Exploring the Role of Natural Agents in the Management of Diabetic-Induced Neuropathy

Authors

  • Darshan Anil Sonawane Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik
  • Sunil K Mahajan Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik
  • Chandrashekhar Patil Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik
  • Durgesh Pagar Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik
  • Gaurav Kasar Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

DOI:

https://doi.org/10.22270/ajprd.v13i5.1633

Abstract

Nephropathy, retinopathy, cardiomyopathy, and peripheral neuropathy are some of the most common and serious complications of diabetes mellitus (DM), affecting around 50% of patients. These issues often arise due to poor blood sugar control or inadequate management of diabetes. Among these, diabetic peripheral neuropathy (DPN) is particularly troubling, as it’s not only widespread but also the most painful. This work aims to explore the various approaches used to manage DPN, from traditional treatments to more alternative options. We’ll dive into common medications, comparing the effectiveness of gabapentin and pregabalin, which are often used when regular painkillers like NSAIDs or opioids don’t work. We’ll also look at the wisdom of Oriental Medicine, which offers unique perspectives, and examine the potential of natural compounds that researchers suggest could be effective either alone or alongside current treatments. Lastly, we’ll discuss ancient practices like acupuncture and electrostimulation as potential non-drug alternatives that may provide relief for those suffering from DPN.

 

Downloads

Download data is not yet available.

Author Biographies

Darshan Anil Sonawane, Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Sunil K Mahajan, Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Chandrashekhar Patil, Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Durgesh Pagar, Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Gaurav Kasar, Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

Department of Pharmacy, SSS’s Divine College of Pharmacy, Satana, Nashik

References

Tomic D, Shaw JE, Magliano DJ. The burden and risks of emerging complications of diabetes mellitus. Nat Rev Endocrinol. 2022 Sep;18(9):525-539. doi: 10.1038/s41574-022-00690-7. Epub 2022 Jun 6. PMID: 35668219; PMCID: PMC9169030.

Parker ED, Lin J, Mahoney T, Ume N, Yang G, Gabbay RA, ElSayed NA, Bannuru RR. Economic Costs of Diabetes in the U.S. in 2022. Diabetes Care. 2024 Jan 1;47(1):26-43. doi: 10.2337/dci23-0085. PMID: 37909353.

Bodman MA, Dreyer MA, Varacallo MA. Diabetic Peripheral Neuropathy. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442009

Syahriyani, St & Yusuf, Saldy&Syam, Yuliana. (2021). The effectiveness of complementary and alternative medicine therapy in reducing pain in diabetic neuropathy: A systematic review. Public Health of Indonesia. 7. 31-40. 10.36685/phi.v7i1.385.

Salih S, Jawahi TA, Al Salem RH, Alhazmi SA, Buayti AA, Alammari AH, Mashi HM, Dobea LA, Muaddi MA. Bridging the knowledge-practice gap: A cross-sectional survey assessing physician knowledge, attitude and practice toward complementary and alternative medicine. PLoS One. 2025 May 14;20(5):e0322613. doi: 10.1371/journal.pone.0322613. PMID: 40367283; PMCID: PMC12077789.

Al-Emadi S, Al-Shehhi F, et al. Undiagnosed diabetes mellitus in rural communities in Sudan: prevalence and risk factors. Eastern Mediterranean Health Journal. 2015;21(3):123-131. Available from: https://www.emro.who.int/emhj-volume-21-2015/volume-21-issue-3/undiagnosed-diabetes-mellitus-in-rural-communities-in-sudan-prevalence-and-risk-factors.html

Diabetes in India. Wikipedia [Internet]. Wikimedia Foundation; updated 2 months ago [cited 2025 Aug 19]. Available from: Diabetes in India article, Wikipedia.

Balakumar, P., Maung-U, K., &Jagadeesh, G. (2016). Prevalence and prevention of cardiovascular disease and diabetes mellitus. Pharmacological research, 113(Pt A), 600–609. https://doi.org/10.1016/j.phrs.2016.09.040

Zheng, Y., Ley, S. H., & Hu, F. B. (2018). Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nature reviews. Endocrinology, 14(2), 88–98. https://doi.org/10.1038/nrendo.2017.151

Elendu, C., John Okah, M., Fiemotongha, K. D. J., Adeyemo, B. I., Bassey, B. N., Omeludike, E. K., &Obidigbo, B. (2023). Comprehensive advancements in the prevention and treatment of diabetic nephropathy: A narrative review. Medicine, 102(40), e35397. https://doi.org/10.1097/MD.0000000000035397

American Diabetes Association (2018). Economic Costs of Diabetes in the U.S. in 2017. Diabetes care, 41(5), 917–928. https://doi.org/10.2337/dci18-0007

Ingrasciotta, Y., Bertuccio, M. P., Crisafulli, S., Ientile, V., Muscianisi, M., L'Abbate, L., Pastorello, M., Provenzano, V., Scorsone, A., Scondotto, S., &Trifirò, G. (2020). Real World Use of Antidiabetic Drugs in the Years 2011-2017: A Population-Based Study from Southern Italy. International journal of environmental research and public health, 17(24), 9514. https://doi.org/10.3390/ijerph17249514

Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C. N., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., &Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes research and clinical practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119

Davies MJ, Gray LJ, Ahrabian D, et al. A community-based primary prevention programme for type 2 diabetes mellitus integrating identification and lifestyle intervention for prevention: a cluster randomisedcontrolled trial. Southampton (UK): NIHR Journals Library; 2017 Jan. (Programme Grants for Applied Research, No. 5.2.) Chapter 2, Systematic review. Available from: https://www.ncbi.nlm.nih.gov/books/NBK409310

Colloca, L., Ludman, T., Bouhassira, D., Baron, R., Dickenson, A. H., Yarnitsky, D., Freeman, R., Truini, A., Attal, N., Finnerup, N. B., Eccleston, C., Kalso, E., Bennett, D. L., Dworkin, R. H., & Raja, S. N. (2017). Neuropathic pain. Nature reviews. Disease primers, 3, 17002. https://doi.org/10.1038/nrdp.2017.2

Jain, A., Gyori, B.M., Hakim, S. et al. Nociceptor-immune interactomes reveal insult-specific immune signatures of pain. Nat Immunol 25, 1296–1305 (2024). https://doi.org/10.1038/s41590-024-01857-2

Ras T. (2020). Chronic non-cancer pain management in primary care. South African family practice : official journal of the South African Academy of Family Practice/Primary Care, 62(1), e1–e4. https://doi.org/10.4102/safp.v62i1.5203

Iannitti, T., Kerr, B. J., & Taylor, B. K. (2014). Mechanisms and pharmacology of neuropathic pain in multiple sclerosis. Current topics in behavioral neurosciences, 20, 75–97. https://doi.org/10.1007/7854_2014_288

sante CO, Wallace VC, Dickenson AH. Mammalian target of rapamycin signaling in the spinal cord is required for neuronal plasticity and behavioral hypersensitivity associated with neuropathy in the rat. The journal of pain : official journal of the American Pain Society. 2010;11:1356–1367.

Attal N. (2019). Pharmacological treatments of neuropathic pain: The latest recommendations. Revue neurologique, 175(1-2), 46–50. https://doi.org/10.1016/j.neurol.2018.08.005

Didangelos T, Doupis J, Veves A. Painful diabetic neuropathy: clinical aspects. In: Aminoff MJ, Boller F, Swaab DF, editors. Handbook of Clinical Neurology. Vol. 126. Amsterdam: Elsevier; 2014. p. 53-61. doi:10.1016/B978-0-444-53480-4.00005-9.

Bodman MA, Dreyer MA, Varacallo MA. Diabetic peripheral neuropathy [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan– [updated 2024 Feb 25; cited 2025 Aug 19]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442009/

esfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010 Oct;33(10):2285-93. doi:10.2337/dc10-1303.

Dhir S, Derue H, Ribeiro-da-Silva A. Temporal changes of spinal microglia in murine models of neuropathic pain: a scoping review. Front Immunol. 2024 Dec 6;15:1460072. doi: 10.3389/fimmu.2024.1460072.

Toth C, Breithaupt K, Ge S, Duan Y. Levodopa, methylmalonic acid, and neuropathy in idiopathic Parkinson disease. Ann Neurol. 2010 Jul;68(1):28-36. doi:10.1002/ana.22021.

Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136–54. doi:10.2337/dc16-2042.

Wiffen, P. J., Derry, S., Bell, R. F., Rice, A. S., Tölle, T. R., Phillips, T., & Moore, R. A. (2017). Gabapentin for chronic neuropathic pain in adults. The Cochrane database of systematic reviews, 6(6), CD007938. https://doi.org/10.1002/14651858.CD007938.pub4

Cao, X., Shen, Z., Wang, X., Zhao, J., Liu, W., & Jiang, G. (2023). A Meta-analysis of Randomized Controlled Trials Comparing the Efficacy and Safety of Pregabalin and Gabapentin in the Treatment of Postherpetic Neuralgia. Pain and therapy, 12(1), 1–18. https://doi.org/10.1007/s40122-022-00451-4

Mayoral V, Gálvez R, Ferrándiz M, Miguéns Vázquez X, Cordero-García C, Alcántara Montero A, Pérez C, Pérez-Páramo M. Pregabalin vs. gabapentin in the treatment of neuropathic pain: a comprehensive systematic review and meta-analysis of effectiveness and safety. Front Pain Res. 2025 Jan 7;5:1513597. doi:10.3389/fpain.2024.1513597.

Athanasakis, K., Petrakis, I., Karampli, E., Vitsou, E., Lyras, L., &Kyriopoulos, J. (2013). Pregabalin versus gabapentin in the management of peripheral neuropathic pain associated with post-herpetic neuralgia and diabetic neuropathy: a cost effectiveness analysis for the Greek healthcare setting. BMC neurology, 13, 56. https://doi.org/10.1186/1471-2377-13-56

Pop-Busui R, Ang L, Boulton AJM, et al. Diagnosis and treatment of painful diabetic peripheral neuropathy. Arlington (VA): American Diabetes Association; 2022 Feb. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580224/doi: 10.2337/db2022-01

Merghany, R.M., Saleh, R.A., Hamed, A.A. et al. Natural therapy proposed for the management of diabetic peripheral neuropathy (DPN). Inflammopharmacol (2025). https://doi.org/10.1007/s10787-025-01790-2

Ge, R., Liu, R., He, M., Wu, J., Zhang, F., & Huang, C. (2024). The efficacy of acupuncture for diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trails. Frontiers in neurology, 15, 1500709. https://doi.org/10.3389/fneur.2024.1500709

Nahm F. S. (2020). From the torpedo fish to the spinal cord stimulator. The Korean journal of pain, 33(2), 97–98. https://doi.org/10.3344/kjp.2020.33.2.97

Henson, J. V., Varhabhatla, N. C., Bebic, Z., Kaye, A. D., Yong, R. J., Urman, R. D., &Merkow, J. S. (2021). Spinal Cord Stimulation for Painful Diabetic Peripheral Neuropathy: A Systematic Review. Pain and therapy, 10(2), 895–908. https://doi.org/10.1007/s40122-021-00282-9

Jin, D., Huang, W. J., Meng, X., Yang, F., Zheng, Y. J., Bao, Q., Zhang, M. Z., Yang, Y. N., Ni, Q., Lian, F. M., & Tong, X. L. (2017). Chinese herbal medicine TangBi Formula treatment of patients with type 2 diabetic distal symmetric polyneuropathy disease: study protocol for a randomized controlled trial. Trials, 18(1), 631. https://doi.org/10.1186/s13063-017-2345-1

Piao, Y., & Liang, X. (2012). Chinese medicine in diabetic peripheral neuropathy: experimental research on nerve repair and regeneration. Evidence-based complementary and alternative medicine :eCAM, 2012, 191632. https://doi.org/10.1155/2012/191632

Li, Y. Y., Guan, R. Q., Hong, Z. B., Wang, Y. L., & Pan, L. M. (2024). Advances in the treatment of diabetic peripheral neuropathy by modulating gut microbiota with traditional Chinese medicine. World journal of diabetes, 15(8), 1712–1716. https://doi.org/10.4239/wjd.v15.i8.1712

Wang J, Ma Q, Li Y, Li P, Wang M, Wang T, et al. Research progress on Traditional Chinese Medicine syndromes of diabetes mellitus. Biomed Pharmacother. 2019;120:109565. doi: 10.1016/j.biopha.2019.109565

Sarkar D, Christopher A, Shetty K. Phenolic bioactives from plant-based foods for glycemic control. Front Endocrinol (Lausanne). 2022 Jan 18;12:727503. doi: 10.3389/fendo.2021.727503

Rashedinia, M., Alimohammadi, M., Shalfroushan, N., Khoshnoud, M. J., Mansourian, M., Azarpira, N., &Sabahi, Z. (2020). Neuroprotective Effect of Syringic Acid by Modulation of Oxidative Stress and Mitochondrial Mass in Diabetic Rats. BioMed research international, 2020, 8297984. https://doi.org/10.1155/2020/8297984

Ristagno, G., Fumagalli, F., Porretta-Serapiglia, C., Orrù, A., Cassina, C., Pesaresi, M., Masson, S., Villanova, L., Merendino, A., Villanova, A., Cervo, L., Lauria, G., Latini, R., & Bianchi, R. (2012). Hydroxytyrosol attenuates peripheral neuropathy in streptozotocin-induced diabetes in rats. Journal of agricultural and food chemistry, 60(23), 5859–5865. https://doi.org/10.1021/jf2049323

Gupta A, Kumar R, Pandey AK. Antioxidant and antidiabetic activities of Terminalia bellirica fruit in alloxan induced diabetic rats. S Afr J Bot. 2020;130:308-315. doi: 10.1016/j.sajb.2019.12.010

Richter, E., Geetha, T., Burnett, D., Broderick, T. L., &Babu, J. R. (2023). The Effects of Momordicacharantia on Type 2 Diabetes Mellitus and Alzheimer's Disease. International journal of molecular sciences, 24(5), 4643. https://doi.org/10.3390/ijms24054643

Xing, Y., Pi, M., Zhang, R., & Wen, T. (2021). Study on the TCM Syndromes Evolution and Chinese Herbal Characteristics of Type 2 Diabetes Patients with Different Courses of Disease in TCM "Heat Stage": A Real-World Study. Evidence-based complementary and alternative medicine :e CAM, 2021, 1282957. https://doi.org/10.1155/2021/1282957

Li, Y. Y., Guan, R. Q., Hong, Z. B., Wang, Y. L., & Pan, L. M. (2024). Advances in the treatment of diabetic peripheral neuropathy by modulating gut microbiota with traditional Chinese medicine. World journal of diabetes, 15(8), 1712–1716. https://doi.org/10.4239/wjd.v15.i8.1712

El-Kossi AA, Abdellah MM, Rashad AM, Hamed S. The effectiveness of evening primrose oil and alpha lipoic acid in recovery of nerve function in diabetic rats. J Clin ExpInvestig. 2011;2(3):245-253. doi: 10.5799/ahinjs.01.2011.03.0049

Won, J. C., Kwon, H. S., Moon, S. S., Chun, S. W., Kim, C. H., Park, I. B., Kim, I. J., Lee, J., Cha, B. Y., & Park, T. S. (2020). γ-Linolenic Acid versus α-Lipoic Acid for Treating Painful Diabetic Neuropathy in Adults: A 12-Week, Double-Placebo, Randomized, Noninferiority Trial. Diabetes & metabolism journal, 44(4), 542–554. https://doi.org/10.4093/dmj.2019.0099.

Downloads

Published

2025-10-15

How to Cite

Darshan Anil Sonawane, Sunil K Mahajan, Chandrashekhar Patil, Durgesh Pagar, & Gaurav Kasar. (2025). Exploring the Role of Natural Agents in the Management of Diabetic-Induced Neuropathy. Asian Journal of Pharmaceutical Research and Development, 13(5), 89–96. https://doi.org/10.22270/ajprd.v13i5.1633