Type 2 Diabetes: Ayurvedic medications are an effective treatment

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A new study, led by experts at the University of Nottingham, has found that several traditional medicines commonly used in South Asia, are effective in maintaining blood sugar levels in patients with type 2 diabetes.

Ayurveda is a traditional medical system that has been used for thousands of years in many South Asian countries such as India and Nepal. Some of the herbs included are also used in other parts of the world including Iran, China, and Mexico—to name a few.

A multi-pronged and individualized approach is used to manage health conditions such as lifestyle modification (including diet), Ayurvedic detoxifying and purifying therapies (e.g. Panchakarma), and Ayurvedic medicines (containing plant, animal, or mineral-origin ingredients – single or in combination).

Beneficial effects of several Ayurvedic medicines on T2DM-related outcomes, including blood glucose, were found. The reduction in HbA1c of at least 0.3% or 0.4% is considered to be clinically meaningful, (US Food and Drug Administration, 2008) and a number of Ayurvedic medicines were found to bring such reduction such as Aegle marmelos (L.) Corrêa, Boswellia serrata Roxb., Gynostemma pentaphyllum (Thunb.) Makino, Momordica charantia L., Nigella sativa L., Plantago ovata Forssk., Tinospora cordifolia (Willd.) Hook.f. & Thomson, Trigonella foenum-graecum L., and Urtica dioica L. compared to control. Similarly, FBG was reduced by 4–56 mg/dl for a range of Ayurvedic medicines.

However, the majority of studies did not assess HRQoL, an important patient-reported outcome. Adverse events were not reported in many studies. If reported, these were mostly none to mild and predominantly related to the gastrointestinal tract. The findings are consistent with several systematic reviews conducted on single herbs as well as Ayurveda as a whole system.

(Hardy et al., 2001; Yeh et al., 2003; Shekelle et al., 2005; Nahas and Moher, 2009; Shojaii et al., 2011; Sridharan et al., 2011; Suksomboon et al., 2011; Akilen et al., 2012; Allen et al., 2013; Gibb et al., 2015; Namazi et al., 2019; Peter et al., 2019; Jalali et al., 2020; Jamali et al., 2020)

It should be noted that the majority of these Ayurvedic medicines are already in use in many countries, and many are used as dietary ingredients such as spices or foods. In many countries, Ayurvedic medicines are available over-the-counter (which includes online shopping) and are considered as dietary supplements. (Chattopadhyay et al., 2020b)

Ayurveda is now recognized in 17 countries, including in and beyond South Asia. (Press Information Bureau, 2021) The integration of Ayurveda and Western medicine has been done in India. (Priya and Shweta, 2010) Many single herbs included in this review are not restricted to Ayurveda but are also used in other traditional therapies around the world such as Iranian traditional medicine and traditional Chinese medicine.

Similarly, many traditional therapies use multi-ingredient medicines such as Unani (Graeco-Arabic), Siddha (from Southern part of India), traditional Chinese medicine, and Russian traditional medicine. (Chattopadhyay and Bochenek, 2008; Li et al., 2014; Shikov et al., 2021).

The Cochrane systematic review was conducted a decade ago and focused on multiherbal formulations and Ayurveda as a whole system and excluded single herbs and their extracts. (Sridharan et al., 2011) In this review, classical and proprietary Ayurvedic medicines in any form were included (containing plant- as well as mineral-origin ingredients–single or in combination).

Many Ayurveda experts and Ayurvedic practitioners may view the inclusion of herb extracts and proprietary Ayurvedic medicines in this review as a deviation from the classical style of management. However, in reality, many Ayurvedic practitioners prescribe, and many people consume these types of medicines.

Similarly, Ayurveda experts and Ayurvedic practitioners may view the exclusion of Ayurvedic detoxifying and purifying therapies (e.g., Panchakarma) in this review as a deviation from the classical style of management. However, considering the feasibility and practicality of the review work, these were beyond the scope of this review. The focus of this review was on Ayurvedic medicines, as these are commonly prescribed and consumed. Having said that, the future review work should consider synthesizing evidence on the effectiveness and safety of such complex interventions.

Overall, the methodology was not adequately reported in the studies, and this resulted in poor methodological quality scoring. The assessment of methodological quality is subjective to a large extent, and the reviewers were strict. For example, other systematic reviewers might be satisfied if the differences between study arms in terms of their follow-up are described. However, the reviewers went a step further and were expecting these to be analyzed.

The strictness is one of the reasons for poor methodological quality scoring. In addition, if the funding statement was provided, it was mostly brief and difficult to determine the level of support received from pharmaceutical companies. For example, it was not always clear if a pharmaceutical company provided the trial medicines for free or these were purchased. Therefore, it was difficult to determine the funding bias i.e., the tendency of a study to support the interests of the study’s financial sponsor.

This systematic review has several strengths and weaknesses. To the best of our knowledge, this was the first comprehensive systematic review on any traditional medicine including Ayurveda, and which included a wide range of classical and proprietary Ayurvedic medicines in any form (containing plant- as well as mineral-origin ingredients–single or in combination).

A large number of sources and databases were searched, without any date or language restrictions. An extensively robust methodology was followed to conduct this review. Although the information provided in the studies was at times confusing, the reviewers tried their best to extract the correct information.

Two independent reviewers were involved throughout the process, and a third reviewer cross-checked everything. The kappa statistic was within the acceptable range i.e., 0.67 and 0.57 for the title and abstract screening and full text screening, respectively. A multi-disciplinary team was involved in the review, with expertise in Ayurveda, medicinal plants, diabetes, systematic reviewing, and statistics.

The initial plan was to perform a range of sensitivity and subgroup analyses. However, many of these could not be performed. For example, complete information on commercial funding or other support was needed to correctly conduct the sensitivity analysis by excluding commercially funded studies.

However, it was unclear in 43% of RCTs. Some of the issues were outside the scope of this review, and the evidence should be synthesized in future reviews to decide the optimal option. For example, comparison of two or more drug manufacturing processes, forms or timings of administration, doses, and Anupans of the same Ayurvedic medicine. Similarly, many other factors, such as patients’ age, sex, ethnicity, lifestyle (e.g., diet and physical activity), chronicity and severity of T2DM, and comorbidities, can influence the outcomes.

However, due to limited data for some comparison, we were not able to conduct separate subgroup analyses to explore the potential influence of these factors. Apart from the issues highlighted in this review, there are some basic issues which were beyond its scope and need addressing as well. For example, standardization and quality control of Ayurvedic medicines. (Chattopadhyay and Bochenek, 2008)

reference link : https://www.frontiersin.org/articles/10.3389/fphar.2022.821810/full

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