Journal of Ethnopharmacology PDF
Journal of Ethnopharmacology PDF
                                                                    Journal of Ethnopharmacology
                                                                    journal homepage: www.elsevier.com/locate/jep
Review
art ic l e i nf o a b s t r a c t
Article history:                                                       Ethnopharmacological relevance: The prevalence of diabetes is on a steady increase worldwide and it is
Received 15 November 2013                                              now identified as one of the main threats to human health in the 21st century. In Nigeria, the use of
Received in revised form                                               herbal medicine alone or alongside prescription drugs for its management is quite common. We hereby
26 May 2014
                                                                       carry out a review of medicinal plants traditionally used for diabetes management in Nigeria. Based on
Accepted 26 May 2014
                                                                       the available evidence on the species' pharmacology and safety, we highlight ways in which their
Available online 12 June 2014
                                                                       therapeutic potential can be properly harnessed for possible integration into the country's healthcare
Keywords:                                                              system.
Diabetes                                                               Materials and methods: Ethnobotanical information was obtained from a literature search of electronic
Nigeria                                                                databases such as Google Scholar, Pubmed and Scopus up to 2013 for publications on medicinal plants
Ethnopharmacology
                                                                       used in diabetes management, in which the place of use and/or sample collection was identified as
Herb–drug interactions
                                                                       Nigeria. ‘Diabetes’ and ‘Nigeria’ were used as keywords for the primary searches; and then ‘Plant name –
WHO Traditional Medicine Strategy
                                                                       accepted or synonyms’, ‘Constituents’, ‘Drug interaction’ and/or ‘Toxicity’ for the secondary searches.
                                                                       Results: The hypoglycemic effect of over a hundred out of the 115 plants reviewed in this paper is backed
                                                                       by preclinical experimental evidence, either in vivo or in vitro. One-third of the plants have been studied
                                                                       for their mechanism of action, while isolation of the bioactive constituent(s) has been accomplished for
                                                                       twenty three plants.
                                                                           Some plants showed specific organ toxicity, mostly nephrotoxic or hepatotoxic, with direct effects on the
                                                                       levels of some liver function enzymes. Twenty eight plants have been identified as in vitro modulators
                                                                       of P-glycoprotein and/or one or more of the cytochrome P450 enzymes, while eleven plants altered the levels
                                                                       of phase 2 metabolic enzymes, chiefly glutathione, with the potential to alter the pharmacokinetics of
                                                                       co-administered drugs.
                                                                       Conclusion: This review, therefore, provides a useful resource to enable a thorough assessment of the profile
                                                                       of plants used in diabetes management so as to ensure a more rational use. By anticipating potential toxicities
                                                                       or possible herb–drug interactions, significant risks which would otherwise represent a burden on the
                                                                       country's healthcare system can be avoided.
                                                                       & 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license
                                                                                                                                       (http://creativecommons.org/licenses/by/3.0/).
Contents
  1.   Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   858
       1.1.   Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .      858
       1.2.   Traditional herbal medicines in diabetes management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                                     858
  2.   Ethno-pharmacological data collection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                     859
       2.1.   Method. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .       859
  Abbreviations: AAN, aristolochic acid nephropathy; ADME, absorption, distribution, metabolism and excretion; CYT P450, cytochrome P450; DPP-IV, dipeptidyl peptidase
IV; GLP1, glucagon like peptide 1; GLUT4, glucose transporter 4; GSH, glutathione; GST, glutathione-S-transferase; IDDM, insulin dependent diabetes mellitus; NIDDM, non-
insulin dependent diabetes mellitus; P-GP, P-glycoprotein; PPARγ, peroxisome proliferator activated receptor gamma; STZ, streptozotocin; WHO, World Health Organization
  n
    Corresponding author. Tel.: þ 44 2077535871.
    E-mail addresses: amaka.ezuruike@gmail.com (U.F. Ezuruike), j.prieto@ucl.ac.uk (J.M. Prieto).
    1
      Tel.: þ44 2077535841.
http://dx.doi.org/10.1016/j.jep.2014.05.055
0378-8741/& 2014 The Authors. Published by Elsevier Ireland Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/).
858                                                             U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924
1. Introduction                                                                                                         2009; Ogbera et al., 2007, 2009). In the presence of these, the
                                                                                                                        number of prescribed drugs increases to an average of four per day
1.1. Diabetes                                                                                                           for each patient (Enwere et al., 2006). This need for the chronic
                                                                                                                        intake of a large number of drugs with their attendant side effects
    Diabetes is a chronic metabolic disorder characterized by high                                                      in addition to their high costs which is often borne by the patients
blood glucose levels. This is either as a result of insufficient                                                         themselves is the identified reason for non-adherence to therapy
endogenous insulin production by the pancreatic beta cells (other-                                                      amongst diabetic patients. As a result, patients often have recourse
wise known as type-1 diabetes); or impaired insulin secretion                                                           to alternative forms of therapy such as herbal medicines (Yusuff
and/or action (type-2 diabetes). type-1 diabetes is an autoimmune                                                       et al., 2008).
disease characterized by T-cell mediated destruction of the pan-
creatic beta cells. In type-2 diabetes, there is a gradual develop-                                                     1.2. Traditional herbal medicines in diabetes management
ment of insulin resistance and beta cell dysfunction, strongly
associated with obesity and a sedentary lifestyle (Zimmet et al.,                                                           A number of reviews on medicinal plants used in the manage-
2001). Due to a higher incidence of the risk factors, the prevalence                                                    ment of diabetes in different parts of the world (Bailey and Day,
of diabetes is increasing worldwide, but more evidently in devel-                                                       1989; Marles and Farnsworth, 1995), as well as those used
oping countries. Current estimates indicate a 69% increase in the                                                       specifically in certain regions, such as in West Africa (Bever,
number of adults that would be affected by the disease between                                                          1980), Central America (Andrade-Cetto and Heinrich, 2005) and
2010 and 2030, compared to 20% for developed countries (Shaw                                                            Asia (Grover et al., 2002) exist. These reviews have highlighted the
et al., 2010).                                                                                                          dependence of a large percentage of the world population on
    Administration of exogenous insulin is the treatment for all                                                        traditional medicine for diabetes management. This is also corro-
type-1 diabetic patients and for some type-2 patients who do not                                                        borated by the WHO fact sheet (No. 134), which estimates that
achieve adequate blood glucose control with oral hypoglycemic                                                           about 80% of the population in African and Asian countries rely on
drugs. Current drugs used in diabetes management can be cate-                                                           traditional medicine for their primary healthcare (WHO, 2008).
gorized into three groups. Drugs in the first group increase                                                             It also recognizes traditional medicine as ‘an accessible, affordable
endogenous insulin availability. These include the sulphonylureas                                                       and culturally acceptable form of healthcare trusted by large
such as glibenclamide, the glinides, insulin analogs, glucagon-like                                                     numbers of people, which stands out as a way of coping with
peptide 1 (GLP-1) agonists and dipeptidyl peptidase-IV (DPP-IV)                                                         the relentless rise of chronic non-communicable diseases in the
inhibitors. The first two members of this group act on the                                                               midst of soaring health-care costs and nearly universal austerity’
sulfonylurea receptor in the pancreas to promote insulin secretion.                                                     (WHO, 2013).
GLP-1 agonists and DPP-IV inhibitors on the other hand act on the                                                           Ethnobotanical surveys of plants traditionally used in diabetes
ileal cells of the small intestine. The second group of drugs                                                           management in different parts of Nigeria have been carried out
enhance the sensitivity of insulin. This includes the thiazolidine-                                                     (Abo et al., 2008; Etuk and Mohammed, 2009; Gbolade, 2009;
diones, which are agonists of the peroxisome proliferator-                                                              Soladoye et al., 2012). These medicinal plants are used either alone
activated receptor gamma (PPARγ) and the biguanide metformin.                                                           as a primary therapeutic choice, or in conjunction with conven-
The third group comprises the α-glucosidase inhibitors such as                                                          tional medicines. On an average, approximately 50% of diabetic
acarbose, which reduce the digestion of polysaccharides and their                                                       patients visiting hospitals in urban cities like Lagos and Benin have
bioavailability (Chehade and Mooradian, 2000; Sheehan, 2003).                                                           used some forms of traditional medicine during the course of their
All the existing therapies however have limited efficacy, limited                                                        disease management (unpublished results of field work conducted
tolerability and/or significant mechanism based side effects                                                             by first author). Unfortunately, clinicians are either unaware of
(Moller 2001; Rotenstein et al., 2012).                                                                                 their patients' herb use or the identity of the herbal product being
    Despite the existing pharmacotherapy, it is still difficult to                                                       taken. To complicate matters further, herbal practitioners are
attain adequate glycemic control amongst many diabetic patients                                                         usually unwilling to divulge the identity of the constituents of
due to the progressive decline in β-cell function (Wallace and                                                          their preparations to patients. Most patients are also not interested
Matthews, 2000). In Nigeria, polytherapy with two or more                                                               in finding this out as they consider herbal preparations to be
hypoglycemic agents to achieve better glucose control is common                                                         ‘safe’; thereby making it difficult to ascertain if the herb may have
practice (Yusuff et al., 2008). There is also a high incidence of                                                       a significant contributory role to the efficacy or failure of the
diabetic complications and hyperglycemic emergencies (Gill et al.,                                                      treatment.
                                        U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924                              859
    In a systematic review of herbs and supplements clinically used             from primary research papers (as indicated in Table 1). These
for glycemic control, Allium sativum, Aloe vera and Momordica                   are tabulated according to their accepted Latin Name (based on
charantia were the only identified plants used in Nigeria.                       http://www.plantlist.org). Synonyms are included for plants which
This inclusion was however based on clinical studies carried out                were not identified with their accepted names in the primary
outside Nigeria (Yeh et al., 2003). This indicates the lack of                  research paper. For each of the identified plants, the family name,
information about the clinical use (or monitoring thereof) of                   common name(s), identified region of use in diabetes manage-
plants in diabetes management in Nigeria, despite widespread                    ment, experimental evidence of activity (where available), other
traditional use.                                                                medicinal uses, plant part(s) used, traditional method(s) of pre-
    In line with the increasing importance of traditional medicine              paration, identified active constituent(s), other relevant phyto-
in various healthcare systems around the world, the WHO Tradi-                  chemical constituents, as well as data on interaction and toxicity
tional Medicine Strategy has recently been updated. ‘The goals of               studies are included [Table 1].
the strategy for the next decade (2014–2023) are to support                         Out of the 115 plants reviewed in this paper, only twelve of
Member States in (a) harnessing the potential contribution of                   them have no experimental evaluation of their blood sugar
traditional medicine to health, wellness and people-centered                    reducing effects, either in vivo or in vitro. In selecting studies to
health-care; and (b) promoting the safe and effective use of                    be included, priority was given to investigations carried out with
traditional medicine by regulating, researching and integrating                 samples collected in Nigeria. Certain publications were not
traditional medicine products, practitioners and practice into                  included if the study design of the experimental evidence
health systems where appropriate’ (WHO, 2013).                                  was not appropriate enough for validating the effect of the plant,
    Given that diabetes is now considered as one of the main                    such as the absence of a suitable control or the use of improper
threats to human health in the 21st century (Zimmet et al., 2001),              doses. Two-thirds of the identified plants with experi-
there might be an even greater reliance by diabetic patients in                 mental evidence for their biological activity involved samples
Nigeria on herbal medicines used in its management. Unfortu-                    collected from Nigeria. For the remaining one-third, although the
nately, pharmacological and toxicological evidences validating the              studies were not carried out with plant samples sourced from
safety and efficacy of these medicinal plants are not readily                    within Nigeria, these were still included, as the experimental
available. The objective of this paper is to collate as much as                 evidence could provide some information validating their use in
possible, available information about medicinal plants tradition-               diabetes management, since they are widely used in Nigeria. The
ally used in diabetes management in Nigeria. In doing so, we aim                ethnobotanical research carried out on Moringa oleifera provides a
to promote the rational use of these plants based on pharmaco-                  rationale for including information from studies carried out in
logical evidence for their therapeutic use and their toxic/interac-             different countries, as some of these locally available plants could
tion profile.                                                                    have been initially sourced from elsewhere (Popoola and Obembe,
                                                                                2013).
                                                                                    In-vitro experimental studies as well as phytochemical studies
                                                                                carried out on the plant species regardless of the source of
2. Ethno-pharmacological data collection                                        the plant samples were also included. These together could
                                                                                provide more insight into the biological activity(s) of the plant,
2.1. Method                                                                     which would in turn help to promote a more rational use
                                                                                of the plant in diabetes management, either in the presence or
   Information about medicinal plants traditionally used in the                 absence of other co-morbidities. For completeness, reports
management of diabetes in Nigeria was obtained from published                   on the antioxidant properties of many of the identified plants
papers and texts on ethnobotanical studies, as well as those                    have been included as this has become a popular parameter
investigating the effect of plant(s) used in diabetes management,               in assessing the beneficial effects of a plant in diabetes
in which the place of use and/or sample collection was identified                management.
as Nigeria. A literature search of electronic databases such
as Google Scholar, Pubmed and Scopus up to 2013 was carried
out using ‘Diabetes’ and ‘Nigeria’ as keywords for the primary
searches; and then ‘Plant name – accepted or synonyms’,                         3. Pharmacological evidence and its clinical implications
‘Constituents’, ‘Drug interaction’ and/or ‘Toxicity’ for the secondary
searches.                                                                       3.1. In vivo hypoglycemic activity
   In order to highlight medicinal plants traditionally used in
diabetes management with the potential for integration into the                     Reducing blood sugar level is the classical clinical target in all
healthcare system, not all identified plants were included in this               forms of diabetes. Thus, the in vivo sugar lowering effect of
paper. Only those with (1) more than one reference to its use in                putative hypoglycemic plants is therefore a premise to infer their
diabetes management in Nigeria based on ethnobotanical studies                  potential clinical efficacy. In vivo validation also provides an
were retained; and/or (2) experimental evidence in one or more                  indication of the relative toxicity of the plant. Although most
diabetes experimental models validating its activity. This review is            herbal medicines have a long history of traditional use, only their
therefore not exhaustive for all the plants used traditionally for              experimental validation at known doses may give a clearer idea
diabetes management in Nigeria.                                                 about its safety and efficacy, in line with the objectives of the WHO
                                                                                Traditional Medicine Strategy (WHO, 2013).
2.2. Results                                                                        Ninety six out of the one hundred and fifteen plants here
                                                                                reviewed have been evaluated in various in vivo animal models
   Data for one hundred and fifteen plants traditionally used in                 of diabetes, mostly using alloxan and/or streptozotocin (STZ)-
diabetes management in Nigeria were obtained, either from previ-                induced diabetic animals, which are the most frequently used
ously conducted ethnobotanical studies (Abo et al., 2008; Aiyeloja              animal diabetes models worldwide (Fröde and Medeiros, 2008).
and Bello, 2006; Ajibesin et al., 2008; Etuk and Mohammed, 2009;                These chemical agents are cytotoxic to the β-cells of the pancreatic
Gbolade, 2009; Igoli et al., 2005; Lawal et al., 2010; Ogbonnia and             islets, generating a state of insulin deficiency (akin to type-1
Anyakora, 2009; Okoli et al., 2007; Olowokudejo et al., 2008); or               diabetes) with subsequent hyperglycemia (Szkudelski, 2001). The
                                                                                                                                                                                                                                                                  860
Table 1
Medicinal plants used in the management of diabetes in Nigeria.
 S/    Plant name        Family          Common          Local           Region of   Experimental evidence for        Other medicinal uses        Plant part      Traditional   Identified active     Other relevant                   Interaction/toxicity
 no.                                     name            Nigerian        use for     its use in diabetes                                          (s) used        preparation   constituent(s)       phytoconstituents                studies
                                                         name(s)*        diabetes#   management                                                                   method                             identified in the plant
 1     Abelmoschus       Malvaceae       Okro/Okra;      Ila (Y);        SW, SS      100 and 200 mg/kg of the         Infections, Immune-         Fruit, Seed     Decoction,                         β-1,3-D-glucans (Sheu and        Water soluble fraction
       esculentus (L.)                   Lady's fingers   Okweje (I);                 seed and peel powder             modulatory, Fevers,                         Maceration                         Lai, 2012); Hydroxy              of the fruits decreased
       Moench                                            Kubewa (H)                  decreased blood glucose in       Spasms, Gonorrhoea,                         food                               cinnamic derivatives,            oral metformin
                                                                                     STZ induced diabetic rats        Dysentry                                    vegetable                          Oligomeric catechins,            absorption in-vivo
                                                                                     (Sabitha et al., 2011)§;                                                                                        Isorhamnetin glycosides,         (Khatun et al., 2011)
                                                                                     Antioxidant effects of the                                                                                      Quercetin, Myricetin and
                                                                                     aqueous extract of the leaves                                                                                   Kaempferol and their
                                                                                     (Tsumbu et al., 2011)                                                                                           glycosides (Arapitsas,
                                                                                                                                                                                                     2008); Abelesculin (Kondo
                                                                                                                                                                                                     and Yoshikawa, 2007);
                                                                                                                                                                                                     Rhamnogalacturonans
  S/    Plant name           Family           Common      Local          Region of   Experimental evidence for         Other medicinal uses      Plant part    Traditional   Identified active      Other relevant                 Interaction/toxicity
  no.                                         name        Nigerian       use for     its use in diabetes                                         (s) used      preparation   constituent(s)        phytoconstituents              studies
                                                          name(s)*       diabetes#   management                                                                method                              identified in the plant
                                                                                                                                                                                                                                                             861
                                                                                                                                                                                                                                                           862
Table 1 (continued )
  S/    Plant name        Family          Common          Local        Region of   Experimental evidence for       Other medicinal uses        Plant part     Traditional     Identified active   Other relevant                 Interaction/toxicity
  no.                                     name            Nigerian     use for     its use in diabetes                                         (s) used       preparation     constituent(s)     phytoconstituents              studies
                                                          name(s)*     diabetes#   management                                                                 method                             identified in the plant
  S/    Plant name        Family         Common          Local           Region of   Experimental evidence for        Other medicinal uses      Plant part       Traditional   Identified active   Other relevant                  Interaction/toxicity
  no.                                    name            Nigerian        use for     its use in diabetes                                        (s) used         preparation   constituent(s)     phytoconstituents               studies
                                                         name(s)*        diabetes#   management                                                                  method                           identified in the plant
                                                                                                                                                                                                                                                             863
                                                                                                                                                                                                                                                                864
Table 1 (continued )
  S/    Plant name         Family             Common         Local          Region of   Experimental evidence for        Other medicinal uses       Plant part     Traditional   Identified active   Other relevant                  Interaction/toxicity
  no.                                         name           Nigerian       use for     its use in diabetes                                         (s) used       preparation   constituent(s)     phytoconstituents               studies
                                                             name(s)*       diabetes#   management                                                                 method                           identified in the plant
                                                                                                                                                                                                    glycosides, Catechin,
                                                                                                                                                                                                    Chlorogenic acid,
                                                                                                                                                                                                    Argentinine, kaempferol
                                                                                                                                                                                                    and its glycosides
                                                                                                                                                                                                    (Nawwar et al., 2012)
  17    Annona             Annonaceae         Wild custard   Uburu ocha    SS, NC,      100 mg/kg of the aqueous         Anti-parasitic, Anti-      Stem-bark,     Decoction                        Acetogenins (Carmen             Stem bark extract
        senegalensis Pers.                    apple          (I), Abo (Y), NW, SW       extract of a herbal              bacterial, Tumours,        Root, Leaves                                    Zafra-Polo et al., 1998);       inhibited P-gp mediated
                                                             Gwander-daji               preparation ADD-199              Erectile dysfunction,                                                      Roemerine, Isocorydine,         Rh-123 efflux (Ezuruike
                                                             (H), Ogoganto              containing the roots of          Wound-healing, Snake                                                       8,8-Bisdihydrosiringenin,       et al., 2012); Roemerine
                                                             (Es),                      Annona senegalesis and three     bites, Convulsions,                                                        Syringaresinol (You et al.,     interacts with P-gp and
                                                             Ndaweewu                   other plants decreased           Hemorrhage                                                                 1995); Kaurane                  enhances vinblastine
                                                             (F)                        plasma glucose and increased                                                                                diterpenes, Quercetin,          cytotoxicity (You et al.,
  S/    Plant name         Family             Common         Local         Region of   Experimental evidence for        Other medicinal uses      Plant part     Traditional   Identified active       Other relevant                    Interaction/toxicity
  no.                                         name           Nigerian      use for     its use in diabetes                                        (s) used       preparation   constituent(s)         phytoconstituents                 studies
                                                             name(s)*      diabetes#   management                                                                method                               identified in the plant
                                                                                                                                                                                                                                                                    865
                                                                                                                                                                                                                                                               866
Table 1 (continued )
  S/    Plant name         Family        Common           Local           Region of   Experimental evidence for       Other medicinal uses       Plant part      Traditional   Identified active      Other relevant                  Interaction/toxicity
  no.                                    name             Nigerian        use for     its use in diabetes                                        (s) used        preparation   constituent(s)        phytoconstituents               studies
                                                          name(s)*        diabetes#   management                                                                 method                              identified in the plant
        Piliostigma                                                                   well as improved serum lipid                                                             the stem bark         acid, Labd-13-en-8-0l-19-       of the monolayer and
        thonningii                                                                    profile in alloxan-induced                                                                decreased blood       oic acid (Baratta et al.,       the secretory transport
                                                                                      diabetic rats (Ojezele and                                                               glucose levels in     1999); Quercetin,               of Cyclosporin A (CsA)
                                                                                      Abatan, 2011)                                                                            alloxan-induced       Quercitrin, C-methyl            indicating possible
                                                                                                                                                                               diabetic rats dose-   quercetin ethers, C-methyl      inhibition of P-gp
                                                                                                                                                                               dependently           kaempferol ethers,              (Deferme et al., 2003)
                                                                                                                                                                               (Asuzu and            Piliostigmin (Ibewuike et
                                                                                                                                                                               Nwaehujor, 2013)      al., 1997); Kaurane
                                                                                                                                                                                                     diterpenes (Martin et al.,
                                                                                                                                                                                                     1997); Griffonilide,
                                                                                                                                                                                                     Rhamnetin, Carotenoids
                                                                                                                                                                                                     (Okwute et al., 1986)
  S/    Plant name          Family           Common          Local            Region of   Experimental evidence for         Other medicinal uses      Plant part       Traditional   Identified active        Other relevant                  Interaction/toxicity
  no.                                        name            Nigerian         use for     its use in diabetes                                         (s) used         preparation   constituent(s)          phytoconstituents               studies
                                                             name(s)*         diabetes#   management                                                                   method                                identified in the plant
                                                                                                                                                                                                                                                                         867
                                                                                                                                                                                                                                                                 868
Table 1 (continued )
  S/    Plant name        Family         Common             Local        Region of   Experimental evidence for          Other medicinal uses       Plant part     Traditional     Identified active   Other relevant                 Interaction/toxicity
  no.                                    name               Nigerian     use for     its use in diabetes                                           (s) used       preparation     constituent(s)     phytoconstituents              studies
                                                            name(s)*     diabetes#   management                                                                   method                             identified in the plant
  34    Bryophyllum       Crassulaceae   Africa never       Ewe abamoda SW           400 mg/kg of the aqueous           Hypertension,              Leaves,        Juice extract                      Syringic acid, Caffeic acid,   Risk of cardiac glycoside
        pinnatum (Lam.)                  die, Life plant,   (Y)                      extract of the fresh leaves        Analgesic,                 Flower                                            4-hydroxy-3-methoxy            poisoning due to the
        Oken                             Resurrection                                produced hypoglycaemia in          Inflammation, Wound                                                           cinnamic acid, 4-hydroxy       bufadienolides
                                         plant                                       both normal and STZ-               ulcers, Anti-parasitic,                                                      benzoic acid, Hydroxy          Bryotoxin A, B, C
                                                                                     induced diabetic rats              Insect bites, Anti-cancer,                                                   cinnamic acid, P-coumaric      (McKenzie et al., 1987);
                                                                                     (Ojewole, 2005);                   Cough, Diarrhoea,                                                            acid, Protocatechuic acid,     Significant decrease in
                                                                                     Hypoglycemic effect of             Sedative, Diuretic, Anti-                                                    Phosphoenolpyruvate,           serum ALT levels in rats
                                                                                     500 mg/kg aqueous extract of       microbial, Convulsions                                                       Ferulic acid, Astragalin,      after daily oral dosing of
                                                                                     the leaves in normal fasted                                                                                     Friedelin, Luteolin,           2 g/kg aqueous extract
                                                                                     glucose-loaded and STZ-                                                                                         Quercetin glycosides,          of the leaves (Ozolua et
                                                                                     induced diabetic rats                                                                                           Epigallocatechin-3-O-          al., 2010)
  S/    Plant name         Family        Common         Local           Region of   Experimental evidence for        Other medicinal uses        Plant part      Traditional     Identified active      Other relevant                  Interaction/toxicity
  no.                                    name           Nigerian        use for     its use in diabetes                                          (s) used        preparation     constituent(s)        phytoconstituents               studies
                                                        name(s)*        diabetes#   management                                                                   method                                identified in the plant
  36    Capsicum annum Solanaceae        Chilli, Bird   Ata or Ata      SW, SE      Alpha glucosidase and α-         Analgesic,                  Fruit           Decoction                            Capsaicinoids
        L., Syn: Capsicum                pepper         wewe (Y),                   amylase inhibitory activities    Antimicrobial,                                                                   (Schweiggert et al., 2006);
        frutescens L.                                   Ose (I),                    and antioxidant effects (Oboh    Inflammation,                                                                     Myricetin, Kaempferol,
                                                        Barkono (H),                et al., 2011; Kwon et al.,       Hemorrhoids, Fevers,                                                             Apigenin, Luteolin,
                                                        Asin (Es)                   2007); Incorporation of 2% of    Dysentry, Malaria,                                                               Quercetin (Miean and
                                                                                    the fruit powder in a high fat   Carminative, Stimulant                                                           Mohamed, 2001); CAY-1
                                                                                    diet given to STZ-induced                                                                                         (Stergiopoulou et al.,
                                                                                    diabetic rats increased serum                                                                                     2008); Alpha tocopherol
                                                                                    insulin levels (Islam and                                                                                         (Ching and Mohamed,
                                                                                    Choi, 2008)§; 100 mg/l fruit                                                                                      2001); Ortho hydroxyl
                                                                                    extracts possessed PPAR                                                                                           N-benzyl 16-Methyl 11,14-
                                                                                    alpha and gamma agonistic                                                                                         diene octadecamide, 9, 12-
                                                                                                                                                                                                                                                                    869
                                                                                                                                                                                                                                                         870
Table 1 (continued )
  S/    Plant name           Family        Common         Local          Region of   Experimental evidence for       Other medicinal uses      Plant part     Traditional    Identified active   Other relevant                 Interaction/toxicity
  no.                                      name           Nigerian       use for     its use in diabetes                                       (s) used       preparation    constituent(s)     phytoconstituents              studies
                                                          name(s)*       diabetes#   management                                                               method                            identified in the plant
  S/    Plant name          Family        Common          Local            Region of   Experimental evidence for       Other medicinal uses      Plant part      Traditional     Identified active   Other relevant                 Interaction/toxicity
  no.                                     name            Nigerian         use for     its use in diabetes                                       (s) used        preparation     constituent(s)     phytoconstituents              studies
                                                          name(s)*         diabetes#   management                                                                method                             identified in the plant
                                                                                                                                                                                                                                                               871
                                                                                                                                                                                                                                                                872
Table 1 (continued )
  S/    Plant name         Family          Common           Local           Region of   Experimental evidence for        Other medicinal uses       Plant part      Traditional     Identified active   Other relevant                  Interaction/toxicity
  no.                                      name             Nigerian        use for     its use in diabetes                                         (s) used        preparation     constituent(s)     phytoconstituents               studies
                                                            name(s)*        diabetes#   management                                                                  method                             identified in the plant
                                                                                                                                                                                                       arabinopyranosides of
                                                                                                                                                                                                       vitexin and isovitexin
                                                                                                                                                                                                       (Veitch and Grayer, 2011);
                                                                                                                                                                                                       Bergamottin, Limettin,
                                                                                                                                                                                                       Bergapten, 5-geranyloxy-
                                                                                                                                                                                                       7-methoxycoumarin,
                                                                                                                                                                                                       Isopimpinellin, 3-methyl-
                                                                                                                                                                                                       1,2-cyclopentadione,
                                                                                                                                                                                                       1-methoxy-cyclohexene,
                                                                                                                                                                                                       Corylone, Umbelliferone,
                                                                                                                                                                                                       5,8-dimethoxypsoralen,
  S/    Plant name          Family          Common         Local           Region of   Experimental evidence for       Other medicinal uses      Plant part     Traditional   Identified active   Other relevant                  Interaction/toxicity
  no.                                       name           Nigerian        use for     its use in diabetes                                       (s) used       preparation   constituent(s)     phytoconstituents               studies
                                                           name(s)*        diabetes#   management                                                               method                           identified in the plant
                                                                                                                                                                                                                                                            873
                                                                                                                                                                                                                                                               874
Table 1 (continued )
  S/    Plant name          Family          Common          Local          Region of   Experimental evidence for        Other medicinal uses     Plant part      Traditional     Identified active   Other relevant                 Interaction/toxicity
  no.                                       name            Nigerian       use for     its use in diabetes                                       (s) used        preparation     constituent(s)     phytoconstituents              studies
                                                            name(s)*       diabetes#   management                                                                method                             identified in the plant
                                                                                                                                                                                                    Dihydrophilonotisflavone,
                                                                                                                                                                                                    Catalposide, Obtusoside,
                                                                                                                                                                                                    Picrosides, Quercitrin,
                                                                                                                                                                                                    Coumarin, Cimifugin,
                                                                                                                                                                                                    (Abu-Reidah et al., 2013)
  48    Cola acuminata      Malvaceae       Kolanut         Obi agada (Y), SW          Antioxidant effects (Atawodi     Stimulant, Appetite      Nuts, Stem-     Decoction,                         Procyanidin B1 and B2,
        (P.Beauv.) Schott                                   Orji (I)                   et al., 2007) 500 mg/kg of the   suppressants,            bark, Leaves    Juice extract                      Catechin, Epicatechin,
        and Endl.                                                                      methanol extract of the stem     Aphrodisiac, Respiratory                                                    Caffeine (Atawodi et al.,
                                                                                       bark decreased blood glucose     infections,                                                                 2007); Theobromine
                                                                                       levels in alloxan induced        Hypertension, Anti-                                                         (Niemenak et al., 2008);
                                                                                       diabetic rats after 21 days      parasitic                                                                   Chlorogenic, Quinnic and
                                                                                       (Adediwura et al., 2011)                                                                                     Tannic acids (Odebode,
  S/    Plant name         Family          Common          Local            Region of   Experimental evidence for        Other medicinal uses        Plant part    Traditional      Identified active     Other relevant               Interaction/toxicity
  no.                                      name            Nigerian         use for     its use in diabetes                                          (s) used      preparation      constituent(s)       phytoconstituents            studies
                                                           name(s)*         diabetes#   management                                                                 method                                identified in the plant
                                                                                                                                                                                                                                                                  875
                                                                                                                                                                                                        Salicyaldehyde, Luteolin
Table 1 (continued )
                                                                                                                                                                                                                                                                876
  S/    Plant name          Family        Common          Local          Region of   Experimental evidence for          Other medicinal uses        Plant part      Traditional   Identified active   Other relevant                  Interaction/toxicity
  no.                                     name            Nigerian       use for     its use in diabetes                                            (s) used        preparation   constituent(s)     phytoconstituents               studies
                                                          name(s)*       diabetes#   management                                                                     method                           identified in the plant
55 Daniellia oliveri Leguminosae African balsam Iya (Y), Maje SE, NE 100, 200 and 400 mg/kg Analgesic, Root, Leaves, Maceration Daniellic acid, Oliveric acid
  S/    Plant name          Family        Common          Local           Region of   Experimental evidence for         Other medicinal uses        Plant part    Traditional   Identified active       Other relevant               Interaction/toxicity
  no.                                     name            Nigerian        use for     its use in diabetes                                           (s) used      preparation   constituent(s)         phytoconstituents            studies
                                                          name(s)*        diabetes#   management                                                                  method                               identified in the plant
                                                                                                                                                                                                                                                                877
                                                                                                                                                                                                                                                      878
Table 1 (continued )
  S/    Plant name          Family        Common      Local        Region of   Experimental evidence for         Other medicinal uses      Plant part     Traditional   Identified active        Other relevant                 Interaction/toxicity
  no.                                     name        Nigerian     use for     its use in diabetes                                         (s) used       preparation   constituent(s)          phytoconstituents              studies
                                                      name(s)*     diabetes#   management                                                                 method                                identified in the plant
                                                                               activity of glucose           problems, Chewing                                          extract of the stem     Aromadendrene and its
                                                                               metabolizing enzymes          stick, Laxative, Ulcer,                                    and leaves in           hydrate, α-Humulene,
                                                                               (Ugochukwu and Babady,        Analgesic, Fevers                                          glucose loaded rats     δ-Cadinene, Germacrene,
                                                                               2003)                                                                                    as well as the          α- and γ-Eudesmol, (E)-
                                                                               Hypoglycaemic effect of                                                                  In vitro glucose        Phytol, Methyl palmitate
                                                                               100 mg/kg of the methanol                                                                stimulating effects     (Edet et al., 2005); 3-O-[6-
                                                                               extract in alloxan-induced                                                               in INS-1 cells led to   deoxy-3-O-methyl-β-D-
                                                                               diabetic mice (Ogundipe et                                                               the isolation of α-     allopyranosyl-(1-4)-β-D-
                                                                               al., 2003)                                                                               and β-amyrin            canaropyranosyl-17β-
                                                                               Antioxidant effects (Fasakin                                                             cinnamate, lupenyl      mardenin and 3-O-[6-
                                                                               et al., 2011; Ugochukwu and                                                              cinnamate and           deoxy-3-O-methyl-β-D-
                                                                               Babady, 2002)                                                                            lupenyl acetate as      allopyranosyl-(1-4)-β-D-
  S/    Plant name        Family           Common         Local           Region of   Experimental evidence for        Other medicinal uses         Plant part     Traditional   Identified active       Other relevant                  Interaction/toxicity
  no.                                      name           Nigerian        use for     its use in diabetes                                           (s) used       preparation   constituent(s)         phytoconstituents               studies
                                                          name(s)*        diabetes#   management                                                                   method                               identified in the plant
                                                                                                                                                                                                                                                                879
                                                                                                                                                                                                                                                                   880
Table 1 (continued )
  S/    Plant name         Family          Common          Local           Region of   Experimental evidence for          Other medicinal uses       Plant part      Traditional   Identified active   Other relevant                  Interaction/toxicity
  no.                                      name            Nigerian        use for     its use in diabetes                                           (s) used        preparation   constituent(s)     phytoconstituents               studies
                                                           name(s)*        diabetes#   management                                                                    method                           identified in the plant
  S/    Plant name        Family      Common           Local          Region of    Experimental evidence for   Other medicinal uses       Plant part   Traditional    Identified active   Other relevant                Interaction/toxicity
  no.                                 name             Nigerian       use for      its use in diabetes                                    (s) used     preparation    constituent(s)     phytoconstituents             studies
                                                       name(s)*       diabetes#    management                                                          method                            identified in the plant
                                                                                                                                                                                         Spirocurcasone, Ellagic
                                                                                                                                                                                         acid, Jatrophalactam,
                                                                                                                                                                                         Jatrogrossidione
                                                                                                                                                                                         derivatives, β-amyrin,
                                                                                                                                                                                         Jatrophalactone, Caffeoyl
                                                                                                                                                                                         aldehyde, Syringaldehyde,
                                                                                                                                                                                         Jatrophadiketone, Uracil,
                                                                                                                                                                                         β-sitosterol, Jatrophalone,
                                                                                                                                                                                         Taraxasterol, Stigmasterol,
                                                                                                                                                                                         Daucasterol, Pyrrolidine,
                                                                                                                                                                                         Curcamide, Tomentin,
                                                                                                                                                                                         Coumarin compounds
                                                                                                                                                                                                                                                   881
                                                                                                                                                                                                                                                  882
Table 1 (continued )
  S/    Plant name     Family       Common         Local          Region of   Experimental evidence for        Other medicinal uses   Plant part   Traditional   Identified active       Other relevant                  Interaction/toxicity
  no.                               name           Nigerian       use for     its use in diabetes                                     (s) used     preparation   constituent(s)         phytoconstituents               studies
                                                   name(s)*       diabetes#   management                                                           method                               identified in the plant
  70    Lawsonia       Lythraceae   Henna plant,   Laali (Y), Lelle SW        Alpha glucosidase inhibitory     Wound infection, Anti- Leaves       Decoction     Lawsone and gallic     β-Sitosterol glucoside,         Administration of
        inermis L.                  Mehndi,        (H)                        effects of the ethanol extract   microbial, Anti-                                  acid isolated from     Gallic acid, Coumarins,         henna leaf extract to
                                    Egyptian's                                of the leaves (Prashanth et      parasitic, Jaundice,                              the ethanol extract    Xanthones, Lawsoniaside,        mice for 21days
                                    priest                                    al., 2001)§ Increased activity   Nervous disorder,                                 of the aerial parts    Lalioside, Luteolin             resulted in increased
                                                                              of in-vivo antioxidant           Arthritis, Analgesic,                             inhibited the          glucosides, 1,2-dihydroxy-      activity of cytochrome
                                                                              enzymes (Dasgupta et al.,        Ulcers, Diarrhea, Anti-                           formation of           4-glucosyloxy                   b5 reductase enzyme
                                                                              2003)§ Daily administration      pyretic, Hepato-                                  glycated protein       naphthalene (Takeda and         and the phase
                                                                              of graded doses (100–            protective, Leucorrhoea,                          In vitro (Sultana et   Fatope, 1988); Vomifoliol,      2 enzymes GST and DDT
                                                                              800 mg/kg) of the ethanol        Excessive ejaculation,                            al., 2009)             Lawsonicin, Lawsonadeem         (Dasgupta et al., 2003)
                                                                              extract of the leaves for        Emmenagog, Skin                                                          (Siddiqui et al., 2003);        Topical application to
                                                                              2 weeks decreased blood          diseases, STDs,                                                          Isoplumbagin, Hexenol,          skin lesions in G6PD
                                                                              sugar levels in alloxan-         Abortifacient, Sickle cell,                                              Linalool, β-Ionone, α- and      deficient patients
                                                                              induced diabetic rats            Tumours, Tuberculosis,                                                   γ-Terpineol, Terpinolene,       resulted in hemolytic
                                                                              (Inawati and Winarno,            Splenomegaly,                                                            δ-3-Carene, Benzaldehyde,       anemia (Kök et al.,
                                                                              2008)§ In vitro antioxidant      Menorrhagia                                                              Isocaryophyllene, Methyl        2004)
                                                                              effects of isolated                                                                                       salicylate, Naphthalene,
                                                                              constituents of the plant                                                                                 Eugenol, Germacrene D,
                                                                              (Hsouna et al., 2011)§                                                                                    Farnesene, Bisabolene, β-
                                                                                                                                                                                        Elemene, Isophytol, δ-
                                                                                                                                                                                        Cadinene, Cadalene,
                                                                                                                                                                                        Geranyl isobutyrate,
                                                                                                                                                                                        Methyl cinnamate
                                                                                                                                                                                        (Oyedeji et al., 2005);
Table 1 (continued )
  S/    Plant name          Family          Common     Local         Region of   Experimental evidence for        Other medicinal uses   Plant part    Traditional   Identified active   Other relevant                 Interaction/toxicity
  no.                                       name       Nigerian      use for     its use in diabetes                                     (s) used      preparation   constituent(s)     phytoconstituents              studies
                                                       name(s)*      diabetes#   management                                                            method                           identified in the plant
                                                                                                                                                                                        Mannitol, Hennatannic
                                                                                                                                                                                        acid, Lawsone (2-hydroxy
                                                                                                                                                                                        1,4-naphtoquinone),
                                                                                                                                                                                        Behenic, Oleic, Linolenic,
                                                                                                                                                                                        Arachidic, Palmitic and
                                                                                                                                                                                        Stearic acids, Laxanthone I,
                                                                                                                                                                                        II and III, Apigenin
                                                                                                                                                                                        glycosides, Stigmasterol,
                                                                                                                                                                                        Acacetin, Cosmosiin, p-
                                                                                                                                                                                        Coumaric acid, Fraxetin,
                                                                                                                                                                                        Hennadiol, Scopoletin,
                                                                                                                                                                                        Esculetin, Apiin, Lupeol,
                                                                                                                                                                                                                                                   883
                                                                                                                                                                                                                                                                  884
Table 1 (continued )
  S/    Plant name     Family          Common           Local          Region of   Experimental evidence for        Other medicinal uses       Plant part     Traditional     Identified active        Other relevant                 Interaction/toxicity
  no.                                  name             Nigerian       use for     its use in diabetes                                         (s) used       preparation     constituent(s)          phytoconstituents              studies
                                                        name(s)*       diabetes#   management                                                                 method                                  identified in the plant
  S/    Plant name         Family        Common           Local       Region of   Experimental evidence for         Other medicinal uses      Plant part       Traditional   Identified active     Other relevant                 Interaction/toxicity
  no.                                    name             Nigerian    use for     its use in diabetes                                         (s) used         preparation   constituent(s)       phytoconstituents              studies
                                                          name(s)*    diabetes#   management                                                                   method                             identified in the plant
                                                                                                                                                                                                   2005); 3β,7β-dihydroxyl-
                                                                                                                                                                                                   cucurbita-5,23,25-trien-
                                                                                                                                                                                                   19-al, Kaempferol-3-O-β-
                                                                                                                                                                                                   D-glucopyranoside
                                                                                                                                                                                                   (Odeleye et al., 2009)
  75    Mondia whiteii     Apocynaceae   White ginger,    Isirigun    SW          Aqueous extract of the roots      Infertility, Erectile     Stem, Root       Infusion,                           Isovanillin, 2-hydroxy-4-
        (Hook.f.) Skeels                 African ginger   orAghuma                did not show any inhibition       dysfunction, Malaria,                      Decoction                           methoxy benzaldehyde
                                                          orGbolo-                against pancreatic alpha          Gonorrhea, Anti-                                                               and its -2-O-β-D-
                                                          gbolo (Y)               amylase and lipase enzymes        parasitic, Anti-                                                               glucopyranose-(1-6)-O-
                                                                                  (Etoundi et al., 2010)§           depressant, Anti-                                                              β-D-xylopyranoside
                                                                                                                    spasmodic,                                                                     (Koorbanally et al., 2000);
                                                                                                                    Hemorrhoids,                                                                   Propacin, 5-methoxy
                                                                                                                    Inflammation, Memory                                                            propacin,
                                                                                                                                                                                                                                                               885
                                                                                                                                                                                                   hydroxyadoxoside, 6β,7β-
                                                                                                                                                                                                   epoxy-8-epi-splendoside,
                                                                                                                                                                                                                                                            886
Table 1 (continued )
  S/    Plant name         Family        Common          Local           Region of   Experimental evidence for        Other medicinal uses       Plant part     Traditional    Identified active     Other relevant                 Interaction/toxicity
  no.                                    name            Nigerian        use for     its use in diabetes                                         (s) used       preparation    constituent(s)       phytoconstituents              studies
                                                         name(s)*        diabetes#   management                                                                 method                              identified in the plant
                                                                                                                                                                                                    Borreriagenin, Deacetyl
                                                                                                                                                                                                    asperuloside, Dehydro
                                                                                                                                                                                                    methoxygaertneroside,
                                                                                                                                                                                                    5,15-dimethyl morindol,
                                                                                                                                                                                                    Alizarin-1-methyl ether,
                                                                                                                                                                                                    Anthragallol-1,3-dimethyl
                                                                                                                                                                                                    ether, Anthragallol-2-
                                                                                                                                                                                                    methyl ether, 6-hydroxy-
                                                                                                                                                                                                    anthragallol-1,3-dimethyl
                                                                                                                                                                                                    ether, Morindone-5-
                                                                                                                                                                                                    methyl ether,
                                                                                                                                                                                                    Asuperlosidic acid,
  S/    Plant name         Family     Common        Local      Region of   Experimental evidence for        Other medicinal uses     Plant part    Traditional   Identified active    Other relevant               Interaction/toxicity
  no.                                 name          Nigerian   use for     its use in diabetes                                       (s) used      preparation   constituent(s)      phytoconstituents            studies
                                                    name(s)*   diabetes#   management                                                              method                            identified in the plant
                                                                                                                                                                                     rhamnopyranosyl)benzyl]
                                                                                                                                                                                     carbamate, Methyl N-4-
                                                                                                                                                                                     [(α-L-rhamnopyranosyl)
                                                                                                                                                                                     benzy] carbamate, O-[20 -
                                                                                                                                                                                     hydroxy-30 -2″-heptenyl
                                                                                                                                                                                     oxy)]-propyl undecanoate,
                                                                                                                                                                                     methyl p-
                                                                                                                                                                                     hydroxybenzoate,
                                                                                                                                                                                     Moringine, Moringinine
                                                                                                                                                                                     (Anwar et al., 2007)
  79    Morus alba L.      Moraceae   White                                Alpha glucosidase inhibitory     Anti-helminthic,         Leaves, Fruit, Infusion,                        Morusin, Isomorusin,         A sodium chloride
                                      mulberry                             effects of the aqueous extract   Laxative, Emollient,     Bark           Decoction,                       Compound A (Taro et al.,     extract of the leaves
                                                                                                                                                                                                                                             887
                                                                           diabetic rats and Antioxidant                                                         (Dineshkumar et     Bismahane, 8,10-
                                                                                                                                                                                                                                                  888
Table 1 (continued )
  S/    Plant name         Family     Common     Local         Region of   Experimental evidence for     Other medicinal uses      Plant part   Traditional     Identified active      Other relevant                   Interaction/toxicity
  no.                                 name       Nigerian      use for     its use in diabetes                                     (s) used     preparation     constituent(s)        phytoconstituents                studies
                                                 name(s)*      diabetes#   management                                                           method                                identified in the plant
  S/    Plant name         Family         Common           Local          Region of   Experimental evidence for         Other medicinal uses     Plant part      Traditional   Identified active   Other relevant                Interaction/toxicity
  no.                                     name             Nigerian       use for     its use in diabetes                                        (s) used        preparation   constituent(s)     phytoconstituents             studies
                                                           name(s)*       diabetes#   management                                                                 method                           identified in the plant
  82    Ocimum             Lamiaceae      Scent leaf,      Nchonwu (I),   SE, SS,     200 mg/kg aqueous extract of      Diarrhoea, Malaria,      Leaves          Infusion,                        Oleanolic acid (Njoku et      Aqueous and ethanol
        gratissimum L.                    African basil,   Efirin (Y),     SWa, NW     the leaves improved glucose       Anti-microbial, Anti-                    Food                             al., 1997); Xanthomicrol,     extract of the leaves
                                          Mint             Daidoya (H)                tolerance in normal and           parasitic, Anxiolytic,                   vegetable                        Cirsimaritin, Rutin,          caused dose-dependent
                                                                                      neonatal STZ-induced              Analgesic,                                                                Kaempferol 3-O-               (400–3200 mg/kg)
                                                                                      diabetic rats (Oguanobi et al.,   Inflammation, Wound                                                        rutinoside, Luteolin 5-O-     increase in AST and ALT
                                                                                      2012) In vitro antioxidant        healing, Cold symptoms,                                                   and 7-O-glucosides,           enzyme levels, markers
                                                                                      effects (Akinmoladun et al.,      Hemorrhoids, Insect                                                       Vicenin-2, Isothymusin,       of hepatotoxicity
                                                                                      2010) (Awah and Verla 2010)       repellent, Anti-                                                          Apigenin 7-O-glucoside,       (Ajibade et al., 2012;
                                                                                      400 mg/kg methanol extract        helminthic, Infant colic                                                  Vitexin, Isovitexin,          Onaolapo and
                                                                                      of the leaves decreased blood                                                                               Quercetin 3-O-glucoside       Onaolapo, 2012)
                                                                                      glucose levels in normal and                                                                                (Grayer et al., 2000);
                                                                                      alloxan-induced diabetic rats                                                                               Thymol, Eugenol, Luteolin,
                                                                                                                                                                                                                                                          889
                                                                                                                                                                                                                                                            890
Table 1 (continued )
  S/    Plant name       Family           Common           Local        Region of   Experimental evidence for         Other medicinal uses     Plant part      Traditional   Identified active    Other relevant                 Interaction/toxicity
  no.                                     name             Nigerian     use for     its use in diabetes                                        (s) used        preparation   constituent(s)      phytoconstituents              studies
                                                           name(s)*     diabetes#   management                                                                 method                            identified in the plant
                                                                                                                                                                                                 thiazole, Trimethyl
                                                                                                                                                                                                 pyrazole, (Ouoba et al.,
                                                                                                                                                                                                 2005); Ferulic acid,
                                                                                                                                                                                                 Isoferuloyl alkanoyl
                                                                                                                                                                                                 glycerol, Feruloyl
                                                                                                                                                                                                 lignoceryl glycerol, Lupeol,
                                                                                                                                                                                                 Epicatechin-3-O-gallate,
                                                                                                                                                                                                 Epigallocatechin-3-O-
                                                                                                                                                                                                 gallate, 4-O-methyl-epi-
                                                                                                                                                                                                 gallocatechin,
                                                                                                                                                                                                 Epigallocatechin (Tringali
                                                                                                                                                                                                 et al., 2000)
  S/    Plant name            Family        Common          Local           Region of   Experimental evidence for        Other medicinal uses       Plant part    Traditional   Identified active       Other relevant                Interaction/toxicity
  no.                                       name            Nigerian        use for     its use in diabetes                                         (s) used      preparation   constituent(s)         phytoconstituents             studies
                                                            name(s)*        diabetes#   management                                                                method                               identified in the plant
        Picralima nitida                                    Mkpokiri or     SW, SE,     kg) of the methanol extract of Jaundice, Pneumonia,  Stem-bark,                         chloroform extract     Melinosime, Akuammine,        produced hepato-toxic
        (Stapf) T.Durand                                    Otosu (I)       NW, NC,     the leaves in normal and       AsthmaTrypanosomiasis Seeds, Root,                       of the seeds           Picracine, Akuammidine,       effects characterized by
        and H.Durand                                                        SS          alloxan-induced diabetic rats                        Fruit rind                         stimulated glucose     Picra-phylline,               necrotic damage
                                                                                        (Okonta and Aguwa, 2007)                                                                uptake in 3T3-L1       Akuammigine,                  congestion of hepatic
                                                                                        300 mg/kg hydro-ethanol                                                                 adipocytes (Shittu     Akuammicine (Oliver-          blood vessels (Fakeye et
                                                                                        extract of the leaves                                                                   et al., 2010)          Bever, 1986); Alstonine,      al., 2004) Methanol
                                                                                        decreased blood glucose                                                                                        Picranitidine, Picratidine,   extract of the fruit rind
                                                                                        levels in STZ-induced                                                                                          Picraline, ψ-akuammigine      administered daily for
                                                                                        diabetic mice and In vitro                                                                                     (Okunji et al., 2005); 10-    6 weeks elevated AST,
                                                                                        antioxidant effects (Teugwa                                                                                    deoxyakuammine,               ALT and GSH levels in
                                                                                        et al., 2013b)§                                                                                                Burnamine (Shittu et al.,     rats (Kouitcheu Mabeku
                                                                                                                                                                                                       2010); Coumesan               et al., 2008)
                                                                                                                                                                                                                                                                 891
                                                                                                                                                                                                                                                               892
Table 1 (continued )
  S/    Plant name           Family           Common         Local          Region of   Experimental evidence for        Other medicinal uses       Plant part     Traditional   Identified active   Other relevant                 Interaction/toxicity
  no.                                         name           Nigerian       use for     its use in diabetes                                         (s) used       preparation   constituent(s)     phytoconstituents              studies
                                                             name(s)*       diabetes#   management                                                                 method                           identified in the plant
                                                                                                                                                                                                    perbenzoates, Tetra-O-
                                                                                                                                                                                                    benzoy-fructo furanoside
                                                                                                                                                                                                    (Abreu et al., 2001);
                                                                                                                                                                                                    Betulinic acid (Yinusa et
                                                                                                                                                                                                    al., 2012)
  90    Scoparia dulcis L.   Plantaginaceae   Sweet          Roma-fada      NC          Administration of the            Anti-infective, HIV,        Leaves,       Infusion,                        Scoparol (30 -O-methyl
                                              broomweed      (H), Aiya (I),             aqueous extract of the leaves    Abortifacient, Sickle cell, Whole plant   Decoction                        luteolin), Scoparoside
                                                             Mesen-                     for 45 days produced a dose      InflammationAnalgesic,                                                      (glycosyl scopanol),
                                                             mesen gogoro               dependent (150–450 mg/kg)        Anti-tumour, Bronchitis,                                                   Amellin (Oliver-Bever,
                                                             (Y)Ndiyang                 decrease in glucose levels       Hypertension, Gastric                                                      1986); Scoparic acid A, B
                                                             (Ef)                       after an OGTT; as well as a      disorders, Sedative                                                        and C, Scopadulcic acid A
                                                             Bibimbelemo                hypoglycaemic effect in                                                                                     and B (Hayashi et al., 1988)
  S/    Plant name       Family          Common          Local       Region of   Experimental evidence for        Other medicinal uses    Plant part     Traditional    Identified active      Other relevant                  Interaction/toxicity
  no.                                    name            Nigerian    use for     its use in diabetes                                      (s) used       preparation    constituent(s)        phytoconstituents               studies
                                                         name(s)*    diabetes#   management                                                              method                               identified in the plant
                                                                                                                                                                                              methoxyxanthone),
                                                                                                                                                                                              2-hydroxy-1,7-dimethoxy
                                                                                                                                                                                              xanthone, 1,6-dihydroxy
                                                                                                                                                                                              xanthone, 6-methoxy
                                                                                                                                                                                              salicylic acid and its
                                                                                                                                                                                              methyl ester, β-D-(6-
                                                                                                                                                                                              sinapoyl)-
                                                                                                                                                                                              glucopyranoside, β-D-(3-
                                                                                                                                                                                              sinapoyl)-fructofuranosyl-
                                                                                                                                                                                              α-D-(6-sinapoyl)-gluco
                                                                                                                                                                                              pyranoside (Meli Lannang
                                                                                                                                                                                                                                                       893
                                                                                                                                                                                                                                                    894
Table 1 (continued )
  S/    Plant name        Family        Common         Local        Region of   Experimental evidence for        Other medicinal uses     Plant part     Traditional   Identified active   Other relevant                 Interaction/toxicity
  no.                                   name           Nigerian     use for     its use in diabetes                                       (s) used       preparation   constituent(s)     phytoconstituents              studies
                                                       name(s)*     diabetes#   management                                                               method                           identified in the plant
                                                                                                                                                                                          3-O-β-D-glucopyranoside,
                                                                                                                                                                                          Luteolin, Chrysoeriol-7-O-
                                                                                                                                                                                          and Rhamnetin-3-O- (2″-
                                                                                                                                                                                          O-β-D-manno pyranosyl)-
                                                                                                                                                                                          β-D-allopyranoside, Aloe-
                                                                                                                                                                                          emodin and its 8-O-β-
                                                                                                                                                                                          glucoside, Chrysophanol,
                                                                                                                                                                                          Rhein, Physcion and its 1-
                                                                                                                                                                                          O-glucoside, Alquinone,
                                                                                                                                                                                          Isochrysophanol, Adenine,
                                                                                                                                                                                          1,3,8-trihydroxy-2-methyl
  S/    Plant name        Family       Common       Local           Region of   Experimental evidence for        Other medicinal uses        Plant part      Traditional     Identified active   Other relevant                 Interaction/toxicity
  no.                                  name         Nigerian        use for     its use in diabetes                                          (s) used        preparation     constituent(s)     phytoconstituents              studies
                                                    name(s)*        diabetes#   management                                                                   method                             identified in the plant
                                                                                                                                                                                                                                                           895
                                                                                                                                                                                                                                                             896
Table 1 (continued )
  S/    Plant name         Family           Common     Local            Region of   Experimental evidence for         Other medicinal uses        Plant part      Traditional   Identified active   Other relevant                 Interaction/toxicity
  no.                                       name       Nigerian         use for     its use in diabetes                                           (s) used        preparation   constituent(s)     phytoconstituents              studies
                                                       name(s)*         diabetes#   management                                                                    method                           identified in the plant
  S/    Plant name     Family        Common         Local          Region of   Experimental evidence for       Other medicinal uses       Plant part     Traditional   Identified active   Other relevant                  Interaction/toxicity
  no.                                name           Nigerian       use for     its use in diabetes                                        (s) used       preparation   constituent(s)     phytoconstituents               studies
                                                    name(s)*       diabetes#   management                                                                method                           identified in the plant
                                                                                                                                                                                                                                                      897
                                                                                                                                                                                                                                                           898
Table 1 (continued )
  S/    Plant name       Family          Common          Local            Region of   Experimental evidence for       Other medicinal uses      Plant part       Traditional   Identified active   Other relevant                Interaction/toxicity
  no.                                    name            Nigerian         use for     its use in diabetes                                       (s) used         preparation   constituent(s)     phytoconstituents             studies
                                                         name(s)*         diabetes#   management                                                                 method                           identified in the plant
  S/    Plant name        Family        Common          Local           Region of   Experimental evidence for        Other medicinal uses       Plant part   Traditional   Identified active   Other relevant                    Interaction/toxicity
  no.                                   name            Nigerian        use for     its use in diabetes                                         (s) used     preparation   constituent(s)     phytoconstituents                 studies
                                                        name(s)*        diabetes#   management                                                               method                           identified in the plant
                                                                                                                                                                                                                                                           899
                                                                                                                                                                                                                                                       900
Table 1 (continued )
  S/    Plant name     Family       Common         Local          Region of   Experimental evidence for        Other medicinal uses       Plant part      Traditional   Identified active   Other relevant                   Interaction/toxicity
  no.                               name           Nigerian       use for     its use in diabetes                                         (s) used        preparation   constituent(s)     phytoconstituents                studies
                                                   name(s)*       diabetes#   management                                                                  method                           identified in the plant
                                                                                                                                                                                           Imperatorin, Mangiferin,
                                                                                                                                                                                           Quercetin, Palmitic and
                                                                                                                                                                                           Linoleic acid triglycerides
                                                                                                                                                                                           (Morelli et al., 2006);
                                                                                                                                                                                           Syringic acid, Gluco-
                                                                                                                                                                                           syringic acid, Salicylic acid,
                                                                                                                                                                                           Protocatechuic acid and its
                                                                                                                                                                                           methyl ester, Caffeic acid,
                                                                                                                                                                                           Hexatriacontanoic acid,
                                                                                                                                                                                           Pentadecanoic acid,
                                                                                                                                                                                           Hexadecanoic acid, Maleic
                                                                                                                                                                                           acid, Heptadecanoic acid,
  S/    Plant name      Family       Common          Local            Region of   Experimental evidence for       Other medicinal uses      Plant part     Traditional   Identified active   Other relevant              Interaction/toxicity
  no.                                name            Nigerian         use for     its use in diabetes                                       (s) used       preparation   constituent(s)     phytoconstituents           studies
                                                     name(s)*         diabetes#   management                                                               method                           identified in the plant
                                                                                                                                                                                                                                                   901
                                                                                                                                                                                                                                                                   902
Table 1 (continued )
  S/     Plant name         Family             Common          Local          Region of    Experimental evidence for        Other medicinal uses   Plant part   Traditional   Identified active         Other relevant                 Interaction/toxicity
  no.                                          name            Nigerian       use for      its use in diabetes                                     (s) used     preparation   constituent(s)           phytoconstituents              studies
                                                               name(s)*       diabetes#    management                                                           method                                 identified in the plant
                                                                                                                                                                                                                                      methoxy phenyl)-N-2-
                                                                                                                                                                                                                                      [4-hydroxy
                                                                                                                                                                                                                                      phenylethyl]-2-
                                                                                                                                                                                                                                      propenamide, E-3-
                                                                                                                                                                                                                                      (3,4-dihydroxyphenyl)-
                                                                                                                                                                                                                                      N-2-[4-hydroxyphenyl-
                                                                                                                                                                                                                                      ethyl]-2-propenamide,
                                                                                                                                                                                                                                      Grossamide,
                                                                                                                                                                                                                                      Demethylgrossamide,
                                                                                                                                                                                                                                      Cannabisin B and D
                                                                                                                                                                                                                                      (Lajide et al., 1995); 7α-
                                                                                                                                                                                                                                      hydroxy trachyloban-
    n
        Bi-Bini, Ef-Efik, Es-Esan, F-Fulani, H-Hausa, I-Ibo, Ib-Ibibio, Id-Idoma, Ig-Igala, Ige-Igede, Ij-Ijaw, Nu-Nupe, Ti-Tiv, and Y-Yoruba.
    #
        NC ¼North central, NE¼ North east, NW ¼North west, SE ¼South east, SS ¼ South south, and SW ¼ South west.
    §
        Experimental evidence involving plant samples not collected from within Nigeria.
                                              U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924                             903
other in vivo models used include spontaneous diabetic animal                         3.2. In vitro pharmacological evidence
models obtained as a result of one or more genetic mutations such
as obese zucker fatty rats, db/db mice and KK-Ay mice; as well as                         It is recommended that in vitro experiments are carried out to
the use of high glucose or fructose-fed animals. This latter group                    ascertain the mechanism of action for the plant. Certain plants
simulate the development of diabetes from insulin resistance                          produce their hypoglycemic effects as a side effect of their in vivo
better as is more commonly found in patients with type-2 diabetes                     toxicity (Marles and Farnsworth, 1995). There is also the risk that
(Srinivasan and Ramarao, 2007).                                                       the hypoglycemic effect is being mediated – at least in part –
    Although most plants were only evaluated experimentally in a                      through an unwanted physical mechanism, rather than a physio-
type-1 diabetes model, some of these have been shown to be                            logical one, such as was observed with Gymnema sylvestre (Retz.)
effective hypoglycemic agents in type-2 diabetes patients, such as                    R. Br. Ex Sm (Persaud et al., 1999). This immediately eliminates the
extracts of Bridelia ferruginea Benth. Daily administration of 15 mg                  potential use of such a plant as a therapeutic hypoglycemic
of the leaves as an infusion to type-2 diabetic patients previously                   agent. In addition, due to the ethical considerations surrounding
on insulin injections for eight weeks resulted in a significant                        animal use (Festing and Wilkinson, 2007), it is advised that
decrease in their blood sugar levels (Iwu, 1983).                                     validation experiments are ‘replaced’ with non-animal models
    Only two out of the 96 plant species were ineffective in the                      where possible.
in vivo experimental model of study, namely Zea mays L. (Suzuki                           Over one-third of the plants in our review have been studied
et al., 2005) and Cucumeropsis mannii Naudin (Teugwa et al.).                         for in vitro in models that could possibly explain some or all of
Despite its identified in in vitro PPARα and γ agonist activities                      their mechanism of action. Twenty-nine plants have inhibitory
and α-glucosidase inhibitory effects (Lee et al., 2010), extracts of                  effects against either α-amylase or α-glucosidase enzymes; five
Zea mays failed to produce a significant hypoglycemic effect                           plants have agonist activity on the PPARγ receptor, whose activa-
in vivo (Rau et al., 2006). This could possibly be as a result of the                 tion enhances glucose metabolism; four plants increase insulin
absence of the bioactive constituent(s) responsible for the                           release from pancreatic cells; five plants increase glucose uptake
hypoglycemic effect in the sample used for the in vivo study.                         in muscles or liver; while two plants increased the expression of
The absence of an in-vivo hypoglycemic effect would however                           the glucose transporter GLUT4, which in turn increases glucose
not ‘eliminate’ its use in the clinical management of diabetes,                       uptake into muscles and adipose tissues. Two plants were identi-
which also takes into account co-morbid conditions. In this                           fied as potential DPP-IV inhibitors, while six plants were identified
regard, Zea mays could also provide protection against diabetic                       as aldose reductase inhibitors (Fig. 1).
nephropathy, as it has been shown to improve kidney para-                                 In vitro experiments are often designed to ‘reflect’ the mechanism
meters in vivo (Suzuki et al., 2005).                                                 of existing drugs used in diabetes management. Plants that possess
    In the case of Cucumeropsis mannii, its traditional use involves                  alpha amylase or alpha glucosidase inhibitory effects reflect the
the ingestion of its ashes or its juice (Gbolade, 2009). This may                     action of acarbose, PPARγ agonist activity reflect the thiazolidine-
indicate that its use is based on its oligo-elements and/or vitamins.                 diones, while aldose reductase inhibitors are potential agents for
In fact the supplementation of elements such as chromium,                             preventing diabetic complications like the drug epalrestat. Thus with
magnesium and vanadium is actively explored in the treatment                          this identified mechanisms, researchers and healthcare professional
of diabetes (Anderson et al., 1997; Halberstam et al., 1996;                          alike can immediately identify the potential therapeutic benefit of
Rodríguez-Morán and Guerrero-Romero, 2003); some of which                             the plant. This information could contribute to a more rational
have been identified in the seeds of Cucumeropsis mannii (Badifu                       therapeutic regimen for diabetes patients, possibly benefitting from
and Ogunsua, 1991).                                                                   a synergistic effect with herbal remedies.
                                     Fig. 1. Proposed molecular mechanisms of hypoglycemic effects for species studied so far.
904                                         U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924
    The disadvantage of the molecular approach for experimental                       fractionation or in silico studies as the bioactive constituents
validation of plant activity is that the biological assays only explore               responsible for some or all of the plants' beneficial effects in
known targets and do not take into account extracts that might be                     diabetes. Some of these constituents are species-specific such as
acting on unknown targets, possibly through innovative mechan-                        the alkaloid mahanimbine from Murraya koenigii (L.) Spreng
isms. In addition, herbal medicines are often complex mixtures                        (Dineshkumar et al., 2010), while others are known to be present
of various phytochemicals which work synergistically to achieve a                     in many plants like the alkaloid trigonelline, which is responsible
desired therapeutic outcome (Campbell-Tofte et al., 2012). In such                    for the hypoglycemic effect of Abrus precatorius L. (Monago and
cases, a single end-point in vitro biological assay will not be                       Nwodo, 2010) and Trigonella foenum-graecum L. (fenugreek), a
sufficient in evaluating the clinical effect of the plant. For                         plant whose use in diabetes management is popular across India
instance, the methanol extract of the root and stem of Gongronema                     and Europe (Bailey and Day, 1989). We hereby classify these
latifolium Benth. produced a greater anti-hyperglycemic effect in                     compounds according to similar chemical features (which may
glucose loaded rats than each of its fractions, indicating a syner-                   not necessarily refer to similar biosynthetic pathways) as follows:
gistic effect of its constituents possibly acting through different                   compounds containing nitrogen (1–9) (Fig. 2), terpenes (10–16)
molecular mechanisms (Adebajo et al., 2013).                                          (Fig. 3), phenolic compounds (17–33) (Figs. 4 and 5), and com-
    There is also a holistic approach in the herbal management of                     pounds containing hydroxyl groups including sugars (34–40)
diabetes such that plants which are not hypoglycemic themselves                       (Fig. 6).
may be included in multi-component preparations because of
their benefits in co-morbid conditions. Thus, in vitro studies might
not immediately indicate the beneficial effect of the plant. A good                    3.3.1. Nitrogen containing compounds
example is the use of the aphrodisiac plant Mondia whiteii (Hook.                         A number of alkaloidal and non-alkaloidal active principles
f.) Skeels (Quasie et al., 2010). Despite not showing in vitro                        from plants used in diabetes management have been reported.
hypoglycemic effect (Etoundi et al., 2010), it is commonly included                   Some of these were isolated from samples not collected from
in multi-component preparations for diabetes management in                            Nigeria such as hypoglycin A (1) and B (2) – from the fruit of
men since erectile dysfunction is a common complication of the                        Blighia sapida K.D.Koenig. (Chen et al., 1957). Murraya koenigii
illness (personal communication during field work). This however                       leaves are also used traditionally in Indian Ayurvedic system to
does not preclude any in vivo activity which is yet to be evaluated.                  treat diabetes. Mahanimbine (5) isolated from the Indian plant
                                                                                      samples decreased blood glucose levels in STZ-induced diabetic
                                                                                      rats and also produced a dose-dependent α-amylase and
3.3. Bioactive compounds                                                              α-glucosidase inhibitory effect (Dineshkumar et al., 2010). Its
                                                                                      cellular mechanism of action is also thought to be mediated by
   Over forty compounds from twenty three of the reviewed                             an increase in glucose utilization (Dinesh Kumar et al., 2013).
plants have been identified, either through an activity guided                         Paradoxically, this and other related carbazole alkaloids isolated
                                                                                                                               Akuammicine(3)
                                                                                                                               Picralima nitida
                          Hypoglycin A (1) & Hypoglycin B (2)
                                    Blighia sapida
              Trigonelline (4)
             Abrus precatorius
                                                           Mahanimbine (5)                                                     Ajmaline (6)
                                                           Murraya koenigii
                                                                                                                           & Isosandwichine (7)
                                                                                                                           Rauvolfiavomitoria
                                                                                                           3-β-D-glucopyranosyl-1-hydroxy-6(E)-
                                                                                                              tetradecene-8,10,12-triyne (10)
                                                                                                          & 2-β-D-glucopyranosyl-1-hydroxy-6(E)-
                                                                                                               tetradecene-7,9,11-triyne (11)
                                                                                                                       Bidens pilosa
Myrcene (12)
Geraniol (14)
Cymbopogon citrallatus
         Kolaviron (17) –
   Mixture of GB1 (R1=H, R2=H),
        GB2 (R1=OH, R2=H)
                                                                                             Damnacanthol -3 -O- β-D-primeveroside ( 18) (R=OCH )
& kolaflavanone (R1=OH, R2=Me)
                                                                                                Lucidin-3-O-β-D-primeveroside(19) (R=OH ).
          Garcinia kola
                                                                                                             Morinda citrifolia
                                                              Lawsone (20)
                                                            Lawsonia inermis
                 Isoscutellarein (28)
                    Bixa orellana
from plant samples from Nigeria decreased the glucose-mediated                           would most likely be contributing to their blood glucose lowering
insulin release from INS-1 cells when compared to control, even                          activity. Ajmaline (6) and isosandwichine (7) from Rauvolfia
though the amount of glucose released was dose dependent.                                vomitoria Afzel. were identified as DPP-IV inhibitors using an in
This effect may however be explained by their known in vitro                             silico approach (Guasch et al., 2012).
cytotoxicity (Adebajo et al., 2005).                                                         Garlic and onions are commonly used as part of the diet in
   The alkaloid trigonelline (4) isolated from the seeds of Abrus                        many Nigerian households and the hypoglycemic effect of
precatorius (L.) collected from the eastern part of Nigeria decreased                    plant samples collected from Nigeria has also been studied
blood glucose levels in alloxan-induced diabetic rats as well                            (Eyo et al., 2011). This hypoglycemic effect is possibly due to the
as reduced the activity of glucose-6-phosphatase and glycogen                            presence of S-methylcysteine sulfoxide (8) (SMCS) in onions
phosphorylase, two enzymes important for glucose production                              and S-allylcysteine sulfoxide (9) (SACS) in garlic, which have
(Monago and Nwodo, 2010). Akuammicine (3) isolated from the                              been isolated from Indian plant samples and have been shown
chloroform extract of the seeds of Picralima nitida (Stapf) T.Durand                     to improve glucose tolerance in alloxan-induced diabetic rats
and H.Durand stimulated glucose uptake in 3T3-L1 adipocytes                              (Sheela et al., 1995). Clinical studies in humans have shown that
(Shittu et al., 2010). It is also present in plants of the genus Alstonia                the supplementation of garlic to diabetic patients in combination
such as Alstonia boonei De Wild. and Alstonia Congensis Engl. and                        with hypoglycemic drugs improves glycemic control in addition to
                                        U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924                             907
the reduction of cardiovascular risk (Sobenin et al., 2008).                    showed potent maltase inhibitory effects in vivo (Matsui et al.,
Although they both contain nitrogen, SMCS and SACS are primarily                2002), while ellagic acid (26) and 3,5-dicaffeoylquinic acid (27)
classed as sulfur containing compounds.                                         isolated from the hot water extract of the leaves showed potent
                                                                                aldose reductase inhibitory effects (Terashima et al., 1991). Law-
                                                                                sone (20) (a naphtoquinone) and gallic acid (21) isolated from the
3.3.2. Terpenes
                                                                                ethanol extract of the aerial parts of Lawsonia inermis L. inhibited
    A number of terpenes have been isolated as bioactive consti-
                                                                                the formation of advanced glycated end products in vitro (Sultana
tuents in plants used for diabetes management (Fig. 3). The leaves
                                                                                et al., 2009). Some methoxy phenyl derivatives (22–25) isolated
of Gongronema latifolium, otherwise known as ‘utazi’ or ‘madu-
                                                                                from the rhizomes of Zingiber officinale Roscoe have been identi-
maro’ in Ibo and Yoruba respectively is commonly used as a food
                                                                                fied as aldose reductase inhibitors both in vitro and in vivo,
vegetable and is widely recognized for its traditional use in
                                                                                suppressing sorbitol accumulation in human erythrocytes as well
diabetes management. Lupenyl cinnamate (15), lupenyl acetate
                                                                                as lens galactitol accumulation in 30% galactose-fed rats (Kato
and α- and β-amyrin cinnamates (16) isolated from the combined
                                                                                et al., 2006).
root and stems of locally obtained samples have recently been
                                                                                    Several isolated flavonoids have also been identified as bioac-
identified as the bioactive compounds, possessing both anti-
                                                                                tive constituents. Isoscutellarein (8-hydroxy apigenin) (28) is a
hyperglycemic effects in glucose-fasted rats as well as insulin
                                                                                flavonoid isolated from the hot water extract of the leaves of Bixa
stimulating effects in INS-1 cells (Adebajo et al., 2013).
                                                                                orellana L., which was identified as an aldose reductase inhibitor
    Foetidin from the whole plant and the unripe fruits of Momor-
                                                                                (Terashima et al., 1991). Rutin (29) and quercetin (30) were
dica foetida collected in Nigeria also decreased blood glucose levels
                                                                                isolated from the leaves of Bauhinia monandra Kurz as the anti-
of normal fasted, but not alloxan-induced rats at only 1 mg/kg
                                                                                hyperglycemic constituents in alloxan-induced diabetic rats (Alade
(Marquis et al., 1977). Acetylenic glucosides (10) and (11) from
                                                                                et al., 2011, 2012). A bioassay guided fractionation of the stem bark
Bidens pilosa decreased blood glucose in the murine type 2 diabetes
                                                                                of Cassia fistula L. led to the identification of catechin (33) as the
model C57BL/Ks-db/db mice (Ubillas et al., 2000), and inhibited the
                                                                                bioactive agent. It decreased plasma glucose levels in STZ-induced
spontaneous development of diabetes in non-obese diabetic
                                                                                diabetic rats, with direct effects on glucose metabolizing enzymes
(NOD) mice by modulating the differentiation of T-helper cells
                                                                                and expression of the glucose transporter GLUT4 (Daisy et al.,
(Chang et al., 2004).
                                                                                2010). Fractionation of the methanol extract of the leaves of Senna
    The monoterpenes myrcene (12), citral (13) and geraniol (14)
                                                                                alata (L.) Roxb. (syn- Cassia alata), which showed potent α-
found in Cymbopogon citratus were identified as aldose reductase
                                                                                glucosidase inhibitory effects, identified kaempferol gentiobioside
inhibitors using in-silico docking methods (Vyshali et al., 2011).
                                                                                (31) and kaempferol (32) as the bioactive compounds (Varghese et
They are also components of the essential oil of many medicinal
                                                                                al., 2013). Increased translocation of GLUT4 receptors to the
plants used in Nigeria as shown in Table 1. This preliminary
                                                                                plasma membrane of L6 myotubes was also observed with a
information warrants further in vitro and in vivo studies involving
                                                                                flavonoid-rich fraction of Scoparia dulcis L. (Beh et al., 2010),
plant samples from Nigeria previously shown to contain these
                                                                                although the bioactive constituent(s) was not identified.
compounds, given that the beneficial effect of the essential oil of
                                                                                    The presence of aromatic hydroxyl groups in the benzo-γ-
Cymbopogon citratus containing high amounts of these monoter-
                                                                                pyran structure of flavonoids is associated with its antioxidant
penes has now been validated in vivo in experimentally induced
                                                                                properties, particularly its free radical scavenging effects. These
type-2 diabetic rats (Bharti et al., 2013).
                                                                                properties have been shown to protect pancreatic islet cells from
                                                                                oxidative stress as well as help in the regeneration of β-cells as
3.3.3. Phenolic compounds                                                       shown with epicatechin found in green tea (Sabu et al., 2002) and
    A wide range of phenolic compounds have been identified                      quercetin (Coskun et al., 2005). More importantly, they can
as active principle(s) in some of the plants here reviewed.                     prevent the formation of advanced glycated end products (AGEs)
Anthraquinone glycosides from Morinda citrifolia L, namely dam-                 and other diabetic complications associated with high oxidative
nacanthol-3-O-β-D-primeveroside (18) and lucidin 3-O-β-D-prime-                 stress conditions such as artherosclerosis, nephropathy, neuropa-
veroside (19), decreased blood glucose levels in STZ-induced                    thy, retinopathy and erectile dysfunction (Rahimi et al., 2005).
diabetic mice at 100 mg/kg (Kamiya et al., 2008). Incidentally, this            Thus, the presence of quercetin and epicatechin as well as other
plant is not native to Nigeria and is not known to grow in Nigeria.             potent antioxidant flavonoids in a wide range of plants such as
However, the use of a registered herbal product of the juice                    Irvingia gabonensis, Khaya senegalensis, Mangifera indica, Securi-
extract, Tahitian noni juices (TNJ) is quite popular in Nigeria for             daca longipedunculata and Ocimum gratissimum, will contribute to
various ailments including diabetes. Administration of 1 ml/                    – and in some cases may be the basis for – their use in the holistic
150 mg body weight of the rats twice daily for four weeks prior                 management of diabetes which includes the prevention of diabetic
to and after the induction of diabetes with alloxan resulted in                 complications.
significant decrease in blood sugar levels, indicating a prophylactic                Other flavonoids have also been shown to directly affect
effect of the extract against alloxan-induced diabetes (Horsfal et              specific therapeutic targets in diabetes. For instance, supplemen-
al., 2008). The presence of these phenolic compounds in the                     tation of mice diet with naringin or hesperidin modulated the
marketed product has however not been confirmed.                                 activity of glucose metabolizing enzymes, with an increase in
    Kolaviron (17) is a mixture of flavanones isolated from the                  hepatic glucokinase activity and decrease in hepatic glucose-6-
acetone extract of the edible nuts of Garcinia kola Heckel (bitter              phosphatase activity in diabetic db/db mice (Jung et al., 2004) and
kola), which is valued in most parts of West Africa. It decreased               GK type-2 diabetic rats (Akiyama et al., 2009). These two flavo-
blood sugar levels in normal and alloxan induced diabetic mice at               noids are constituents of all citrus fruits and have also been
a dose of 100 mg/kg, as well as inhibited rat lens aldose reductase             identified in Senna alata (Hennebelle et al., 2009) and Rauvolfia
(RLAR) activity (Iwu et al., 1990a).                                            vomitoria (Campbell-Tofte et al., 2011) and as such may account for
    Other phenolic compounds have been identified as bioactive                   some of their effects. Myricetin is another flavonoid that has
constituents but not from plant samples collected in Nigeria.                   shown direct beneficial effects in diabetes through enhanced
A diacylated anthocyanin peonidin 3-O-[2-O-(6-O-E-feruloyl-β-                   glycogen metabolism (Ong and Khoo, 2000) and improved insulin
D-glucopyranosyl)-6-O-E-caffeoyl-β-D-glucopyranoside]-5-O-β-D-                  sensitivity (Liu et al., 2007). It has been identified in some of the
glucopyranoside isolated from the root of Ipomoea batatas (L.) Poir.            plants either in its aglycone form or as a glycoside. These are the
908                                     U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924
Allium species, Aloe vera, Azadirachta indica, Citrus species, Carica           appropriate conclusions that will act as guidelines for their clinical
papaya, Bryophyllum pinnatum, Cassia sieberiana, Chrysophyllum                  use cannot be drawn.
albidum, Ipomoea batatas and Bridelia ferruginea.                                   A good knowledge of the traditional use of these plants based
                                                                                on ethnobotanical studies is very important in the design of a good
                                                                                clinical study. This is especially important for plants which are
3.3.4. Hydroxylated compounds including sugars                                  used as mixtures, as the individual components may be working
    Some other non-phenolic hydroxylated cyclic compounds have                  synergistically to produce the overall desired effect. An example is
been isolated and identified as bioactive agents. These include the              the synergistic effect produced by a decoction mix of the leaves
gingerols (34–36) from Zingiber officinale, which were shown to                  of Gongronema latifolium, Ocimum gratissimum and Vernonia
enhance glucose uptake into muscles as a result of a direct                     amygdalina in modulating baseline blood glucose levels, which
increase in the expression of the GLUT4 receptor (Li et al., 2012).             was not observed with the individual plants (Ejike et al., 2013).
An inositol derivative, D-3-O-methyl chiroinositol (37) isolated                Given that many of these herbal remedies are currently being
from the methanol extract of the stem bark of Bauhinia thonningii               taken by diabetic patients alongside their prescription medicines,
Schum. produced a dose-dependent decrease in blood glucose                      a concerted effort between clinicians and researchers would be an
levels in alloxan-induced diabetic rats (Asuzu and Nwaehujor,                   ideal way to recruit patients to such studies.
2013).                                                                              To ensure the reliability of conclusions drawn from any clinical
    Finally, a number of benzyl derivatives including carbamates                study, they should always involve proper planning with appro-
and thiocarbamates have been isolated from fractions of the                     priate controls and ought to be conducted within a reasonable
methanol extract of the fruits of Moringa oleifera Lam. These                   time frame, in line with the guidelines of the Declaration of
compounds have been shown to possess insulin secretory effects,                 Helsinki. In addition, the recommendations for reporting rando-
stimulating Z 15 ng insulin/mg protein in pancreatic INS-1 cells at             mized clinical trials, as defined in the ‘Consolidated Standards
100 ppm. Some of these compounds were identified as 1-O-phenyl                   of Reporting Randomized Clinical Trials (CONSORT) statement’
α-L-rhamnopyranoside (38), methyl N-{4-[(α-L-rhamnopyranosyl)                   (Schulz et al., 2010) should also be followed. Nonetheless,
benzyl]}carbamate (39), and methyl N-{4-[(40 -O-acetyl-α-L-rham-                this relatively high ‘success’ rate amongst the various studies
nopyranosyl)benzyl]}carbamate (40).                                             conducted highlights the potential of harnessing ethnobotanical
    Many plant secondary metabolites have been associated with                  information in enhancing patient therapy.
specific beneficial effects in diabetes, which might account for the
therapeutic effect of the herbal drug (Qi et al., 2010; Singh et al.,
2013). Thus, apart from a bioguided fractionation, the biologically
active agent of a plant can also be inferred by evaluating the                  4. Toxicological evidence and considerations
phytochemical constituents that have previously been isolated.
These can thereafter be confirmed in specific pharmacologic                           The administration of whole plant extracts or fractions con-
experiments.                                                                    sisting of a myriad of compounds, can elicit different biological
                                                                                effects in the body, some of which may be harmful toxic effects.
                                                                                Sometimes, these toxic effects are only associated with certain
3.4. Clinical studies                                                           parts of the plant. For example, the leaves of Senna occidentalis
                                                                                have hepatoprotective effects and are used traditionally for the
    The validation of biologically active plants in randomized,                 treatment of liver disorders (Jafri et al., 1999). However, ingestion
placebo-controlled clinical trials involving human subjects is a                of toxins found in the seeds (beans) is thought to be the probable
necessary step towards the possible integration of traditional                  cause of acute hepato-myoencephalopathy (HMP) in children
herbal products into health systems. For these purposes, isolation              (Vashishtha et al., 2009). This risk of toxicity associated with the
of the active constituent may not be necessary. The European                    use of herbal products is one of the main reasons for the hesitance
Directive of Traditional Herbal Medicinal Products is an example of             amongst healthcare practitioners towards promoting their inte-
how reports of traditional use and a sound safety profile are                    gration into healthcare systems.
enough to regulate herbal medicines (Cox and Roche, 2004).                          Adequate knowledge about the traditional use of such plants is
However, knowing the identity of the active principle would be                  very necessary as this often helps to forestall the ingestion of such
ideal in order to ensure a better quality control and perhaps a                 toxic plants or plant parts. Sometimes the toxic component may
more defined dosage.                                                             have been identified such as abrin, a toxic protein found in the
    Fourteen of the plants reviewed in this paper have been                     seeds of Abrus pecatorius, with an estimated human fatal dose of
clinically evaluated in human subjects, either singly or in combi-              0.1–1 mg/kg (Kirsten et al., 2003). In rare cases, the hypoglycemic
nation. These are Bridelia ferruginea, Citrus aurantium, Gongronema             agent in the plant could also be the toxic agent, such as with
latifolium, Ocimum gratissimum, Rauvolfia vomitoria, Vernonia                    hypoglycin from Blighia sapida (Sherratt, 1986). Thus, the thera-
amygdalina, Carica papaya, Curcuma longa, Ipomoea batatas, Irvin-               peutic use of such a plants as whole extracts is therefore not
gia gabonensis, Gymnema sylvestre, Phyllanthus amarus and Sola-                 recommended.
num aethiopicum (Table 1), of which the first six involved plant                     Various plants in Table 1 have been associated with specific
samples collected from Nigeria. Only Phyllanthus amarus did not                 organ toxicity. Examples include the nephrotoxic effects of Alstonia
produce the desired clinical effect (Moshi et al., 2001).                       congensis, Aristolochia spp., Cassia sieberiana, Ficus exasperata,
    Most of the clinical studies were not randomized, controlled                Securidaca longipedunculata and the hepatotoxic effects of Cassia
trials but preliminary studies evaluating the therapeutic effect                sieberiana, Ficus exasperata, Morinda citrifolia, Picralima nitida and
of the plant in human subjects. Exceptions to these were those                  Senna occidentalis. The hepatotoxic effects of some extracts such as
carried out on Rauvolfia vomitoria and Citrus aurantium (Campbell-               Ocimum gratissimum and Sphenocentrum jollyanum are directly
Tofte et al., 2011), Irvingia gabonensis (Ngondi et al., 2009) and              linked to their effect on the liver function enzymes. The cardio-
Ipomoea batatas (Ludvik et al., 2004). Similarly, a meta-analysis by            toxic and neurotoxic effects of some other extracts have also been
Leung et al. (2009) of all clinical studies carried out on Momordica            identified. Sometimes, these toxic effects are only seen at high
charantia identified flaws in their study design, despite the extract             doses, which would therefore not preclude their continued use
consistently producing a hypoglycemic effect. As a result,                      as medicinal plants so long as there is appropriate information
                                         U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924                             909
about the safe dose ranges. The use of other more toxic plants                       A synergistic effect should however not be assumed. It is
would however need to be completely discontinued.                                sometimes advisable for patients not to take drugs alongside their
    A thorough analysis of the plant's extracts as well as identified             herbal products due to negative drug interactions that may occur.
phytochemical constituents with respect to their safety/toxicity                 For instance, the water soluble fraction of okra fruits has been
profile particularly in humans can ensure a critical assessment of                shown to decrease the absorption of metformin (Khatun et al.,
its therapeutic potential. Previously, coumarins which are a                     2011). Although both would otherwise be beneficial in diabetes
component of a wide range of plants were identified as hepato-                    management, taken together would result in a decrease in the
toxic based on various studies carried out in rodents. However,                  therapeutic concentration of metformin, which in turn may not
further studies have showed that certain animal species are                      bring about the desired hypoglycemic effect in the patient.
resistant to coumarin-induced toxicity. The 7-hydroxylation meta-                    Constituents of medicinal plants also undergo the four main
bolic pathway is the most favored in humans leading to the                       pharmacokinetic processes of absorption, distribution, metabolism
formation of non-toxic metabolites, whereas in rats the most                     and elimination (ADME). There is therefore the possibility of an
favored pathway is a 3,4-epoxidation leading to the formation of                 interaction with one of the different ADME parameters by the
toxic metabolites. Knowledge of this and a quantitative health risk              herb, which could invariably affect the fate/bioavailability of a co-
assessment have now confirmed its safety in humans (Felter et al.,                administered drug and possibly, the resulting therapeutic benefit
2006; Lake, 1999).                                                               (s). This is known as a ‘pharmacokinetic interaction’.
    Evaluation of medicinal plants for potential herb–drug interac-                  Out of the one hundred and fifteen plants reviewed in this
tions is equally as important as its evaluation for efficacy                      paper, over thirty of them have shown in vitro and/or in vivo
and safety. Two types of herb–drug interactions exist: pharmaco-                 modulation of the activity of one or more of these ADME para-
dynamic interactions and pharmacokinetic interactions. If a herbal               meters (Fig. 7). Some of these interactions were on absorption,
plant alters the expected pharmacological effect of a drug as a                  either by modulating the effect of P-glycoprotein (P-gp), an
result of its biochemical or physiological effect on                             intestinal efflux transporter, or by direct effects on the intestinal
the body, this is known as a ‘pharmacodynamic interaction’.                      tight junctions. Other pharmacokinetic interactions were on
If the herb and the drug are both expected to produce the same                   metabolism, by interacting with one or more cytochrome P450
pharmacological effect, there may be an increased therapeutic                    enzymes responsible for phase 1 metabolism or either of the
effect produced with their co-administration. This knowledge can                 phase 2 metabolic enzymes (Table 1).
be harnessed towards producing a synergistic effect between the                      The role of P-gp in the intestinal epithelium is the extrusion
two, which would possibly require a dose adjustment. Otherwise,                  of certain xenobiotics from the blood to the intestinal lumen
the resulting effect could be detrimental if appropriate monitor-                as well as to minimize the entry of drugs in the lumen into the
ing and evaluation is not done. A good example is the severe                     bloodstream, ultimately resulting in decreased absorption and
hypoglycemic that was observed in a female diabetic patient                      decreased oral bioavailability (Sharom, 2007). For drugs that are
taking chlorpropamide and a meal containing Momordica char-                      P-gp substrates such as glibenclamide, this effect of the efflux
antia and Allium sativum (Izzo and Ernst, 2001).                                 transporter is one of the determinant factors in the recommended
                                                                Acacia nilotica
                                                             Annona senegalensis
                                                              Bauhinia thonningii
                                                                Carica papaya
                                                               Moringa oleifera
                                                             Solanum melongena
                                                             Vernonia amygdalina
                                                              Ximenia americana
                                                              Zingiber officinale
                                                 P-gp                                     P-gp
                                                              Bridelia ferruginea
                                                             Catharanthus roseus
                                                               Curcuma longa
                                                               Khaya ivorensis
                                                              Mangifera indica
                                                               Morinda lucida
                                                 CYP                                    CYP
                                                           Aframomum melegueta
                                                                Bixa orellana
                                                             Citrus aurantiifolia
                                                              Citrus aurantium
                                                            Citrullus colocynthis
                                                             Corchorus olitorius
                                                              Ipomoea batatas
                                                                                                                  Lawsonia inermis
                                                               Jatropha curcas
                                                                                                                 Momordica charantia
                                                              Lawsonia inermis
                                                                                                                 Morinda citrifolia
                                                            Momordica charantia
                                                                                                                 Morinda lucida
                                                                 Morus alba
                                                                                                                 Moringa oleifera
                                                              Murraya koenigii
                                                                                                                 Phyllanthus amarus
                                                             Persea americana
                                                                                                                 Securidaca longipedunculata
                                                            Phyllanthus amarus
                                                                                                                 Senna alata
                                                                 Senna alata
                             Fig. 7. In vitro pharmacokinetic herb–drug interactions identified based on the literature reviewed.
910                                     U.F. Ezuruike, J.M. Prieto / Journal of Ethnopharmacology 155 (2014) 857–924
dose of the drug to ensure that an adequate therapeutic concen-                 of these plants as herbal preparations (such as pharmacopoeial
tration is achieved in the bloodstream. Co-administration of the                monographs) would be required to ensure the reproducibility of
drug with a herb with inhibitory effects on P-gp such as Acacia                 their therapeutic effects. Finally, as a means of giving credence to
nilotica, Annona senegalensis, Bauhinia thonningii, Bridelia ferrugi-           the pre-clinical experimental evidence, intervention or clinical
nea, Carica papaya and Morinda lucida might result in increased                 studies with the standardised materials should be carried out in
plasma concentration of the drug.                                               order to validate their usefulness in diabetes management. We
    The cytochrome P450 (CYP) family of enzymes are respon-                     hope that in this manner the therapeutic potential of these
sible for phase 1 oxidative, peroxidative and reductive metabolic               medicinal plants can be best harnessed, towards a possible
transformations of drugs, environmental chemicals and natural                   integration into the healthcare system.
compounds into less toxic, more water-soluble products, in order
to facilitate their excretion from the body. They are most abundant
in the liver, which is the primary site for metabolism. The activity            Acknowledgments
of CYP enzymes can be modified either by induction or inhibition
as seen with the extracts of Bixa orellana and Jatropha curcas                     U.F. Ezuruike is grateful to the Commonwealth Scholarship
respectively. The biological activity of the xenobiotics metabolized            Commission in the UK for the award of a DFID (Department for
by these enzymes can be greatly altered as a result (Rendic and                 International Development) sponsored Ph.D. scholarship.
Carlo, 1997). St John's wort (Hypericum perforatum) is a very good
example of a herbal product that has produced clinically signifi-
cant effects as a result of its interactions with P-gp and CYP
                                                                                Appendix A. Supplementary information
enzymes (Henderson et al., 2002).
    In vitro interactions have also been identified with the phase
                                                                                   Supplementary data associated with this article can be found in
2 metabolizing enzymes, particularly with the glutathione trans-
                                                                                the online version at http://dx.doi.org/10.1016/j.jep.2014.05.055.
ferases (GSTs). As with P-gp and CYPs, such interactions can alter
the plasma concentration and the resulting therapeutic effect of
the co-administered substrate drug. In addition, GSTs directly                  References
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