Disease-Consensus Index as a tool of selecting potential hypoglycemic plants in Chikindzonot, Yucatán, México
Introduction
Type 2 diabetes is one of the most important health problems in Mexico (SSA, 2005) and is commonly treated using a large variety of medicinal and health food plants (Andrade-Cetto, 1995, Andrade-Cetto and Heinrich, 2005). In Mexico at least 306 species from 235 genera and 93 families are used to treat diabetes. On a world-wide level, it is the most common endocrine disorder. The World Health Organization (WHO, 2004) estimates that in Mexico the number of diabetic people will increase from 2.2 million in 2000 to more than 6 million in 2030, about 281%, world wide this figures will increase on an average of 214%.
Diabetes also is the first cause of mortality among the Mexican population (SSA, 2005). Because of the complications linked to diabetes like heart disease, retinopathy, kidney disease, and neuropathy, it is also a common cause of chronic morbidity and disability among the working population. The term diabetes mellitus describes a metabolic disorder of multiple etiologies and is characterized by chronic hyperglycemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both. The causes of Type 2 diabetes are either predominantly insulin resistance with relative insulin deficiency or predominantly an insulin secretion defect with or without insulin resistance (WHO, 1999).
The biguanide metformin is an example of a drug modelled on the basis of the natural product guanidine obtained from the French lilac; Galega officinalis L. traditionally used as an anti-diabetic (Witters, 2001). In ethnobotanical driven drug development project searching for novel therapeutic entities clear selection criteria are needed (Cordell and Colvard, 2005, Patwardhan, 2005).
One way is always the quantification of the species use as exemplified in the works of Trotter and Logan (1986) (cf. Phillips, 1996). With regard to Mexico, Heinrich et al. (1998) stated: “when we examined the use of medicinal plants there are two alternatives: consensus and variation”. They analyzed semi-quantitative ethnobotanical data from several studies with the Nahua, Zapotec and Maya and developed the Factor Informant Consensus (FIC2). The factor was used to highlight plants of particular intra- and intercultural relevance and the agreement in the use of plants for the treatment of gastrointestinal problems between the selected cultures was particularly strong.
Since the FIC analyzes the general use of plants and classifies the illnesses in broad disease categories (several diseases based on the organ systems in one category), the main limitation of this approach has been the lack of analysis on the level of one single disease/syndrome. In order to select species which are relevant for the treatment of one specific disease like diabetes, we developed the Disease-Consensus Index (DCI2), and tested its usefulness using diabetes as an example in the community of Chikindzonot, Yucatán, where ethnobotanical studies had been conducted previously (Heinrich et al., 1998, Ankli et al., 1999, Ankli, 2000). Specifically, the aim of the present work is to select the culturally most important species used by diabetic people in a single area to treat the disease and to assess how useful this approach is to prioritise species for further ethnopharmacological studies.
Section snippets
Chikindzonot, Yucatán
The municipality of Chikindzonot is located in the centre of the state of Yucatán, at 20°03′–20°27′ North and 88°43′–88°20′ West at 33 m above sea level. The climate corresponds to tropical monsoon with summer rains and a mean annual temperature of 25.9 °C. The type of vegetation is medium–high subtropical rainforest (Rzedowski, 1978). Species such as Swietenia macrophylla King (caoba), Cupressus arizonica Greene (cedro), Ceiba pentandra (L.) Gaertn. (ceiba), Ceiba parvifolia Rose (pochote), and
Case detection
With prior ethical approval by our university (UNAM), local authorities were contacted and the relevant permits were obtained. Diabetic patients were traced from the Health Centre (part of the services of the Mexican Department of Health; “SSA”): their names, ages, last glucose measure, treatment and address (initial list or list 1) were recorded. In addition, since not all diabetics attend to the health services, we asked the people from list 1 if they had relatives or knew other sufferers
Development of the index
Here we propose a new index for evaluating the consensus within a group of people with one illness (in this case diabetes) as it relates to use of various species. Crucial for the index is the inclusion of various types of data about a single species as well as the collective knowledge for the same species in the group of informants and subsequently the comparison of the individual (folk) species.
When conducting an ethnobotanical survey searching for new plants with potential pharmacological
Conclusions
We noted an alarming increase in the number of diabetic people in the period 2003–2005. In part this may well be due to a more systematic detection of diabetics by physicians (esp. in the Health Centre). Furthermore is the possibility that several people with Insulin resistance or initial phases of type 2 diabetes were not previously detected. During our field work directed exclusively to detect diabetic people and the species used in its treatment in Chikindzonot, we identified a larger number
Acknowledgments
We are grateful to our informants in Chikinzdonot, especially Don Susano Tamay, healer. This work was partially supported by DGAPA, PAPIIT project IN204703.
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