The management of non-communicable chronic diseases such as diabetes and hypertension remains a concern in developing countries. In Guinea, whether by choice or necessity, traditional medicine and herbal remedies are the primary recourse for the population, both in rural and urban areas. Previous investigations led to the development of two phytomedicines designed for managing essential hypertension (HTN) and type 2 diabetes (DT2), named “Guinex-HTN？” and “Sattagas.” An evaluation of their therapeutic benefits was conducted during a prevalence survey carried out in Dubréka. This survey revealed a prevalence of 73.52% (211/287) for HTN, 36.58% (105/287) for DT2, and 33.45% (96/287) for combined DT2/HTN. The therapeutic potential of Sattagas and the combination of Sattagas with Guinex-HTN were assessed in diabetic and hypertensive diabetic patients, respectively. Comparisons were made between Sattagas, Metformin, Sattagas plus Metformin, and Sattagas plus Guinex-HTN regarding their impact on blood glucose levels and/or blood pressure values. After 6 months of treatment with 2 x 2 capsules per day, the anti-diabetic potential of Sattagas was confirmed by a significant reduction in blood glucose levels (from 2.59 ± 0.43 to 1.22 ± 0.43) in 80.95% (85/105) of patients, as well as a significant decrease in blood pressure values (from 177 ± 20.77/98 ± 10.70 to 149 ± 29.02/85 ± 13.64) in 90.16% (55/61) of hypertensive diabetics. The anti-diabetic effect of Sattagas (from 2.19 ± 0.29 to 1.22 ± 0.31 g/l) was similar to that of Metformin (from 2.14 ± 0.23 to 1.28 ± 0.41 g/l), and a synergistic effect was observed when Sattagas was combined with Metformin (from 2.21 ± 0.49 to 1.10 ± 0.20 g/l). In hypertensive diabetics, the combination of Sattagas and Guinex-HTN demonstrated a beneficial effect on blood pressure values. Except for some symptoms (epigastric pain, nausea, diarrhea, drowsiness, fatigue) reported in 17 out of 103 patients that did not interfere with the continuation of treatment, both phytomedicines were well tolerated. Sattagas and Guinex-HTN, two products derived from Guinean pharmacopoeia, represent interesting and accessible alternatives for managing type 2 diabetes and hypertension, particularly among underprivileged populations in rural and urban areas of Guinea.
References
[1]
GBD 2015 Risk Factors Collaborators, Forouzanfar, M.H., Afshin, A., Alexander, L.T., Anderson, H.R., Bhutta, Z.A., Biryukov, S., et al. (2016) Global, Regional, and National Comparative Risk Assessment of 79 Behavioural, Environmental and Occupational, and Metabolic Risks or Clusters of Risks, 1990-2015: A Systematic Analysis for the Global Burden of Disease Study 2015. The Lancet, 388, 1659-1724. https://doi.org/10.1016/s0140-6736(16)31679-8
[2]
Mathers, C.D. and Loncar, D. (2006) Projections of Global Mortality and Burden of Disease from 2002 to 2030. PLOS Medicine, 3, e442. https://doi.org/10.1371/journal.pmed.0030442
[3]
Bertrand, C. (2015) Diabète de type 2: Les leçons des grands essais des années de l’intensification à la personnalisation. Janvier-Février, 74, 7-11.
[4]
Blacher, J., Levy, B.I., Mourad, J., Safar, M.E. and Bakris, G. (2016) From Epidemiological Transition to Modern Cardiovascular Epidemiology: Hypertension in the 21st Century. The Lancet, 388, 530-532. https://doi.org/10.1016/s0140-6736(16)00002-7
[5]
Adler, A.J., Prabhakaran, D., Bovet, P., Kazi, D.S., Mancia, G., Mungal-Singh, V., et al. (2015) Reducing Cardiovascular Mortality through Prevention and Management of Raised Blood Pressure: A World Heart Federation Roadmap. Global Heart, 10, 111-122. https://doi.org/10.1016/j.gheart.2015.04.006
[6]
Nguemo Dongock, D., Laohudumaye Bonyo, A., Mapongmestem, P.M. and Bayegone, E. (2018) Etude ethnobotanique et phytochimique des plantes médicinales utilisées dans le traitement des maladies cardiovasculaires à Moundou (Tchad). International Journal of Biological and Chemical Sciences, 12, 203-216. https://doi.org/10.4314/ijbcs.v12i1.16
[7]
Fletcher, B.R., Hartmann-Boyce, J., Hinton, L. and McManus, R.J. (2015) The Effect of Self-Monitoring of Blood Pressure on Medication Adherence and Lifestyle Factors: A Systematic Review and Meta-Analysis. American Journal of Hypertension, 28, 1209-1221. https://doi.org/10.1093/ajh/hpv008
[8]
Kazi, D.S., Prabhakaran, D. and Bolger, A.F. (2015) Rising above the Rhetoric: Mobile Applications and the Delivery of Cost-Effective Cardiovascular Care in Resource-Limited Settings. Future Cardiology, 11, 1-4. https://doi.org/10.2217/fca.14.74
[9]
Institute for Health and Clinical Excellence (2012) Hypertension: Clinical Management of Primary Hypertension in Adults. CG127.
[10]
Li, X., Wang, X. and Snyder, M.P. (2019) Metformin Affects Heme Function as a Possible Mechanism of Action. G3 Genes|Genomes|Genetics, 9, 513-522. https://doi.org/10.1534/g3.118.200803
[11]
IRDPMAG (2018) Report 2010-2012.
[12]
Xu, T., Brandmaier, S., Messias, A.C., Herder, C., Draisma, H.H.M., Demirkan, A., et al. (2015) Effects of Metformin on Metabolite Profiles and LDL Cholesterol in Patients with Type 2 Diabetes. Diabetes Care, 38, 1858-1867. https://doi.org/10.2337/dc15-0658
[13]
Geerling, J., Van der Zon, G., Van den Hoek, A., Princen, H., Havekes, L., Rensen, P., Guigas, B. Geoffroy, L. and Gonthier, M. (2012) Le diabète sous toutes ses forms: Dans Le diabète chez l’enfant et l’adolescent. 2e Édition, Éditions du CHU Ste-Justine.
[14]
Inzucchi, S.E., Bergenstal, R.M., Buse, J.B., Diamant, M., Ferrannini, E., Nauck, M., et al. (2012) Management of Hyperglycaemia in Type 2 Diabetes: A Patient-Centered Approach. Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia, 55, 1577-1596. https://doi.org/10.1007/s00125-012-2534-0
[15]
Jean-Luc, H. (2013) Dominique Maigne. H.A.S. Rapport d’activité I.
[16]
Buysschaert, M., Preumont, V., Oriot, P.R., Paris, I., Ponchon, M., Scarnière, D., et al. (2010) One-year Metabolic Outcomes in Patients with Type 2 Diabetes Treated with Exenatide in Routine Practice. Diabetes & Metabolism, 36, 381-388. https://doi.org/10.1016/j.diabet.2010.03.009
[17]
El Khoury, J.W. and Décosterd, D. (2013) Toxicité de la metformine: Pour ou contre une restriction de ses contre-indications? Revue Médicale Suisse, 9, 1473-1477. https://doi.org/10.53738/revmed.2013.9.394.1473
[18]
Rinaldi, D. (2012) La metformine, une vieille molécule pleine d’espoir. Master’s Thesis, Université de Lorraine.
[19]
Gerstein, H.C., Miller, M.E., Byington, R.P., et al. (2008) Effects of Intensive Glucose Lowering in Type 2 Diabetes. The New England Journal of Medicine, 358, 2545-2559. https://doi.org/10.1056/NEJMoa0802743
[20]
The ACCORD Study Group (2010) Effects of Intensive Glucose Lowering in Type 2 Diabetes. The New England Journal of Medicine, 362, 1575-1585.
[21]
Mathieu, C., Ranetti, A.E., Li, D., Ekholm, E., Cook, W., Hirshberg, B., et al. (2015) Randomized, Double-Blind, Phase 3 Trial of Triple Therapy with Dapagliflozin Add-On to Saxagliptin Plus Metformin in Type 2 Diabetes. Diabetes Care, 38, 2009-2017. https://doi.org/10.2337/dc15-0779
[22]
Rojas, L.B.A. and Gomes, M.B. (2013) Metformin: An Old but Still the Best Treatment for Type 2 Diabetes. Diabetology & Metabolic Syndrome, 5, Article No. 6. https://doi.org/10.1186/1758-5996-5-6
[23]
Berard, L.D., Siemens, R. and Woo, V. (2018) Surveillance de la maîtrise glycémique. Comité d’experts des Lignes directrices de pratique clinique de Diabète Canada. Canadian Journal of Diabetes, 42, S47-S53. https://doi.org/10.1016/j.jcjd.2017.10.007
[24]
Patel, A. (2007) Effects of a Fixed Combination of Perindopril and Indapamide on Macrovascular and Microvascular Outcomes in Patients with Type 2 Diabetes Mellitus (the ADVANCE Trial): A Randomised Controlled Trial. The Lancet, 370, 829-840. https://doi.org/10.1016/s0140-6736(07)61303-8
[25]
Duckworth, W., Abraira, C., Moritz, T., Reda, D., Emanuele, N., Reaven, P.D., et al. (2009) Glucose Control and Vascular Complications in Veterans with Type 2 Diabetes. New England Journal of Medicine, 360, 129-139. https://doi.org/10.1056/nejmoa0808431
[26]
Holman, R.R., Paul, S.K., Bethel, M.A., Neil, H.A. and Matthews, D.R. (2008) Long-Term Follow-Up after Tight Control of Blood Pressure in Type 2 Diabetes. The New England Journal of Medicine, 359, 1565-1576.
[27]
Turner, R.C., et al. (1998) Intensive Blood-Glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications in Patients with Type 2 Diabetes (UKPDS 33). The Lancet, 352, 837-853.
[28]
Ray, K.K., Seshasai, S.R.K., Wijesuriya, S., Sivakumaran, R., Nethercott, S., Preiss, D., et al. (2009) Effect of Intensive Control of Glucose on Cardiovascular Outcomes and Death in Patients with Diabetes Mellitus: A Meta-Analysis of Randomised Controlled Trials. The Lancet, 373, 1765-1772. https://doi.org/10.1016/s0140-6736(09)60697-8
[29]
Currie, C.J., Peters, J.R., Tynan, A., Evans, M., Heine, R.J., Bracco, O.L., et al. (2010) Survival as a Function of Hba1c in People with Type 2 Diabetes: A Retrospective Cohort Study. The Lancet, 375, 481-489. https://doi.org/10.1016/s0140-6736(09)61969-3
[30]
Nonnotte, A.C. (2017) Discordance entre HbA1c et résultat de l’autosurveillance glycémique. Elsevier Masson.
[31]
Fonfrede, M. (2006) Un résultat d’hémoglobine A1c estil toujours interprétable? Spectra biologie, 152, 48-53.
[32]
Valérie, G. (2014) Mise en place de l’électrophorèse capillaire MINICAP® (Sebia) pour le diagnostic des hémoglobinopathies au CHU de Nancy. Master’s Thesis, Université de Lorraine.
[33]
Nathan, D.M., Buse, J.B., Davidson, M.B., Ferrannini, E., Holman, R.R., Sherwin, R., et al. (2008) Medical Management of Hyperglycaemia in Type 2 Diabetes Mellitus: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A Consensus Statement from the American Diabetes 252Association and the European Association for the Study of Diabetes. Diabetologia, 52, 17-30. https://doi.org/10.1007/s00125-008-1157-y
[34]
Blacher, J., Levy, B.I., Mourad, J., Safar, M.E. and Bakris, G. (2016) From Epidemiological Transition to Modern Cardiovascular Epidemiology: Hypertension in the 21st Century. The Lancet, 388, 530-532. https://doi.org/10.1016/s0140-6736(16)00002-7
[35]
Mancia, G., Fagard, R., Narkiewicz, K., Redón, J., Zanchetti, A., Böhm, M., et al. (2013) 2013 ESH/ESC Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Journal of Hypertension, 31, 1281-1357. https://doi.org/10.1097/01.hjh.0000431740.32696.cc
[36]
Issa, C. (2010) Etude des facteurs de risque cardiovasculaire chez les patients diabétiques à Bamako. Master’s Thesis, Université de Bamako.
[37]
Hansson, L., Zanchetti, A., Carruthers, S.G., Dahlöf, B., Elmfeldt, D., Julius, S., et al. (1998) Effects of Intensive Blood-Pressure Lowering and Low-Dose Aspirin in Patients with Hypertension: Principal Results of the Hypertension Optimal Treatment (HOT) Randomised Trial. The Lancet, 351, 1755-1762. https://doi.org/10.1016/s0140-6736(98)04311-6
[38]
Franck, W., Jean, P.L., Dominique, H., Patrick, C., et al. (2010) Le zéro inventé Préférence numérique dans la mesure de la pression artérielle au sein d’un essai randomisé en grappes. ESCAPE-AMPA.
[39]
Bouhanick, B., Ah-Kang, F. and Chamontin, B. (2011) Hypertension artérielle et diabète: Nouvelles données apportées par l’étude ACCORD-Blood Pressure (ACCORD-BP). Médecine des Maladies Métaboliques, 5, 312-316. https://doi.org/10.1016/s1957-2557(11)70246-2
[40]
Cooper-DeHoff, R.M., Gong, Y., Handberg, E.M., Bavry, A.A., Denardo, S.J., Bakris, G.L., et al. (2010) Tight Blood Pressure Control and Cardiovascular Outcomes among Hypertensive Patients with Diabetes and Coronary Artery Disease. JAMA, 304, 61-68. https://doi.org/10.1001/jama.2010.884
