Advances in Life Sciences, 2010, 4 (1-4), 21-29

Therapeutic potential of triphala therapy in human in Type II diabetes

Usha Singh Baghel*1, Dhananjay Yadav2 and GBKS Prasad2
1
School of Environmental Science, Jawaharlal Nehru University, New Delhi
2
SOS in Biochemistry & Biotechnology, Jiwaji University, Gwalior, India
*Email: usha.jnu@gmail.com
Triphala an ancient herbal blend is one of the most commonly used herbal remedies
in Ayurveda, an Indian system of medicine. It is considered as an effective resource in
medicine possessing antidiabetic properties. We here aimed at investigating the
antihyperglycemic, antilipidemic and antioxidant activities of Triphala in 55 human subjects.
Thirteen normal subjects treated with Triphala (Blood glucose (BG) 80-110mg/dl), Fifteen
diabetic subjects treated with insulin sensitizer (Fasting BG level ≥ 200 mg/dl), and twenty-
seven Triphala treated diabetic subjects (Fasting BG level 180 mg/dl) were included in study.
Fasting blood glucose and post prandial blood glucose found to be significantly reduced in
Triphala as well as insulin sensitizer treated diabetic subjects by 18.77% (P<0.001) 31.8%
(P<0.001) and 19.7% (P<0.001) and 40.25%, respectively after 120 days of therapy.
Glycosylated hemoglobin (GHb) was significantly reduced by 23.41% (P<0.05) and 13%
(P<0.05) in Triphala treated diabetics and insulin sensitizer treated diabetics. Liver function
markers, viz SGOT, SGPT and Bilirubin showed a significant reduction of 25.01 % (P<0.001),
34.79% (P<0.001), 22.01 % (P<0.001) and 28.8%, 13.07% and19.5%, respectively in both
groups of subjects. Study also revealed reduction in the level of kidney function markers in
≥ cholesterol, triglycerides, VLDL and LDL
both groups of the subjects. The serum lipid levels
in both group showed decrease by 15.95 % (P<0.001), 16.6 % (P<0.001), 15.95% (P<0.001),
49.5% (P<0.001) and 27.24% (P<0.001), 17.78%, 17.7% and 46.6% (P<0.001), respectively
after 120 days of therapy, whereas HDL-C level was increased by 10.22%, 7.4 % respectively.
Keywords: Triphala, Ayurveda, Antidiabetic, Hemoglobin, Cholesterol, Antioxidant

Diabetes mellitus (DM) (madhumeha), known mellitus, NIDDM) or adult–onset diabetes results from
to ancient Indian physicians 3000 years ago, is a the development of insulin resistance due to which
metabolic disorder characterized by insufficiency of hyperglycemia develops gradually and often goes
secretion or action of endogenous insulin, derangement untreated for years until symptoms become clinically
in carbohydrate and lipid metabolism and is diagnosed obvious (Fronzo et al., 1997). However, Gestational
by the presence of hyperglycemia (Like et al., 1979; diabetes mellitus (GDM) is defined as any degree of
Paik et al., 1982; Kataoka et al., 1983; Sandler et al., glucose intolerance, with the onset of pregnancy.
2000; Shewade et al., 2001). Based on World Health Diabetes mellitus has reached epidemic
Organization (WHO) recommendation, DM is classified proportions and affects more than 170 million individuals
into three major subtypes: Type I (insulin dependent worldwide. Global estimates for the year 2010 predict
diabetes mellitus, IDDM) or juvenile-onset diabetes, a further growth of almost 50%, with the greatest
an autoimmune disease in which patients own immune increases in the developing countries of Africa, Asia and
system reacts against islet antigens and destroys the South America. Diabetes in the world is accounted by
pancreatic â-cells (Aikinson et al., 1994; Takeshi et “common” Type 2 diabetes, which has a multifactorial
al., 2002). Type II (non-insulin dependent diabetes pathogenesis, caused by alterations in several gene
* Corrosponding author products. Cardiovascular morbidity in patients with type
21
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2 diabetes is two to four times greater than that of non- described for the treatment of diabetes throughout the
diabetic people (Zimmet et al., 2001). Due to increasing world (Kesari et al., 2005). The medicinal plants might
obesity and unhealthy dietary habits in both Western provide a useful source of new oral hypoglycemic
and developing countries, the prevalence of type 2 DM compounds for development of pharmaceutical entities
is growing at an exponential rate (Zimmet and Lefebvre, or as a dietary adjunct to existing therapies (Bailey and
1996).Oxidative stress has been shown to be a hallmark Day, 1989).
of many disease linked with metabolic or vascular As the global scenario is changing towards the
disorder, numerous studies demonstrated that oxidative use of non-toxic plant products having traditional
stress, mediated mainly by hyperglycemia – induced medicinal use, development of modern drugs from
generation of free radicals contribute to the development “Triphala” should be emphasized for the control of
and progression of diabetes and is related complication. diabetes. Triphala is an ayurvedic formulation, commonly
Thus ameliorating oxidative stress might be an effective prescribed by most healthcare practitioners in India.
strategy for reducing diabetic complications. Oxidative Triphala, Meaning three fruit, made from the fruits of
stress thought to be increased in a system where the three trees, Indian gooseberry (Emblica officinalis),
rate of free radical production is increased and/or the Belleric myrobalan (Terminalia bellerica) and
antioxidant mechanisms are impaired (Halliwell et al., Chebulic myrobalan (Terminalia chebula). Triphala
1990; Baynes, 1991; Mclennam et al., 1991; Chang has been reported to be a rich source of vitamin C,
et al., 1993; Saxena et al., 1993; Young et al., 1995; ellagic acid, gallic acid, chebulinic acid, bellericanin,
Baynes and Thorpe, 1999). beta-sitosterol and flavanoids.
In making therapeutic choices in the
Subjects and Methods
management of type 2 diabetes, the major goal of
Diabetes mellitus patients were screened out
protecting patients from the long-term complications of
from the general population in Gwalior region according
the disease must be considered. Because insulin
resistance plays a fundamental role in the pathogenesis ≥to WHO standards and are provided with regular
counseling on the causes, symptoms, complications of
of type 2 diabetes and especially its adverse
diabetes, apart from traditional ayurvedic medicines. Out
cardiovascular outcomes, interventions should initially
of total 55 human subjects included in the study (age:
be aimed towards improvement in tissue insulin sensitivity.
35-65 years and weight: 45-80 kg), Thirteen normal
This often involves lifestyle intervention, with modest
subjects (BG- 80-110mg/dl) were given Triphala,
exercise and weight loss, which clearly reduces the risk
Fifteen diabetic subjects (Fasting BG level 200 mg/
of progression of impaired glucose tolerance to overt
dl) were given allopathy (insuliln sensitizer) and twenty-
diabetes (Diabetes Prevention Program Research
Group, 2002; Tuomilehto et al., 2001). The Allopathy seven diabetic subjects (Fasting BG level 180 mg/dl)
drugs such as, Thiazolinediones, Metformin, á- were given Triphala. The selected subjects were not
glucosidase inhibitors, sulfonyl derivative, a tolbutamide, taking any other antihyperglycemic, antihypertensive or
gliclazide, and glipizide are used in the treatment of antihyperlipidemic allopathic drugs.
hyperglycemia in diabetes mellitus in last decades. In Triphala Dosage: 4 gm Triphala per day was
modern medicine, no satisfactory effective therapy is administered for 120 days. Triphala was provided by
still available to cure diabetes mellitus (Sumana and Dindayal Ayurvedic Pvt. Ltd. Gwalior (M.P.).
Suryawashi, 2001). It can be managed by exercise, diet Experimental design: The human subjects were
and chemotherapy. However, the pharmaceutical drugs categorized into three groups. Both males and females,
are either too expensive or have undesirable side effects Age; 35-65, weight; 45-80 kg, n=55. Diabetic (blood
(Berger, 1985; Huupponen, 1978). The use of medicinal sugar): 150 180mg/dl. Subjects were divided into
plants for the treatment of diabetes mellitus dates back following groups:
from the Ebers papyrus of about 1550 B.C. A multitude Group I - Normal subjects treated with Triphala (n =13)
of herbs spices and other plant materials have been Group II- Diabetic subjects (150 180mg/dl) treated
Advances in Life Sciences, 2010, 4 (1-4), 21-29
 23
with Triphala (n=27) Pvt. Ltd. Low density lipoprotein (LDL) and very low
Group III - Diabetic subjects (150 180mg/dl) treated density lipoprotein (VLDL) were calculated from
with insulin sensitizer (n=15) Freidewald’s Formula all the estimation were carried
All subjects were given Triphala at about 4 gm out from fasting serum samples. The detailed
/day. The selected subjects, who were diagnosed with methodology is described below: The kidney function
type II diabetes, were then asked to start the Triphala markers such as serum creatinine (Mod. Jaffe’s Kinetic
powder therapy starting at day 0 and continuing up to 4 method), serum urea (GLDH Kinetic method) and serum
months for both diabetic and normal subjects. uric acid (Uricase / PAP method) were estimated by
Sample Collection: The selected subjects were using kits manufactured by Crest Biosystems, India, Pvt.
asked to devoid of food for 12 hrs or overnight and Ltd. Liver function markers such as Serum Glutamate
their blood was withdrawn from venous vein, the serum Pyruvate Transaminase (SGPT), Serum Glutamate
was separated and stored at -20OC for the analyses of Oxaloacetate Transaminase (SGOT) (Modified IFCC
lipid profile, kidney function, liver function markers and method) and Total Biliburin (Modified Jendrassik and
the remaining blood samples was stored at 4OC for Grof’s method) were estimated by commercial kits
analysis the of markers of oxidative stress (GSH, MDA, manufactured by Crest Biosystems, India Pvt
SOD and Catalase). Ltd.Oxidative Stress markers like GSH was estimated
Biochemical assays: Fasting and post prandial in whole blood (50 µl blood in 950 µl Distilled water)
blood glucose level was estimated by glucose oxidase- whereas, TBARS and Catalase were estimated from
peroxidase method, employing commercial kits hemolysate. Estimation of Reduced Glutathione (GSH)
manufactured by Crest Biosystems, India Pvt. Ltd. The by Ellman (1959), Catalase by Sinha (1972),
estimation was carried out at one month interval up to Superoxide dismutase by Mishra (1972), Thiobarbituric
end of the study. Glycosylated hemoglobin is estimated acid reactive substances (TBARS) by Ohkawa (1979).
to assess the efficacy of anti-diabetic preparations Statistical analysis: Data were expressed as
≥
described by calorimetric method of Abhram et al. mean ± standard deviation. Statistical comparisons were
(1987). The lipid profile parameters such as total made before and after therapy by the paired’ test using
cholesterol (Cholesterol oxidase-peroxidase method), statistical software Sigma Stat 3.5.3
serum triglyceride (GPO-POD Method), serum HDL–
Results
cholesterol (Phosphotungstate Method) using
The present study was focused to explore the
commercial kits manufactured by Crest Biosystems India

Advances in Life Sciences, 2010, 4 (1-4), 21-29

24

antihyperglycemic, antihyperlipidemic and antioxidative showed reduction of 13.96% (P<0.001) (Table 1). A
potential of Triphala on Diabetes mellitus subjects. significant reduction of 23.41% (P<0.05) and 13%
Fasting blood glucose level found to be significantly (P<0.05) was observed in GHb levels after 120-days
reduced in Triphala as well as insulin sensitizer treated of therapy in Triphala treated diabetics and insulin
diabetic subjects by 18.77% (P<0.001) and 31.8% sensitizer treated diabetics.
(P<0.001), after 120 days of therapy. However, a Total Cholesterol level was found to be reduced
significant decrease of 16.4% (P<0.001) was observed significantly by 16.63% (P<0.001) after 120 days of
in the fasting blood glucose level of Triphala treated Triphala therapy in diabetic subjects, whereas it’s level
normal subjects (Table 1). Post Prandial blood glucose was reduced significantly by 27.24% (P<0.001) in insulin
level was significantly reduced in both the Triphala and sensitizer treated diabetic subjects. Total Cholesterol
insulin sensitizer treated diabetic subjects by 19.7% level reduced by 7.24% in Triphala treated normal
(P<0.001) and 40.25% (P<0.001) respectively, after subjects (Table 2). Triglyceride level was significantly
120 days of therapy. Triphala treated normal subjects reduced by 15.95 % (P<0.001) after 120 days of

Advances in Life Sciences, 2010, 4 (1-4), 21-29

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Triphala therapy in diabetic subjects whereas 17.78% normal subjects (Table 2). VLDL level was significantly
reduction was observed in insulin sensitizer treated reduced by 15.95% (P<0.001) in Triphala treated
diabetic subjects and 6.73 % reduction was also diabetic subjects and 17.7% in insulin sensitizer treated
observed in Triphala treated normal subjects (Table diabetic subjects after 120 days of the therapy. Triphala
2). An increment of 10.22% found in HDL-C level of treated normal subjects showed reduction of 7.06%
Triphala treated diabetic subjects and a similar result (Table 2). A significant reduction was observed in VLDL
observed with insulin sensitizer treated diabetic subjects levels after 120 days of therapy in both Triphala and insulin
where the level was increased by 7.4% after therapy. sensitizer treated diabetic subjects by 49.5% (P<0.001),
However, 12.4 % increase found in Triphala treated 47.6% (P<0.05) respectively. Triphala treated normal

Advances in Life Sciences, 2010, 4 (1-4), 21-29

26
subjects showed reduction of 18.5% (Table 2). diabetic subjects and by 45% in insulin sensitizer treated
Blood SGOT activity was found to be diabetic subjects after 120 day. Triphala treated normal
significantly decreased in both Triphala and insulin subjects also showed a significant reduction in the SOD
sensitizer treated diabetic subject by 25.01% (P<0.001) activity by 31.15% (P<0.05) (Table 5). TBARS/MDA
and 28.8% respectively, after 120 days of the therapy. level was found to be significantly decreased up to 25.87
However, a significant decrease of 21.35% (P<0.001) (P<0.05) in Triphala treated diabetic subjects whereas
was observed in the blood SGOT level of Triphala a reduction of 12.16% was observed in insulin sensitizer
treated normal subjects (Table 3). SGPT level was treated diabetic subjects after 120 days of therapy.
significantly decreased by 34.74% (P<0.001) in Triphala Similar results were observed in Triphala treated normal
treated diabetic subjects, whereas 13.07% decrease subjects where the TBARS level was reduced up to
was observed in insulin sensitizer treated diabetic 12.2% (Table 5). Catalase activity was significantly
subjects after 120 days of the therapy. Triphala treated increased up to 118.45% (P<0.001) in Triphala treated
normal subjects showed reduction of 16.1% (P<0.05) diabetic subjects. Similarly the insulin sensitizer
(Table 3). Bilirubin level was found to be significantly administration for 120 days, increased the catalase
decreased in Triphala as well as insulin sensitizer treated activity up to 48.73% (P<0.05). Normal subjects treated
diabetic subjects by 22.01% (P<0.001) and 13.86% with Triphala showed increase in catalase activity up
respectively, after 120 days of the therapy. A significant to 18.7% (Table 5).
decrease of 19.5% (P<0.05) was observed in the
Discussion
Bilirubin level of Triphala treated normal subjects (Table
Diabetes mellitus (DM) is characterized by the
3). Blood urea level was found to be significantly
increase in blood glucose level, along with profound
decreased in Triphala as well as insulin sensitizer treated
alteration in concentration and composition of lipids
diabetic subjects by 14.37% (P<0.001) and 7 %
resulting from insulin resistance and defects in insulin
respectively, after 120 days of the therapy. A significant
secretion. Many herbal remedies individually or in
decrease of 10.8% (P<0.05) was observed in the blood
combination have been recommended in various medical
urea level of Triphala treated normal subjects (Table 4).
treaties for the cure of different diseases. “Triphala”
Uric Acid level was significantly reduced by 15.15%
which is widely used in all parts of India as effective
(P<0.001) in Triphala treated diabetic subjects, whereas
laxative, powerful antioxidant and antibacterial with
5.7% reduction was found in insulin sensitizer treated
anticancer preparation is well known ayurvedic herbal
diabetic subjects after 120 days of the therapy. It was
formulation. Triphala, being rich in antioxidants, plays
found to be significantly reduced by 12% (P<0.05) in
an essential role in the treatment of a wide variety of
Triphala treated normal subjects (Table 4). Creatinine
conditions like infection, obesity, anemia, fatigue,
level was significantly reduced up to 18.72% (P<0.05)
constipation and in infectious diseases like tuberculosis,
in Triphala treated diabetic subjects, and 25.83%
pneumonia and AIDS. Triphala constituents (Emblica
(P<0.05) was observed in insulin sensitizer treated
officinalis, Terminalia belerica and Terminalia
diabetic subjects after 120 days of therapy. A significant
chebulla) have been reported to be a rich source of
reduction of 11.17% (P<0.05) was also observed in
vitamin C, ellagic acid, gallic acid, chebulinic acid,
Triphala treated normal subjects (Table 4).
bellericanin, â-sitosterol and flavanoids. In present study,
GSH level was found to be significantly
Triphala administration for 120 days in diabetics showed
increased in Triphala as well as insulin sensitizer treated
significant reduction of 18.77% (P<0.001) in fasting and
diabetic subjects up to 78.47% (P<0.001) and 87.44%
19.7% (P<0.001) in post prandial blood glucose levels,
(P<0.001) respectively, after 120 days of therapy.
whereas diabetic subjects treated with insulin sensitizer
However, a significant increment of 72.57% (P<0.001)
showed reduction of 31.83% (P<0.001) in fasting and
was observed in the GSH level of Triphala treated
40.25% (P<0.001) in P.P. level after 120 days of
normal subjects (Table 5). SOD activity was significantly
therapy. Hence, proving anti-hyperglycemic activity
increased by 213.25% (P<0.001) in Triphala treated
Advances in Life Sciences, 2010, 4 (1-4), 21-29
 27
Triphala on humans with type II diabetes mellitus. respectively.
Triphala extract has been reported to reduce blood sugar Fortunately, there are several antioxidant
level in normal and in alloxan treated diabetic rats mechanisms that can neutralize the free radicals in the
significantly within 4 hours (Sabu et al., 2002). In the living organisms (Parra et al., 2003). The three primary
present observation, Triphala treatment showed a scavenging enzymes involved in detoxifying the free
significant reduction of 23.41% (P<0.05), whereas radicals in mammalian systems are SOD, CAT and GPx.
insulin sensitizer showed reduction of 13 % (P<0.05) SOD dismutates the highly reactive superoxide anion
in GHb levels after 120 days of therapy, indicating to the less reactive species H2O2 (Teixeira et al., 1998).
efficacy of Triphala over insulin sensitizer in lowering CAT efficiently reacts with H2O2 to form water and
down GHb levels in type II diabetics. Increase in the molecular oxygen. GPx catalyses the reduction of
levels of glycosylated hemoglobin (HbA1c) in diabetic hydroperoxides, against the oxidative damage (Sigalov
patient is due to the presence of excessive amount of et al., 1998). Depletion in the activities of these
blood glucose. Apart from the blood sugar lowering antioxidant enzymes can be showed to an enhanced
effects, beneficial changes in lipid profile have also been radical production. Triphala showed significant elevation
observed. Diabetic subjects generally show an increased in SOD activity by 213.25% (P<0.001) and CAT
level of TG, Cholesterol, VLDL and LDL–cholesterol activity was increased by 118.45% (P<0.001) in diabetic
levels compared to non-diabetics. In the present study, subjects, whereas diabetic subjects treated with insulin
4 gm Triphala daily showed similar results as an insulin sensitizer showed reduction of 48.73% (P<0.05) and
sensitizer on lipid profile, when administered for 120 45% respectively, after 120 days of the therapy.
days. Triphala treated diabetic subjects showed 15.95% Administration of Triphala was found to
(P<0.001), 16.63% (P<0.001), (P<0.001), and 49.5% decrease the level of TBARS up to 25.8% (P<0.05) in
(P<0.001) reduction in Triglyceride, cholesterol, VLDL diabetic subjects, whereas a reduction of 12.16% was
and in LDL level respectively. Diabetic subjects treated observed in diabetic subjects treated with insulin
with insulin sensitizer showed reduction of 17.78% sensitizer after 120 day of the therapy. TBA, a chemical
(P<0.001), 27.24 % (P<0.001), 7.4%, 17.7% that reacts with plasma MDA to give TBARS, was
(P<0.001), and 47.6% (P<0.001) in triglyceride, significantly increased in type 2 DM with the duration
cholesterol, HDL-C, VLDL and in LDL level of disease and development of complications (Sundaram
respectively, after 120 days of therapy. et al., 1996). TBARS may be reversed by treatment
In our study, diabetic subjects treated with with combined vitamins C, E, and â-carotene
Triphala showed reduction of 25.01% (P<0.001), (Mekinnova et al., 1995). In the present study, GSH
34.74% (P<0.001) and 22.01% (P<0.001) in SGOT, levels were increased to its normal range in both Triphala
SGPT and in bilirubin level respectively. This might be as well as insulin sensitizer treated diabetics, thus
due to phenolic compounds and tannins present in preventing lipid peroxidation. In diabetics GSH gets
Triphala components. Whereas diabetic subjects treated oxidized, to compensate for the loss due to free radicals
with insulin sensitizer showed reduction of 28.8% present. Reduced glutathione donates its hydrogen to
(P<0.001), 13.07% (P<0.001) and 19.5% (P<0.001) lipid hydroperoxide produced due superoxide ion or
in SGOT level, SGPT and in bilirubin levels respectively. hydroxyl ion present in the vicinity of polyunsaturated
These results prove hepatoprotective action of traditional fatty acids present in the membrane. Diabetic subjects
Indian medicine like Triphala with phenolic compounds treated with Triphala and diabetic subjects treated with
over synthetic drugs. Administration of Triphala was insulin sensitizer showed increase in GSH levels by 78.47
found to decrease the level of creatinine up to 18.72% (P<0.001) and 87.44% (P<0.001) respectively, after
(P<0.001), urea up to 14.37% (P<0.001) and uric acid 120 days of the therapy. Due to decreases in activities
up to 15.15% (P<0.001) in diabetic subjects, whereas of the enzymes involved in GSH synthesis (such as ã-
diabetic subjects treated with insulin sensitizer showed glutamycystein synthetase) or in the transport rate of
reduction of 25.83% (P<0.001), 7% and 5.7% oxidized glutathione (GSSG) from erythrocytes
Advances in Life Sciences, 2010, 4 (1-4), 21-29
28
(Murakami et al., 1989) and enhanced sorbitol pathway of vascular reactivity in aortas from
(Ciuchi et al., 1996), decrease in the concentration of streptozotocin-treated rats. J Charmacol Exp
reduced glutathione (GSH) has been observed in Ther. 266:992–1000.
erythrocytes of DM subjects. The modifying role of Ciuchi E, Odetti P, Prando R 1996. Relationship
Triphala observed in our study may be due to its property between glutathione and sorbitol concentrations
of decreasing insulin resistance or increasing insulin in erythrocytes from diabetic patients.
sensitivity or by directly stimulating the utilization of the Metabolism. 45 : 611-613.
glucose by the tissues. Further long term studies are Diabetes Prevention Program Research Group 2002.
needed to fully elucidate the antidiabetic potential of Reduction in the incidence of type 2 diabetes
‘Triphala’. with lifestyle intervention or metformin. N Engl
J Med. 346:393–403.
Conclusion
Ellman GL 1959. Tissue sulfhydryl groups. Arch
In conclusion, present study with a therapeutic
Biochem. 82: 70-77.
dose of 4gm Triphala daily for 120 days indicated a
Fronzo De, Bonadonna RA, Ferrannini E 1997.
significant antidiabetic, antioxidative and renoprotective
Pathogenesis of NIIDM, Internatinal Text Book
effects and encourages even the long term administration
of Diabetes Mellitus, 2nd ed. Chichester, John
of Triphala free of side effects unlike synthetic drugs.
Wiley, England. 365-712.
The study disclosed the avenue properly for evaluating
Halliwell B, Gutteridge JM 1990. Role of free radicals
the therapeutic efficacy of a common preparation like
and catalytic metal ions in human disease: An
“Triphala” on life style disorder and well-being. The
overview. Meth Enzymol. 186:1–85.
results indicate that Triphala powder has good potential
Huupponen, R 1978. Adverse cardiovascular effects
of being good drug for the treatment of Diabetes mellitus.
of sulphonylurea durgs clinical significance.
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