million deaths, approximately 463 million people are living with diabetes and by 2045, this will rise to 700 million. Nowadays, the physicians and common people in both developed and developing countries are using medicinal plants and their formulations to treat diseases with the postulation that organic commodities are safe for consumption. These plants may act as inhibitors or inducers of the Cytochrome P450 or transport and efflux proteins or both and may alter gastrointestinal, renal functions leading to Herb‐Drug Interactions. This review intends to focus on the frequently employed medicinal plants, their traditional uses, their Cytochrome P450 inhibition or induction activity, phytochemical, and pharmacological effects, established HDI with the help of in vitro tools, in vivo pharmacokinetics and pharmacodynamics studies to understand the impact of herbs on ADME of the drug and whether it is beneficial, harmful or has no effect respectively. This review will help the physicians and other health care professionals as a reference guide to update their knowledge and expertise about HDI. However, more quality research in this area is needed to evaluate the efficacy of many herbal medicines, thereby reducing side effects and improving the safety of patients.

Treatment of type 2 diabetes mellitus using the traditional Chinese medicine Jinlida as an add-on medication: A systematic review and meta-analysis of randomized controlled trials

“…The global epidemic of T2DM is an alarming cause of mortality and disability. Some physicians agree that herbal medicine and its formulations are safe and useful in treating persons with T2DM in many countries ( 48 – 50 ). The aim of our study was to evaluate the adjuvant hypoglycemic effect of jinlida granules in the treatment of T2DM and to explore the source of heterogeneity between these RCTs.…”

Effect of herbal formulation on glimepiride pharmacokinetics and pharmacodynamics in nicotinamide-streptozotocin-induced diabetic rats

“…Glimepiride increases peripheral glucose absorption by stimulating insulin granule production and improving insulin sensitivity in peripheral tissues, lowering plasma blood glucose and glycated haemoglobin (HbA1c) levels [ 37 ]. Diabecon, a polyherbal formulation, which comprises Gymnema sylvestre, Eugenia jambolana, Glycyrrhiza glabra, Momordica charantia as the key constituents present in it, and has been reported for its antidiabetic and hypolipidemic activity [ 7 ].The decreased glucose level in the PD study suggested that co-administration of DB formulation and GP has a synergistic effect, possibly leading to increased intracellular insulin receptor activity, stimulation of pancreatic beta cells to release insulin, decreased hepatic glucose production, and improved pancreatic beta cell restoration. In addition, there was no incidence of hypoglycemia in the GP+DB treatment group.…”

“…The mechanism of action of a combination is unlikely to be as important as that of the individual medications [ 6 , 7 ]. However, the latest studies showed that there exist interactions between some commonly administered traditional medicinal herbs and widely used oral hypoglycemic agents in diabetes mellitus [ [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] ].…”

To Investigate the Potential Mechanism of Huanglian Jiangtang Formula Lowering Blood Sugar in View of Network Pharmacology and Molecular Docking Technology

“…At present, research shows that the traditional Chinese medicine treatment of DM is mainly from stimulating insulin secretion, protecting and repairing islets of Langerhans-β Cells, improving insulin resistance, inhibiting glucosidase activity, inhibiting glucose absorption in the body, promoting glucose utilization, improving the level of oxidative stress, and other ways to play a hypoglycemic role. Te promotion of the traditional Chinese medicine as a therapy for diabetes relies on the fndings of research on individual traditional Chinese medicines that have been shown to have a hypoglycemic impact [5].…”