Alternative Drugs for the Treatment of Diabetes
The industry for natural or herbal preparations is burgeoning due to increasing consumer receptiveness to and reliance on alternative health care. Americans spend about $14 billion a year on alternative healthcare products and services, including natural products, which purportedly lower blood glucose levels. There is also the widespread yet misguided notion that just because a product is natural, it is completely safe and without side effects. Due to the increasing popularity of natural or herbal medications, healthcare professionals are becoming more educated about these products and the salutary effects they are claimed to have.
In fact, the National Institutes of Health (NIH) recently formed the Office of Alternative Medicine. Previously, several clinical trials were performed on natural glucose-lowering agents, but the methodology was deemed questionable; therefore, the results were not taken seriously. However, experiences of consumers and the remarkable claims about these products merit consideration. There are hundreds of natural products that are claimed to treat various aspects of the pathophysiological aspects of diabetes.
The following are examples of natural products sometimes used by consumers to treat diabetes and is complications. The hypoglycins found in the unripe fruit of the ackee tree lower blood glucose but are also toxic and have led to numerous reported deaths since the late 1800s. Oral extracts from bitter melon have been shown to mildly lower blood glucose and serum cholesterol levels in studies that were reported in scientific journals; currently, there is no standardize version of the drug. Dandelion root contains insulin and has a potentially very mild effect on blood glucose levels. Garlic is renowned for its coronary benefits, but garlic also lowers blood glucose levels. Allylpropyl-disulphide (APDS), the active agent in garlic, competes with insulin-inactivating sites in the liver. Unfortunately, garlic is not standardized enough to recommend for the primary treatment of diabetes.
Studies have shown that ginseng (in 200-mg doses) reduces FPG and elevates mood. Glucomannan, a dietary fiber, has been proven to reduce FPG levels 29% after a 90-day period. Unfortunately, currently there is no form of glucomannan that facilitates administration to patients with diabetes. Gymnena has a mechanism of action similar to that of sulfonylureas and has been shown to have a hypoglycemic effect equivalent to lbutamide. Many patients in India use gymnena, but large doses are required for efficacy, and the toxic effects of this drug are unknown.
Instead of promoting hypoglycemia, some natural agents are claimed to have properties that beneficially affect other complications associated with diabetes. For example, aloe vera and ginkgo biloba are claimed to be useful for wound healing and treating intermittent claudicating, respectively. Cayenne pepper has been shown to have beneficial effects on neuropathic pain when topically administered.
None of these agents has been definitively proven to have the hypoglycemic effects of the FDA-approved drugs currently in clinical use. However, as physicians continue to investigate the beneficial properties of natural agents, there may be substantial advances in this area.