Background Moroccan flora is rich with medicinal plants that are widely used in traditional medicine for the treatment of various diseases including diabetes. These plants possess several classes of bioactive molecules, which belong to different chemical families such as phenolic acids, flavonoids, terpenoids and alkaloids. Scope and approach This review highlights the published reports on the antidiabetic properties of Moroccan medicinal plants. The mechanism of action of these plants and their secondary metabolites were discussed in detail. Clinical trials on the antidiabetic active constituents were summarized demonstrating the potential application of these natural treasures to be developed as potent antidiabetic agents. Key findings and conclusions were reported to be used in the treatment of diabetes in Morocco. Among these medicinal plants, the antidiabetic activity was evaluated for 15 species in vitro and 30 species in vivo. The in vitro studies showed significant inhibition of enzymes involved in the intestinal metabolism of carbohydrates. The in vivo reports revealed that the extracts and essential oils of these plants exhibited several antidiabetic effects such as a decrease of blood glucose and an increase of insulin secretion. Phytochemical analysis of the active plants revealed the presence of 148 secondary metabolites. These compounds belong to different chemical classes such as terpenoids, flavonoids, alkaloids, phenolic acids, and fatty acids. Among the identified compounds, 95 were evaluated for their antidiabetic activity. The results showed that these compounds manage diabetes by several mechanisms such as enzymatic inhibition, interference with glucose and lipid metabolism signaling pathways, and the inhibition and/or the activation of gene expression involved in glucose homeostasis. Eighteen active compounds reached clinical trials and showed impressive results in controlling diabetes and its manifestations.

Moroccan antidiabetic medicinal plants: Ethnobotanical studies, phytochemical bioactive compounds, preclinical investigations, toxicological validations and clinical evidences; challenges, guidance and perspectives for future management of diabetes worldwide

Diabetic retinopathy in the Eastern Morocco: Different stage frequencies and associated risk factors.

Microvascular and macrovascular complications in type 2 diabetes in a multi-ethnic population based in Amsterdam. The HELIUS study.

Introduction microvascular and macrovascular complications of type 2 diabetes mellitus (T2DM) are one of the major causes of morbidity and mortality worldwide among patients with T2DM. This study aims to estimate the prevalence of these chronic complications and identify the associated risk factors among Moroccan patients with T2DM. Methods this cross-sectional study was conducted on 505 T2DM patients followed by the healthcare Centers of the Casablanca-Settat region from January 2017 to July 2018. The socio-demographic, anthropometric, biochemical, and clinical data were recorded using a structured survey. For statistical analysis, SPSS version 20 is used. Univariate and multivariate logistic regression analyses are used to determine the risk factors associated with chronic complications of T2DM. Results among the 505 Moroccan patients with T2DM, 84.98% were women. The average age of the patients was 57.27±10.74 years. Diabetic eye disease was the most frequent complication (29.5%) followed by cardiovascular diseases (CVDs) (22.4%), kidney disease in diabetes (9.8%), diabetes foot (2.8%), and neuropathy (1.8%). Logistic regression analysis showed that the CVDs was associated with hypertension (OR: 2.41; 95% CI: 1.11-5.22; p=0.026), hypolipidemia treatment (OR: 2.20; 95% CI: 1.06-4.59; p=0.034), insulin use (OR= 0.39; 95%CI: 0.15-0.96, p=0.043) and LDL-C (OR: 1.01; 95% CI: 1-1.02; p=0.035) in T2DM patients. However, the major risk factors for the development of kidney disease in T2DM patients were a lack of regular physical activity (OR: 3.77; 95% CI: 1.22–11.67; p=0.021), hypolipidemia treatment (OR: 8.31; 95% CI: 1.86–36.97; p=0.005), and high serum creatinine (OR: 1.33; 95% CI: 1.16-1.53; p≤0.001). In addition, LDL-C levels were found to be a significant risk factor for diabetes eye disease (OR: 1.01; 95% CI: 1.00-1.03; p=0.008). Conclusion this study shows that the increased duration of diabetes, insulin use, lack of regular physical exercise, hypertension, hypolipidemia treatment, high serum creatinine, and LDL-C were significant risk factors for chronic complications of T2DM in Moroccan patients.

Prevalence and risk factors of chronic complications among patients with type 2 diabetes mellitus in Morocco: a cross-sectional study

Objective: This study aims to investigate the risk factors of diabetes and its complications in the eastern region. Design: This is a retrospective study conducted on diabetic patients followed at the regional center of diabetology and chronic diseases in Oujda for the period 2012-2019. Materials and Methods:Clinical, biological, therapeutic and anthropometric data were collected from patient records. Result: A total of 3.976 patients participated in the study. The frequency of complications is around 1/3. One diabetic out of four has at least one modifiable cardiovascular risk factor: arterial hypertension at 25.35%, dyslipidemia at 12.67%, overweight and obesity at 35.48% and 27.8%. The most discriminating factors in the pathogenesis of diabetic complications in order of importance are age of diabetes, hypertension, HbA1c and dyslipidemia, statistically significant associations were found with p 0.0082, 0.0001, 0.002, 0.0001 respectively). Then a multifactorial analysis coupled with a hierarchical ascending classification in birth data to two large groups of diabetics with complications and those without complications. Discussion: The age of trend T2DM has fallen to less than 40 years, so that the first characteristics of an epidemiological and nutritional transition are being established in our region. In addition, blood pressure and glycemic imbalance in diabetics reflect a problem of medical and therapeutic management that needs to be resolved. Conclusion: The pathogenesis of diabetic complications is multifactorial. However, medical care must be taken to reduce the risk of degenerative complications.

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Prevalence and Risk Factors for Diabetic Complications: 8-Year Retrospective Report from a Single Regional Diabetes Center to the Eastern Region of Morocco

Objectives: Diabetes is one of the most challenging health problems in the 21st century that brings a considerable economic burden on worldwide healthcare resources. Indeed, people with diabetes have a higher lifetime healthcare expenditure due to the long-term complications, which include micro and macrovascular complications. This study sought to estimate the frequency of diabetes complications, and to investigate the associated risk factors. Methodology: Data were obtained from the medical records of 2401 diabetic patients followed at the Reference Center of Diabetes and Chronic Diseases (RCD) in Oujda (Morocco) during the period 2006-2011. Results: Our sample of 2401 diabetic patients include 64.7% women. 32% of patients have one or more complications; retinopathy is the most frequent complication (16.8%), followed by nephropathy (12.4%), cardiovascular diseases (5.4%), neuropathy (3.6%) and diabetes foot (2%). Logistic regression in univariate followed by multivariate analysis has showed that age, duration of diabetes and high albuminuria are the major risk factors for the development of diabetic complications in both type 1 and type 2 diabetes. Conclusions: Nearly one third of diabetic patients were affected by at least one diabetic complication; retinopathy is the most common complication in these patients. Strengthening programs to improve diabetes management and to reduce the risk of these complications should be a high priority in order to control the cost of treatment.

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Nourel Houda Bouanani

Papers

Risk Factors and Diabetes Related Complications Frequency in the Population of the Northeastern Morocco