DIABETES MELLITUS: ECONOMIC AND HEALTH BURDEN, TREATMENT AND THE THERAPEUTICAL EFFECTS OF HYPOXIS HEMERROCALLIDEA PLANT - CPUT
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Medical Technology SA Volume 30 No. 2 | December 2016
Peer reviewed REVIEW
Diabetes mellitus: economic and health burden, treatment
and the therapeutical effects of Hypoxis hemerrocallidea
plant
M Goboza1 MTech | YG Aboua2 DTech | S Meyer2 PhD | OO Oguntibeju1 DTech
1
Oxidative Stress Research Centre, Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula
University of Technology, South Africa
2
Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, South Africa
Corresponding author: O.O Oguntibeju | tel: +27 (0)21 053 8495 | email: oguntibejuo@cput.ac.za, bejufemi@yahoo.co.uk
ABSTRACT
Diabetes mellitus (DM) is becoming one of the leading causes of death worldwide because of its adverse complications that include
cardiovascular related diseases and chronic kidney disease. DM is considered a menace to public health due to the unavailability
of adequate drugs to manage this condition, especially in poor developing countries such as those in the African continent. Proper
management and treatment of this is lacking, which possibly explains escalating percentages of morbidity and mortality associated
with it. In Africa, as a result of poor socio-economic conditions, it is nearly impossible to properly monitor and manage DM.
Globally, the commercially available drugs used in diabetes treatment regimens have been associated with drastic side effects and
are also mostly unaffordable in some developing countries (particularly in Africa), hence the need to investigate cheap and readily
available medicinal plants such as Hypoxis hemerocallidea. It is important to thoroughly investigate the activities of medicinal
plants in animal models to identify both their therapeutic and toxic effects. This review paper examines the potential anti-diabetic
benefits of Hypoxis hemerocallidea based on experimental studies done on this plant between the years 2000 and 2016. The
authors recommend that further studies on the different extracts of the plant be undertaken to discover the exact mechanisms of
their action.
Keywords
Diabetes Mellitus (DM), Hypoxishemerocallidea, African potato, rooperol, oral anti-diabetic drugs
INTRODUCTION ticed in the Western countries.[8] Obesity and unhealthy dietary
habits have been linked to the acceleration of the pathogenesis
General overview of Diabetes Mellitus of type 2 DM.[9,10] A marked increase in the consumption of
Diabetes mellitus (DM) is described as a group of metabolic genetically modified animal products as well as fatty foods has
disorders characterised by hyperglycemia resulting from defects become more pronounced in South Africa. In addition to the
in the insulin action, secretion or both.[1] DM in its chronic unfavourable dietary shift, poor body weight maintenance, eth-
stages is associated with complications that affect the heart, nicity, age, gender, country of residence are also major factors
kidneys, nerves, blood vessels and eyes. Diabetes exists in in the development of non-communicable diseases, diabetes
two main types; type 1 and type 2. Type 1 DM is insulin de- mellitus inclusive.[11,12] Previous studies showed that 87% of the
pendent because of the absolute insulin deficiency that occurs type 2 DM patients in South Africa were obese or overweight.[13]
as a consequence of auto immune attack on beta pancreatic Obesity therefore exacerbates the onset of DM.[3] Other epide-
cells. Daily doses of insulin are given to type 1 DM patients miological studies showed that the obesity trend have shifted
to maintain euglycaemia and thus preventing life threatening from urban societies and is affecting the poorer, rural popula-
complications.[2] In type 2 DM, there is a partial deficiency of tions contributed by the economic growth rate.[14] From this
insulin rather than an absolute deficiency, hence the name non- information, it can be hypothesised that DM incidence and
insulin dependent. The aetiology of type 2 DM is predisposed prevalence rates are increasing in the rural areas of Southern
by lifestyle practices as well as genetic effects. Although insulin Africa. Although obesity is the chief contributory factor in the
is produced, the problem lies in the recognition of insulin by development of type 2 DM, other factors such as age and anti-
body cell receptors or insulin resistance. Hyperglycemia is the retroviral therapy have also been associated with the onset and
common characteristic feature of DM, and other symptoms progression of DM in South Africa.[15]
include polyphagia, polydipsia, polyuria, unexplained weight DM and its epidemiology
loss and visual disturbances.[3,4,5,6,7]
The prevalence of DM has grossly increased world wide and
Global statistical data shows that type 1 DM accounts for about 25% of the world population is believed to be suffering from
5-10% of all diabetic cases while type 2 DM is responsible for this disease.[16] DM has become a major public health burden
90-95%.[4,7] In African societies, type 2 DM is more prevalent that is reported to become the 7th leading cause of mortality by
than type 1.[7] In South Africa, recent evidence suggest the in- the year 2030.[17] It has also been predicted that 552 million
crease in the prevalence of type 2 DM to be related to the stand- people will be diabetic by 2030,[11] presently, 382 million peo-
ard of living and the life styles that closely mimic those prac- ple are diabetic. The rate of the incidence of DM is so alarming
ISSN 1011 5528 | www.smltsa.org.za 39Medical Technology SA Volume 30 No. 2 | December 2016
that reports project that 1 in 10 non-diabetic adults will become sequently, an extensive study on the global burden of DM is
diabetic by the year 2030.[17] In 2004, studies carried out in imperative in the health sector, as it enables proper planning,
middle income countries reported that DM was responsible validation and analysis. All of these enable the best strategic
for an estimated 0.5 million deaths, equating to approximately measures be put in place in order to eradicate the disease.[28]
2.1% of all deaths that occurred. In high income countries 0.2
million deaths were due to DM, equating to 2.8% of all deaths. Treatment and Management of DM
These results reflect the burden and overall health consequenc- An early diagnosis of a hyperglycaemic state and a comprehen-
es of DM in developing countries.[18] sive approach in the maintenance of normoglycaemia is linked
Epidemiology of Type 2 DM in Africa to favourable long term glycaemic control.[29] Patient education
and life style modifications greatly improve the prognosis of
In the past decades the prevalence of type 2 DM was reported diabetic complications. For example, cardio-vascular diseases
to be generally low in Africa and deaths caused by DM were (CVD) and its related complications can be reduced by 70-
insignificant, mainly because of the consumption of natural 80%.[29,30] Diabetic patients and their families are the best peo-
unprocessed plant foods. However, due to changes in dietary ple to provide supportive care and management as the disease
trends and lifestyle practices, increasing figures of mortality in is affected by daily fluctuations in environmental stress, diet
African societies due to DM are becoming noticeable.[19] A 2.5 and infections.[31]
fold increase in DM prevalence is expected in the developing
Researchers have reported that oral anti-diabetic drugs (OADs)
countries by the years 2020-2025.[12] In Sub Saharan countries,
together with lifestyle changes can provide both short and long
10.2 million people are reported to have type 2 DM. These fig-
term benefits to diabetic patients. The need to educate both pre-
ures are expected to reach 18.7 million by 2025.[20,21] Nigeria
diabetic and diabetic patients on the importance of proper care
tops the list of 5 countries greatly affected by DM in the Sub-
and management of their disease is vital.[29] Emphasis should
Saharan region with 1.2 million of its population being diabetic,
be put on appropriate dietary and lifestyle changes.[32] Various
followed by South Africa with 841 000, Democratic Republic of
clinical trials have established that type 2 DM can be prevented
Congo with 552 000 and lastly Ethiopia and Tanzania with 550
by modifying dietary and lifestyle changes.[14,28 ]
000 and 380 000 diabetics respectively.[19]
In addition, diet and exercise are the primary prevention strate-
Epidemiology of Type 1 DM gies of the pathogenesis of DM as well as other chronic dis-
Type 1 DM has the highest prevalence and incidence in Euro- eases.[12] For example, a high energy expenditure rate, achieved
pean populations, with an overall rate of increase of 3-4%.[22,23] through physical activity decreases insulin resistance in relative
Non-European populations around the world have a relatively terms, whilst increasing glucose tolerance. Physical activity has
low incidence of type 1 DM.[11] The highest incidence has a great impact on muscle and bone tissue and in overall obesity.
been noted in North-West Europe and the Scandinavian coun- In obese diabetics, a weight loss of ≥4 kilograms ameliorates
tries, with Finland, Sweden and Norway being the top 3 of hyperglycemic conditions, which may further improve normal
significantly affected.[24] Type1 DM has a childhood onset and glycaemic control.[29,33] A major setback detected in the role of
studies have shown that 25 juveniles (Medical Technology SA Volume 30 No. 2 | December 2016 undergo bariatric surgery will eventually attain near normal Alpha-glucosidase inhibitors glycaemic states. Other beneficial lifestyle changes include ces- The α-glucosidase inhibitors decrease the rate of absorption of sation of smoking and reduced alcohol consumption.[14] carbohydrates, thus lowering postprandial glucose. The major Oral anti-diabetic drugs (OADs) side effect is excess gas production.[47] In view of the fact that diabetes exists in several different forms, Medicinal Plants and their health benefits with unique combinations of OADs are available to maintain a normal focus on DM glycaemic status and thus prevent diabetic complications.[37,38] Evaluations on the best algorithmic treatment have to be cau- Plants with medicinal benefits are known to play significant tiously investigated. The best choice of pharmacological regi- roles globally in the management and treatment of various mens should include the following properties: effective glycae- chronic diseases including diabetes, particularly in African and mic control, minimal side effects, tolerable, readily available, Asian regions. In these regions, due to low socio-economic pat- help in the mitigation of diabetic symptoms and lastly are in- terns, about 80% of the population rely on plant products as expensive.[29,39] Pharmacological agents have been reported to their primary healthcare sources.[20,46] exhibit adequate glycaemic control despite their side effects.[29] The interest in medicinal plants has grown simply because Medical practitioners worldwide are facing difficulties in mak- they are readily available and have minimal side effects.[48] ing decisions on the best algorithms to prescribe as well as The relative cost of pharmacological drugs globally has raised when to initiate the therapy.[29,40] Timing on pharmacological concerns. The cost of metformin has been reported to be almost treatment is important as a delay in treatment can result in 5 times higher than that of the cheapest generic sulphonylureas, poor glycaemic control.[41] The American Diabetic Association 6 times higher for repaglinide and close to 30 times higher for (2011) proposed that a HbA1c level of
Medical Technology SA Volume 30 No. 2 | December 2016
most plants modes of action remains unclear, hence the need glucose reduction in treated diabetic rats was noted after 60
for further studies to determine these exact mechanisms.[57] days of treatment. To validate earlier findings, other authors ob-
served an increase in the activity of glucose metabolic enzymes
Examples of some medicinal plants used in the as well as a decrease in lipid peroxidation, a driving factor in
treatment of DM in South Africa the development of diabetic complications.[63] An increase in
The following plants have been reported to treat DM and they glucose utilisation in hepatocytes was also reported.[64]
are mainly used in the Eastern Cape region of South Africa. They
Vernonia amygadalina
include: Artemisia afra, Vernonia amygadalina, Bulbine frutes-
cens and Catharanthus roseus.[58] Vernonia amygadalina, also known as the bitter leaf, grows
wildly in the KwaZulu Natal, Mpumalanga and the Eastern and
Artemisia afra Northern Cape regions of South Africa.[57] In folk medicine the
Artemisia afra is a medicinal plant frequently used in South Af- plant was and still is being used to treat parasitic infections in-
rica to treat DM. A. afra is a shrub that usually reaches 2m in cluding malaria, diabetes and eczema. In attempts to confirm
height with hairy, leafy stems. Studies carried out by Afolayan its anti-diabetic nature, several in vivo tests were carried out. V.
and Sunmonu,[58] showed this plant's ability to reverse diabetic amygadalina also reverses diabetic oxidative stress.[65] The abil-
oxidative stress in the pancreas of streptozotocin (STZ)-induced ity of the plant to curb diabetic oxidative stress was assessed in
diabetic rats. They concluded that this was due to the reduction a series of experiments carried out in 3 groups of rats namely:
of lipid peroxidation that was accompanied by an increase in normal control, STZ-induced non-treated and STZ-induced dia-
activity of antioxidant enzymes.[58] betic treated with 200 mg/kg of the plant extract. Malondialde-
The plant has been studied by the same authors[59] to substanti- hyde, glucose and lipid parameters were measured in all groups
ate its anti-diabetic effects. In a 15 day experimental study, rats and the results indicated the hypolipidemic, hypoglycaemic
were divided into 6 groups where group 1 and group 2 were and antioxidant effects of V. amygadalina in the diabetic treated
normal and diabetic controls respectively. Groups 3 to 5 were group. The significant fall of triglyceride levels was associated
diabetic rats treated with aqueous extracts of (50, 100 and 200 with the delay of CVD progression.[65] These results collaborated
mg/kg) of A. afra respectively. The 6th group consisted of dia- the findings in which a reduction of low density lipoproteins,
betic rats treated with glibenclamide, a standard drug for DM. triglycerides and cholesterol was observed in diabetic Albino
rats.[66] A dose related reduction in blood glucose levels after V.
The results highlighted that the effects of the 200 mg/kg dosage
amygadalina extract induction was reported in adult alloxan-
had almost the same effects as glibenclamide. The effect of the
ised rabbits.[67] In normal treated rabbits a fall from 96 mg/dL-48
plant on blood glucose levels showed a significant reduction
mg/dL was observed while a 520 mg/dL-300 mg/dL fall in al-
with the greatest reduction seen in the 200 mg/kg concentra-
loxanised treated rabbits was reported.[67] The mode of action of
tion. The oral glucose tolerance test indicated an equivalent
blood glucose reduction between the plant extract and gliben- this plant was suggested to be associated with insulin produc-
clamide. The study also monitored water/feed intake and weight tion and correction of carbohydrate metabolism.[68]
changes. The results highlighted that A. afra prevented the pro-
Hypoxis hemerocallidea and its effects in DM
gression of the symptoms of diabetes namely polydipsia and
treatment and Management
polyphagia in A. afra treated diabetic groups when compared
to the diabetic controls, which consumed higher quantities of Hypoxis hemerocallidea is a plant of the hypoxidaceae (Star
water and feed.[59] lily) family. This plant was first described by Linnaeus in 1759
and the name was derived from the Greek words hypo (below)
Bulbine frutescens
and oxy (meaning sharp), in reference to the ovary which is
B. frutescens is is well known for its use as a topical ointment as pointed at the base. The plant has recently drawn attention of
well as a digestive tonic.[60,61] Apart from the above mentioned researchers worldwide. H. hemerocallidea is also known as the
uses, the plant has been used as a hypoglycaemic agent in the African potato and has been referred to as the miracle plant.
treatment of diabetes by traditional healers in the Nelson Man- [57,69,70,62]
In South African vernacular, it is referred to as Ilabathe-
dela Metropole of South Africa. To support these claims, van ka (IsiZulu), sterretje/afrikaanpatat (Afrikaans), star lily and yel-
Huyssteen et al investigated the effects of B. frutescens in C2 low star. Geographically, the plant is distributed in the Southern
and C12 muscle cell lines and in Chang liver cells by assessing hemisphere and is abundant in Southern Africa. In South Africa,
glucose utilisation in treated cell lines. They reported that aque- the African potato mainly grows in the Eastern Cape and all the
ous plant extract improved the glucose utility/uptake in these way to the KwaZulu Natal area. It is also native in some parts of
cell lines when compared to insulin.[61] A synergistic effect of Lesotho, Mozambique and Zimbabwe. The plant is character-
ethanolic extract of B. frutescens with insulin on glucose utilisa- ised by strap shaped leaves and thick green hairy stems that are
tion was also reported. unbranched. The stems hold stalks supporting 2-12 yellow, star
Catharanthus roseus shaped flowers. At the base of the plant (just above the ground)
lies the corm – a tuberous root stalk, that is wrongly referred to
C. roseus or Vinca rosea is a shrub with distinct purple or white
as the potato.[57,69,70,71,7273]
flowers that has its origin in Madagascar.[62] The hypoglycaemic
nature of the plant was associated with the presence of various The tuberous part of the H. hemerocallidea is believed to pos-
phytochemicals distributed throughout the plant. C. roseus was sess medicinal effects.[57,74] In folk medicine, the African potato
reported to be an anti-hyperglycemic plant[62] rather than a hy- was used for centuries to treat various ailments including the
poglycaemic plant as it increases glycolysis and glucose oxida- following: arthritis, cancer, diabetes mellitus, high blood pres-
tion (via the Pentose phosphate shunt pathway). A 77.7% blood sure, psoriasis, gastric ulcers, wounds, tuberculosis, urinary tract
42 www.smltsa.org.za | ISSN 1011 5528Medical Technology SA Volume 30 No. 2 | December 2016
infections, asthma, central nervous system disorders and epi- antioxidant capacity and the ferric reducing antioxidant power
lepsy.[57,69,70,71,72] Most of these were just anecdotal claims, how- assays.[71,75] Accumulation of reactive oxygen species instigates
ever scientific studies indicated that H.hemerocallidea possess the rate of shrinkage of cells, chromatin condensation, DNA
anti-diabetic, anti-inflammatory, antioxidant, anti-nociceptive, fragmentation as well as cellular apoptosis (programmed cell
antibacterial, anticancer and anti-diarrhoeal effects.[70,71,74,75] death).[78] These cellular changes play an essential role in the
Previous reports highlighted that the African potato has the abil- pathogenesis of diabetic complications.
ity to boost immunity in HIV infected patients; however, the Hyperglycaemia causes tissue injury via 4 major mechanisms:
plant was also linked to the suppression of the bone marrow. (1) increased glucose flux through the polyol pathway; (2)
For this reason, the use of the plant in HIV infected patients has increased intracellular formation of AGEs (advanced glyca-
been terminated in South Africa.[57,74] tion end products); (3) activation of the protein kinase (PK)C
These medicinal effects of the African potato are attributed to pathway and (4) increased activity of the hexosamine pathway.
the presence of sterols, starols, sterolins, norlignan, daucos- Scientific evidence has shown that all four mechanisms are
terols and hypoxides.[69,73,75] Amongst these phytochemicals; triggered by a particular upstream event that points to mito-
daucosterols, beta sitosterol and hypoxide are associated with chondrial overproduction of ROS.[79] The ability of rooperol to
its therapeutic activities. Hypoxide is the major component iso- inhibit lipid peroxidation was compared to the activity of green
lated from the corm. Hypoxide is a glycosylated norlignan that tea and rooperol caused higher inhibition.[75] Rooperol has the
is derived from cinamic acid. In its natural form, hypoxide is in- ability to scavenge hydroxyl radicals and hence reducing mem-
active but can be converted to rooperol by beta glucosidase en- brane lipo-oxidation.[75] Therefore, the high antioxidant power
zyme. This conversion occurs in the gut in humans; in animals of rooperol contributes immensely to its hypoglycaemic effects.
bacterial beta glucosidase catalyses the conversion. Rooperol is Our laboratory conducted further investigations into the ac-
a bioactive compound that has powerful antioxidant properties tivities of H. hemerocallidea in the liver and kidney tissue of
in human blood.[69,73,74,75,76] diabetes-induced rats. Our findings correlated with the results
Anti-diabetic activities of H. hemerocallidea in experimental obtained by[70,76,78] where significant decreases in fasting glu-
studies cose levels were also observed. Two dosages of 200 and 800
mg/kg of the aqueous extract were administered to diabetic
In reference to experimental studies carried out by several groups and to a non-diabetic group (for toxicity evaluation).
authors; H. hemerocallidea was shown to be an anti-diabetic Based on our results, treatment of diabetic rats with a high dose
plant.[70,76,77,78] In a study carried out by Ojewole,[70] STZ-induced of 800 mg/kg resulted in abnormal kidney function, which was
diabetic rats were divided into 7 groups made up of 8 rats per indicated by abnormally elevated relative kidney weights when
group. Five groups were subjected to different concentrations values were compared to the normal controls. The increase in
of aqueous plant extract (50, 100, 200, 400 and 800 mg/kg). relative kidney weights was linked to hyper filtration, aggrega-
Depending on the group; the other 2 groups were treated with tion of lymphocyte, fat filtration and glomerular hypertrophy.
either chlorpropamide (a reference drug) or distilled water (in The antioxidant evaluation of the kidneys of the group treated
diabetic control). After STZ administration, animals were fasted with 800 mg/kg of the plant extract did not differ significantly to
for 16 hours, after fasting; rats were orally treated with respec- the results obtained from the diabetic controls. These abnormal
tive dosages of the aqueous plant extract. Blood glucose levels kidney function results are in agreement with the results ob-
were measured at 1, 2, 4 and 8 hours post treatment. The results served by[81] who reported that H. hemerocallidea impairs kid-
indicated that all extracts significantly reduced blood glucose ney function by decreasing urinary sodium output, glomerular
levels and the reduction was dose dependent. The greatest filtration rate and also increases plasma creatinine levels. Potent
reduction of 41% was observed in the group that was treated antioxidant activities of the plant were observed in the liver of
with 800 mg/kg. In addition; treatment with chlorpropamide treated groups which were assessed by measuring the oxygen
decreased blood glucose levels by 65%. Therefore the 800 mg/ radical absorbance capacity, ferric reducing antioxidant power,
kg of the plant extract had almost the same effect on blood catalase, superoxide dismutase and reduced glutathione ac-
glucose reduction as chlorpramide.[70] In another study; treat- tivities. It was concluded that H. hemerocallidea demonstrated
ment of fasted normal and STZ-induced diabetic rats with 800 excellent hypoglycemic and antioxidant effects especially in the
mg/kg aqueous extract of H. hemerocallidea caused respective liver with possible negative effects on the kidneys.[77]
reductions in blood glucose levels by 30, 20% and 48, 54%.[76]
The results obtained from this study indicate that H. hemerocal- Limitations and Recommendations
lidea has hypoglycemic effects since a 30% reduction in normal
DM incidence is rising in all regions of Africa even in the poor-
fasted non-diabetic rats was observed. The presence of phyto-
est of societies, inflicting a heavy burden on the limited resourc-
sterols was, however, linked to the hypoglycaemic action.[76]
es available in these poor societies. The pathogenesis of DM
The hypoglycemic effect of H. hemerocallidea was also com-
portrays a serious therapeutic challenge. Despite all the efforts
pared to the activities of glibenclamide in diabetic rats where in DM research, no drug has been found that can cure diabetes
the reduction was 55, 32% and 68, 71% respectively. Although or totally reverse its complications. Orthodox drugs have been
H. hemerocallidea is less potent than glibenclamide, the plant linked to serious side effects, hence the call for medicinal plants
still possess hypoglycemic effects, validating its folkloric use in in the treatment and management of DM. Medicinal plants have
South Africa.[78] shown significant potential to counteract the hyperglycaemic
The antioxidant capacity of rooperol (a bioactive compound of effects as they contain phytochemicals with minimum side ef-
H. hemerocallidea) was also extensively evaluated using the fects. The use of medicinal plants in the treatment of DM has
thiobarbituric acid reactive substances assay, trolox equivalent not gained much global recognition, despite all the compelling
ISSN 1011 5528 | www.smltsa.org.za 43Medical Technology SA Volume 30 No. 2 | December 2016
experimental evidence of hundreds of plants with anti-diabetic 13. Steyn NP, Labadarios D. Understanding the determinants of
activities. Further research studies on medicinal plants are obesity. South African Journal of Clinical Nutrition. 2008 Dec
11;21(4):304-5
therefore recommended in African settings since it is almost im-
14. Hu FB. Globalization of Diabetes The role of diet, lifestyle and
possible for poor citizens to purchase the costly orthodox drugs.
genes. Diabetes care. 2011 Jun 1;34(6):1249-57
High throughput screening tests are necessary to isolate active
15. Kengne AP, Echouffo-Tcheugui JB, Sobngwi E, Mbanya JC. New
compounds that may be developed into clinical agents either insights on diabetes mellitus and obesity in Africa—Part 1:
as natural products or maybe synthetically modified to enhance prevalence, pathogenesis and comorbidities. Heart. 2013 May
their clinical action. In previous studies, we successfully evalu- 16;99:979-983
ated the effects of Hypoxis hemerocallidea in the liver and 16. Oyagbemi AA, Salihu M, OO O, Farombi EO. Some selected
kidneys of STZ-induced rats. H. hemerocallidea significantly medicinal plants with antidiabetic potetials. Antioxidant-Antidi-
abetic Agents and Human Health. InTech Croatia. 2014:95-113
reduced hyperglycemic-induced oxidative damage in the liver
17. Arise RO, Ganiyu AI, Oguntibeju OO. Lipid profile, antidiabetic
tissue, however at higher concentrations negative effects were and antioxidant activity of Acacia ataxacantha bark extract in
observed in the kidneys. We recommend that further tests to be streptozotocin-induced diabetic rats. Antioxidant-antidiabetic
done on hypoxide and rooperol the active compounds that are Agents and Human Health. InTech Croatia. 2014:3-24
speculated to be responsible for both antioxidant and antidi- 18. Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp
abetic effects. U, Shaw JE. Global estimates of diabetes prevalence for 2013 and
projections for 2035. Diabetes research and clinical practice.
2014 Feb 28;103(2):137-49
Acknowledgments
19. Udenta EA, Obizoba IC, Oguntibeju OO. Antidiabetic effects of
The authors acknowledged the financial support from the Nigerian indigenous plant foods/diet. Antioxidant-Antidiabetic
University Research Fund (URF), Cape Peninsula University of and Human Health. InTech Croatia. 2014:59-93
Technology, granted to Dr. Yapo G. Aboua and Professor Olu- 20. Abo KA, Fred-Jaiyesimi AA, Jaiyesimi AE. Ethnobotanical studies
wafemi O. Oguntibeju. of medicinal plants used in the management of diabetes mellitus
in South Western Nigeria. Journal of Ethnopharmacology. 2008
Jan 4;115(1):67-71
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