In Malaysia, diabetes is a silent epidemic but beyond its alarming statistics lies a fascinating journey of bridging ancient wisdom with modern science in its treatment. 
Oftentimes we hear news about the diabetes crisis in Malaysia. It is indeed a crisis because the prevalence of diabetes in Malaysia, at 20%, is alarmingly high in other words, 1 in every 5 adults in Malaysia has diabetes.
An Alarming Health Challenge
Based on the latest edition of the International Diabetes Federation’s 2021 data, the top 5 countries with the highest diabetes prevalence rates in adults are Pakistan (30.8%), French Polynesia (25.2%), Kuwait (24.9%), New Caledonia (23.4%) and Northern Mariana Islands (23.4%).
Due to its large population, China, despite having a moderate prevalence of 13.0%, has the highest number of people with diabetes, followed by India, Pakistan, the USA, and Indonesia.
Diabetes mellitus, more simply called diabetes, is a long-term or chronic condition that occurs when raised levels of blood glucose occur in the body.
Many understand that when the pancreas produces little or no insulin, a person can develop diabetes. However, this so-called type 1 diabetes mellitus only accounts for 10% of all diabetes cases.
Ninety per cent of diabetes cases are type 2 diabetes mellitus (T2DM), where the body either produces insulin normally or at lower levels, but the other organs fail to respond to the insulin sufficiently. This condition is known as insulin resistance.
Modern Treatments and Their Side Effects
Hence, administrating insulin hardly solves the issue of raising blood sugar levels because the organs do not take in sugars from the blood. Blood sugars come from diet, but our body also produces blood sugar via gluconeogenesis in the liver.
Metformin is commonly prescribed to reduce blood sugar. It diverts the metabolic pathway into producing more lactic acid instead of sugar. However, a potential side effect is an excess of lactic acid, which can cause acidosis.
Another medication, known as SGLT2 inhibitors, can reduce blood glucose levels by compromising the kidney’s natural ability to retain sugar. Instead, the sugar is flushed out through urine, which can lead to unnecessary urinary tract infections as one of the many side effects. While there are a few other medications available, it is widely agreed that there is no cure for T2DM, only treatment to manage its progression.
These two examples highlight the conundrum of modern medicine, which often attempts to remedy a specific disease condition but along the way creates many serious side effects.
However old wisdom and traditional knowledge could serve as valuable resources for developing new ideas to treat diseases. Some of this traditional knowledge has been recorded for a long time. For instance, in traditional Chinese medicine (TCM), the Yellow Emperor’s Inner Canon or Huang Di Nei Jing was compiled over 2,200 years ago.
TCM: An Ancient Approach to Diabetes
Diabetes would not be specifically stated per se in Huang Di Nei Jing, as you would have expected, because ancient people would not know about blood sugars.
However, they spent time recording the observations associated with diabetes, such as polydipsia, polyphagia, polyuria, and weight loss, which correctly matched the symptoms in the middle to late stage of T2DM. In TCM, this is called “Wasting and Thirst Disorder,” and the reasons were described as excessive consumption of fatty food, causing obesity, and the root cause was pinpointed to the spleen.
As we all know, the spleen neither produces insulin nor controls blood sugar, but it plays a significant role in blood circulation and the lymphatic system, which circulates the fluid in our body. An unhealthy diet or lifestyle can lead to obesity and other conditions that cause issues in fluid circulation. It is called yin deficiency, and this can lead to heatiness in the spleen which eventually affects the pancreas. Poor circulation also causes blood stasis and dampness, demonstrated by a host of symptoms from night sweats to microvascular disease associated with T2DM.
The recent trend in treating diabetes involves addressing the stage before the onset of diabetes, known as pre-diabetes. In pre-diabetes, blood sugar levels are higher than usual but not as high as in T2DM.
The goal is to treat early, like TCM, which focuses on early intervention and addresses underlying risk factors like obesity.
Integrating Old Wisdom with Modern Science
Medicine used in TCM is often prescribed as decoction or formulation which contains many herbs. Da Chaihu is one such decoction prescribed for Wasting and Thirst Disorder, and it contains eight herbs, each with specific purposes.
Chinese thorawax root (Bupleurum chinense), immature bitter orange (Citrus aurantium) with rhubarb (Rheum spp.), and Chinese skullcap (Scutellaria baicalensis) are used to alleviate the heatiness generated in the liver meridian, yangming meridian (including stomach and liver), and gallbladder meridian, respectively.
The twelve meridians in TCM, more famously known in acupuncture, dictate the flow of vital energy or qi in our body. Ternate pinellia (Pinellia ternate) enhances qi movement, thereby improving the overall effects of other herbs in combating heatiness.
The last three herbs focus on improving the patient’s well-being. Chinese peony (Paeonia lactiflora) mediates pain, ginger (Zingiber officinale) regulates the rising of stomach qi which can cause vomiting, and red date (Ziziphus jujube) with its saponin content helps to ‘calm the mind.’ In contemporary TCM, specific herbs can also be added or removed from traditional decoctions to enhance therapeutic efficacy based on recent scientific findings.
For instance, Chinese goldthread rhizome (Coptis chinensis) is added into Da Chaihu decoction to regulate blood sugar and lipids and is traditionally valued for its heat-alleviating properties. It contains berberine – an active compound now scientifically recognised as an anti-hyperglycemic agent. Berberine impacts glucose metabolism by stimulating glycolysis, increased insulin secretion and suppression of hepatic gluconeogenesis and adipogenesis.
Berberine, an alkaloid, occurs naturally as a secondary metabolite in plants like Berberis spp. – the source of its name. Berberis, belonging to the Ranunculaceae family, encompasses over 2,000 species of flowering plants found globally. These plants are commonly known as buttercups or crowfoots.
Through big data meta-analysis of treatment records from various hospitals, scientists have unravelled the effectiveness of various complex TCM formulations, which are often composed of multiple herbs.
In recent years, researchers have also focused on signalling pathways associated with diabetes. One such pathway involves the Protein Tyrosine Phosphatase 1B (PTP1B), a critical enzyme that regulates blood sugar levels. PTP1B plays a vital role in the insulin signalling pathway, and its excessive activity directly correlates with insulin resistance.
Additionally, natural products, found within these herbs, serve as essential chemical ingredients. Their unique structures and biological activities make them valuable resources for drug discovery.
Using Computer Aided Drug Design (CADD) technology and the continuous enrichment and optimization of natural product libraries, researchers can quickly discover and evaluate many natural products with potential biological activities through high-throughput virtual screening.
By applying these technologies, researchers can now screen natural products for high affinity and selectivity. This process serves as the foundation for subsequent in vitro experiments using cell cultures and in vivo validation in animal models.
It paves the way for clinical research and the approval of novel medicines.
The opinions expressed in this article are the author’s own and do not reflect the view of Swinburne University of Technology Sarawak Campus.
Guo Bao and Liu Zhen are international students pursuing PhD studies in Biology and Biochemistry with Swinburne University of Technology Sarawak Campus. Crystal Ling is a research assistant for the projects.
Daniel Tan Lee Tung is a lecturer from the Science Department, Faculty of Engineering, Computing and Science at Swinburne University of Technology Sarawak Campus. He can be reached by email at ltdtan@swinburne.edu.my.