Abelmoschus manihot alleviates insulin resistance in biopsy-proven diabetic kidney disease through attenuation of inflammation

Abstract Background: Research is lacking on the effects of Abelmoschus Manihot on insulin resistance (IR) and chronic microinflammation in patients with diabetic kidney disease (DKD). This study aims to explore the effects of Abelmoschus Manihot on IR and high-sensitivity C-reactive protein (hs-CRP) levels in DKD, as well as to analyze the relationship between the two factors. Methods: Biopsy-proven DKD patients with a homeostatic model assessment of IR (HOMA-IR) ≥ 5 and hsCRP ≥ 1 mg/L were recruited from the Department of Nephrology at China-Japan Friendship Hospital between January 2012 and December 2023. All patients received standard care medications, and those in the Manihot group were treated with Abelmoschus Manihot for 12 months. Participants were followed up every 3 months for a total of 1 year. Changes in HOMA-IR, hsCRP, 24-hour urine protein excretion (24-h-UPE), and estimated glomerular filtration rate (eGFR) from baseline during follow-up were assessed. Additionally, differences in 24-h-UPE, eGFR, and major cardiovascular and cerebrovascular events between the groups after treatment were evaluated. Adverse events and laboratory test abnormalities were also recorded. Results: A total of 94 biopsy-proven DKD patients were included. Among them, 45 patients received standard care (control group), while 49 additionally took standard care plus Abelmoschus Manihot. The results revealed a statistically significant reduction in 24-h-UPE in the manihot group compared to the control group at 6 months (−232.9 vs −145.8 mg, P = 0.04) and beyond. Since the 9-month follow-ups, the manihot group exhibited a significantly slower eGFR decline (-3.2 vs -4.7 mL/min/1.73m², P < 0.05). Additionally, IR in the manihot group was significantly reduced in both within- and between-groups (compared to the control), and hsCRP also exhibited analogous findings. In the manihot group, a significant positive correlation was observed between the decrease in hsCRP and the decrease in HOMA-IR, with P-value < 0.01. In contrast, no such significant correlation was observed in the control group, where the P-value was 0.1. No significant adverse events or laboratory test abnormalities were observed. Conclusion: This study demonstrates that in biopsy-confirmed DKD patients, A. manihot not only enhances the clinical outcomes of standard care,but also significantly alleviaties IR, potentially through its anti-inflammatory effects.