Abelmoschus manihot alleviates insulin resistance in diabetic kidney disease through attenuation of inflammation

Emerging evidence implicates insulin resestance (IR) and chronic inflammation as interdependent drivers of diabetic kidney disease (DKD) progression. This study aims to investigate whether Abelmoschus manihot can concurrently ameliorate both pathological pathways in DKD patients. This study enrolled 94 biopsy-proven DKD patients (45 controls, 49 manihot group) with Homeostatic model assessment of insulin resistance (HOMA-IR) ≥ 5 and high-sensitivity C-reactive protein (hsCRP) ≥ 1 mg/L from China-Japan Friendship Hospital (2012–2023). All patients received standard care medications, and those in the manihot group were treated with Abelmoschus Manihot for 12 months. Participants were followed up every 3 months for a total of 1 year. Changes in HOMA-IR, hsCRP, 24-hour urine protein excretion (24-h-UPE), and estimated glomerular filtration rate (eGFR) from baseline during follow-up were assessed. Additionally, differences in 24-h-UPE, eGFR, and major cardiovascular and cerebrovascular events between the groups after treatment were evaluated. Adverse events and laboratory test abnormalities were also recorded. A total of 94 biopsy-proven DKD patients were included. Among them, 45 patients received standard care (control group), while 49 additionally took standard care plus Abelmoschus Manihot. The results revealed a statistically significant reduction in 24-h-UPE in the manihot group compared to the control group at 6 months (− 232.9 vs. − 145.8 mg, P = 0.04) and beyond. Since the 9-month follow-ups, the manihot group exhibited a significantly slower eGFR decline (-3.2 vs. -4.7 mL/min/1.73m2, P < 0.05). Additionally, IR in the manihot group was significantly reduced in both within- and between-groups (compared to the control), and hsCRP also exhibited analogous findings. In the manihot group, a significant positive correlation was observed between the decrease in hsCRP and the decrease in HOMA-IR, with P-value < 0.01. In contrast, no such significant correlation was observed in the control group, where the P-value was 0.1. No significant adverse events or laboratory test abnormalities were observed. This study suggests that in biopsy-confirmed DKD patients, Abelmoschus Manihot may provide additional benefits to standard care, including improvements in IR and inflammatory markers. However, longitudinal studies are needed to examine the causal association.