Abstract
Herbal medicines (HMs) are a major subset of complementary and alternative medicine. They have been employed for the efficient clinical management of type 2 diabetes mellitus (T2DM) for centuries. However, the related underlying mechanisms still remain to be elucidated. It has been found out that microbiota is implicated in the pathogenesis and treatment of T2DM. An interplay between gut microbiota and host occurs mainly at the gastrointestinal mucosal barrier. The host movements influence the composition and abundance of gut microbiota, whereas gut microbiota in turn modulate the metabolic and immunological activities of the host. Intestinal dysbiosis, endotoxin-induced metabolic inflammation, immune response disorder, bacterial components and metabolites, and decreased production of short-chain fatty acids are considered significant pathogenic mechanisms underlying T2DM. The interaction between gut microbiota and HMs during T2DM treatment has been investigated in human, animal, and in vitro studies. HMs regulate the composition of beneficial and harmful bacteria and decrease the inflammation caused by gut microbiota. Furthermore, the metabolism of gut microbiota modulates HM biotransformation. In this review, we have summarized such research findings, with the aim to improve our understanding of the pathogenesis and potential therapeutic mechanisms of HMs in T2DM and to provide new insights into specific targeted HM-based therapies and drug discovery.
Highlights
Diabetes mellitus (DM) is a widely prevalent chronic disease associated with significant healthcare problems worldwide
Intestinal dysbiosis, endotoxin-induced metabolic inflammation, immune response disorder, bacterial components and metabolites, and a decreasing production of SCFAs are closely associated with the pathogenesis of Type 2 diabetes mellitus (T2DM) and represent a mechanism of gut microbiota-host interplay
Our analysis of relevant clinical studies showed that most merely analyzed the modulation of gut microbiota composition by Herbal medicines (HMs), whereas the underlying mechanisms, including the interaction mode of floras with HMs, the affected host pathways, and the therapeutic targets were rarely studied
Summary
Diabetes mellitus (DM) is a widely prevalent chronic disease associated with significant healthcare problems worldwide. Type 2 diabetes mellitus (T2DM) is one of the main types of DM. It is characterized by hyperglycemia resulting from progressive β-cell dysfunction in the presence of insulin resistance (American Diabetes Association, 2019). The prevalence of T2DM has increased markedly over the years, causing a significant global burden of mortality and disability (Zheng et al, 2017). Obesity is the most prominent risk factor for T2DM. Other risk factors include a low-fiber diet and an unhealthy lifestyle, including inactivity, smoking, and alcohol consumption (Wu et al, 2014; Kautzky-Willer et al, 2016). There are various therapeutic approaches to T2DM, such as lifestyle management (Schellenberg et al, 2013) (self-management education and support, nutrition therapy, physical activity, dietary planning, and psychosocial care), oral medications (Qaseem et al, 2017) (metformin, sulfonylureas, thiazolidinediones, α-glucoside inhibitors, dipeptidyl peptidase-4 inhibitors, and sodiumdependent glucose transporter 2), injectable medications (Tran et al, 2015) (insulin and glucagon-like peptide-1), surgery (Maleckas et al, 2015), and complementary and alternative medications (Nahas and Moher, 2009)
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