A Systematic Review on Management of Type 2 Diabetes Mellitus: Conventional Treatment Strategies v/s Phyto-Alkaloids as Natural Alternatives

Diabetes mellitus is a multifactorial global pandemic that occurs due to an impaired production or action of insulin and is being prevalent at an alarming rate. The WHO supported organization NCD-RisC has reported that there are over 800 million diabetic individuals worldwide. Pharmacological and non-pharmacological treatment strategies aim to protect diabetic patients from various microvascular disorders, including retinopathy, nephropathy, neuropathy and dermopathy. The conducted systematic review adopted the methodology of Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) to conduct this systematic review and a flow chart has been used to provide a systematic search of included studies. Adhesion to intensive glycemic control methods also decreases the risk of macrovascular diseases such as cerebrovascular diseases, coronary artery disease (CAD), peripheral arterial disease, walking impairment, and amputations. This systematic review discusses the pathophysiology of T2DM and its current treatment strategies, including pharmacotherapy (biguanides, thiazolidinediones, sulphonylureas, meglinides, α-glucosidase inhibitors, SGLT-2 inhibitors, DPP-4 inhibitors, GLP-1R agonists, amylin agonists and insulins) and non-pharmacological methods (bariatric surgery, insulin pumps, and CGM) along with their contraindications and limitations. The conducted study has compiled various antidiabetic plant-based alkaloids (e.g., berberine, cryptolepine, conophylline, magnoflorine, palmatine, trigonelline, vicine etc.) that have potential to be used as natural alternatives to the conventional anti-hyperglycemic drugs. Mechanisms of their antidiabetic action are also provided briefly. The review also anticipates the prospects of phyto-alkaloids with the potential to improve the standard of care and finding new formulations to improve the complications associated with T2DM.