Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. There are two types of diabetes, which are namely the type 1 (insulin-dependent diabetes) where the body does not produce insulin and type 2 (insulin-independent diabetes) where the body does not produce enough insulin. Approximately 90% of all cases of diabetes worldwide are type 2^[1].

  Diabetes is becoming a common disease in the Middle East region as the incidence of type 1 diabetes ranges from 2.62- 20.18/100,000/year and the percentage of type 1 diabetes is 4.6 to 40% in the region^[1].

  Plants have always been a good source of drugs, and many of the currently available drugs are derived directly or indirectly from them. Herbs play a big role in managing several diseases including diabetes. Examples of herbs used as anti-diabetic agents are the following, Ganoderma lucidium, Morinda citrifolia, Spirulina, Allium sativum, Eugenia jambolana, momordica charantia ocimum sanctum, phyllanthus amarus, tinospora cordifolia and trigonella foenum graecum^[2].

  The Ganoderma lucidum, which is an example of a herbal anti-diabetic agent, is a large dark mushroom, which grows in six colours; blue, red, yellow, purple, black and white, each has different names and characteristics^[3]. An animal experiment was done by Xiao and colleague^[4] to investigate the hypoglycemic effects and action of Ganoderma lucidum polysaccharides (GLP) on diabetic mice. Results showed that GLPs received mice had significantly decreased the fasting serum glucose compared with the diabetic control group^[4].

  Morinda citrifolia, which belongs to the family Rubiaceae; are small evergreen trees that grow in tropical climate zone^[5]. The leaves are about 8 inches long and are oval, the tubular flowers are white and the fruit is 3 to 4 inches in diameter with a warty, pitted surface^[6].

  Morinda citrifolia can be found in India, Southeast Asia, Australia, Polynesia and Hawaii. The fruit is commonly known as “Noni” or “Indian Mulberry”; in Australia it is called “cheese fruit” and in Japan “Yaeyama-aoki”^[7].

  In the Pacific Islands “noni”- Morinda citrifolia is used by the Polynesians in folk medicine. All parts of the plants have been used, including leaf, fruit, flower, roots, bark and seed. The juice extracted from Morinda citrifolia fruit possesses an anti-oxidative activity. Kamiya et al.^[8] showed that the methanol extracts and ethyl acetate-soluble phases from Morinda citrifolia fruit inhibited copper-induced LDL (low-density lipoprotein) oxidation. Previously Wang et al.^[9] showed that extracts from Morinda citrifolia induced dose-dependent inhibition of the oxidant substances produced by lipid hydrogen peroxide or superoxide anion radicals.

  A detailed study of the nutritional composition of Morinda citrifolia juice has been analyzed. Results showed that it contains glucose and fructose (3 - 4 % each), protein (0.2 - 0.5 %), lipids (0.1 - 0.2%) and vitamin C. The potassium content is relatively high (30 - 150 ppm), followed by calcium, sodium and magnesium^[5].

  On the other hand, Spirulina is a blue-green microalgae that grows in tropical salt lakes. It is a multicellular, filamentous cyanobacteria belonging to the algae class cyanophyta^[10]. It is produced primarily from two species of cyanobacteria: Arthrospiraplatensis and arthrospira maxima classified into the genus Arthrospira^[11]. Spirulina is proven to be a rich source of protein and vitamins, especially vitamin B₁₂, minerals, carotenoids, and phycocyanins^[12].

  Beyond nutritional value, certain species of Spirulina have shown therapeutic properties such as metabolic, anti-viral, liver-protecting and blood-vessel relaxing effects; anti-cancer, anti-inflammatory and antioxidant properties^[11]. A human study was done by Mani etal.^[1] to observe the long-term effect of spirulina in diabetic patients. After 2 months of treating patients with Spirulina only, the results showed significant reduction of blood sugar levels and glycosylated serum protein levels, confirming the hypoglycaemic effect of spirulina. Kim and Park^[13] asserted that Spirulina can be used as dietary supplementation in nutritionally vulnerable groups, Korean elder lies, to improve nutritional and health status and prevent chronic diseases such as hyperlipidaemia^[13].

  Kusirisin et al.^[14] compared between morinda citrifolia and other natural plants such as Kaempferia parviflora and reported that morinda citrifolia had the lowest total poly phenol and tannin content.

  Considering previous studies, we hypothesized that the combination of Spirulina and Morinda citrifolia might give stronger anti-diabetic effects. Our study aimed to report the antidiabetic and lipid profile effects of the combination of Spirulina and Morinda citrifolia from four diabetic Omani patients.

Materials and Methodology

  Four Omani diabetic patients that were between 22 - 35 years of age, who had been diabetic for 12 years of duration, had daily administered the combined herbal intervention for 4 months 4 g/day of Spirulina tablets and 40 ml/day of Morinda citrifolia juice with standard insulin treatment. Pre-intervention and post intervention fasting blood glucose levels, glycosylated haemoglobin (HbA1c) levels, low-density lipoprotein (LDL) and body weight were reported in all the subjects. Other four Omani diabetic patients with same age range and duration of the disease receiving type 1 standard diabetic treatment, insulin injections only.

Statistical Analysis:
  The statistical SPSS program (version 20.0) was used for all the analysis. The data were analyzed by one-way ANOVA and two-way ANOVA. All the results are expressed as mean ± standard error of the mean (SEM), and with the level of significance set at P < 0.05.

Results

  Table (1) shows characteristics of the subjects. Two females and two males with duration of 12 years of diabetes for group 1 as a control group. There were three females and one male with duration of diabetes for 12 years for group 2 receiving the intervention.

Table 1: Characteristics of the investigated subject

Duration of diabetes 12years 12years
Group 1* = diabetic patients receiving type 1 standard diabetic treatment- insulin injections; as a control group
Group 2# = diabetic patients receiving herbal anti-diabetic intervention.

Table 2: Body weights of subjects investigated.

  No significant change was found in the body weights of the subjects of group 2 post intervention compared to the pre-intervention weights P = 0.07. Also, there was no significant change as well when compared to the control group - group 1, P = 0.06. Post intervention, fasting blood glucose serum levels of group 2 subjects, that used the combination of spirulina and morinda citrifolia, were significantly lower (P < 0.002) as compared to pre-intervention measurement of those patients and also in comparison to fasting blood glucose serum levels post-treatment for the control group- group1 (P < 0.001) as shown in figure 1.

Figure 1: Fasting blood glucose serum levels.

References