Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2019, Article ID 6021209, 23 pages
https://doi.org/10.1155/2019/6021209
Review Article
Phytomedicines Used for Diabetes Mellitus in
Ghana: A Systematic Search and Review of Preclinical and
Clinical Evidence
Michael Buenor Adinortey ,1 Rosemary Agbeko ,2 Daniel Boison ,1
William Ekloh,1,3 Lydia Enyonam Kuatsienu,4 Emmanuel Ekow Biney,1 Obed O. Affum,1
Jeffery Kwarteng ,1 and Alexander KwadwoNyarko5
1Department of Biochemistry, School of Biological Sciences, University of Cape Coast, Cape Coast, Ghana
2Department of Molecular Biology and Biotechnology, School of Biological Sciences, University of Cape Coast, Cape Coast, Ghana
3West Africa Centre for Cell Biology of Infectious Disease and Pathogens, Department of Biochemistry, Cell and Molecular Biology,
University of Ghana, Legon, Ghana
4Department of Pharmacology, School of Pharmacy, Princefield University College, Ho, Ghana
5Department of Pharmacology and Toxicology, School of Pharmacy, University of Ghana, Legon, Ghana
Correspondence should be addressed to Michael Buenor Adinortey; madinortey@ucc.edu.gh
Received 22 January 2019; Accepted 19 March 2019; Published 18 April 2019
Guest Editor: José C. T. Carvalho
Copyright © 2019 Michael Buenor Adinortey et al. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Background. Available data indicate that diabetesmellitus leads to elevated cost of healthcare.This imposes a huge economic burden
on households, societies, and nations. As a result many Ghanaians, especially rural folks, resort to the use of phytomedicine, which
is relatively less expensive. This paper aims at obtaining information on plants used in Ghana to treat diabetes mellitus, gather and
present evidence-based data available to support their uses and their mechanisms of action, and identify areas for future research.
Method. A catalogue of published textbooks, monographs, theses, and peer-reviewed articles of plants used in Ghanaian traditional
medicine between 1987 and July 2018 for managing diabetes mellitus was obtained and used. Results. The review identified 76 plant
species belonging to 45 families that are used to manage diabetes mellitus. Leaves were the part of the plants frequently used for
most preparation (63.8%) and were mostly used as decoctions. Majority of the plants belonged to the Euphorbiaceae, Lamiaceae,
Asteraceae, and Apocynaceae families. Pharmacological data were available on 23 species that have undergone in vitro studies.
Forty species have been studied using in vivo animal models. Only twelve plants and their bioactive compounds were found with
data on both preclinical and clinical studies. The records further indicate that medicinal plants showing antidiabetic effects did
so via biochemical mechanisms such as restitution of pancreatic 𝛽-cell function, improvement in insulin sensitivity by receptors,
stimulating rate of insulin secretion, inhibition of liver gluconeogenesis, enhanced glucose absorption, and inhibition of G-6-Pase,
𝛼-amylase, and 𝛼-glucosidase activities. Conclusion. This review contains information onmedicinal plants used tomanage diabetes
mellitus, including their pharmacological properties and mechanisms of action as well as models used to investigate them. It also
provides gaps that can form the basis for further investigations and development into useful medications for effective treatment of
diabetes mellitus.
1. Introduction both [1].There are fourmain types of diabetesmellitus: type-1,
type-2, gestational diabetes mellitus, and “other specific types
Diabetes mellitus is a metabolic and/or hormonal condition of diabetes mellitus” [2]. Inadequate management or uncon-
that is usually described by persistent hyperglycemia, as a trolled hyperglycemia manifests into signs and symptoms
result of defects in insulin secretion by pancreatic 𝛽-cells, that can also be referred to as acute complications. When
and reduced sensitivity of cell surface receptors to insulin or these signs and symptoms are overlooked or not detected
2 Evidence-Based Complementary and Alternative Medicine
early, they lead to the development of chronic complications Glucagon-like peptide-1 receptor agonists: Liraglutide.
such as hypertension, stroke, blindness, erectile dysfunction,
and kidney malfunction [3]. Amylin analogues: Pramlintide.
This metabolic disorder, which is on the ascendancy all Selective sodium-glucose cotransporter-2 (SGLT-2) in-
over theworld, is a progressive one that is found among all age hibitors: remogliflozin, etabonate (known as 189075;
groups.Theprevalence of diabetesmellitus is estimated to rise GSK), and Sergliflozin.
to 592million by the year 2035 [4]. Whiting and colleagues in Dipeptidyl peptidase-4 (DPP-4) inhibitors: Sitagliptin
2011 [5] also reported a prevalence rate of the disease inGhana and vildagliptin.
to be 4.1 % in 2011 and projected a rate of 5.0 % by 2030 to be
one of the highest in the West African subregion. According Most of these orthodox drugs used are either bedeviled
to the International Diabetes Federation, diabetes is one of with many side effects such as hypoglycemia, weakness,
the highest causes of mortality in low- and middle-income diarrhea, shortness of breath, fatigue, nausea, dizziness, lactic
countries [5]. Peer and colleagues reported in 2014 that acidosis, weight gain, increase in LDL-cholesterol levels, hep-
noncommunicable diseases would outdo infectious diseases atotoxicity and kidney toxicity, and lactic acid intoxication or
as the foremost cause of death in Africa in the next 20 are relatively expensive [9, 10]. The high cost of managing
years [6]. This is alarming and more attention needs to be diabetes mellitus compels many Ghanaians to patronize
channeled towards diabetes mellitus and its complications. herbal medicine that is less expensive. This calls for intensive
The high morbidity and mortality rate seen in this condition research to provide needed information, including the effi-
stems from factors such as rapid rise in unhealthy lifestyles in cacy and safety of these medicinal plants. Managing diabetes
diet and lack of exercise, urbanization, and aging [7]. mellitus using herbal remedies is not uncommon inGhanaian
Management of this chronic disease involves the use rural and urban communities [11]. According to WHO, the
of pharmacotherapy, exercise, and dietary therapy. Differ- number of people that choose traditional herbal medicines in
ent classes of antidiabetic pharmacotherapeutic agents have most African countries is driven by amalgamation of factors
been discovered and their selection for use in management which include economic hardships, difficult geographical
depends on the type of diabetes mellitus, age of individual, approachability of the populace to conventional antidiabetics,
response of the person, and other factors. Generally, pharma- inadequacy of healthcare systems, ease of accessibility of
cotherapy used includes (i) drugs that stimulate or facilitate herbal medicine, and indigenous knowledge of the people in
the release of insulin from the pancreatic 𝛽-islet cells, (ii) addition to the role of traditional healers [12].
those that increase the sensitivity of receptors to insulin or Ghana is endowed with a rich floral diversity and likewise
reduce insulin resistance, (iii) those that reduce the rate at rich plant ethnomedicinal tradition. Several herbal prepa-
which glucose is absorbed, and (iv) those that inhibit protein rations have been used in folklore for the management
glycation. of diabetes mellitus that are purported to possess hypo-
Currently, the different classes of orthodox drugs used glycemic effect. This assertion has heightened the interest
to manage diabetes mellitus include insulin, biguanides, in plant medicines as alternatives for orthodox medicines.
sulfonylureas, inhibitors of 𝛼-glucosidase and 𝛼-amylase, Despite the progress made in the development of plant-based
aldose reductase inhibitors, thiazolidinediones, dipeptidyl antihyperglycemic agents by many countries [13], Ghana is
peptidase-4 (DPP-4) inhibitors, carbamoylmethyl benzoic yet to fully harness its plant biodiversity for this purpose.
acid and insulin-like growth factor, Selective sodium-glucose Though Ghana has a rich history of herbal medicine usage,
cotransporter-2 (SGLT-2) inhibitors, glucagon-like peptide-1 pharmacological efficacy data on these plants are highly
receptor agonists, and amylin analogues [8]. A brief narrative fragmented, which underscores the need for compilation of
of the classes of antihyperglycemic drugs with examples is as evidence-based data on the subject. Proper documentation of
follows: these traditional medicinal plants used in managing diabetes
mellitus constitutes an important task.
Insulin: (Several generics). This review aimed to compile ethnopharmacological data
Sulfonylureas: Examples includeGlutril, Tolbutamide, on medicinal plants found in Ghana and brings together
Glibenclamide, Gliclazide, Glibenese, Glurenorm, findings available on their bioactive compounds, efficacy,
and Glimepiride. safety, and clinical trials. Information gathered is expected
Biguanide: Examples include Phenformin and Dim- to assist in preserving indigenous knowledge and biodi-
ethylbiguanide. versity and enhance awareness on medicinal plants and
consequently access to information on medicinal plants to
𝛼-Glucosidase inhibitors: Examples include Acarbose, serve as a resource to facilitate the development of new and
Voglibose, Miglitol, Emiglitate, and Precose. standardized herbal-based drugs.The availability of one-stop
Aldose reductase inhibitor: Tolrestat, Epslstat, data on antihyperglycemic plants in Ghana is crucial for
Alredase, Kinedak, Imirestat, Opolrestat, etc. identifying gaps in knowledge and stimulating research that
iazolidinediones: Examples include Rosiglitazone, could lead to identification of lead compounds. This piece
Troglitazone, Englitazone, and Pioglitazone. thus focuses on medicinal plants used in Ghana to manage
diabetes mellitus and synthesizes research findings on the
Carbamoylmethyl benzoic acid: Repaglinide. bioactive phytoconstituents and efficacy of medicinal plants
Insulin-like growth factor: IGF-1. concerned.
Evidence-Based Complementary and Alternative Medicine 3
Table 1: Summary of studies included in this review.
Characteristics of paper used Number of articles source
Ethnomedicinal report 11 Table 2
In vitromechanism 26 Table 3
In vivomechanism 53 Table 4
Clinical studies 12 Table 5
Bioactive compounds with anti-diabetic activity 12 Table 6
One study can fall into more than one grouping.
2. Method and Literature Search Strategy in Ghana for the management of diabetes mellitus. Tables
3–5 depict data for in vitro, in vivo, and clinical trials for
A catalogue of textbooks, monographs, published theses, and medicinal plants used in managing diabetes mellitus. Table 6
published peer-reviewed articles of plants used in Ghanaian provides information on plants with their corresponding
traditional medicine was sourced [14–16, 19, 21, 21, 23, 24, bioactive ingredients responsible for the hypoglycemic effect.
26, 26]. Electronic databases, namely, ScienceDirect, Scopus, Figure 1 shows chemical structures of bioactive compounds
PubMed, Springer Nature, Web of Science, and Google isolated from plants experimentally shown to possess antidi-
Scholar were used to gather information. English language abetic property. Also evidence-based data relating to in
articles were the sole source of information for this review. vitro, animal, and human studies aside from their bioactive
The key terms that were used in the search were “Anti- compounds have been described in this piece.
diabetic”, “Hypoglycemic effect”, “Ethnomedicine”, “Tradi-
tional medicine”, and “Ghana”. All retrieved articles were
reviewed to obtain the needed information on Ghana- 3.2. Preclinical and Clinical Data on Plants with Antidiabetic
ian antidiabetic medicinal plants. For each plant material Effects. Phytomedicines have been used for the management
identified to be used to treat diabetes mellitus in Ghana, of different ailments, and many populations in the world
peer-reviewed or published theses between 1987 and July depend entirely on plants medicines for their healthcare
2018 were scrutinized of which the active components needs such as management of diabetes mellitus. From the
attributed/reported to possess antidiabetic effectwere consid- ethnobotanical studies, many plants found to possess antidi-
ered. Synthesized or isolated active compounds of respective abetic activities were used for dietary purposes with no com-
plants that have been used to carry out antidiabetic studies prehension of their proper functions and active principles.
with significant success were considered. In addition, plants This practice may have continued due to their fewer side
with information on preclinical and clinical studies were effects compared to orthodox drugs.
the ones that were expatiated on. All articles accessed were Although many orthodox synthetic drugs have been
evaluated for information on methods employed by inves- developed to manage diabetes mellitus, few of them are
tigators in their studies such as preclinical in vitro, in vivo available for use inmanaging diabetesmellitus.Over 200 pure
(rodents and human) data or clinical trials and mechanism compounds from plants shown to possess antihyperglycemic
of action. Plants that did not show any marked antidiabetic effects [118] in different classes of natural products such as
effects experimentally were not included in the study. Bibli- flavonoids and alkaloids are available.
ographies of ultimately used articles were appraised for other This report presents information on plants that possess
relevant information to the type of plant extract, scientific antidiabetic properties from which bioactive compounds
names, plant part used, active principles, category of diabetes have been isolated and tested. The families of plants showing
mellitus, and disease animal model. Only peer-reviewed or some level of potency with regard to their hypoglycemic
published theses were used as sources for this piece. A effects include Passifloraceae, Liliaceae, Asphodelaceae,Meli-
summary of the main sources consulted is shown in Table 1. aceae, Cucurbitaceae, Fabaceae, Lauraceae, Costaceae, Anac-
ardiaceae, Scrophulariaceae, and Zingiberaceae.
3. Results
Allium cepa. Allium cepa, commonly known as onion, is a
3.1. Overview of Characteristics of Studies Included in is plant grown in Ghana. The bulb and leaves, which are used
Review. A summary of source of materials used for the for cooking, possess nutritional and medicinal benefits [18].
review process is shown in Table 1. A major barrier to It serves as a rich source of protein, fibre, fat, folic acid,
understanding the diversity and uses of medicinal plants sodium, vitamin C, vitamin B , and many other micronutri-
6
in Ghana has been the lack of research and available data ents [119]. The health benefits of onion include management
on these plants. In this review, efforts have been made to of a number of diseases including diabetes mellitus. Jung
gather information regarding herbs used to manage diabetes and colleagues in a study involving streptozotocin-induced
in Ghana. About ten identified plants with data on preclinical diabetic rats showed that onion peel extract improves glucose
and clinical trials met inclusion criteria and have been control and insulin resistance associated with type-2-diabetes
discussed. Information gathered is summarized in Tables mellitus [120]. Additionally, research work carried out by
2–6. Table 2 presents information on reported plants used Ojieh and colleagues [56] demonstrated the hypoglycemic
4 Evidence-Based Complementary and Alternative Medicine
Table 2: Ethnomedicinal reports of plants used in Ghana for managing diabetes mellitus.
Scientific name Family Common name Plant part Preparation Reference
Abelmoschus esculentus Malvaceae Okra Fruit Decoction [14]
Adenia lobata Engl Passifloraceae Snake Rope Stem Decoction [15]
Ageratum conyzoides L Asteraceae Goat weed Whole plant/Leaf Decoction [16–18]
Allium cepa L. Amaryllidaceae Onion Bulb Mastication [17, 18]
Allium sativum L. Liliaceae Garlic Bulb Mastication [17, 19]
Acalypha wilkesiana Euphorbiaceae Copper leaf Leaf Decoction [19]
Aloe barbadensis Asphodelaceae Aloe vera Leaf Decoction [14]
Alstonia boonei Apocynaceae Stool wood Leaf, Stem bark Tincture [14, 20]
Amaranthus viridis L. Amaranthaceae Green amaranth Leaf Decoction [16]
Anogeissus leiocarpus Combretaceae African birch Leaf, Stem bark Decoction [18]
Annona muricata L. Annonaceae soursop leaf Decoction [21]
Azadirachta indica A. Juss Meliaceae Indian Lilac tree Leaf Decoction [17, 21]
Bauhinia rufescens Lam. Fabaceae Silver butterfly tree Leaf Decoction [16]
Bridelia ferruginea Benth Euphorbiaceae Bridelia Leaf Decoction [17, 18]
Boerhavia diffusa L Nyctaginaceae spreading hogweed whole plant Decoction [21]
Bombax buonopozense Bombacaceae Gold coast Bombax Leaf Infusion [14],
Carica papaya L. Caricaceae Pawpaw Leaf Decoction [18, 21]
Cassia siamea Caesalpiniaceae Cassia tree Leaf Decoction [17]
Cassia auriculata L. Fabaceae Tanner’s cassia Flowers, Root, Seed Decoction [16]
Catharanthus roseus (L.) G. Don Apocynaceae Madagascar periwinkle Leaf Powder [16]
Cinnamomum zeylanicum Lauraceae Cinnamon Bark Mastication [17]
Clausena anisata Rutaceae Clausena Root Decoction [17]
Costus afer Ker-Gawl Costaceae Bush cane Whole plant Decoction [22]
Costus schlechteri Costaceae Hairy ginger lily Whole plant Decoction [23]
Cyperus esculentus Cyperaceae Tiger nut Fruit Mastication [22]
Ehretia cymosa Boraginaceae Ehretia Cymosa Leaf Decoction [24]
Emilia coccinea Asteraceae Emelia Entire plant Decoction [19]
Euphorbia hirta L. Phyllanthaceae asthma plant Leaf Decoction [21]
Euphorbia prostrate Aiton Euphorbiaceae Prostrate sandmat Whole plant Decoction [16]
Fleurya ovalifolium Moraceae Sand paper leaf Stinging nettle Decoction [19]
Garcinia afzelii Guttiferae Bitter cola Leaf Decoction [18]
Glyphaea brevis Tiliaceae Masquerade stick Leaf Decoction [18]
Gongronema latifolium Asclepiadaceae Bush buck Leaf Decoction [16]
Guiera senegalensis Combretaceae Moshi medicine Leaf Decoction [18]
Harungana madagascariensis Hypericaceae Dragon’s blood tree Stem bark Decoction [18]
Hoslundia opposita Lamiaceae Orange bird berry Root Decoction [18]
Hyptis suaveolens (L.) Poit Lamiaceae Pignut Leaf Decoction [16]
Indigofera arrecta Papilionoideae African indigo Leaf Decoction [18]
Ipomoea sepiaria Roxb. Convolvulaceae Purple Heart Glory Leaf Decoction [16]
Jatropha curcas Euphorbiaceae Barbados Leaf Decoction [18]
Khaya senegalensis Meliaceae African mahogany Stem bark Decoction [17]
Kigelia Africana (Lam) Benth Bignoniaceae Sausage Tree leaf, stem bark, fruit and roots Decoction [19]
Launaea taraxacifolia Asteraceae African Lettuce Leaf Decoction [14, 18, 21]
Evidence-Based Complementary and Alternative Medicine 5
Table 2: Continued.
Scientific name Family Common name Plant part Preparation Reference
Lagerstroemia speciosa Lythraceae Giant crepe-myrtle Leaf Decoction [19]
Mangifera indica L. Anacardiaceae Mango Leaf Stem bark Decoction [18, 21]
Mimosa pudica L. Fabaceae Touch- Me-Not Leaf Tincture [16]
Mollugo nudicaulis Lamk. Molluginaceae Naked- stem carpetweed Whole plant Decoction [16]
Mitragyna inermis O. Kuntze Rubiaceae Not known leaf Decoction [21]
Morinda citrifolia L. Rubiaceae Noni Fruit Decoction [21]
Morinda lucida Rubiaceae Brimstone tree Root Decoction [18]
Moringa oleifera Moringaceae Moringa Leaf Decoction [17]
Momordica charantia Cucurbitaceae bitter gourd Whole plant Infusion [14, 17, 18, 21]
Myrianthus arboreus P. Beauv Urticaceae Monkey fruit Stem bark Decoction [23]
Newbouldia laevis Bignoniaceae Sesemasa Leaf Decoction [19]
Ocimum canum Sim Lamiaceae Basil Leaf Decoction [23]
Ocimum gratissimum Lamiaceae clove basil leaf Decoction [23, 25]
Phyllanthus amarus Schum. Euphorbiaceae Stonebreaker or seed-under-leaf Leaf Decoction [16, 17]
Paullinia pinnata Griseb Sapindaceae Tietie Leaves Decoction [21]
Phyllanthus fraternus Euphorbiaceae Quinine weed Leaves Decoction [17]
Rauvolfia vomitoria Apocynaceae poison devil’s-pepper Leaf Decoction [19]
Scoparia dulcis Scrophulariaceae Sweet broom Dried leaves Decoction [17, 18]
Securinega virosa Euphorbiaceae Snow berry tree Leaves Decoction [18]
Senna siamea (Lam) H.S. Fabaceae Yellow cassia Leaves Root Infusion decoction [17, 21]
Senna occidentalis Fabaceae Coffee weed Stem bark, Leaves Infusion [16, 19, 26]
Sida acuta Burm. f Malvaceae broomweed Leaves Decoction [16, 18]
Sesamum indicum L. Pedaliaceae Sesame seed powder [21]
Solanum torvum Solanaceae Turkey berry fruit Decoction [19]
Saccharum officinarum L. Poaceae sugar cane stem Decoction [21]
Stachytarpheta indica Verbenaceae Blue vervain Leafy stem, Leaves, Flowers Decoction [19]
Strychnos spinosa Lam. Loganiaceae Monkey orange Leaves Decoction [18]
Tapinanthus banguensis Loranthaceae Mistletoe Young stems, leaf Decoction [19]
Trema orientalis Ulmaceae Charcoal tree Leaves Decoction [14, 17]
Talinum triangulare Portulacaceae Water leaf Leaf Decoction [19]
Vernonia amygdalinaDelile. Asteraceae Bitter leaf Leaves and Root Decoction [14, 16, 17, 21]
Vernonia conferta Asteraceae Cabbage tree Root and bark Decoction [14, 18]
Zingiber officinale Zingiberaceae Ginger Root Mastication [14, 17]
6 Evidence-Based Complementary and Alternative Medicine
Table 3: Reported in vitro studies of plants used for the management of diabetes mellitus in Ghana.
Scientific Name Part used Mode of action Reference
Abelmoschus esculentus Okra pod 𝛼-amylase inhibitory activity [27]
Abelmoschus esculentus Peel and Seed 𝛼-amylase and 𝛼- glucosidase inhibitory activity [28]
Alstonia boonei Stem bark, flower 𝛼- glucosidase, 𝛼- amylase inhibitory activity [29]
Anogeissus leiocarpus Leaves 𝛼-amylase and 𝛼- glucosidase inhibitory activity [30]
Cassia auriculata Seed, Whole plant 𝛼-amylase and 𝛼- glucosidase inhibitory activity [31]
Cassia siamea Leaves 𝛼-glucosidase inhibitory activity [32]
Catharanthus roseus Leaves alkaloid (vindolicine) exerted high hypoglyceamic activity [33]
Clausena anisata Leaves inhibition on 𝛼-amylase and G-6-Pase activity [34, 35]
Costus afer Ker-Gawl Leaf, Stem and Rhizome 𝛼-amylase and 𝛼- glucosidase inhibitory activity [36]
Cyperus esculentus Tuber 𝛼-amylase and 𝛼- glucosidase inhibitory activity [37]
Ehretia cymosa Leaves competitive and non-competitive inhibition on 𝛼-amylase and 𝛼- glucosidase respectively [38]
Ipomoea sepiaria Koenig Ex. Roxb Leaves anti-hyperglycemic property [39]
Launaea taraxacifolia Leaves 𝛼- glucosidase inhibitory activity [40]
Mangifera indica Leaves Exerts insulin like action [41]
Mangifera indica Leaves 𝛼-amylase and 𝛼- glucosidase inhibitory activity [42]
Mimosa pudica Aerial part 𝛼-amylase and 𝛼- glucosidase inhibitory activity [43]
Mimosa pudica Whole Plant 𝛼-amylase inhibitory activity [44]
Moringa oleifera Leaves 𝛼-amylase and 𝛼- glucosidase inhibitory activity [45]
Myrianthus arboreus Stem bark 𝛼-amylase and 𝛼- glucosidase inhibitory activity [46]
Ocimum canum Leaves increase insulin release from 𝛽-islet cells [47]
Scoparia dulcis Ariel part 𝛼-amylase and 𝛼- glucosidase inhibitory activity [48]
Securinega Virosa Root anti-hyperglyceamic activity [49]
Sida acuta Leaves 𝛼-amylase inhibitory activity [50]
Strychnos spinosa Leaves 𝛼- glucosidase inhibitory activity [40]
Khaya senegalensis Stem bark, Root and Leaves 𝛼-amylase and 𝛼- glucosidase inhibitory activity [51]
Zingiber officinale Rhizome 𝛼-amylase and 𝛼- glucosidase inhibitory activity [52]
Evidence-Based Complementary and Alternative Medicine 7
Table 4: Reported in vivo studies of medicinal plants used for the management of diabetes mellitus in Ghana.
Scientific Name Part used Method Observation Reference
Abelmoschus esculentus Peel and Seed Streptozotocin induced exert blood glucose normalization and lipid profiles lowering activity [28]
Adenia lobata Stem Streptozotocin induced provide protective mechanism against reactive oxygen species associated withchronic hyperglyceamia and diabetic complications [15]
Ageratum conyzoides Leaves Glucose induced exert extra pancreatic action by stimulating insulin secretion [53]
Ageratum conyzoides Leaves Streptozotocin induced possess blood glucose lowering effect [54]
Allium cepa Bulb Alloxan-induced Stimulates insulin release and action to enhance glucose cellular uptake andutilization [55]
Allium cepa Bulb Streptozotocin induced Ameliorate possible complications associated with diabetes mellitus. [56]
Allium sativum Bulb Streptozotocin-induced Restores delayed insulin response by reacting with endogenous thiol containingmolecules [57]
Aloe barbadensis Leaves Alloxan induced useful and safe agent in reducing hyperglycemia induced by alloxan [58]
Alstonia boonei Leaves Alloxan induced exert significant antidiabetic activity [59]
Alstonia boonei Stem bark Streptozotocin-induced inhibit the activity of glucogenic enzymes [60]
Amaranthus viridis Leaves Streptozotocin-induced inhibit the activity of glucogenic enzymes and restore 𝛽-cell function [61]
Amaranthus viridis Stem Streptozotocin-induced protective potential against glucogenic enzymes [62]
Amaranthus viridis Whole plant Streptozotocin-induced increased uptake of glucose for glycogen synthesis [63]
Bauhinia rufescens Leaves Alloxan induced exert significant antidiabetic activity [64]
Bridelia ferruginea Leaves Sucrose-induced Improves insulin sensitivity [65]
Cassia auriculata Flower Streptozotocin induced extract enhances the utilization of glucose through increased glycolysis [66]
Cassia auriculata Leaves Streptozotocin induced exert insulinogenic action [67]
Cassia auriculata Whole plant Streptozotocin induced exert significant antidiabetic activity [31]
Cassia auriculata Flower Alloxan induced ethanolic extract possesses hypoglycemic activity [68]
Cassia occidentalis Whole plant Alloxan induced exert significant antidiabetic activity [69]
Carica papaya Leaves Streptozotocin induced Restores pancreatic islet cell function [70]
Catharanthus roseus Leaves, Stem Root, flower Alloxan induced aqueous stem extract depicted best hypoglyceamic activity [71]
Catharanthus roseus Leaves Streptozotocin induced increase insulin sensitivity [72]
8 Evidence-Based Complementary and Alternative Medicine
Table 4: Continued.
Scientific Name Part used Method Observation Reference
Catharanthus roseus Leaves Alloxan restores pancreatic 𝛽-cell function [73]
Clausena anisata Root Streptozotocin induced secondary metabolites responsible for the hypoglycemic effect [74]
Costus afer Ker-Gawl Stem, leaf Alloxan induced hypoglycemic, protective potential and regenerative effect on pancreas [75, 76]
Ehretia Cymosa Whole plant Streptozotocin induced hypoglycemic effects [24]
Glyphaea brevis Leaves Oral starch tolerance 𝛼-amylase inhibitory properties coupled to control of body weight [77]
Gongronema latifolium Leaves Alloxan induce pancreatic cell regeneration [78]
Gongronema latifolium Leaves Alloxan ameliorate oxidative stress associated with diabetes mellitus [79]
Guiera senegalensis Leaves Glucose induced stimulate insulin production and glucose utilization [80]
Hoslundia opposita Leaves Alloxan ameliorative effect on Type 2 diabetic patients and associated complication [81]
Hyptis suaveolens (L.) Poit Leaves Streptozotocin induced exerts additive hypoglycemic effect with antioxidant [82]
Indigofera arrecta Leaves Streptozotocin induced insulinotropic effect [83]
Ipomoea sepiaria Roxb. Leaves Streptozotocin induced restore glucose levels to near normal level [39]
Mangifera indica Leaves Alloxan induced Insulin like effect by Inhibiting hepatic gluconeogenesis or glucose absorption inmuscles or adipose tissues [84]
Mangifera indica Leaves Streptozotocin induced 𝛼-amylase and 𝛼- glucosidase inhibitory activity [85]
Mimosa pudica L Leaves Alloxan induced exerts hypoglycemic effect [86]
Mimosa pudica L whole plant Streptozotocin induced stimulates insulin secretion by the regeneration of pancreatic 𝛽-cells [87]
Mollugo nudicaulis whole plant Alloxan induced increase release of insulin from Pancreatic 𝛽 -cells [88]
Morinda Lucida Leaves Streptozotocin induced glucose lowering property [89]
Momordica charantia Fruit Streptozotocin induced stimulates insulin secretion by the regeneration of pancreatic 𝛽-cells [90, 91]
Myrianthus arboreus P.
Beauv Stem bark Streptozotocin induced exerts hypoglycemic effect [92]
Ocimum canum Sim Leaves C57BL/KsJ db/db enhanced insulin release genetically modified from pancreatic 𝛽 –cells diabeticanimal [47]
Ocimum gratissimum Leaves Streptozotocin induced exerts hypoglycemic effect [25]
Pergularia daemia Leaves Alloxan induced restores pancreatic 𝛽 –cells function [93]
Phyllanthus amarus Whole plant Alloxan exerts hypoglycemic effect [94]
Phyllanthus fraternus Whole plant Alloxan induced possess antidiabetic and antioxidant activity [95]
Scoparia dulcis Ariel part Streptozotocin-induced possess antidiabetic and antioxidant activity [48]
Securinega virosa Leaves Streptozotocin-induced hypoglycemic activity [96]
Trema orientalis Stem bark Streptozotocin induced Sensitize insulin receptors or stimulate 𝛽 cells of the Islet of Langerhans in thepancreas [97]
Zingiber officinale Bulb Streptozotocin and alloxaninduced diabetes mellitus exhibits hypoglycemic activity in both normal and diabetic rats [98, 99]
Evidence-Based Complementary and Alternative Medicine 9
Table 5: Clinical studies on medicinal plants used in Ghana for the management of diabetes mellitus.
Scientific name Part/form Disease type Observation Reference
Allium cepa Aqueous extract Type 2 regulates blood glucose and lipids levels to normal [100]
Allium sativum Bulb (Garlic tablet) Type 2 Inhibits insulin inactivation by thiol groups as well as advance glycation endproducts [101]
Allium sativum Capsule Type 2 significant effect on improvement of glycemic status with lowering fasting bloodglucose level and postprandial blood glucose level [102]
Allium sativum Aqueous extract Type 2 regulates blood glucose and lipids levels to normal [100]
Aloe barbadensis Pulp Types 1&2 Aloe vera treatment with glibenclamide depicted significant decrease in glucose level [103]
Cinnamomum zeylanicum Bark Type 1 Improves insulin potentiating activity [104]
Guiera senegalensis Aqueous extract Type 2 regulates blood glucose and lipids levels to normal [100]
Indigofera arrecta Aqueous leaves extract Types 1&2 significant change in fasting blood glucose level [105]
Momordica charantia Vegetable (V-insulin) Idiopathic Type hypoglyceamic effect in only diabetic patients [106, 107]
Zingiber officinale Root Type 2 Increase insulin receptors and enhance 𝛽- cell function to decrease insulinresistance [98]
Zingiber officinale Ginger powder Type 2 Promotes glucose clearance in insulin responsive peripheral tissues [108]
10 Evidence-Based Complementary and Alternative Medicine
Table 6: Plant bioactive constituents used experimentally in diabetes mellitus.
Scientific name Part used Active ingredient Reference
Adenia lobata Stem bark Palmitic acid [109]
Allium cepa Bulb Allyl propyl disulphide [17]
Allium sativum Bulbs Allyl propyl disulphide, allicin [110]
Aloe barbadensis Leaf Lophenol, 24-methyl lophenol 24-methylene cycloartenol, Cycloartenol, 24-ethyl lophenol [111]
Azadirachta indica Leaves, flowers & seed Nimbidin, 𝛽-sitosterol [17]
Cassia auriculata Flower 𝛽-sitosterol [67, 112]
Cinnamomum zeylanicum Bark Cinnamaldehyde, eugenol [113]
Costus afer Ker Gawl Whole plant Diosgenin [114]
Mangifera indica Leaf, stem bark, fruit Mangiferin [85]
Momordica charantia Leaves, whole plant, fruit Charantin, momordicin, Oleanolic acid, vicine [115]
Scoparia dulcis Whole plant Apigenin, luteolin, scoparic acid D coxicol, glutinol [17, 116]
Zingiber officinale Bulb Gingerol [117]
Evidence-Based Complementary and Alternative Medicine 11
S S OS S H
O S
O
Allyl propyl disulphide O
Allicin NH H
S-Allylcysteine Sulphoxide
OH O
O
＃（3
HO O N O HO O
（3＃ O
OH O O
OH
Apigenin Charantin Cinnamaldehyde
OH
O O
（ ＃ S S H3
O S H
O HDiallyl trisulphide H
NH O H
Coxicol
Diosgenin
O
＃（2 HO
H
H O
H
H OHH
HO
H HO O ＃（3
24-ethyl lophenol Eugenol Gingerol
H
OH O
O
H
H H HO O
H
H H OH
OH
HO H
Glutinol Lophenol Luteolin
Figure 1: Continued.
12 Evidence-Based Complementary and Alternative Medicine
OH
O HO
OH
HO
O HO O H
HO O H H
H
HO HO
H
H
OH HH O
HO H OH H
Mangiferin 24-Methylenecycloartanol
Momordicin
H O
O
H H H O O
N H H
H S O
O H
H O
H
H O O
HO
H H H S-Methylcysteine Sulphoxide O
O
24-Methyl Lophenol Nimbidin
H
H O
H
O H
O HO
H O OO H
H O O
O Palmitic acid
O O H
H O H H H
Oleanolic acid N
H
N N
H
O N
OH H
H O O HO
H
O O
H
H H O H
HOOC OH HHO
Vicine
Scoparic acid D Beta-sitosterol
Figure 1: Chemical structures of isolated compounds listed in Table 6.
Evidence-Based Complementary and Alternative Medicine 13
effects of Allium cepa and its ability to ameliorate complica- [131]. Alloxan induced diabetic rats put on a diet containing
tions associated with diabetes mellitus. Babu and Srinivasan garlic for a period of 15 days recorded a significant reduction
[121] also reported that feeding onion powder-containing in blood glucose as compared to the control group [132].
diet to diabetic animals produces marked reduction in their Oral administration of diet containing ajoene (obtained from
hyperglycaemic status. Petroleum ether extract of onion garlic) for two months was also reported to reduce blood
was demonstrated to reduce blood glucose levels in normal glucose in genetically transformed diabetic mice [133]. Garlic
rabbits. Prolonged addition of freeze-dried onion powder in oil and diallyl trisulfide given for 3 weeks to diabetic rats
the diet of STZ-diabetic rats produced antihyperglycemic, markedly elevated the basal insulin levels and also increased
hypolipidemic, and antioxidant effects [122]. Kelkar and its sensitivity [134]. Oral administration of S-allyl cysteine
colleagues also reported a higher hypoglycemic potential of sulphoxide isolated from garlic to alloxan diabetic rats for
onion callus cultures over natural onion bulb [123]. Onion onemonth ameliorated hyperglycaemia in treated rats, which
juice administered to alloxan induced diabetic rats for a was comparable to glibenclamide and insulin treated rats
period of one month showed characteristics of antihyper- [125]. Furthermore, S-allyl cysteine sulphoxide was reported
glycemia [124]. to significantly stimulate insulin secretion from beta cells
The presence of quercetin, allyl propyl disulphide oxide isolated from healthy rats [135]. Intraperitoneal injection
(dipropyl disulphide oxide), S-methylcysteine sulphoxide, and oral administration of Bis (allixinato) oxovanadium
and S-allyl cysteine sulphoxide in onion is reported to be (IV) to type-1-diabetic mice showed potential as a potent
responsible for the drop in glucose level and lipid profile. antidiabetic agent [136]. According toMathew et al. [137], oral
Allyl propyl disulphide oxide also aids in insulin secretion [14, administrations of 0.25 mg of allicin to mild diabetic rabbits
120]. S-allyl cysteine sulphoxide from onion also markedly exhibited pronounced antihyperglycemic effect.
decreased blood glucose level of diabetic rats [125]. Daily A clinical study has confirmed that garlic improves
oral administration of about 200mg of S-methylcysteine glycemic status by decreasing fasting blood glucose concen-
sulphoxide for 45 days to alloxan diabetic rats controlled their tration and postprandial blood glucose level in humans [102].
blood glucose and lipid levels. The same study also reports According to Miron et al. [110], allicin acts to restore delayed
improvement in the activities of liver glucose-6-phosphatase, insulin response by reactingwith endogenous thiolmolecules
hexokinase, and HMG CoA reductase. The observed effect and to lower insulin resistance in diabetic patients. It has
of S-methylcysteine sulphoxide was analogous to that of the ability to freely permeate through phospholipid bilayers
insulin and glibenclamide [126]. Oral administration of of membranes and this enhances its intracellular interaction
S-methyl cysteine sulphoxide to alloxan diabetic rats for with thiols. Toxicity studies have shown that excessive intake
one-month period ameliorated hyperglycaemia and was of garlic is considered toxic due to the sulphone hydroxyl
similar to animals treated with glibenclamide and insulin ion constituent. This constituent is capable of penetrating
[121]. the blood-brain barrier and can cause damage to brain
In a clinical study of individuals with diabetes mellitus cells. A study by Johnson et al. [138] on alloxan induced
administered with juice of onion bulb, a decrease in blood diabetic Wistar rats demonstrated that high doses of garlic
glucose concentration was observed [127]. Our search did extract greater than 400-mg/kg body weight per day induced
not find any published work on any reported case of adverse morphological changes that presented severe threats to the
toxicity associated with the consumption of onion. Mean- heart, kidney, and liver of Wistar rat. However, low doses of
while there are reports of unfavorable effects of excessive 250-350mg/kg body weight/day had no deleterious effects on
intake such as abdominal bloating, heartburn, hypotension, the organs mentioned. Raw garlic is reported to also promote
allergies, and bad breath [128]. botulism, inhibit blood clotting, and trigger allergic reactions
by the skin and mucous membrane [17].
Allium sativum. Allium sativum commonly known as garlic
is one of the oldest known medicinal spices in existence. Aloe vera (Aloe barbadensis).This plant is commonly referred
It is cultivated all over Ghana. It is used to manage many to as Aloe. Aloe barbadensis: the plant is widely dis-
disorders, which include diabetes mellitus. The bulb is tributed, cultivated, and used in many homes in Ghana
washed, dried, and chewed as required for the management for several purposes. It is believed to have originated
of diabetes mellitus [18]. The cloves of the plant are reported from Sudan. The sap consists largely of D-glucose, D-
to possess a sulphur-containing chemical compound called mannose, tannins, steroids, phytosterols [lophenol, 24-
allicin that is also responsible for its pungent smell [128].The methyl-lophenol, 24-ethyl-lophenol, cycloartenol, and 24-
bulb is reported to contain other principles such as S-allyl methylene-cycloartanol], amino acids, vitamins, and miner-
cysteine sulphoxide, allicin, Bis (allixinato) oxovanadium als. Fresh aloe juice from the inner leaf parenchyma contains
(IV), vitamins C and B , and manganese [128, 129]. 96 % water.
6
Administration of extract of garlic orally to normal and Dry sap of the plant produced conspicuous antihyper-
STZ-diabetic rats daily for 5 weeks controlled hyperglycemia glycemic response in alloxan induced diabetic albino mice
[130]. A study by Kumar et al. [101] found that garlic [139]. Aloe vera leaf pulp extract showed antihyperglycemic
plus metformin treatment in patients with type-2-diabetes activity on both types of diabetes in rat models, with the
mellitus for a duration of 12 weeks produced a drastic decline outcome enhanced in type-2-diabetes compared with the
in blood glucose level. In alloxan induced diabetic rabbits, positive control-glibenclamide [140]. Extracts of aloe vera
different solvent extracts produced antihyperglycemic effect orally administered produced antihyperglycemic activity in
14 Evidence-Based Complementary and Alternative Medicine
oral glucose fed and STZ-diabetic rats [141]. Oral adminis- mellitus, polypeptide-p obtained from fruit, seed, and tissue
tration of ethanolic extract to diabetic rats for three weeks exhibited antihyperglycemic effects with no adverse reactions
resulted in a conspicuous decrease in fasting blood glucose [153].
along with enhanced plasma insulin levels [142]. Oral admin- Data available shows that extracts and the main isolated
istration of aloe vera gel extract for three weeks to diabetic bioactive compounds [charantin, vicine, polypeptide-p, and
rats ensued in a substantial reduction of blood glucose and momordicin] from Momordica charantia are considered to
improved the plasma insulin level [141]. Aqueous leaf extract produce their antidiabetic effects through diverse physiolog-
of Aloe vera was reported to be useful and safe for reducing ical and biochemical processes [145].
blood glucose levels in alloxan induced diabetes mice [58]. The ethanolic extract of the fruit is reported to be safe in
Administration of some phytosterols isolated from aloe vera Sprague-Dawley rats at 2000mg and below, whereas doses
to type-2-diabetic mice for 28 days resulted in a reduction in higher than 2000mg could pose safety problems to delicate
blood glucose levels [111, 143]. A clinical study reported that organs like the liver [154]. The seeds have been shown to
oral administration of aloe vera was beneficial in lowering decrease fertility in male Wistar rats and also produce side
blood glucose concentration in diabetic patients [104, 144]. effects such as fever and coma. Momordica charantia is also
It could be adduced that the antihyperglycemic effect of aloe reported to induce abortion in pregnant women [155]; thus
vera and its principles may be through stimulating synthesis care must be taken in usage.
and/or release of insulin from the beta cells.
Cinnamomum zeylanicum. Cinnamon is a spice derived from
Momordica charantia. This plant commonly referred to as the stems of the C. zeylanicum tree. It is widely used in
bitter gourd is an annual climber grown in Ghana for use as food preparations as a spice particularly in baking and for
vegetable. It has a wide array of medicinal uses; however it culinary purposes.The plant is not only used formaking food
is widely known for its use in the management of diabetes taste better, but also used as home remedies and medicines.
in Ghana. In Ghanaian traditional medicine, the aerial part The dried bark has golden-yellow colour with pungent taste
is crushed and boiled and the strained liquid drunk as and scent due to the active constituent cinnamaldehyde
required [18]. Research has shown that [115, 145] bitter gourd and eugenol [113]. Cinnamon is reported to reduce blood
extracts from the fruit, seeds, and leaves contain several glucose through decrease of insulin resistance and upsurge
bioactive compounds that have hypoglycemic activity in both in the rate of hepatic glycogenesis [156, 157]. Cinnamaldehyde
diabetic rats and humans. The hypoglycemic ameliorative possesses antioxidant and antidiabetic properties. Moreover,
effects of the fruit extract of the plant are reported to be cinnamaldehyde demonstrated antihyperglycemic and anti-
closely linked to the increase in hepatic glycogen, peripheral hyperlipidemic effects in rodent models [158]. Cinnamalde-
tissue’s glucose transporter (GLUT-4) expression, and higher hyde is also reported to markedly and dose-dependently
insulin sensitivity through downregulating the expression decrease plasma glucose concentration in streptozotocin-
of suppressor of cytokine signaling 3 (SOCS-3) and c- induced diabetic rats [113]. All these evidence supports
Jun N-terminal kinase (JNK) [90]. Fruit aqueous extract the fact that cinnamaldehyde from cinnamon extract is a
administered orally for 6 weeks with exercising decreased potential antidiabetic agent and thus more research is needed
blood glucose of type-2 diabetic rats [146]. Blood glucose in that direction.
level dropped when about 4000mg of Momordica charan- Clinical investigation shows that cinnamon is useful
tia fruit extract was orally used to treat alloxan diabetic in the management of both type-1 and type-2 diabetes
rats for 8 weeks [147]. Seed aqueous extract showed con- mellitus [159]. Daily consumption of cinnamon regulates
spicuous decrease in blood glucose, glycated haemoglobin, high triglyceride or cholesterol levels tremendously. It also
glucose-6-phosphatase, lactate dehydrogenase, fructose-1, 6- aids in controlling elevated glucose level in type-2 diabetic
bisphosphatase, and glycogen phosphorylase coupled with a patients. Toxicity studies conducted with ethanolic extracts
rise in glycogen content, hexokinase, and glycogen synthase of C. zeylanicum bark did not exert any observable adverse
activities [148]. Ethanolic extract of Momordica charantia effects. Although the ethanolic extracts of C. zeylanicum bark
also produced antihyperglycemic effects in streptozotocin have no reported acute or chronic oral toxicity in mice, it has
diabetic rats [149]. been reported to cause reduction in liver weight as well as
Bioactive principles reported to be found in Momordica haemoglobin levels [160].
charantia are charantin, oleanolic, vicine, and momordicin
[115]. Charantin, a sterol isolated from Momordica charan- Costus afer Ker-Gawl. Costus afer Ker-Gawl (bush cane or
tia seeds, induced hypoglycemic effect by stimulating the ginger lilly) is herbaceous monocot, tropical plant with
release of insulin [150]. Momordica charantia has also been creeping rhizome commonly found in moist and shady forest
reported to inhibit gluconeogenesis [151]. Its antidiabetic of West and Tropical Africa. It is often planted in home
effect is similar to sulfonylurea-like medicines. According gardens. The leaves are edible and the rhizome is sometimes
to Matsuda et al. [152], an experiment conducted using rat used as a spice. In Ghana, all parts of the plant are used in
intestine showed that oleanolic acid and momordin from the traditional medicine, but the stem is the part mostly used
plant exhibit antihyperglycemic activity through inhibition of for treatment of diabetes [75]. In an alloxan induced rat,
glucose transport in the intestine. These compounds could there was a marked reduction in the blood glucose level
be considered for use as dietary supplements for people with when Costus afer aqueous leaf extract with concentrations
diabetes mellitus. In a clinical study of people with diabetes 375, 750, and 1125mg/kg and control drug (glibendamide
Evidence-Based Complementary and Alternative Medicine 15
(5mg/kg)) were orally given [76]. A dose of 375mg/kg of the glucosidase inhibitory activity. Intraperitoneal administra-
extract had a preservative effect on 𝛽-cells [161]. This report tion of aqueous extract of stem bark produced a marked
is consistent with work by ThankGod et al. [162] that also antihyperglycemic effect in streptozotocin-induced diabetic
reported on the regeneration of islet cells on administration rats in a dose dependent manner. The oral administration of
of Costus afer stem extract to streptozotocin-induced rats. peel extract to streptozotocin-induced diabetic rats exhibited
Moreover, the oral administration of 750 and 1125mg/kg of a significant antidiabetic effect [168].
Costus afer extract produced a more prominent regeneration Bioactive compound, mangiferin (MGF), mostly found
of pancreatic islet cells and exocrine cell [163]. This therefore in the leaves is reported to have alpha amylase and alpha
indicates that C. afer extract has a pancreatic (islet cells) glucosidase inhibitory effects [85]. Furthermore, mangiferin
curative property, which could help manage type I diabetes is reported to have antidiabetic as well as hypolipidemic
mellitus.This was consistent with the histopathological study potential effects in type-2-diabetic model rats. MGF inhibits
ofCostus afer extract on damaged pancreatic cells as reported anaerobic metabolism of pyruvate to lactate but enhances
by Ezejiofor et al. [161].When stem extract was orally given to pyruvate oxidation suggesting that one of the targets of
streptozotocin-induced rat, there was amarked drop in blood MGF is pyruvate dehydrogenase [169]. These observations
glucose level at extract dosage of 500, 1000, and 1500mg in a highlight the therapeutic potential of activation of carbo-
concentration dependent manner [164]. In an in vitro study hydrate utilization in the correction of metabolic syndrome
of the effect of solvents [hexane, ethyl acetate, methanol, and and emphasize the potential of MGF to serve as a model
water] extracts of Costus afer stem, leaf, and rhizome on the compound that can elicit fuel-switching effects. Mangiferin,
activity of 𝛼-glucosidase and 𝛼-amylase activity, there was a a polyphenol isolated from M. indica, significantly prevents
significant inhibition of the enzymes. Ethyl acetate rhizome progression of diabetic nephropathy and improves renal
and methanolic leaf extract showed the highest inhibitory function in diabetic nephropathy rat model and cultured
effect of the activity of the aforementioned enzymes with an rat mesangial cells [170]. Implicitly mangiferin is likely to
IC value of 0.10 and 5.99mg/mL [36]. possess beneficial effects in the management of type-2-
50
The stem and seeds are reported to contain several diabetes mellitus with hyperlipidemia.
steroids and sapogenins; thus, diosgenin, saponins aferosides
A-C, diosin, parphyllin c, flavonoid, and glycoside with dios- Scoparia dulcis. Scoparia dulcis, commonly referred to as
genin are the most potent [75]. Diosgenin ameliorates insulin sweet broomweed, is an annual erect herb with many medici-
resistance by increasing glucose usage and intracellular glyco- nal uses. It is a rich source of flavones, terpenes, and steroids.
gen synthesis [165]. This is achieved by restoring pancreatic Some compounds found include coxicol, glutinol, scoparic
𝛽-cell function, alteration of hepatic enzymes, enhancement acid D, luteolin, and apigenin; they are the main constituents
of adipocyte differentiation, inhibition of macrophage infil- found in the leaves and they have various pharmacological
tration into adipose tissue, and decreased expression of activities. The whole plant is used as a remedy for many
inflammatory genes [165]. It is also reported to decrease the ailments including diabetes mellitus.The fresh or dried leaves
expression of the C/EBP homologous protein (CHOP) lead- are used to manage hypertension and diabetes mellitus [171].
ing to reduced stress of endoplasmic reticulum in pancreatic In Ghanaian traditional medicine, the dried leaves are boiled
𝛽-cells. with water and strained and the decoction is drunk when
Also the effectiveness of diosgenin as an antidiabetic needed [17].
agent was evident by its effect on the renal antioxidant system An in vitro study performed to assess the 𝛼-amylase
and oxidative markers such as myeloperoxidase and lipid and 𝛼-glucosidase inhibitory potentials of the plant extract
peroxidation. Diosgenin is reported to exhibit a protective showed that the methanol extract of Scoparia dulcis effec-
effect on the kidney of diabetic rats and therefore serves as tively reduces postprandial glucose levels [172]. Investiga-
a potential candidate for treatment of diabetes mellitus with tion of the effect of the aqueous extract of Scoparia dulcis
renal associated problems [165, 166]. There is no reported on streptozotocin-induced diabetes mellitus showed that
toxic effect of diosgenin isolated from Costus afer in liver. the plant extract-mediated reduction in blood glucose was
Meanwhile a study conducted by Ezejiofor et al. [167] to significant and was similar to that of glibenclamide [173].
investigate the subchronic toxic effect of the aqueous extract According to Latha et al. [174], Scoparia dulcis possesses
of Costus afer leaves on the liver and kidney of albino rats insulin-secretagogue activity. The administration of an aque-
reported that it may be toxic to the liver but not to the kidney. ous extract of Scoparia dulcis to streptozotocin diabetic rats
This implies that much work needs to be done to provide at a dose of 200mgmarkedly reduced the blood glucose with
more information on its toxicological effects. significant increase in plasma insulin level during a 15-day
period of treatment. The mechanisms of action of Scoparia
Mangifera indica. Mango is a delicious and succulent fruit dulcis plant extracts possessing antidiabetic effect have also
that has immense health benefits. It is popular in every been reported. According to Latha et al. [174], the antidiabetic
part of the world including Ghana due to its delicious fruit. activity of the aqueous extracts of S. dulcismay be attributable
It is the major traditional fruit that is exported from the to its insulin-secretagogue activity. Also, S. dulcis imparts its
country. The leaf is traditionally used to treat diabetes in antidiabetic effects via altering the levels of many antioxidant
Ghana. Traditionally, a decoction of the leaves is drunk after enzymes and enzymes of the polyol pathway. In fact, Latha et
meals [17]. Ganogpichayagrai et al. [42] demonstrated that al. showed, using streptozotocin-induced diabetic rats, that
leaf extract of mango tree possesses alpha amylase and alpha the aqueous extract of S. dulcis significantly decreases the
16 Evidence-Based Complementary and Alternative Medicine
level of sorbitol dehydrogenase while increasing the levels of following consumption of ginger. High dose of ginger can
the antioxidant enzymes [173]. Beh et al. [175] demonstrated also interact with certain drugs such as warfarin used in the
using L6 rat myoblasts (CRL-1458) that the TLC fraction treatment of heart condition and increase their effect to result
seven of the aqueous extract of S. dulcis possesses glucose in symptoms such as irregular pulse, palpitations, confusion,
uptake activity comparable to that of insulin. loss of appetite, diarrhea, nausea, and vomiting. Large doses
Luteolin, a flavonoid isolated from Scoparia dulcis, is may also cause dizziness andminor sedation and increase the
reported to inhibit alpha glucosidase better than acarbose, a risk of bleeding in women as well [17].
standard drug. Luteolin, an active constituent in the leaves
of Scoparia dulcis, is reported to improve hepatic insulin
sensitivity by suppressing expression of sterol regulatory 4. Discussion
element-binding transcription protein 1 (SREBP1) that mod-
ulates insulin receptor substrate 2 (Irs2) expression through The adoption of a Western lifestyle and urbanization is cited
its negative feedback and gluconeogenesis. Scoparic acid as a major cause for the tremendous increase in metabolic
D has also been reported to possess antidiabetic effects diseases such as diabetes mellitus in Africa, including Ghana
[176]. [183]. Currently, there is no known cure for diabetes mellitus
The data supports the traditional use of Scoparia dulcis despite the availability of various classes of pharmacological
as an antidiabetic medicinal plant. Furthermore, luteolin and agents for management of diabetes mellitus. Currently, issues
apigenin, flavonoids of Scoparia dulcis, have been shown to related to efficacy, safety, and affordability of existing phar-
influence glucose metabolism by activating the transcription macological agents for management of diabetes are driving
factor FOX O1 (forkhead-box gene O1) in human cells [177, patients to turn to complementary and alternate medicine
178]. (CAM), including plant medicines for the management ofdiabetes mellitus. Indeed, it has been estimated that up to
Zingiber officinale. Ginger is one of the most ancient spices one-third of diabetic patients use CAM to manage their
cultivated for its edible rhizome.The rhizome serves a variety condition. A growing number of phytomedicines and their
of purposes including culinary and medicinal applications. chemical constituents have been studied in the treatment
Medicinal properties attributed to ginger include hypolipi- of diabetes mellitus. Despite the increased use of phy-
demic, hypocholesterolemic, and antidiabetic effects. In a tomedicines, with over 70% of the world’s population using
study based on STZ induced diabetic rat model reported, some form of it, according to WHO [184] many still lack
oral administration of ethanolic extract of ginger markedly thorough experimental investigation data to support their
reduced blood glucose level [179]. Another study demon- use.
strated that there is a substantial blood glucose lowering effect Plant medicine remains an important means by which
of ginger juice in diabetic animals [180]. Ahmed and Sharma humans have treated ailments, prevented diseases, and main-
have also shown that administration of ginger extract in rats tained health for centuries. Traditional knowledge and use of
recorded a significant hypoglycemic effect [181]. plant-based medicines remain important in Ghana because
Several constituents are reported to be present in ginger Traditional Medical Practice (TMP) is readily available and is
that include terpenes and oleoresin, which are generally affordable to rural communities in Ghana. Various plants are
called ginger oil. Ginger also contains volatile oils and used for managing diabetes mellitus in Ghanaian Traditional
nonvolatile pungent components such as oleoresin [182].The Medicine Practice [14, 17, 18, 21, 185] but not much is known
major identified components from terpene are sesquiterpene about the plants used.
hydrocarbons and phenolic compounds, which are gingerol Of the plants discussedAloe vera has the highest evidence
and shogaol. supporting its use in diabetes mellitus, with multilateral level
The major bioactive constituent reported to be present in of support from in vitro, animal, and clinical studies and
ginger is gingerol. Studies on ginger show that it increases glu- elucidation of active principle and testing in an animal model
cose uptake through promotion of GLUT-4 translocation via [103, 111, 143, 185]. Other findings also support its use in the
adenosine monophosphate-activated protein kinase (AMPK) treatment of various complications that arise from diabetes
activation in L6 myocytes. It has been reported that gingerol mellitus demonstrating broad clinical utility. Thus Aloe vera
protects pancreatic 𝛽-cells from oxidative stress, increases remains the hallmark of phytomedicine for diabetes mellitus
insulin receptors sensitivity, and enhances 𝛽-cell function though there are minor concerns over toxicity. Momordica
to decrease insulin resistance [117]. Gingerol has also been charantia and Zingiber officinale offer the next most extensive
shown to regulate in vivo hepatic gene expression of enzymes evidence for use in managing diabetes mellitus with preclin-
involved in glucose metabolism, leading to a decrease in ical studies in animal models, with human studies showing
glucose production and an increase in glycogen synthesis, clinical efficacy.
which contributes to the antihyperglycemic effect of gingerol. In this review, information on Ghanaian medicinal plants
Studies have shown that gingerol could provide therapeutic used for diabetes mellitus has been compiled (Tables 2 and
as well as prophylactic benefit for type-2 diabetes individuals 3).The information gathered demonstrates that some of these
[117]. Ginger has no known reported toxic dose. However plants and/or their preparations show promise in managing
overconsumption can cause some minor side effects. For diabetes mellitus. The review provides information on phar-
example, some people have experienced side effects includ- macological mechanisms of some of the plants. The study
ing heartburn, diarrhea, and general stomach discomfort shows that some of the plants and their bioactive compounds
Evidence-Based Complementary and Alternative Medicine 17
(Figure 1) act by reducing glucose absorption through inhibi- References
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