Diabetic Neuropathy and Polyherbal Approaches: A Comprehensive Review of Mechanisms, Efficacy, and Future Directions

Abstract:

Diabetes mellitus (DM) is a chronic metabolic condition characterized by persistent hyperglycemia caused by abnormalities in insulin production, insulin action, or both. Long-term hyperglycemia causes a variety of problems, the most common and debilitating of which is Diabetic Neuropathy (DN), significantly reducing patients' quality of life. There are several forms of nerve damage due to diabetes, which include peripheral, autonomic, proximal, and focal neuropathy. The mechanism of nerve damage and subsequent neuronal death due to diabetes is a multifactorial process that includes activation of the polyol pathway, oxidative stress, and inflammation. The traditional treatment of DN is mainly focused on managing glucose and pain with the help of medications (antidepressants, anticonvulsants) or topical creams/gels; however, the conventional pharmacological approach has been proven to be ineffective for many patients and also has some side effects. Due to the broad mechanisms of action and the synergistic effects (in the case of more than two herbal ingredients taken together-more than two), alternative (or complementary) medicine has gained popularity over the past few years, especially in the context of botanical combinations. The clinical, preclinical, and very limited research studies assessing the therapeutic potential of various combinations (i.e., Curcuma longa, Ocimum sanctum, Clitoria ternatea, Eclipta alba, etc.) have revealed the presence of such properties as anti-neuropathic agents, neuroprotective agents, and antioxidants, and also the antidiabetic potential. The aim of this research is to provide a full synthesis of the existing scientific information on the effectiveness of polyherbal formulations in the treatment of DN. It also highlights the pathophysiological basis of DN, its classifications, the problems associated with the traditional treatment of DN, and a full analysis of the experimental studies on the assessment of polyherbal formulations. Moreover, this review also explores the mechanisms of action of these drugs, which include their antioxidant properties, anti-inflammatory mechanisms, blood glucoselowering properties, and neuroprotective mechanisms. The information clearly shows that polyherbal formulations are a promising and comprehensive approach towards the reduction of problems associated with DN.