The anti-diabetic activities of natural sweetener plant Stevia: an updated review

Diabetes mellitus is one of the key metabolic diseases cause due to defects in the secretion of insulin, insulin resistance in peripheral tissues, or both. Plants remained an important source of nutrition as well as medicine. Stevia rebaudiana Bertoni is one of the important high qualities non-caloric sugar substitute sweetener plants against diabetes disease. The compounds like steviol, rebaudioside A, stevioside, etc. can lower the sugar level many fold. In addition, it decreases oxidative stress, hence reduces the risk of diabetes. Its leaves have been used for the control and treatment of diabetes and many other metabolic diseases. In animal model experiments it reduces blood sugar level and promotes liver and kidney functions. In this review, we highlighted the most recent literature on the safe use of Stevia for the treatment of diabetes, its use as a functional food, and its mode of therapeutic action in different animal model experiments. However, keeping Stevia as a model plant; detailed investigations are needed for the identification of new metabolites and its use against diabetes and related diseases.

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1 Introduction

Stevia (Stevia rebaudiana Bertoni) is a branched bushy shrub and belongs to the family Asteraceae. It is considered native to the northeastern regions of Paraguay [27, 28]. It is also found in Brazil and Argentina. In addition, its cultivation is directly spread all over the world including Canada and some Asian and European regions [28]. It is known as “calorie free bio-sweetener of high quality” [34]. It shows resistance to high temperatures and used in many food products including beverages, jams, sauces, confections, and other dental products. The 50 g Stevia leaf can replace 1 kg of sugar and the stevioside does not indicate any brown appearance in cooking [32].

Diabetes mellitus is the most common metabolic disease characterized by an increase in glucose levels due to defects in the secretion of insulin, insulin resistance in peripheral tissues, or both [3]. According to World Health Organization (WHO), worldwide it will be the seventh leading cause of death by 2030 [30]. Proper diet, exercise, and medicine can overcome this lethal disease [29]. The pharmacological drugs and combinations have several side effects and are too costly. Therefore, use of traditional medicinal plants is a best option to treat diseases [23, 37, 43]. Stevia is one of the miracle medicinal plants against many diseases. Limited review articles are available on the applications of Stevia in medical field. No single comprehensive review is available that explain its role against diabetes diseases in different animal model of diseases and other human cell lines, and to discuss it functional food values for a healthy life. The present review highlighted the new up to date literature related to the anti-diabetic properties of Stevia plants and also emphasized its role against diabetes in the different animal models. The detailed functional food products of Stevia for the diabetic patients were also discussed.

2 Bioactive compounds of Stevia

More than 1200 medicinal plants mimic anti-diabetic activities have been identified so far. These phyto-therapies are considered safe and cost effective methods as compared to synthetic treatment options [41]. Stevia is full of many important phytochemicals/compounds that have properties to reduce blood cholesterol and sugar levels, as well as blood pressure. In addition, it can to enhance taste and flavor; and also have reported antibacterial properties [32]. The leaves contain eight important diterpene glycosides i.e. rebaudiosides A-E, dulcoside A, stevioside and steviolbioside [1]. Among 230 species of Stevia, the two species namely rebaudiana and phlebophylla produce important steviol glycosides [11]. The stevioside and rebaudioside A are the two important sweetening thermostable compounds used as a source of cooked foods [28]. Stevioside, is found in the leaves of S. rebaudiana Bertoni and is 300 times sweeter than sucrose [21]. The rebaudioside A is considering 250 to 400 times sweeter than sucrose and used for food/sweetener purposes [20]. The leaves are also full of carbohydrates [21].

3 Use of Stevia as functional food against diabetes

The functional food is useful to provide nutrient requirements to the body and helps against other degenerative diseases related to today’s changing lifestyles [25]. The modified coconut jelly was prepared by replacing 50% sugar with Stevia. This jelly decreases the postprandial Blood Glucose Level (BGL) without any release of insulin. Hence are recommended as a safe food product for the diabetic patient [15]. Ruiz-Ruiz et al. [36] designed an efficient functional wheat bread by replacing the sugars with the aqueous extract of S. rebaudiana Bertoni. The 50% sugars replaced with aqueous extract showed maximum anti-oxidant activities and lower level of sugar by inhibition of alpha amylase (IC50 = 198.40 μg/mL) and glucosidase (596.77 μg/mL). While the IC50 value (335.94 mg/mL) was noted with radical scavenging activity. They also found lower microbial growth during the shelf-life of soft Stevia extract. All the quality characteristics were more acceptable at 50% substitution through the sensory test. All the biological properties of retained after bread making process and they recommend it as optimum nutrient and quality of bread for human nutrition. Mayasari et al. [31] also reported that consumption of Rosella-Stevia Tea can decrease fasting BGL with no changes in 2-h postprandial BGL in pre-diabetic women. The application of Stevia as functional food is given in Table 1.

figure 1

Table 2 The Potential bioactive metabolites of Stevia and their mode of actions against diabetic disease

5 Conclusion

Stevia is full of many important phytochemicals (Steviol, Steviosides, rebaudiosides, etc.) that have properties to reduce blood sugar levels. It possesses high anti-hyperglycemic activity and serves as a substituent for saccharose in diabetes patients. It has beneficial activities in pancreatic tissue by increasing the insulin level and enhances anti-diabetic properties. It also helps in maintaining normal blood sugar level by lowering inflammation and oxidative response. It is a major source of high potency sweetener for the growing natural food market. The efficient functional Stevia breeds, tea, jelly, etc. can provide optimum nutrients to the body but also help in controlling of diabetes. Further research is needed to determine if its regular consumption brings sustained benefits for human.

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Author information

Authors and Affiliations

  1. Department of Bioinformatics and Biosciences, Capital University of Science and Technology, Islamabad, Pakistan Sohail Ahmad Jan
  2. Department of Microbiology, Shaheed Benazir Bhutto Women University, Peshawar, Khyber Pakhtunkhwa, Pakistan Neeli Habib
  3. Department of Plant Sciences, Quaid-i-Azam University, Islamabad, Pakistan Zabta Khan Shinwari
  4. Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan Muhammad Ali & Nasir Ali
  1. Sohail Ahmad Jan