ABSTRACT
Type 2 diabetes (T2D) is a major health problem worldwide. In this condition, the organism can produce insulin but becomes resistant to it; thus the insulin is ineffective. High blood glucose levels are a result of insulin resistance and insulin deficiency; they produce diabetes-associated complications such as kidney failure, blindness, cardiovascular disease, and lower-limb amputation. In Guatemala, there were over 752.700 cases of the disease in 2017 with prevalence of 8.4 (IDF, 2017). The use of plants for medicinal purposes has been practiced in the country since pre-Hispanic times. Among the Cakchiquels, the aerial parts of Hamelia patens Jacq., Neurolaena lobata (L.) R.Br. ex Cass., and Solanum americanum Mill. and the cortex of Croton guatemalensis Lotsy are used to treat type 2 diabetes. The aim of the present study was to confirm the hypoglycemic effect of the plants under normal conditions and under maltose and sucrose tolerance tests, as well as to test the activity of the plant extracts in vitro against alpha-glucosidases types I and II. In agreement with the traditional usage of the plants, in normal conditions without a sugar load, the extracts produced a statistically significant hypoglycemic effect similar to the control drug glibenclamide. When the sugar load was maltose, only Croton and Solanum produced a statistically significant (p < 0.05) hypoglycemic effect compared to the control drug, but when the sugar was sucrose, Croton and Hamelia produced a statistically significant effect (p < 0.05) beginning at 30 min compared to the control group, while Solanum did so at 60 min and Neurolaena at 90 min. In vitro assays showed that the extracts inhibited yeast alpha-glucosidases but not the rat intestinal ones. Of the tested plants, Croton exert an effect both under sugars' tests and under a normal tolerance test; these results suggest the potential use of this plant. The results presented here provided evidence based on the use of these plants as hypoglycemic agents in the treatment of type 2 diabetes.
ABSTRACT
ETHNOPHARMACOLOGICAL RELEVANCE: Type 2 diabetes is characterized by tissue resistance to the action of insulin, combined with a relative deficiency in insulin secretion. In Guatemala, type 2 diabetes results in significant mortality rates. The low incomes of the indigenous population results in the use of alternative therapies such as medicinal plants to treat the illness. We could not find any previous study related to the use of medicinal plants to treat diabetes in Guatemala. The aim of this work is to determine the most effective plant species used in traditional medicine to treat type 2 diabetes. MATERIALS AND METHODS: We performed an ethnopharmacological field study among the Cakchiquels of Chimaltenango to select the most prominent plants used to treat the disease. Type 2 diabetic patients from their community health centers were interviewed using structured questionnaires. Two mathematical tools were used to identify potential plant species: the Disease Consensus Index and the Use Value. International databases, including SCOPUS, PubMed, and Google Scholar, were used to identify whether the plants with the highest scores were known to elicit hypoglycemic effects. RESULTS: After analyzing the data, we can propose the following plants as the most prominent among the Cakchiquels of Chimaltenango to treat type 2 diabetes: Hamelia patens Jacq., Neurolaena lobata (L.) R.Br.ex Cass., Solanum americanum Mill., Croton guatemalensis Lotsy, and Quercus peduncularis Née. CONCLUSIONS: The Cakchiquel patients interviewed did not understand type 2 diabetes; however, they associated the onset of their disease with a negative emotion, such as shock, sadness or anger. Despite changes in lifestyle, influences of advertising, the availability of innovative treatments and the use of oral hypoglycemic treatments provided by health facilities serving indigenous communities, the Cakchiquel continue to use medicinal plants as adjunctive treatment. While they are unaware whether the plants can cause additional harm, they consider their consumption beneficial because they feel better. There were 11 plants identified with UVs greater than 0.5 and high DCIs; from these 64% of the plants have been identified as having hypoglycemic effects; this finding supports the traditional selection by the Cakchiquels of medicinal plants to treat T2D.