Customized Integrated Management for Non-Insulin Dependent Diabetes Mellitus (NIDDM) and its Complications: Literature Review and Recommendations for the Future Policy Decisions

Abstract

Background: Siddha system of medicine is an ancient medical system practised in Dravidian culture. It mainly focused on dietary and lifestyle recommendations along with medications. Non-Insulin Dependent Diabetes Mellitus (NIDDM) is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and impaired insulin secretion. Integrated Siddha medicine and modern medicine play a significant contribution in averting and treating NIDDM and its complications. Currently, there is a lack of evidence-supported recommendations for the integrated treatment of NIDDM with Siddha and modern medicine. Hence, developing evidence-based recommendations for NIDDM by integrating both medicines is important. Methods: This recommendation on therapeutic management for NIDDM is based on the Guidelines issued by the Indian Council of Medical Research (ICMR) for the management of type 2 diabetes mellitus in 2018, Siddha Standard Treatment Guidelines on Non-Communicable Disease (NCD), and other published works of literature in Google Scholar, PubMed, EMBASE. The recommendation includes both pharmacological and non-pharmacological management. Results and Discussion: This review contains standard recommendations in modern medicine and Siddha's evidence-based recommendations for 9 clinical situations, including recommendations for pre-diabetes, severe diabetes, diabetic prevention, diabetic complications, diabetic foot, and diabetes associated with hypertension. This review also includes Siddha's pharmacological management of single herbs, polyherbal formulations, Herbo mineral formulations, external medicines, and non-pharmacological management like Yoga interventions, varmam interventions (physical manipulation), etc. Conclusion: This review provides a guide to clinicians to manage the patients with NIDDM at various levels of severity and complications. Additionally, long-term, high-quality studies are needed to evaluate the effectiveness of integrative medicine in preventing and treating NIDDM and its complications.