diabetes mellitus ( dm ) is a metabolic disease in which individuals have elevated blood glucose levels . the world health organization ( who ) has reported that 347 million people worldwide suffer from diabetes , with about 3.4 million people dying in 2004 due to consequences of high fasting blood glucose . in 2030 , diabetes can lead to a variety of complications , including cardiovascular diseases such as ischemic heart disease , peripheral vascular disease , cerebrovascular disease , and many types of ocular disease such as retinopathy , nephropathy , and neuropathy [ figure 1 ] . diabetes and its complication of vascular diseases cell - mediated autoimmune destruction of pancreatic islet beta cells causes decreased insulin production , which leads to type 1 diabetes mellitus or t1 dm . although only about 10% of world population suffers from t1 dm , the risk of death from t1 dm is high . if this trend continues , the number of new cases of t1 dm in european children younger than 5 years is predicted to double between 2005 and 2020 and rise by 70% , with the condition common in children younger than 15 years . in the united states , about 215,000 people aged 20 years or older are diagnosed with diabetes and the number of new cases with diagnosis of diabetes is about 1.9 million . it is expressed in 0.26% of all people in this age group . health care and social care related to t1 dm are significant burdens for the economy of any country . in developed countries , diabetes is one of the leading causes of retinopathy , kidney disease , and foot problems and the main cause of deaths from cardiovascular disease , all of which place a heavy burden on their economies . in addition , a study from us has shown that t1 dm subtracts 520 years from a patient 's lifespan . this is similar to the finding of a european study , which reported that when a child has t1 dm , the standardized mortality rate ( smr ) increases up to fourfold . t1 dm not only affects economies and the lifespan of patients , but also causes major psychological impacts , particularly in adolescents . the development of long - term microvascular and macrovascular complications is the main cause for the increased morbidity and mortality related to t1 dm . while testing the ratio of microvascular and acute diabetes complications and the relationship between diabetes duration and blood glucose control , stephenson and fuller found a significant correlation between microvascular and acute complications and the duration of diabetes and glycemic control . in addition , degradation of long - term control of glucose metabolism and blood pressure and the development of retinopathy , neuropathy , and atherosclerotic complications lead to increasing trends in patient mortality . for example , glomerular basement membrane thickening , increased mesangial matrix , and reduced glomerular filtration surface density are caused by renal disease which has long been considered the worst complication in patients with t1 dm . these pathologies have been shown to be related to albumin excretion rate and decreased glomerular filtration rate , which usually occur in most patients with t1 dm . recent studies report that the relationship between diabetes and cardiovascular dysfunction has become clearer and more pernicious . ischemia leads to mortality rates higher than those due to other complications in the t1 dm population at all ages . occurrence of ischemia is extremely high not only in young women with t1 dm but also in men under the age of 40 . in younger population , imaging techniques have demonstrated that children with t1 dm are exposed to greater risk of atherosclerosis than children without t1 dm . the leading cause of mortality in young patients with t1 dm , i.e. nephropathy , has been replaced by cardiovascular disease . coronary atherosclerosis occurs in most of the diabetic population , and 20% of the deaths of diabetic patients are due to myocardial infarction . early diastolic dysfunction and late systolic dysfunction are characteristics of diabetic cardiomyopathy , in which intracellular calcium and sodium levels are maintained but potassium is reduced . the following are the risk factors related to microvascular and macrovascular complications in t1 dm : reformative factors , including glycemic monitoring , hypertension , dyslipidemia , diet , sedentary lifestyle , and tobacco use ; and non - reformative factors , including diabetes monitoring and duration , genes , and puberty . impairment in remodeling of microvasculature related to hyperglycemia is the main indicator and the main factor leading to target organ damage . according to a recent study , 86% of young people suffering from t1 dm have at least one risk factor for cardiovascular disease , 45% are exposed to at least two factors , and 15% have at least three modifiable risk factors related to the disease . clinical methods for detecting vascular dysfunction can help experts use appropriate treatment methods to prevent the development of complications . maintaining the blood glucose levels as close to normal as possible is the most effective way to manage diabetes . variability in hemoglobin a1c ( hba1c ) and diabetes duration are the modifiable risk factors closer to development of complications . in another study , the authors reported a relationship between significantly increased incidence of congestive heart failure and higher hba levels in individuals with diabetes . in 2008 , reached the conclusion in their article that the rate of incidence of heart failure is closely related to diabetic retinopathy . they observed an increase in the development of heart failure in patients with retinopathy ( cumulative incidence of 21.6% ) compared to individuals without retinopathy ( cumulative incidence of 8.5% ) . experts suggest that individuals with t1 dm who have a strong family history of cardiovascular disease should practice a fasting lipid blood screening at 2 years of age . to avoid an atherogenic lipoprotein profile , glycemic control is necessary , and if there is an abnormal lipid profile , annual monitoring is required . if the lipoprotein density value is greater than 4.1 mmol / l or 3.4 mmol / l and the individual has at least one other evident cardiovascular risk factor , the individual should follow a diet that restricts dietary fat to 7% of total calories and dietary cholesterol to 200 mg / d . age of onset , duration , blood glucose monitoring , and cardiovascular risk factors affect the appearance of complications such as neuropathy , retinopathy , and especially renal disease . several studies have described the relationship between hyperglycemia and cardiovascular disease , but the relationship in the setting of t1 dm is still unclear and incompletely understood . moreover , psychological factors , in particular depressive symptomatology , are not only the leading factors in angina and insulin resistance but also barely predict coronary artery disease ( cad )  the buildup of plaque in the arteries , cause of atherosclerosis status , leading to the interruption of blood flow end points . because the incidence of cardiovascular dysfunction in patients with t1 dm is higher than in those without t1 dm , to prevent heart disease with its long asymptomatic latent period , the estimated global risk scores for cardiovascular risk should be provided . normoglycemia is a prerequisite to reduce the risk of microvascular and neurologic complications related to t1 dm . by observing the symptoms of cardiovascular disease , such as nonfatal myocardial infarction , stroke , death from cardiovascular disease , confirmed angina , or the need for coronary artery revascularization , researchers have realized a significant percentage reduction in cardiovascular disease occurrence ( 42% , p = 0.02 ) and the risk of nonfatal myocardial infarction , stroke , or death from cardiovascular disease ( 52% , p = 0.02 ) in diabetic patients . in addition , decreasing glycosylated hemoglobin content has a positive effect in intensive therapy on the risk of cardiovascular disease . there is a close relationship between microalbuminuria and albuminuria and an increased risk of cardiovascular complications . intensive treatment , either by external insulin pump or three or more daily insulin injections , guided by frequent blood glucose monitoring improved the resistance and retarded the appearance of complications such as diabetic retinopathy , nephropathy , and neuropathy in patients with t1 dm . furthermore , self - monitoring of blood glucose can also provide an accurate assessment of blood sugar levels . results of self - monitoring blood glucose are helpful in preventing hypoglycemia and adjusting medication use , physical activity , and diet . self - monitoring has been identified as an integral part of diabetes education , and self - management of diabetes medical nutrition therapy is essential for patients with diabetes . it also helps in prevention of cardiovascular risk factors , leads to weight loss , and improves health in diabetic subjects . strictly controlled dietary behaviors improve diabetic subjects health status . a protein - deficient diet ( 0.60.7 g / kg / d ) minimizes the complications of diabetic nephropathy . more than 150 min of intense physical activity per week supports the melioration of metabolic control . consumption of carbohydrates might be increased by an active lifestyle in patients who underwent islet cell transplantation . supporting knowledge of diabetes is also important in reducing negative psychological impacts on the patient . a danish study showed that patients with a positive view in life will have lower complication rates than the patients with psychosocial distress . traditional chinese medicines or functional foods are also positive treatments to improve the health of patients with diabetes status . the pharmacological activities of herbal medicines , such as ameliorating insulin sensitivity , promoting insulin secretion , increasing glucose uptake by adipose and muscle tissues , inhibiting sugar absorption in the intestines , and increasing the storage of sugar in the liver , have been demonstrated in many studies . moreover , traditional chinese medicines have been shown to have an effective impact on the treatment of cardiovascular complications in diabetic patients . in type 1 diabetes , most of the herbal in some way protect the beta cells from attack by the immune system . krg extract not only protects against streptozotocin ( stz)-induced destruction of pancreatic tissue but also restores insulin secretion . the herbal was a success in the fight against cd8(+ )  a cytotoxic t cell  and inhibited infiltration of lymphocytes into islets . but in type 2 diabetes , these receptors are encouraged to produce as well as increase its efficiency by the effects of herbal , thereby reducing the blood glucose level . certain herbals have been demonstrated to have properties that can improve the health of diabetics . korean red ginseng (  hng shn ; panax ginseng ) , one type of traditional chinese medicine , has been demonstrated to ameliorate diabetes . extracts of this herb reduced glycemia and simultaneously reduced stz - induced destruction of pancreatic tissue , while regenerating insulin secretion . green tea (  l ch ; camellia sinensis ) has also shown a positive antihyperglycemic and antioxidant activity after 4 weeks of treatment at a dose of 200 mg / kg in stz - induced rats . ginger (  shng jing ; zingiber officinale ) not only increases glucose tolerance but also increases serum insulin levels ; this is likely related to participation of 5-hydroxytryptamine ( 5-ht ) receptors . the use of cucurbitaceae (  k gu ; momordica charantia l. ) juice also showed a hypoglycemic effect similar to camellia and z. officinale , but its side effect is still a troubling issue and unclear . another herb , polygonatum odoratum (  y zh ; tfp ) , has also been investigated for its antihyperglycemic effects . the hypoglycemic activity of to - kai - san ( ts )  a complex chinese medicine  was reported by miura et al . ts not only exhibits hypoglycemic action but also decreases plasma insulin levels after 20 days of oral administration . chinese herbs , including holy basil leaves ( ocimum tenuiflorum ) , xianzhen pian ( c. sinensis ) , qidan tongmai ( a tablet of chinese herbs ) , traditional chinese formulae ( tct ) , huoxue jiangtang pingzhi , and inolter , exhibited significant hypoglycemic effects when compared with placebo . moreover , seven herbal medicines , including bushen jiangtang tang ( a chinese herbal recipe ) , composite trichosanthis (  gu lu ; trichosanthes kirilowii ) , jiangtang kang , ketang ling , shenqi jiangtang yin ( schisandra (  w wi z ) , astragalus (  hung q ) , dioscorea (  hui shn yo ) , rehmannia (  shu d ) , rubus chingii hu (  f pn z ) , wolfiporia (  f ling ) , trichosanthes kirilowii , xiaoke tang , and yishen huoxue tiaogan , were found to exhibit better metabolic control than the hypoglycemic drugs such as glibenclamide , tolbutamide , and gliclazide . furthermore , there have been no reports about the side effects from herbal medicines . so , the effect of each herb is not clear and this causes difficulties in the treatment of diabetes . since ancient times , sesame (  zh m ; sesamum ) has been considered a rare herb that can treat or prevent diseases . sesame oil has been shown to reduce the risk of cardiac hypertrophy in mice with high blood pressure . regression of left ventricular hypertrophy in hypertensive rats has been shown by its effects in reduction of cardiac mass , left ventricular thickness , and cardiomyocyte diameter , showing that sesame oil can have a positive effect on the status of cardiac hypertrophy in hypertensive rats . in recent studies , sesame and its ligands have been shown to have beneficial effects in treating , preventing , and ameliorating diabetes . the combined consumption of sesame oil and glibenclamide not only reduced the blood glucose levels significantly ( 36% in treatment compared to no treatment ) but also decreased plasma total cholesterol , and this significantly improved the condition of subjects with type 2 diabetes . incubation of beta cells damaged by stz with sesamin significantly improved cell viability , insulin secretion activity , activities of superoxide dismutase ( sod ) and glutathione peroxidase ( gshpx ) , and reduced glutathione ( gsh ) content . significant reductions in malondialdehyde ( mda ) content , nitric oxide ( no ) production , the enzyme activities of no synthase ( nos ) , and induced nos ( inos ) were observed in these cells when they were incubated with sesamin . the status of the damaged cells changed in a positive way . sesamin can reduce beta cell - damaging factors such as oxidative stress and no synthesis . hypoglycemic and hypolipidemic activity has been observed in kk - a mice , an animal model of type 2 diabetes and insulin resistance , when they were given sesamin orally . such activity might be due to increased insulin sensitivity and improved insulin resistance by sesamin . blood glucose in adult female albino wistar rats was significantly reduced from 322.61  9.49 mg / dl to 222.02  8.27 mg / dl when they were fed with sesamin . elevated levels of glycosylated hemoglobin , vitamin e , thiobarbituric acid - reactive substances ( tbars ) , and lipid hydroperoxides were found to decrease on administration of sesamin . in contrast , the levels of hemoglobin , vitamin c , and gsh increased on oral administration of sesamin . bone loss due to estrogen deficiency was reduced by oral administration of diets supplemented with soybean oil and sesame oil in ovariectomized rats . concentrations of vitamins e and k increased in rat tissue on using sesame seeds and ligands as the main diet . in another study on the inhibition of systemic ige levels in allergic asthma , sesame oil reduced pulmonary edema and neutral bronchitis ; meanwhile the interleukin ( il)-1 and il-6 levels were significantly decreased in bronchoalveolar lavage fluid . it exhibits a variety of actions and functions , and is of much value as a pharmaceutical . numerous studies have demonstrated that sesamin has numerous health benefits , including improvement in fat metabolism , antioxidant action , hypolipidemic activity , reduction of cholesterol , anti - inflammatory action , enhanced potency of vitamin e , etc . surpassing nephropathy , cardiovascular diseases have become the most serious complications resulting in high morbidity and mortality rates in diabetic subjects . in addition , other risk factors associated with macrovascular diseases such as diabetic nephropathy , diabetic retinopathy , and diabetic neuropathy require attention during disease process monitoring . numerous studies have provided a variety of methods for improving the diabetes status and related complications , including intensive treatment , pumping and injecting insulin , hypoglycemia drugs , and placebos . a current interest is the application of natural medicines in disease treatment to limit the adverse effects of chemical drugs . effects of sesame in reducing glycemia and improving the diabetes status and its complications have long been demonstrated . however , few reports suggest that sesame can aid in improving cardiovascular complications in diabetic patients , and therefore necessitates further research [ figure 2 ] .