This form of diabetes is also known as autoimmune diabetes, and it was previously referred to as juvenile onset or ketosis prone diabetes. Other autoimmune disorders that the person may seek treatment for include Grave's disease, Hashimoto's thyroiditis, and Addison disease. 6 Type 1 diabetes mellitus, commonly known as insulin-dependent diabetes mellitus, is a type of diabetes that affects primarily children and young adults. 4

Adult-onset diabetes is another name for type 2 diabetes mellitus in the background of insulin resistance. 7 The action of insulin is frequently resistant in people with this kind of diabetes. Both types of diabetes have long-term problems in the blood vessels, kidneys, eyes, and nerves, which are the leading causes of morbidity and death. 1 Obesity, sedentary lifestyle, increasing age, and genetic factors are all predisposing factors, and such patients are at an increased risk of developing macrovascular and microvascular complications. 8, 9

Gestational diabetes mellitus (GDM) refers to glucose intolerance that occurs for the first time or is diagnosed during pregnancy. 2 Gestational diabetes mellitus is a term used to describe women who develop type 1 diabetes mellitus during pregnancy or women who have undetected asymptomatic type 2 diabetes mellitus that is identified during pregnancy. 10 GDM can develop during pregnancy and subside after delivery; however, children born to mothers who have GDM are more likely to develop obesity and type 2 diabetes later in life, a condition attributed to the consequences of intrauterine hyperglycaemia. 6

The most prevalent type of monogenic diabetes is caused by a mutation on chromosome 12 in the hepatic transcription factor hepatocyte nuclear factor (HNF)-1α, which is also known as a genetic deficiency of beta cells. 11 These types of diabetes are often marked by the beginning of hyperglycaemia at a young age. A few families have been discovered with genetic anomalies that result in the inability to convert proinsulin to insulin, and such features are inherited in an autosomal dominant way. They account for less than 10% of all DM cases. 12

Macrovascular disease leads to cardiovascular disease, which is exacerbated by accelerated atherosclerosis:

This test is a blood check at any time of the day if one has severe diabetes symptoms. Diabetes is diagnosed at blood sugar of greater than or equal to 200 mg/dl. 11

The A1C test measures average blood sugar for the past two to three months. The advantages of being diagnosed this way are that patients don't have to fast or drink anything. Diabetes is diagnosed at an A1C of greater than or equal to 6.5%. 11

This test checks fasting blood sugar levels. This test is done first thing in the morning, before breakfast. Diabetes is diagnosed at fasting blood sugar of greater than or equal to 126 mg/dl. 11

The OGTT is a two-hour test that checks your blood sugar levels before and two hours after you drink a special sweet drink. It tells the doctor how your body processes sugar. Diabetes is diagnosed at 2- hour blood sugar of greater than or equal to 200 mg/dl. 11

Metformin is a biguanide that inhibits hepatic glucose synthesis, increases insulin sensitivity, promotes glucose uptake by phosphorylating GLUT-enhancer factor, increases fatty acid oxidation, and lowers glucose absorption from the gastrointestinal system. When compared to sulfonylureas, it has a low rate of hypoglycaemia. 39

These are generally well tolerated, although they can cause hypoglycaemia because they enhance endogenous insulin secretion. 37 Individuals with DM who are treated with sulfonylureas are 36% more likely to develop hypoglycaemia than younger patients^. 40 When compared to glipizide, glyburide is linked to a greater rate of hypoglycaemia. 41 Age-related reduced renal function, concurrent use of insulin or insulin sensitizers, age above 60 years, recent hospital discharge, alcohol misuse, calorie restriction, multiple drugs, or medications that amplify sulfonylurea effects are all risk factors for hypoglycaemia. 42 In senior diabetic individuals, long-acting sulfonylureas like glyburide should be avoided. 37

Repaglinide and nateglinide are non-sulfonylurea secretagogues that stimulate insulin release by acting on the ATP-dependent K-channel in pancreatic β cells, similar to sulfonylurea, however the binding location is different. 43 Because meglitinides have a quick onset and a brief duration of action (4-6 hours), they reduce the risk of hypoglycaemia. Meglitinides are used to control blood glucose levels after meals. Pre-prandial administration gives you more freedom if you miss a meal without risking hypoglycaemia. 44 Because repaglinide is mostly processed in the liver and excreted in very small amounts through the kidneys, dose adjustments are not required in patients with renal insufficiency, with the exception of those with end-stage renal disease. 43

Thiazolidinedione is an insulin sensitizer that binds to the peroxisome proliferator activated γ transcription factor. 44 Pioglitazone does not cause hypoglycaemia and can be administered in the presence of renal impairment, making it well tolerated in the elderly. 45 However, its usage in women may be restricted due to concerns of peripheral adenoma, fluid retention, and fracture risk. Pioglitazone should be avoided in elderly patients with congestive heart failure and is contraindicated in patients with class III-IV heart failure. 46

Although Acarbose, Voglibose, and Miglitol have not been widely used to treat type 2 diabetes, these are likely to be safe and effective. These medications work well for postprandial hyperglycemia and should be avoided in patients with severe renal impairment. Due to the high likelihood of adverse effects such as diarrhoea and flatulence, their use is usually restricted. 47 The newest of the medications, Voglibose, has been proven in a study to enhance glucose tolerance in terms of delayed disease development and the number of patients who reach normoglycemia. 48

The core of incretin-based therapeutics is glucagon-like peptide 1 (GLP-1) analogues, which are designed to target this hitherto unknown component of DM pathophysiology, resulting in lasting improvements in glycaemic control and body weight control. 48 In individuals with diabetes, they can be used as a monotherapy, as an adjuvant to diet and exercise, or in combination with oral hypoglycaemic medications. Liraglutide and Exenatide, an incretin mimetic are also used in type 2 diabetes. With the administration of GLP-1, there is no danger of hypoglycaemia. 37 Furthermore, new research reveals that incretin-based medicines may benefit inflammation, cardiovascular and hepatic health, sleep, and the central nervous system. 49

DPP IV inhibitors inhibit dipeptidyl peptidase-4 (DPP-4), a ubiquitous enzyme that rapidly inactivates both GLP-1 and GIP, increasing active levels of both hormones and improving islet function and glycaemic management in type 2 diabetes. 50 DPP-4 inhibitors are a novel family of anti-diabetic medications that are comparable to current treatments in terms of efficacy. They work as a monotherapy in people who can't control their diabetes with diet and exercise, and as an add-on therapy with metformin, thiazolidinediones, and insulin. The DPP-4 inhibitors are well tolerated, carry a low risk of producing hypoglycaemia and are weight neutral. However, they are relatively expensive. 50

Insulin is used alone or in combination with oral hypoglycaemic medications to control blood sugar levels. If some β-cell function remains, augmentation therapy with basal insulin can help. If β-cell fatigue occurs, basal-bolus insulin replacement is required. In cases of glucose poisoning, replacement therapy is required, which should mirror the normal release of insulin by the pancreas β-cells. Insulin is available in four different types of injectables: rapid acting, short acting, intermediate acting, and long acting. When compared to short-acting versions, long-acting forms are less likely to cause hypoglycaemia. 51

Insulin therapy's capacity to replicate normal physiologic insulin production was restricted. Traditional intermediate and long acting insulin have variable absorption and activity peaks, which can lead to hypoglycaemia. The new insulin’s analogues pharmacokinetic characteristics differ from those of normal insulin, and their onset and duration of action range from rapid to long. Two rapid-acting insulin analogues, insulin lispro and insulin as part, are currently available, as well as one long-acting insulin analogue, insulin glargine. 52, 53

Inhibitors of the sodium-glucose co-transporter 2, which improve renal glucose clearance, and inhibitors of 11β-hydroxysteroid dehydrogenase 1, which limit glucocorticoid effects in the liver and fat. Insulin-releasing glucokinase activators, pancreatic G-protein-coupled fatty-acid-receptor agonists, glucagon-receptor antagonists, and metabolic inhibitors of hepatic glucose production are currently being investigated. 54

Acacia has various pharmacological effects like antihypertensive, antimutagenic, antibacterial, antifungal, antidiarrheal and also antidiabetic effect. Acacia is taken for one week to exhibit hypoglycaemic effect in the body which lowers the blood glucose level. Acacia gives hypoglycaemic effect by the mechanism of direct or indirect stimulation of β-cells of islets of Langerhans to secret more insulin which lower the blood glucose level. 58

Scientific name of onion is Allium cepa. It is used in the diabetes. The extract of onion clinically prove to be effective in diabetes mellitus and lower blood sugar level in body. The research result about active principle of onion showed that allyl propyl disulphide and S-methyl cysteine sulfoxide have an antidiabetic, anti-carcinogenic, and cardiovascular effects, and normalized the activities of liver hexokinase, glucose 6-phosphatase and HMG Co A reductase. 59, 60

Scientific name of garlic is Allium sativum. Its extract has antidiabetic activity. Ethanolic extract of garlic and juice or oil of garlic remarkably lowers blood glucose level with efficiency compared to tolbutamide. 61 It also treats the diabetic cardiovascular complications. The chief constituents of the garlic are allicin and s-allyl cysteine sulfoxide (SACS). These constituents having an anti-hyperglycaemic mechanism which stimulate the insulin secretion from cells of pancreatic islets, which increases serum insulin level and improves glucose tolerance and increase glycogen synthesis. S-allyl cysteine, the precursor of allicin and garlic oil, is a sulphur containing amino acid which controls lipid peroxidation better than insulin. SACS also stimulate in-vitro insulin secretion from β-cell. 62

The scientific name of methi is Trigonella foenum graecum which belongs to Leguminosae family. Fenugreek seeds is the traditional drug having an antidiabetic activity and hypocholesterolemic activity in both animal and human. 63 Activity has been attributed largely to fenugreek’s saponins, fiber content, the amino acid 4- hydroxyisoleucine and the major alkaloid trigonelline. Anti-hyperglycaemic effect is linked to delayed gastric emptying caused by the high fiber content, inhibiting of carbohydrate digestive enzymes and stimulation of insulin secretion. 64

The scientific name of the aloe vera is Aloe barbadensis, which belongs to Liliaceae family. The aloe vera has alloin as chief-constituent. The aloe vera containing the gel and yellow exudate from pericyclic tubules. 65 Previous research concluded that aloe vera has hypoglycaemic effect in diabetic patient. Alloin stimulates insulin secretion from the pancreatic β-cell. It also has anti-inflammatory effect. 66, 67

The biological source of the neem is Azadirachta indica which belongs to Maliaceae family. The chief constituent of neem is azadirachtin. It has anti-hyperglycaemic activity to treat diabetes by increasing glucose uptake and glycogen deposition in body. 68, 69 It has other activities like anti-bacterial, antioxidant, hepatoprotective effects. 70

The biological source of bitter guard is Momordica charantia which belongs to Cucurbitaceae family. Its chief constituent is momordicin. It has antidiabetic effect as demonstrated in several studies reported earlier. It decreases the blood glucose level by inhibition of glucose-6-phosphate to fructose-1,6-biphosphate in liver and stimulation of hepatic glucose-6-phosphate dehydrogenase activities. 71

Camellia sinensis, commonly known as green tea, is a medicinal plant traditionally used to treat various health conditions, including diabetes, arthritis, bacterial infections and hyperlipidaemia. Kalagara et al. studied on combined therapy of Camellia sinensis extract and Glibenclamide. Diabetic rats were treated with Glibenclamide (4mg/kg), Camellia sinensis (300mg/kg) and its combination. This study provided experimental evidence of preventive and curative effect of Camellia sinensis as antioxidant and antinociceptive in animal model of diabetic neuropathy. 72

Both antidiabetic and ulcer-protective properties have been attributed to Syzygium cumini seeds. Annosha et al. assessed the anti-diabetic effects of an ethanolic extract of dried Syzygium cumini seed kernels and its comparative impact on gastric ulceration in comparison to standards such as the glucosidase inhibitor Acarbose and the naturally occurring standards Quercetin 50 mg/kg and 100 mg/kg. The combined effects of oral hypoglycemic medications and Syzygium cumini seed kernel extracts on diabetes-induced ulcers were also examined in the study. It has been demonstrated that Syzygium cumini and acarbose together constitute a possible treatment alternative for lowering the risk of stomach ulcerogenic stimuli caused by diabetes in type 2 diabetic individuals. 73

One of the oldest Indian medicinal plants, Terminalia bellirica (Gaertn.) Roxb., is a component of the Ayurvedic medicine triphala, which is used to treat diabetes as well as liver and digestive diseases. The antioxidant activity of T. bellirica may be effective in reducing the oxidative stress-induced nerve degeneration in diabetic neuropathy, whilst the antidepressant property may be useful for treating diabetic neuropathy-induced symptoms. 74

Coccinia indica belongs to Cucurbitaceae family, an ivy gourd that is native to India, is known as the "Indian insulin alternative" because of how well it manages hyperglycemia. There have been claims that Coccinia indica possesses anti-diabetic qualities. Coccinia indica leaf extract showed good glycemic control and a positive renoprotective impact when co-administered with a low dose of pioglitazone as anti-diabetic therapy, according to Basavarajappa et al. As seen from normalized nephropathic indicators in a diabetic rat model, combination therapy would reduce the dose of pioglitazone and also protect kidneys against drug-induced damage. 75

The combined effects of Coccinia indica leaf extract and acarbose in type II diabetes-induced neuropathy in rats were assessed by Sanket Kohli et al. in 2014. Two weeks of HFD treatment were followed by a modest dose of 35mg/kg of STZ dissolved in 0.1M/l of citrate buffer administered intravenously. Blood glucose levels in diabetic rats treated with ethanolic extract of Coccinia indica leaf alone and in conjunction with mild doses of acarbose were significantly decreased. Diabetic rats left untreated exhibited a notable susceptibility to thermal stimulation. Histopathological analyses showed that the groups treated with the ethanolic extract of Coccinia indica and its combination with low doses of acarbose had no injury to their sciatic nerves^. 76

Ayurveda uses Emblica officinais (E. officinalis; Family: Euphorbiaceae) as a strong rasayana, a class of plant-derived medications thought to increase defense against illnesses like diabetes and improve health and longevity. Prem Kumar and others demonstrated in animal models of diabetic neuropathy the preventative and therapeutic effects of E. officinalis on nerve function and oxidative stress. E. officinalis fruit may be tested as a preventive medication for diabetics at risk of developing neuropathy because it is already used in clinical settings for diabetic patients. 77

One of the medicinal plants that is crucial in the treatment of diabetes mellitus is Trigonella foenum graecum. The medicinal plant serves as a good source of dietary supplements to existing therapies as well as a great source of oral antihyperglycemic bioactive substances for the discovery of novel pharmacological insights. Premkumar et al. Studied Fenugreek seed powder and reported to have both preventative and therapeutic effect on oxidative stress and nerve function in an animal model of diabetic neuropathy. In conclusion, fenugreek seed powder may be explored for preventive measures in diabetes patients at risk of developing neuropathy. 78

The inhaled version of quickly acting insulin was approved by the Food and Drug Administration for the treatment of type 1 and type 2 diabetes. It is fast-acting insulin that has the benefit of being delivered straight into the lungs, has been found in studies to be beneficial. 79