synthetic drug treatments

www.wjpps.com Vol 4, Issue 07, 2015.

149

Jagessar et al. World Journal of Pharmacy and Pharmaceutical Sciences

THE STATUS OF DIABETES IN GUYANA, IT’S HERBAL AND

SYNTHETIC DRUG TREATMENTS

R.C. Jagessar1* and S. Kingston

2

1Reader

Department of Chemistry, University of Guyana.

2Department of Pharmacy, University of Guyana.

ABSTRACT

Diabetes mellitus also is a group of metabolic diseases in which a

person blood sugar level is higher above the threshold limit. This may

result from the inability of the pancreas to secrete insulin or the body

cells are resistant to insulin. Diabetes results in a wide range of

ailments in humans that can ultimately lead to death. These include:

heart diseases and stroke, nerve damage, diabetic neuropathy, erectile

dysfunction, retinopathy, slow healing of cuts, burns and wounds, high

blood pressure and cholesterol, diabetic nephropathy, nerve damage,

leading to nausea, constipation or diarrhea. Thus, diabetes is a serious

disease worldwide. The status of diabetes (diabetic mortality and

diabetic morbidity) in Guyana was investigated over a period of time 2003 to 2008.There was

a general increase in the Diabetic Mortality number from 2003 to 2008. This may have been

due to the eating habits and lifestyle of the populace in that region. Over the period 2003 to

2008, the average mortality of 403.5 ± 29.30 was observed. A variance value of 162, 812.25

was computed. The confidence at the 95% level was calculated to be 403.5 ± 9.57. Morbidity

is the state of being diseased. This was recorded over the period 2003 to 2009. For the years

2003-2008, a mean morbidity of 9,506.71 ± 496.86. The confidence interval was found to

9,506.71 ± 139.12. In general, there was an increase in Morbidity from 8,920 in 2003 to

15,727 in 2009. The highest entry of 15, 727 was obtained in 2009.Diabetes can be controlled

by both synthetic and herbal treatments. Synthetic treatments include the use of Insulin

Secretagogues (Sulfonylureas), biguanides, Thiazolidinediones, - Glucosidase, Glucagon

etc. Herbal treatments include plant parts from Momordica charantia, Phyllanthus niruri,

Cajanus cajan, Desmodium barbatum, Tinospora cordifolia , Azadirachta indica, Abrus

WWOORRLLDD JJOOUURRNNAALL OOFF PPHHAARRMMAACCYY AANNDD PPHHAARRMMAACCEEUUTTIICCAALL SSCCIIEENNCCEESS

SSJJIIFF IImmppaacctt FFaaccttoorr 55..221100

VVoolluummee 44,, IIssssuuee 0077,, 114499--116655.. RReesseeaarrcchh AArrttiiccllee IISSSSNN 2278 – 4357

*Correspondence for

Author

Dr. R.C. Jagessar

Reader Department of

Chemistry, University of

Guyana.

Article Received on

28 April 2015,

Revised on 22 May 2015,

Accepted on 14 June 2015


150


precatorius, Catharanthus roseus, Centella asiatica Curcuma longa, Phyllanthus emblica,

Piper betle and Sphaeranthus indicus.

KEYWORDS: Diabetes mellitus, pancreas, insulin, diabetes mortality, diabetes morbidity,

synthetic and herbal treatments

INTRODUCTION

Diabetes mellitus (diabetes) is a group of metabolic diseases in which a person blood sugar

level is higher above the threshold limit.[1-7]

This may result from the inability of the pancreas

to secrete insulin or the body cells being resistant to insulin. Insulin, one of the hormones

produced by the pancreas, allows glucose to get into the cells.

Insulin is a polypeptide hormone produced by the pancreatic -cells.[7-8]

It is a small protein

(Mr = 5,800) consisting of two polypeptide chains, A and B, joined by two disulphide bonds.

It is synthesized in the pancreas as an inactive single-chain precursor, preproinsulin with an

amino-terminal “signal sequence” which directs its passage into secretory vesicles.Proteolytic

removal of the signal sequence and formation of three disulphide bonds produced proinsulin.

The latter is stored in secretory granules in pancreatic -cells.When elevated blood glucose

triggers insulin secretion, proinsulin is converted By the pancreas, allows glucose to active

insulin by specific proteases which cleave two peptide bonds to form the mature insulin

molecule. Human insulin contains 51 amino acids. Bovine insulin differs from human insulin

at the three amino acid sites. Insulin is stored as a complex with zinc. Two molecules of zinc

complex six molecules of insulin. Insulin binds to specific high-affinity receptors with

tyrosine kinase activity located in the plasma membrane. This results in the increase in

glucose transport in the muscle and adipose tissue and is mediated by the recruitment of

hexose transport molecules into the plasma membrane. Insulin can be prepared and are of

several types. These include: Ultra-rapid with very short action e.g Insulin Lispro; Rapid

onset and short action e.g crystalline zinc (regular) insulin; Intermediate onset and action e.g

NPH insulin and lente suspension; Slow onset and long action e.g Ultralente insulin.[7-8]

Insulin has several functions in the human body. In the liver insulin increases the storage of

glucose as glycogen. This involves the insertion of additional GLUT2 glucose transport

molecules in cell plasma membranes. In the muscle, insulin stimulates glycogen and protein

synthesis. Glucose transport into muscle cells is facilitated by insertion of additional GLUT4

transport molecules into cell plasma membrane. In adipose tissue, insulin facilitates


151


triglyceride storage by activating plasma lipoprotein lipase, increasing glucose transport into

cells via GLUT4 transporters and reducing intracellular lipolysis.[7-8]

Insulin may cause minor and usually temporary side effects such as rash, irritation or redness

at the injection site. Too much insulin can cause low blood sugar (hypoglycemia). The

symptoms include cold sweat, shaking, rapid heart rate, weakness, headache and fainting

which, if untreated, may lead to slurred speech and other behaviors that resemble

drunkenness. Too little insulin can cause symptoms of high blood sugar (hyperglycemia)

which includes confusion, drowsiness, rapid breathing, fruity breath odor, increased urination

or unusual thirst. Symptoms of an allergic reaction may occur which includes: rash, itching,

swelling, dizziness, trouble breathing.[7-9]

There are three main types of diabetes mellitus (DM). Type 1 DM results from the body

failure to produce any insulin. The insulin secreting cell in the pancreas are gradually

destroyed. This may be the result of an autoimmune response where the body recognizes the

pancreas as “foreign” and try to eliminate it or a childhood viral infection may destroyed it.

Type 1 diabetes requires a person to inject insulin or wear an insulin pump. Type 1 diabetes

usually occurs in young people, 50 percent of the cases occurring around the time of puberty.

Type 2 diabetes or maturity onset diabetes occurs at an older age, usually over 40 years. In

this type of diabetes, the levels of insulin in the blood is usually high. However, the cells of

the body are resistant to insulin and have a reduced glucose uptake, despite the high levels of

insulin. This results in an hyperglycemic condition. Obesity is the major cause of Type II

diabetes.

Other forms of diabetes include gestational and congenital diabetes. The latter is due to

genetic defects of insulin secretion. Also, there exist cystic fibrosis-related diabetes, steroid

diabetes, resulting from high doses of glucocorticoids and other forms of monogenic

diabetes.[10-13]

Several conditions/effects are thought to be associated with diabetes in individuals, including

heredity, environmental factors, high fat diet, high blood pressure, obesity, etc. Diabetic

patients are likely to develop heart diseases and stroke. This is primarily because of the

accumulated amounts of glucose that is stored up in the blood. High glucose increases the

viscosity of the blood, which can produce very high blood pressures. In addition, diabetes can


152


also lead to high amounts of blood cholesterol. Cholesterol can accumulate at the linings of

the blood vessels, blocking the flow of the fluid entirely and cutting off oxygen and nutrient

supply to various tissues and organs in the body. Over time, these accumulated amounts of

cholesterol can also damage the blood vessels resulting in heart attack and even death.[14-19]

Diabetic patients are also very prone to nerve damage, diabetic neuropathy. The extent of

nerve damage can vary from one patient to another and this can occur in various parts of the

body. The presence of nerve damage is commonly noticed by numbness or tingling in the

hands or feet, lack of arousal in the penis or clitoris, excessive sweating or diagnosis of

delayed stomach emptying.[14-19]

Diabetes can also result in erectile dysfunction. High blood glucose can block or even

damage the vessels that supply blood to the penile area, which is necessary for erection to

take place. The most common effects of diabetes in female patients are urinary inconsistency

or bladder problems such as poly urea or the excessive production of urine. This kind of

complication can have a huge impact on the patient’s lifestyle.[14-19]

Diabetes can also impair the sense of sight. The disease can lead to a condition called diabetic

retinopathy, where the retina of the eye is damaged. Retinopathy is caused by blood vessels

in the back of the eye (the retina) swelling and leaking. High blood pressure is also a

contributing factor for diabetic retinopathy. This condition can eventually lead to total

blindness if left untreated.[14-19]

Diabetes can lead to dry skin, slow healing of cuts, burns and

wounds, fungal and bacterial infections and loss of feeling in the foot as a result in damage to

the blood vessels and nerves of the feet. Diabetes can also cause damage to the liver resulting

in a condition called nonalcoholic fatty liver disease, resulting in the liver having difficulty in

processing fats. The kidneys are another organ that is at particular risk of damage as a result

of diabetes and the risk is again increased by poorly controlled diabetes, high blood pressure

and cholesterol, resulting in diabetic nephropathy.[14-19]

Diabetes can affect digestion in a

number of ways. If diabetes has caused nerve damage, this can lead to nausea, constipation or

diarrhea. An alternative cause of disturbed digestion can be the result of diabetes medication.

Some type 2 diabetes medications for instance are prone to causing digestive issues, although

these tend to settle down after the body gets used to them. Thus, diabetes is a serious disease

worldwide. Its increase globally is noticeable.This paper focuses on the statistical status of

diabetes in Guyana during the period 2003-2009, its herbal and synthetic treatments.

http://www.diabetes.co.uk/type2-diabetes.html


153


MATERIALS AND METHODS

Diabetes data with regards to Diabetes Mortality and Diabetes Morbidity were collected via

the certified permission from the Health Statistics Unit and Ministry of Health Statistical

Bulletins, 2008, Ministry of Health, Brickdam, Georgetown, Guyana, South America and

these data were statisically analysed (Mean Mortality and Mean Morbidity with Standard

Deviation, Variance and Confidence Interval at the 95%) and are presented in the Results

section. No data were available from the Ministry of Health as it pertains to Type 1 and Type

11 diabetes.

RESULTS

Table 1.0: Diabetes Mortality Guyana

Number of Diabetes deaths by region and year

Region Years

2003 2004 2005 2006 2007 2008

1 0 0 1 1 1 2

2 35 18 27 23 31 20

3 39 35 43 71 47 69

4 177 208 207 192 179 167

5 21 20 24 41 25 49

6 77 84 96 86 92 91

7 4 11 0 9 1 6

8 0 0 0 0 0 0

9 0 0 1 1 1 2

10 7 9 14 17 19 20

mean death, X per region 36 38.5 41.3 44.1 39.6 42.6

Total 360 385 413 441 396 426

Mean Mortality (2003-2008)

with Standard Deviation, SD 403.5 ± 29.30

Variance, SD2 162,812.25

CL (95%) 403.5 ± 9.57

( Health Statistics Unit and Ministry of Health Statistical Bulletins, 2008)

Data collected from the Ministry of Health)

Table 2.0: Diabetes Morbidity Guyana

Number of Diabetes first visit cases by regions and year

Region Year

2003 2004 2005 2006 2007 2008 2009

1 70 73 142 6 24 22 28

2 2,232 3,023 2,645 3,084 1,105 1,015 1,312

3 1,961 1,054 1,288 1,212 1,099 649 1,756

4 1,696 1,582 1,913 2,445 3,917 3,552 3,640

5 1,593 2,157 3,259 2,638 1,999 464 381


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6 538 729 802 902 1,255 4,230 4,959

7 190 143 312 267 363 249 3,335

8 13 29 37 3 48 28 20

9 10 44 249 62 56 152 259

10 617 398 421 361 270 123 37

Mean, X per region 892.0 923.2 1,106.8 1,098 1,013.6 1,048.4 1,572.7

Total 8,920 9,232 11,068 10,980 10,136 10,484 15,727

Mean Morbidity

(2003-2008) with Standard

Deviation, SD

9,506.71 ± 496.86

Variance, SD2 90,377,535.02

CL (95%) 9,506.71 ± 139.12

( Health Statistics Unit and Ministry of Health Statistical Bulletins, 2008)

Key

Regions of Guyana Designation

1 Barima-Waini

2 Pomeroon-Supernaam

3 Essequibo Islands-West

Demerara

4 Demerara-Mahica

5 Mahaica- Berbice

6 East Berbice-Corentyne

7 Cuyuni-Mazaruni

8 Potaro-Siparuni

9 Upper Takutu Upper Essequibo

10 Upper Demerara Berbice

Graphs

Fig.1.0. Showing mortality due to Diabetes for the years 2003-2008 in Guyana

0

50100

150200

250300

350400

450

Mortality

2003 2004 2005 2006 2007 2008Years


155


0

50

100

150

200

250

Mortality

2003 2004 2005 2006 2007 2008

Years

Fig. 2.0: Showing mortality per region 1-10 due to Diabetes for the years 2003-2008 in

Guyana

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Morbidity

2003 2004 2005 2006 2007 2008 2009

Years

Fig. 3.0. Showing morbidity due to Diabetes for the years 2003-2008 in Guyana

0

500

1000

1500

2000

2500

3000

3500

4000

Morbidity

2003 2004 2005 2006 2007 2008 2009

Years

Fig. 4.0: Showing morbidity per region 1-10 due to Diabetes for the years 2003-2008 in

Guyana


156


DISCUSSION

The data on the status of Diabetes Mortality and Diabetes Morbidity in the different regions

(1-10) of Guyana for the years 2003 to 2008 were obtained from the Ministry of Health. The

data were statistically analysed. Guyana is divided into ten (10) administrative regions.

Mortality is the state of being mortal, or susceptible to death. Morbidity is a diseased state,

disability, or poor health due to any cause.[20]

It also refers to the existence of any form of

disease, or to the degree that the health condition affects the patient. Morbidity rate is being

expressed as the number of cases of a disease, occurring within a particular population.[20]

The Mortality Table, Table 1.0. shows that in 2003, there were 360 persons of the populace

who died from the disease. The mortality figure increased to 441 in 2006. In 2007, there was

a decrease of 396 deaths. However, an increase of 426 deaths were noticeable in 2008. Thus,

there was a general increase in the Diabetes Mortality from 2003 to 2008. This may have

been due to the eating habits and lifestyle of the populace in those regions. Over the period

2003 to 2008, the average mortality of 403.5 ± 29.30 was observed. A variance value of 162,

812.25 was computed. The confidence at the 95% level was calculated to be 403.5 ± 9.57.

For the mean mortality per region per year, ranging from 2003-2008, mortality of 360, 385,

413, 441, 396 and 426 was obtained respectively.

With regards to the different regions, it is observed that region 4 recorded the highest

mortality for 2003 to 2008, with the highest mortality of 208 in 2004. Region 8 recorded 0

mortality for all the years 2003-2008. Regions 1 and 9 recorded 0 mortality in 2003 and 2004,

1 mortality from 2005 to 2007 and 2 mortality in 2008. The second highest mortality was

recorded in region 6. This range from 77 to 96. The highest mortality of 96 was observed in

2005. These data are plotted in Fig.1.0 and Fig. 2.0. The highest mortality in region 4 may

have been due to the life style of the residents. A large percentage of the populace may have

preferred the Fast Food Services. Persons would consume more fatty foods and sugars which

will lead to diabetes. Moreover, the busy life style of persons, residing in the region may not

permit them to have regular check up with their doctors. Hence, early onset of diabetes may

not be detected. Also, a large percentage of the region populace may have the sedentary mode

of life. The zero and 1,2 mortality in region 8 and 9 respectively may be due to the active life

style of the residential populace. It’s a farming area and most residents cultivate their own

cash crops. Besides, a large percentage of the populace have to be active in order to survive.

Type II diabetes can be averted via a good diet and active life.


157


Morbidity is the state of being diseased.[20]

This was recorded over the period 2003 to 2009.

For the years 2003-2008, a mean morbidity of 9,506.71 ± 496.86 was observed. The

confidence interval was found to 9,506.71 ± 139.12. In general, there was an increase in

Morbidity from 8,920 in 2003 to 15,727 in 2009. The highest entry of 15, 727 was obtained

in 2009. In 2006, 10,980 cases were reported. The second highest morbidity of 11,068 was

obtained in 2005. Region 6 seems to record the highest number of entries for a particular

year. A morbidity figure of 4,9569 and 4,230 was noted for 2008 and 2009 respectively.

Region 4 seems to record the second highest number of entries. These range from 1,582 to

3,640 cases, with the highest entry of 3,640 noticeable. The lowest morbidity of 1,582 was

noted in 2004. The lowest morbidity was noted for Region 8. This range from 3 to 48.

Diabetes in Guyana seems to be on the increase. In addition, the mean Morbidity per region

for the year span: 2003-2009 was 892, 923.2, 1,106.8, 1,098, 1,013.6, 1,0 484.4 and 1,572.7

respectively. These data are shown in Fig. 3.0 and Fig. 4.0.

It is reported that diabetes accounts for approximately 7.7% of the total deaths recorded

annually in Guyana. During the period, 2001- 2004, an annual average of 8,433 new diabetes

cases were reported. There were 6,832 persons, or 74% of the total population with diabetes,

aged under 65, and some 2,400 (26%) were older than age 65. Available statistics indicated

that twice as many females as males are affected; which may be due to the more sedentary

life style observed amongst females and more health-promoting behaviors seen amongst

males. It is also observed that a high percent of Tuberculosis (TB) patients are also diabetics

in the population. Diabetes is ranked as the either the number three or four cause of death in

Guyana as it changes place with cancer from year to year and accounts for an average of

about 425 deaths each year, or about six deaths for every 10,000 persons in Guyana.[21-26]

It has been revealed that that diabetes and HIV are frequent in Guyanese Tuberculosis

patients. Routine screening of Tuberculosis patients for diabetes and diabetic patients for

Tuberculosis should be implemented as soon as possible. The National TB Programme

should work closely with the diabetes clinics so that TB patients who are diabetics are

effectively treated.[20-25]

There are several synthetic antidiabetic drugs. These include Insulin Secretagogues

(Sulfonylureas), biguanides, Thiazolidinediones, - Glucosidase, Glucagon[8,27]

etc. The

structure of some of these drugs are shown in Fig. 5.0. The scientific name is given in Table

3.0. Interestingly, most of these drugs seem to incorporate the urea linkage.


158


R1

S

OO

NH

O

NH

R2

Cl

S

OO

NH

O

NH

H3C

S

OO

NH

O

NH

N

Cl

S

OO

NH

O

NH

N

Gliclazide

Tolazamide

ChlorpropamideSULFONYLUREAS

O

NH

S

O O

NH

O

NH

Cl

O

H3C

Glibenclamide

N

NH

O

O

O

OH

Repaglinide

OHN

O

-O

H

Nateglinid

e

NH

NH2NH

NH

NH3

C

CH3 Metformin

(Tolbutamide)

(Tolinase)

(Micronase)

(Prandin)

(Glucophage)

O

ONH

S

O

O

HOTroglitazone

(General Structure)

Fig. 5.0, Antidiabetic drugs


159


Table 3.0: IUPAC name for several synthetic antidiabetic drugs

NAME OF DRUG SCIENTIFIC NOMENCLATURE

Acetohexamide (1-[(4-acetylbenzene)sulfonyl]-3-cyclohexylurea-4-

acetylN(cyclohexylcarbamoyl)benzenesulfonamide),

Chlorpropamide 4-chloro-N-(propylcarbamoyl)benzenesulfonamide

Glimepiride

3-ethyl-4-methyl-N-(4-[N-((1r,4r)-4-

methylcyclohexylcarbamoyl)sulfamoyl]phenethyl)-

2-oxo-2,5-dihydro-1H-pyrrole-1-carboxamide

Glipzide

N-(4-[N-

(cyclohexylcarbamoyl)sulfamoyl]phenethyl)-5-

methylpyrazine-2-carboxamide

Glyburide also called

Glibenclamide

5-chloro-N-(4-[N-

(cyclohexylcarbamoyl)sulfamoyl]phenethyl)-2-

methoxybenzamide

Metformin N,N-Dimethylimidodicarbonimidic diamide

Nateglinide (3-phenyl-2-[(4-propan-2-

ylcyclohexanecarbonyl)amino]propanoic acid)

Repaglinide (S)-(+)-2-ethoxy-4-[2-(3-methyl-1-[2-(piperidin-1-

yl)phenyl]butylamino)-2-oxoethyl]benzoic acid

Tolazamide (N-[(azepan-1-ylamino)carbonyl]-4-

methylbenzenesulfonamide

Tolbutamide (N-[(Butylamino)carbonyl]-4-

methylbenzenesulfonamide

Troglitazone ((RS)-5-(4-[(6-hydroxy-2,5,7,8-tetramethylchroman-

2-yl)methoxy]benzyl)thiazolidine-2,4-dione)

Insulin Secretagogues: A secretagogue is a substance that causes another substance to be

secreted. One example is gastrin, which stimulates the H/K ATPase in the parietal cells

(increased gastric acid production by the stomach). Sulfonylureas are insulin secretagogues,

triggering insulin release by direct action on the KATP channel of the pancreatic -cells. All,

but one of the insulin secretagogues belongs to the class called sulfonylureas. They are

divided into three generations: First, Second and Third Generation. The first generation

includes Tolbutamide, Acetohexamide, Chlorpropamide, Tolazamide). The second

Generation includes Glipzide and Glyburide. The third generation has Glimepiride.

Repaglinide is a newer insulin secretagogue from a chemical class known as the meglitinides.

These agents are oral insulin secretagogues that act by blocking ATP-dependent potassium

channels. This leads to increase insulin secretion by pancreatic -cells. Nateglinide has a

more rapid onset of action and it’s more specific than Repaglinides. These drugs are

metabolized by the liver and should not be used in patients with hepatic insufficiency. Major

adverse effect is hypoglycemia. Sulfonylureas act by closing potassium channels in the

pancreatic -cell membrane. Closure of the channel depolarizes the cell and triggers insulin


160


release. Insulin secretagogues are not effective in patients who lack functionalized - cells.

They may also reduce glucagon release and increase the number of functional insulin

receptors in peripheral tissues. The second generations are two hundred times more potent

than the first generation agents and are used much more commonly than the first generation.

All sulfonylureas are well absorbed after oral administration and bind to plasma proteins

notable albumin.[8]

With regards to the mode of action, Sulfonylureas causes an increase in the amount of insulin

secreted by beta cells in response to a glucose challenge. They promote the sensitivity of

cells to insulin, perhaps by increasing the number of insulin receptors. However,

sulfonylureas do not decrease the insulin requirements of patients with type 1 diabetes.

Sulfonylureas decrease serum glucagon, which opposes the action of insulin. Sulfonylureas

are very useful in treating type 2 diabetes mellitus but are not effective against type 1.[8]

Sulfonylureas have side effects. They can induce weight gain, mainly as a result of their

effect to increase insulin levels and thus utilization of glucose and other metabolic fuels.

Other side-effects are: abdominal upset, headache and hypersensitivity reactions.

Sulfonylureas are potentially teratogenic and cannot be used in pregnancy or in patients who

may become pregnant. Impairment of liver or kidney function increases the risk of

hypoglycemia, and are contraindications. As other anti-diabetic drugs cannot be used either

under these circumstances, insulin therapy is typically recommended during pregnancy and in

hepatic and renal failure, although some of the newer agents offer potentially better options.

Metformin is the primary member of the Biguanides. Metformin reduce hepatic glucose

production and intestinal absorption of glucose. It does not alter insulin secretion. It’s precise

mechanism is not known. Metformin probably increases peripheral insulin sensitivity.

Metformin may be used alone or in combination with sulfonylureas.Metformin rarely causes

hypoglycemia or weight gain. Adverse effects results in lactic acidosis and gastrointestinal

distress.

These agents are oral insulin secretagogues that act by blocking ATP-dependent potassium

channels. This leads to increase insulin secretion by pancreatic - cells. Nateglinide has a

more rapid unset of action and it’s more specific than Repaglinides. These drugs are

metabolized by the liver and should not be used in patients with hepatic insufficiency. Major

adverse effect is hypoglycemia.


161


Thiazolidinediones are new class of oral hypoglycemic agents that act by increasing tissue

sensitivity to insulin. These drug binds to a specific intracellular receptor. Thiazolidinediones

increase glucose uptake in muscle and adipose tissue, inhibit hepatic gluconeogenesis, affects

lipid metabolism and the distribution of body fat. They reduce both fasting and postprandial

hyperglycemia. Troglitazone was the first to be introduced but was removed because of its

hepatotoxicity. Thiazolidinediones predominantly affects the liver, skeletal muscle and

adipose tissue. Rosiglitazone and pioglitazone appear to carry less risk of serious liver

dysfunction.[2,8, 27]

Acarbose and miglitol (-glucosidase inhibitors) are carbohydrates analogs that act within the

intestine to inhibit -glucosidase, an enzyme necessary for the conversion of complex

starches, oligosaccharides and disaccharides to the monosaccharides that can be transported

out of the intestinal lumen into the blood stream. Slowed absorption reduced postprandial

hyperglycemia.

There are several herbs that are used to treat diabetes locally and internationally.[28-32]

Locally

Momordica charantia[29]

, an herbaceous, tendril-bearing vine contains a compound called

charantin, which have hypoglycaemic effect. It has been found to increase insulin sensitivity.

A daily dose of 100 mg per kilogram of body weight is comparable to 2.5 mg/kg of the anti-

diabetes drug glibenclamide taken twice per day. Other compounds in M.charantia have been

found to activate the AMPK, the protein that regulates glucose uptake. The whole plant is

used as a decoction for diabetes.The dry leaf and stem are boiled and the water drunk as an

anti diabetic. The fruit is cooked and eaten as an anti diabetic. Use with almond oil for a

vulnerary. Tablets of M.charantia extract are sold in the United Kingdom.

Phyllanthus niruri[29]

contains alkaloids, flavonoids and triterpenes. The whole plant is used

as a blood purifier (bitter tonic) to reduce blood sugar level. It’s available as capsules.

Cajanus cajan[29]

, Pigeon peas contains high levels of protein and the important amino acids

methionine, lysine, and tryptophan. Leaves and flowers are boiled for a diuretic and diabetes

remedy. The whole plant of Desmodium barbatum[29]

is used to reduced blood sugar level.

The wood of the plant, Telitoxium[29]

is used for diabetes. The active adaptogenic constituents

of Tinospora cordifolia[29]

are diterpenoid compounds: polyphenols, and polysaccharides,

including arabinogalactan polysaccharide. T. crispa and T. rumphii are used in Thailand and


162


Philippines for treatment of diabetes. A decoction of the leaves of Azadirachta indica[30]

,

Neem is used as a bitter tonic for treating diabetes and jaundice.

Internationally, The juice of the leaves of Abrus precatorius[31]

are given to diabetic patients.

Achyranthes aspera[31]

is used as a decoction in the treatment of diabetes mellitus. Likewise,

the roots of Catharanthus roseus is used as decoction in the treatment of diabetes mellitus.

The entire plant of Centella asiatica[31]

, is also used as a decoction in the treatment of

diabetes mellitus.[31]

Curcuma longa is a rhizomatous herbaceous perennial plant which is

used in the treatment of diabetes mellitus. Phyllanthus emblica[31]

, edible fruits are

antidiabetic in nature. Piper bettle[31]

leaf extract is used in the treatment for diabetes

mellitus. Sphaeranthus indicus[31]

is also used in the treatment for diabetes mellitus. Plant

extracts have also shown to have anti-diabetic activity 33-35

.

ACKNOWLEDGEMENTS

We thank the authority at the Ministry of Health for providing us with genuine data on the

mortality and morbidity status of Diabetes in Guyana during the years: 2000-2008.

CONCLUSION

Diabetes results in a wide range of ailments in humans that can ultimately lead to death.

Thus, diabetes is a serious disease worldwide. The status of diabetes (diabetic mortality and

diabetic morbidity) in Guyana was investigated over a period of time, 2003 to 2008.There

was a general increase in the Diabetic Mortality number from 2003 to 2008. This may have

been due to the eating habits and lifestyle of the populace in that region. Over the period 2003

to 2008, the average mortality of 403.5 ± 29.30 was observed. A variance value of 162,

812.25 was computed. The confidence at the 95% level was calculated to be 403.5 ± 9.57.

Morbidity is the state of being diseased. This was recorded over the period 2003 to 2009. For

the years 2003-2008, a mean morbidity of 9,506.71 ± 496.86 was observed. The confidence

interval was found to 9,506.71 ± 139.12. In general, there was also an increase in Morbidity

from 8,920 in 2003 to 15,727 in 2009. The highest entry of 15, 727 was obtained in 2009.

Diabetes can be controlled by both synthetic and herbal treatments. Synthetic treatments

include the use of Insulin Secretagogues (Sulfonylureas), biguanides, Thiazolidinediones, -

Glucosidase, Glucagon etc. Herbal treatments include plant parts from Momordica charantia,

Phyllanthus niruri, Cajanus cajan, Desmodium barbatum, Tinospora cordifolia , Azadirachta

indica, Abrus precatorius, Catharanthus roseus, Centella asiatica Curcuma longa,


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Phyllanthus emblica, Piper betle and Sphaeranthus indicus. Type II diabetes is most likely to

be developed in regions where there sedentary mode of life. Residents may also lack physical

exercise and their diet is mainly of the Fast Food type. Unless effective prevention strategies

are implemented, the incidence of diabetes in Guyana will continue to rise, increasing the

already high socioeconomic burden on families and the health system.

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