1,2Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201306, India
Email: priyankakesari7@gmail.com   

Received: 08 Sep 2015 Revised and Accepted: 27 Feb 2016


Among the most common chronic diseases in the world, Diabetes mellitus (DM) is an extremely studied and widely manifested multi-factorial disease which deliberately requires multi-modal therapeutic strategies [1]. It has an age-old history of being recognized and even symptomised in various cultures of the world majorly as glycosuria (sweet urine). Hence, the treatment strategies for DM have been in the process of development and documentation since a long time in traditional medicine systems. Back then the nature of drug used to be mostly unorganized and crude. The major difference now in the modern era is that the treatment strategies basically concentrate on identifying, isolating, modifying or searching alternatives of the lead compounds and exact active principles which attribute to the desired therapeutic nature of the plant. The aim of this paper is to acknowledge the various treatment methods available for Diabetes mellitus and to review the Traditional Indian herbs and plants which are most efficiently, safely and widely accepted medicament for DM and source of future lead compounds and family-wise segregation of these plants. This review is in total compliance with the strong and effective traditional medicinal systems of India.

Keywords: Traditional medicinal herbs, Diabetes treatment, Alternative Anti-diabetics, Herbal Drugs


Diabetes mellitus (DM), or commonly known as ‘diabetes’ is a very common metabolic disorder of human endocrine system having a significant impact on the health, quality of life and life expectancy of the patient and health care systems and is becoming alarmingly common worldwide. The estimated cases of the disease around the globe are around 6.4%, and more than 280 million people in the world suffer from diabetes. The majority affected, live in the developing world [2]. The World Health Organization (WHO) has estimated that there are 33 million diabetes cases in India, and that number will reach 80 million by 2030 [3].

This primary defect in fuel metabolism of the body has been acknowledged since ages in several early civilizations as Indian, Egyptian, Greek, Chinese, Iranian, Arabians and Spanish histories. In India, the disease was known as ‘Asrava’ during the Vedic era (600 BC) and a detailed description of it is available in Brahatta, viz. Charak Samhita, Sushruta Samhita, and Vagbhatta. Asthanga Haridaya (600 AD) is the first medical treatise in which we get a clear definition of ‘Madhumeha’ by mentioning glycosuria (madhviv mehati-honey like urine) [4]. The word diabetes was coined by the Greek physician Aeretaeus in the first century A. D. in the 17th century.

It is an important chronic ailment characterized by profound disturbances in glucose, fat and protein metabolism which in turn results in widespread, multi-organ secondary complications that ultimately encompass virtually every system of the body and indulges every specialty of medicine [5, 6]. The disease is caused due to the failure of a number of metabolic activities in which a person shows high blood sugar, either because the body is not able to move out sugar from the bloodstream into tissues rapidly or efficiently after a meal, or because the body cells behave unresponsive to the insulin that is produced.

Etiologically two main categories of diabetes recognized are Primary diabetes and Secondary Diabetes. Primary diabetes is of two types-Insulin dependent diabetes mellitus (IDDM) in which there is a profound decrease in the number of ‘b cells’ in the islet of Langerhans, because of which there is absolute deficiency of insulin (Type 1) and Non-insulin-dependent diabetes mellitus (NIDDM) which is caused due to insulin resistances as well as loss of insulin secretion. The person with type 1 diabetes needs daily insulin treatment for his sustenance while a person with type 2 may get rid of this disease by taking oral hypoglycemic drugs or through natural diet. The symptoms of Secondary Diabetes results from factors like pancreatic dysfunction, hormonal imbalance, drugs or chemical induced reactions.

Various symptoms associated with the disease are hyperglycemia (fasting plasma glucose level>126 mg/dl, or glycosylated hemoglobin A1c (HbA1c)>6.9%) [7] resulting in ‘polyuria’ (frequent urination), ‘polydipsia’ (increased thirst) and ‘polyphagia’ (increased hunger), glycosuria (release of glucose in urine), loss of weight, ketosis (accumulation of ketone bodies in blood), ketonuria (elimination of ketone bodies in urine), acidosis (lowering of pH of blood due to circulating keto acids), dehydration and lipemia (increased levels of lipid, fatty acids and cholesterol in blood) etc. [8].

Diagnostic criteria for diabetes

The blood glucose levels of a healthy man are 80 mg/dl on fasting and up to 160 mg/dl in the postprandial state. Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating one of the following:

fasting plasma glucose level at or above 126 mg/dl or 7.0 mmol/l, plasma glucose at or above 200 mg/dl or 11.1 mmol/l two hours after a 75 g oral glucose load in a glucose tolerance test, random plasma glucose at or above 200 mg/dl or 11.1 mmol/l.

Two fasting glucose measurements above 126 mg/dl or 7.0 mmol/l or random blood sugar level>200 mg/dl on two different occasions is considered diagnostic for diabetes mellitus. Patients with fasting sugars between 6.1 and 7.0 mmol/l (110 and 125 mg/dl) are considered to have impaired fasting glucose and patients with plasma glucose at or above 140 mg/dl or 7.8 mmol/l two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance [9]

Various treatments strategies available for diabetes

Different methods to ameliorate or control diabetic symptoms, prescribed and practiced with varying degrees of success, are Drugs which lower the blood sugar and can treat the symptoms of DM known as hypoglycemic drugs. These drugs could be categorized as insulin, and insulin preparation, which is employed only parenterally and oral hypoglycemic drugs are administered orally [9], Antibodies (monoclonal antibodies) [10], Organ Transplantation [11], Islet transplantation [12], mineral supplementation [13, 14,15] and Physical interventions as Acupuncture [16] and hydrotherapy [17] but lifestyle management like exercise, weight control, and medical nutrition therapy is at the most accepted of therapy options.

The richness of Indian floral biodiversity and the medicinal potentials of their extracts more precisely phytochemicals and secondary metabolites have been used since ages and documented in various ancient scriptures for medicament against various ailments. Till date, rural India depends solely on herbal remedies as the non-prescription cure of several minor and severe ailments. Moreover, modern inclinations of researchers and medical practitioners towards Herbal remedies and Naturopathy, and technical advancements with biotechnology have generated new horizons for the better and complete exploitation/utilisation of the available floral resources with lots of efficacy and potency and in most instances over and above the existing conventional and chemotherapeutic treatments for various diseases including Diabetes mellitus [18].

Conventional diabetic drugs

Since in the development of diabetic symptoms insulin related imbalances play a most important role, pathological impact involves three key organs, i.e., pancreatic islets, liver, and skeletal muscle. Almost all anti-diabetic drug formulations aim at these organs. Absence, under-production or in sensitization of insulin can lead to severe biochemical imbalances in the metabolic control of the body fuel, glucose causing diabetes.

Western treatments thereby treat DM by supplementing insulin or administering medicaments for improving cellular sensitivity for insulin, improving insulin secretion from the pancreatic cells, preventing gluconeogenesis in the liver or some target gastric emptying regulations to maintain euglycemic condition (72–126 mg/dl) [19].

Insulin and insulin preparations

Human insulin is a peptide hormone synthesized in the pancreas as an inactive single chain precursor preproinsulin having a signal sequence responsible for its targeting to secretory vesicles and which undergoes proteolytic cleavage to form proinsulin. This proinsulin is now stored in pancreatic b cells and in elevated levels of glucose gets secreted and cleaved by specific proteases to yield active insulin consisting of two amino acid chains A and B, which are linked by two disulphide (–S–S–) linkages. The chain A contains 21 amino acids and chain B contains 30 amino acids. The disulphide bridges are essential for its biological activity. This active insulin now starts the chemical cascade for conversion of the excess blood glucose to two storage forms-glycogen (in liver and muscle cells) and triacyl glycerols (in adipose tissue)[20].

Human insulin is an amphoteric protein, forms salts with weak acids and alkalis. Its properties such as water solubility and combining potency with proteins such as protamine and with zinc do not bring any change in its biological activity. The solubility of insulin depends on three factors, its physical state (that is, amorphous or crystalline), on the concentration of zinc and on the nature of buffer in which it is being suspended. It is not suitable for oral administration because it is inactivated by digestive enzymes. The normal human pancreas contains about 8-10 mg of insulin. In normal individuals, pancreas contains about 8-10 mg of insulin, and its secretion is low between meals and increase with each meal. The amount of insulin secreted per day in a normal human is about 40 units (286 mmol). All tissues have the ability to metabolize insulin, but 80% of exerted insulin is normally degraded in the liver and kidneys. Diabetic patients, in whom the defect seems from a paucity or apoptosis of pancreatic b cells, completely rely on external insulin injections which could be either intravenous or subcutaneous. The dose of insulin required to control diabetes varies from patient to patient and from time to time in the same patient [4].

Table 1: Various western drugs and their side effects in diabetes [21]

Drug group

Representative drug/s

Mode of action

Major clinical effect/s

Side effects reported


1st generation

2nd Generation

Activate receptors on the â islet cells of the pancreas to release more stored insulin in response to glucose.

Reduced blood glucose


weight gain











Impaired hepatic gluconeogenesis,

Decreased production of very-low-density lipoprotein

Decrease fasting glucose levels, thereby reducing hemoglobin A1c (A1C).

Gastroin­testinal upset, including nausea, vomiting, anorexia, and diarrhea.





Binds to peroxisome proliferator–acti­vated receptors (PPARs) in cells forming drug-PPAR complex stimulate the production of proteins that increase insulin sensitivity, such as adiponectin. It also acts by blocking transcription of other proteins responsible for insulin resistance or inflammation.

glucose-lowering effects and lower triglyceride levels


α-glucosidase inhibitors



Inhibits the intestinal enzyme that cleaves polysac­charides into monosaccharides.

slowdowns the absorption of carbohydrates after a meal limiting postprandial hyperglycemia an A1C reduction of 0.5–0.8% is typical

flatulence and other gastrointestinal symptoms



Augments insulin secretion

Glycemia control

weight gain,

gastrointestinal disturbances, and hypoglycemia

DPP-4 inhibitors


Inhibits the enzymatic degradation of glucagon-like peptide 1 (GLP-1) which acts to delay gastric emptying, suppress glucagon release, and increase glucose-stimulated insulin release.

Limit postprandial hyperglycemia, A1C reduction of 0.5–1% in patients with type 2 diabetes.


Oral hypoglycemic and antidiabetic drugs

Any drug which has the power and potency to treat diabetic complications upon oral administration is termed as oral hypoglycemic drug. Since insulin is ineffective orally and also is not required always (viz. NIDDM), oral agents which target or effect some or the other phenomenon which directly or indirectly affects the control of glucose metabolism may be of great help. But anyway these drugs can never show an effect if any reluctance is taken on controlled diet regime and other lifestyle management steps.

The various classes of glucose-lowering drugs include sulfonylureas, biguanides, alpha-glucosidase inhibitors, thiazolidinediones, and meglitinides [21]. These drugs may be categorized on the basis of their major action mechanism as insulin secretagogues (sulfonylureas, meglitinides), insulin sensitizers (biguanides, thiazolidinediones), α glucosidase inhibitors (miglitol, acarbose). Serum GLP-1 concentration enhancers and gastric emptying down-regulators (exenatide, liraglutide, and DPP-4 inhibitors) [19]. Though these drugs have been proved for their efficacy in controlling diabetic symptoms most of them have been reported to pose one or other physiological complication or side effects on use [table 1].

Traditional Indian herbal anti-diabetics

It is now internationally accepted and acknowledged that traditional medicines systems of India and other ancient origins report, advocate and justify the significance of floral biodiversity as an effective and reliable treatment strategy of hyperglycemia and related malfunctions.

Several disadvantages associated with insulin and synthetic drugs and their failure to divert the course of diabetic complications have opened up tremendous horizons for searching possibilities in complementary and alternative medicine (CAM) for diabetes as well as many other chronic diseases. Plants, herbs and their derivatives owing to their wide spectrum of active principles representing numerous chemical compounds hold promising potentials for their consistent usages in the treatment of Diabetes [4]. According to WHO, 21,000 plants around the globe have been reported for medicinal uses. India is posted to have an enormous medicinal flora of some 25,000 species, out of these 150 species are commercially exploited for medicinal extractions or drug formulation [22]. There are about 800 plants species reported having the probability of possessing antidiabetic potentials in the ethnobotanical surveys [23]. The antidiabetic effects of the plants are attributed to the wide range of chemicals and secondary metabolites. Reports have essayed approximately 200 pure compounds from plant sources to show blood glucose lowering effect. These compounds range vividly in chemical nature like alkaloids, carbohydrates, glycosides, flavonoids, steroids, terpenoid, triterpenoid, peptides and amino acids, lipids, phenolics, glycopeptides, and iridoids. Here we review traditional Indian herbs which are most efficiently, safely and widely accepted as a medicament for DM and source of future lead compounds for the disease with family-wise segregation of these plants [table 2].

Table 2: Family wise segression of the most scientifically validated antidiabetic plants



Indian vernacular name



Asteracantha longifolia

Kokilaksha, Talmakhana



Andrographis paniculata




Barleria prionitis

kuranta, Vjradanti



Barleria lupulina




Achyranthes aspera

Aghata, Khara-manjari



Aerva lanata




Amaranthus spinosus

Tanduliuyah, Kanta chaulai 



Mangifera indica




Anacardium occidentale

Kajutak, Agnikrit



Annona squamosa




Daucus carota




Coriandrum sativum




Cuminum cyminum

Karavi, Krishna jeeraka



Cuminum nigrum

Kala jeera



Carum Carvi

Karavi, Krishna jeeraka



Ferula assafoetida




Catharanthus roseus




Carissa carandas

Karamarda, Karonda



Cocos nucifera




Gymnema sylvestre

Vrikshamla, Gur-mar



Calotropis gigantea




Tridax procumbens

Khal muriya, Ghamra



Basella rubra

Poi, Safed Bachla



Tecoma stans




Bombax ceiba




Eruka sativa

Safed Sarson



Brassica juncea




Commiphora mukul 




Capparis deciduas

Kurira, Karira



Artemisia pallens




Beta vulgaris




Terminalia arjuna




Terminalia chebula

Harad, Haritaki, Harra



Ipomoea batatas




Cressa cretica




Bryophyllum pinnatum

Pashanbhed, patharchatta



Citrullus colocynthis

Indravaruni, Mahendravaruni



Coccina indica




Cucurbita ficifolia

Chappan kaddu



Momordica charantia




Momordica cymbalaria

Athalkkai, Karchikai



Momordica dioica




Cucumis sativus




Luffa acutangula




Luffa cylindrica

Ghiya torai



Juniperus communis

Dal chini



Phyllanthus amarus

Bhumiamalaki, Jangli amla


Fabaceae (Leguminosea/Papilionaceae)

Cajanus cajan

Adhaki, Tur



Mucuna pruriens




Pterocarpus marsupium Roxb.




Caesalpinia bonducella

Kantkarej, Kantikaranja



Erythrina variegate

Pangara, Paribhadra



Acacia arabica




Trigonella foenum greacum




Medicago sativa




Pongamia pinnata




Phaseolus vulgaris

Balka, Rajma



Saraca Asoca

Asokah, Tamra Pallav



Butea monosperma




Clitoria ternatea




Tephrosia villosa



 Prosopis cineraria




Casearia esculenta




Hordeum Vulgare




Bambusa vulgaris




Cynondon dactylon

Doab, arugampul



Swertia chirayita




Enicostemma littorale

Nahi, Maja-makka booti



Garcinia indica

kokum, punar puli



Aesculus hippocastanum

Kanor, Bankhor



Salacia macrosperma




Salacia reticulata




Salacia oblonga

Vairi, pitika



Juglans regia




Prunella vulgaris




Ocimum sanctum




Teucrium polium




Vitex negundo

Nirgundi, Sephali


Clerodendrum phlomidis

Agnimantha, Jaya


Clerodendrum serratum



Clerodendron infortunatum




Allium sativum




Allium cepa




Aloe barbadensis/Aloe vera




Asparagus officinalis




Strychnos nux-vomica

Kuchila, Bailewa



Lagerstroemia speciosa




Hibiscus rosa-sinesis




Sida cordifolia

Bala, Khareti



Thespesia populnea Soland. ex Correa




Abelmoschus esculentus (L.) Moench




Memecylon umbellatum Burm.




Osbeckia octandra

Heen bowitiya



Azadirachta indica




Tinospora cordifolia

Guduchi, Amrita.



Tinospora crispa

Akar patawali



Acacia arabica




Acacia catechu




Ficus carica




Ficus bengalensis L.




Ficus exasperata




Ficus religiosa




Artocarpus heterophyllus

Panasa, katahal



Morus alba




Embelia ribes

Bidanga, Vidanga



Eucalyptus globulus Labill

Tailapatra, Sugandhapatra



Eugenia jambolana

Jambu, jamun



psidium guajava




Musa sapientum




Boerhavia diffusa




Nelumbo nucifera

Kamal, Sarsija



Nymphaea pubescens




Olea europea




Schrebera swietenioides




Averrhoa bilimbi




Biophytum sensitivum

Jallapushpa, Lajjalu



Oxalis corniculata

Changeri, Amlapatrika



Pandanus amaryllifolius




Piper longum




Piper betel




Piper nigrum




Plantago psyllium




Plantago ovata

Isabgolam, Snigdhbijam



Picrorrhiza kurroa

Katuka katurohini



Bacopa monnieri




Adianthum capillus veneris




Primula denticulata

drumstick primula



Punica granatum

Dalima, Anaar



Nigella sativa

Upakuncika, Kalonji



Zizyphus mauritiana

Ber, Badri



Zizyphus nummularia

Jhar Beri



Rhizophora mucronata

Kullalaji, Kala Lakri



Eriobotrya japonica




Prunus amygdalus

Vatadha, Badam



Morinda citrifolia

Ayushka, Achuka



Aegle marmelose

Bengal quince, Bel



Murraya koenigii




Madhuca longifolia

Mahua, Mahwa



Scoparia dulcis

Mithi patti



Ailanthus excelsa

Aaralu,aldua bhootjhad



Smilax glabra

Copchini, dvipantarvaca



Solanum torvum

Bhurat, Bhankatiya



Withania somnifera




Solanum nigrum

Kakamachi, Kakahva



Lycium barbarum.

Kad Mool



Abroma augusta




Helicteres isora L.

Maror phali



Camellia sinensis




Lantana camara




Gmelina arborea

Gambhar, bhadraparni



Costus speciosus

Keukand, Keu



Curcuma longa

Haridra, Haldi



Tribulus terrestris




Balanites aegyptiaca

Hingn, hingot


Concerns and complications of herbal treatments

Herbal medicines are very often used as therapeutic remedies in combination with allopathic drugs [178]. The potency of herbal drugs has been proved to be significant, and they have negligible side effects than the synthetic anti-diabetic drugs [179]. Although phytotherapy for Diabetes continues to be used in several countries till date but there are some facts which should not be ignored in the context of their regular use. First, only a few plants have undergone scientific or medical scrutiny. Secondly, a large number of medicinal plants possess some degree of toxicity. For example, it was reported that about one-third of medicinal plants used in the treatment of diabetes are considered to be toxic [180]. Thirdly, the test results of hypoglycemic plants are subject to several factors. Like, each herb contains thousands of components, only a few of which may be therapeutically effective [181]. Different parts of a herb have different ingredient profiles. Moreover, different extraction methods may yield different active ingredients [182]. Also herbal formulae containing multiple herbs may have synergistic effects [183] and [184]. The multiple constituent natures of botanical products have made standardization a challenging task. Advocates of herbal remedies have also suggested that in standardizing one plant constituent, resulting extracts may lose a proportion of benefit as compared with the whole plant [185]. Also precise considerations of purity, chemical composition, and potency of derivatives may be grossly influenced by the age of the plant (especially of roots), the source location, the season of harvest, the method of drying and crude preparation, etc. [186].


Diabetes mellitus is the most common multifactorial chronic disease. High levels of free radicals and malfunction in antioxidant defence mechanism formed as a result of glucose oxidation and non-enzymatic glycation of proteins generates a condition of high oxidative stress in the patient which in turn produces stress-induced damage of cellular organelles, enzymes, increased lipid peroxidation and insulin resistances [187]. DM has been a target for study and multiple therapy options since ages, and several effective therapies have been documented for its treatment and control. Recently because of much growing mass awareness about prominent side-effects of western treatments, attentions are concentrating on plant based treatments including whole drug and poly herbal formulations.

Plant-based medicinal products have been known to man since ancient times [188]. Plants have been the primary source of drugs and lead compounds, and many of the currently available drugs have been directly or indirectly derivatized from them. The families of plants with the most potent and also widely studied hypoglycemic effects include Leguminosae, Lamiaceae, Liliaceae, Cucurbitaceae, Asteraceae, Moraceae, Rosaceae, Euphorbiaceae, and Araliaceae. The plant kingdom is owing to a wide spectrum of its phytol antioxidants resulting in vast medicinal potency exhibit tremendous opportunity to reduce the oxidative stress induced symptoms of diabetes mellitus.

Scientific findings on the action mechanisms of the plant compounds have proposed many means in which they act to provide the anti-hyperglycemic and anti-hyperlipidemic effects. Some of them relate to their effects on the activity of pancreatic ß cells (synthesis, release, cell regeneration/revitalization) or the increase in the protective/inhibitory effect against insulinase and the increase of the insulin sensitivity or the insulin-like activity of the plant extracts. Other mechanisms involve improved glucose homeostasis including an increase of peripheral utilization of glucose, an increase of synthesis of hepatic glycogen and/or decrease of glycogenolysis acting on enzymes, inhibition of intestinal glucose absorption, reduction of glycogenic index of carbohydrates, reduction of the effect of glutathione [189].


Plants with acknowledgments in common folklore and traditional Indian medicinal systems (IMS) are very significant and medically potent in the treatment of various human ailments including Diabetes mellitus. Alternative therapies with anti-hyperglycemic effects are becoming increasingly popular among patients and are certainly significant because of the inability of conventional treatments to relieve one from the complications without having threats of additional ill-effects. Moreover, the constants like high cost and inaccessibility mostly to the rural population add up to the reasons for general inclinations towards alternative therapies. So, Consuming plants with potent anti-diabetic activity for the treatment of diabetes is now becoming very popular macrobiotics treatment regime for diabetes all over the world, as most of the times, it promises no additional pains in the form of side effects. This also proves a famous saying in India;

“Any disease is half way treated if the fear for its cure is gone,”

But major hindrance in the amalgamation of traditional knowledge with modern medical practices is a lack of sufficient scientific and clinical trials, especially on human subjects. It is unfortunate that even though plant based drugs have tremendous medicinal priority over synthetic drugs, but the significant trials are not adequately available in order to advocate their scientific merit and supremacy over the existing drugs. Nonetheless, it should never be ignored that there are always probabilities of any adverse herb-drug interaction in the case of patients also receiving conventional anti-diabetic medications [21]. This review has presented a comprehensive list of a few scientifically validated anti-diabetic plants. There are absolute possibilities for developing novel and useful drugs, formulations and lead compounds from these plants. Also, some specific genetic markers which can account for the phylogenetic relationship between the different plants and families owing to the anti-diabetic character could be developed in near future which would narrow up and limit the studies and searches for herbal drug development. The scope of utilizing chemoinformatics and bioinformatics to test the harnessable and adverse synergistic behavior of various herbs and their components would also help to define the clear-cut outline of drug designing and clinical research.


Declared none

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International Journal of Pharmacy and Pharmaceutical Sciences
Vol 8, Issue 4, 2016 Page: 10-19

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Priyanka .
Department of Biotechnology, School of Engineering and Technology, Sharda University, Greater Noida 201306, India

Rita Singh

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