title: Traditional management of diabetes in Pakistan: Ethnobotanical investigation from Traditional Health Practitioners.
abstract: BACKGROUND
  The uses of anti-diabetic plants are well anchored in the traditional health care system of Pakistan. To the best of our knowledge, this is the first ethno-botanical study about the uses of plants for the treatment of diabetes. The aim of the study is to record indigenous knowledge on anti-diabetic plants from Traditional Health Practitioners (THPs) and diabetic patients. In addition, it is aimed to ascertain and validate the traditional uses of anti-diabetic plants by citing pharmacological activities and phytochemical constitutes from previously published literature.
  
  
  METHODS
  The ethno-medicinal data was documented during 14 field surveys, each comprising of 10 days, from 3 regions of Pakistan (Islamabad, Khyber Pukhtoonkhwa and Deserts of Sindh). In total, 113 THPs and 44 diabetic patients were interviewed using open-ended and semi-structured questionnaires. Quantitative indices, including Relative Frequency of Citation percentage (RFC %) and Disease Consensus Index (DCI) were calculated. The documented data is authenticated by comparing with 28 published articles on ethno-botanical aspects and many pharmacological studies.
  
  
  RESULTS
  In total, 120 plant species belonging to 50 families were reported. The ethno-botanical results indicated that Moraceae (11 species); herb (56 reports) is dominant life form; the leaves (56 reports) are the most used plant part and decoction (24%) is the preferred mode of preparation. The quantitative analysis shows that RFC% ranges from 14 to 42 and DCI varies from 0.15 to 0.74. By comparing to previous studies, 64 species are reported new in traditional treatment of DM; 40 species are new to pharmacological evidence and 3 species are new to phytochemical studies.
  
  
  CONCLUSIONS
  This study recoded the significant indigenous knowledge about anti-diabetic plants among the THPs and diabetic patients in Pakistan. This type of ethno-botanical knowledge on traditional use of anti-diabetic plants is an important step in designing detailed pharmacological and clinical trials for Diabetes Miletus treatment. It is recommended that further pharmacological and phytochemical analysis should be conducted on those species which lack previous references in literature and have highest Frequency of Citation (FC), Disease Consensus Index (DCI) and Relative Frequency of Citation percentage (RFC%).
authors.affiliation: Department of Plant Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan. Electronic address: ghulamyaseenawan@gmail.com.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Yaseen
authors.affiliation: Department of Plant Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan. Electronic address: mushtaqflora@hotmail.com.
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Ahmad
authors.affiliation: Department of Plant Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Zafar
authors.affiliation: Department of Plant Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan.
authors.forename: Shazia
authors.initials: S
authors.lastname: Sultana
authors.affiliation: Department of Plant Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan.
authors.forename: Sadaf
authors.initials: S
authors.lastname: Kayani
authors.affiliation: Cellular Biology Department School of Science, National Autonomous University of Mexico (UNAM), Mexico.
authors.forename: Adolfo Andrade
authors.initials: AA
authors.lastname: Cetto
authors.affiliation: Department of Botany, Lahore College for Women University, Lahore, Pakistan.
authors.forename: Shabnum
authors.initials: S
authors.lastname: Shaheen
mesh_terms: D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D019468:Disease Management; D019448:Ethnobotany / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008519:Medicine, Traditional / Q000379:methods*; D010154:Pakistan / Q000208:ethnology; D028321:Plant Preparations / Q000302:isolation & purification / Q000627:therapeutic use*; D018514:Plant Structures; D010946:Plants, Medicinal
chemical_list: D028321:Plant Preparations
keywords: (PubChem CID: 54670067); Ascorbic acid; Berbamine (PubChem CID: 275182); Cardenolide (PubChem CID: 388098); Codeine (PubChem CID: 5284371); Diabetes; Diosgenin (PubChem CID: 99474); Disease Consensus Index; Ethnobotany; Kaempferol (PubChem CID: 5280863); Linoleic acid (PubChem CID: 5280450); Medicinal plants; Nicotinic acid (PubChem CID: 938); Relative Frequency of Citation; Traditional Health Practitioners; Triterpene (PubChem CID: 122724); β-sitosterol (PubChem CID: 222284)