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Endocrinology & Metabolism International Journal

Research Article Volume 7 Issue 6

Diabetes mellitus, challenges & hopes

Avinash Shankar,1 Amresh Shankar,2 Anuradha Shankar3

1Chairman, National Institute of Health and Research, India
2Bihar State Health Services, India
3Director, Centre for Indigenous Medicine and Research, India

Correspondence: Avinash Shankar, Chairman, National Institute of Health and Research, Bihar, India

Received: October 21, 2019 | Published: November 15, 2019

Citation: Shankar A, Shankar A, Shankar A. Diabetes mellitus, challenges & hopes. Endocrinol Metab Int J. 2019;7(6):160-169. DOI: 10.15406/emij.2019.07.00264

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Abstract

India, a world capital of diabetes mellitus and Bihar to be considered a first state in the world with 30% population suffering with diabetes mellitus as per 2019 report, a consequent t of changed dietary status, emergence of non nutrients in diet, altered life style and increasing stress, poses a challenge in spite of continuing anti diabetics and insulin supplementation due to increasing insulin resistance, thus an study to evaluate the regime dietary restriction, limited initial diet, modified life style and an adjuvant herbal composite been done.

Material: 3770 diabetic patients attending RA. Hospital & Research Centre, Warisaliganj (Nawada) Bihar and Aarogyam punarjeevan Bihar Patna during Jan 2017 to December 2017 been selected for the study.

Method: Selected patients were interrogated for the history of disease how it is detected, treatment taken and their result, clinically examined and, investigated for diabetic, lipid, haematological, hepatic and renal profile pre and post therapy. Each patients after 10days of restriction, changed life style, limited initial diet, been supplemented with herbal composite Cap META Reg 1 cap 30minutes before breakfast, lunch and dinner. Patients were followed up every 15days for 1year to adjudge the efficacy, safety profile and quality of life.

Result: All patients show marked decline in blood sugar and HbA1C, lipid profile and continuing dose of antidiabetics with complete withdrawal of insulin in 6months of therapy, marked improvement in haematological, hepatic and renal profile. No patients had any blood sugar surge or any consequent sequel during 1 year of follow up with minimal dose of OHA, adjuvant and modified dietary schedule, and life style.

Conclusion: Though growing incidence of diabetes mellitus in India affecting even hard worker, remain a challenge but modified life style, dietary plan and adjuvant Herbal composite remain a hope in control of diabetes mellitus and its sequel to ensure quality life.

Keywords:dietary non nutrient, OHA, herbal composite, limited initial diet, Lipid profile, hepatic, renal, quality of life

Introduction

As per 2016 WHO survey 422million adults are suffering with diabetes mellitus globally and is increasing rapidly and IDF predicted to be its double by 2030.1‒8 A disease of luxury today affecting more the persons of low socio economic status and is attributed to trend of urbanization, change in lifestyle, sedentary life, less physical work, changing dietary constituents and emergence of non nutrients in the diet. Presently India had more diabetics than any other country and is considered diabetic capital of the World as 62million Indians i.e.- more than 7.2% of adult population are affected with Diabetes mellitus and nearly 1 million dies of diabetes mellitus every year.9 Recent survey reveals 30% population of Bihar is affected with Diabetes mellitus which only represent the registered cases while at least 10 % cases remain unregistered and taking vague treatment or treated by non qualified doctors. Due to rampant use of fertilisers chemical insecticide and soil energisers the food and drinks constitute a non nutrient constituent due to changed soil texture and chemical status which causes various metabolic and endocrinal disorders and these days also a cause of carcinogenesis due to increased proliferation and decreased apoptosis.10 In past patients with blood sugar more than 400mg % remain unable to stand or present with hyperglycaemic coma but these days patients even with blood sugar more than 500mg remain standing and dictate the disease history which affirms the changed etiopathogenesis of diabetes mellitus i.e. combined effect of hepato pancreatic dysfunction as evidence by its incidence and changed hepatic profile in majority cases.11 Study approves the initial dietary dose effect on the prognosis of diabetes mellitus as 100 calories initial diet improves the quality of life and diabetic control.12

Material & method

Material:

3770 patients of diabetes mellitus enrolled at RA Hospital & Research Centre Warisaliganj (Nawada) Bihar and Aarogyam Punarjeevan, Ram Bhawan, Ara Garden Road, Jagdeopath, Baily Road Patna 14 were considered for the proposed study.

Methods:

Enrolled patients were interrogated thoroughly for their disease history, treatment taken, their response, clinically examined and investigated for Fasting blood sugar, post prandial blood sugar, HbA1C, lipid profile, hepatic profile and renal profile. For ease of evaluation urine was also assessed for sugar and albumin. Old patients were continued with continuing therapeutics with suggestive care while newly detected cases were advised as per their glycaemic status

  1. Restriction of carbohydrate (Rice, potato, sugar strictly)
  2. Initial diet not more than 100calories
  3. Total calorific requirement as per need
  4. Adjuvant herbal therapeutics META Reg 1 cap 30minutes before breakfast, lunch and dinner
  5. In new cases after 4weeks, patients were re evaluated for diabetic parameters and patients having fasting blood sugar >250mg% was advised Oral hypoglycaemic agent with vigil watch on blood sugar or any manifestation of hypoglycaemia.
  6. In old cases with adjuvant, continuing therapeutic dose been tapered down on any evident manifestation of hypoglycaemia.

Patients of either group been given a follow up card to enter hypoglycaemic event or any other sequel, on hypoglycaemic manifestation patients are warned to take sugar candy and taper the dose of continuing Insulin dose by 25% and visit the centre for evaluation or contact the project in charge for evaluation.

Each Cap of Meta Reg constitutes active ingredient of:

Each capsule of 500mg constituents

Ficus bengalensis (Bad ka chhal)

90mg

Gymnema sylvestre (Gudmar)

40mg

Syzgium cumini (Jamun)

40mg

Coccinia grandis (Kundru)

40mg

Tribulus terristeris (Bada gokshuru )

40mg

Calotropis gigantea (Ark root )

20mg

Opuntia dilenii (Thhuhar)

4mg

Picrorhiza kuroo( Kutki )

20mg

Terminalia arjuna (Arjun )

40mg

Sida rhombifolia ( Mahavala)

40mg

Momordica charantia (Karela )

40mg

Rubia cordifolia (Manjishtha )

40mg

Aegle marmelos (Vel patra )

20mg

 Tigonella foenum graecum ( Methi seed )

6mg

During each visit diabetic, lipid, renal and hepattic profile been repeated to adjudge the response of therapeutics, diet and life style changes, in addition safety profile.

Observation

Among the 3770 selected patients , 2250 and 1520 were male and female respectively of age group 22-52years while among them 2520 were old diabetics taking various i.e. Insulin, OHA and OHA combination (Table 1, Figures 1‒3) Out of all old cases 1230patients were having no diabetic sequel while 545, 540 and 205 patients were with associated hypertension, neuropathy and nephropathy respectively (Figure 4) 322 old and 120 new cases were with fasting blood sugar 130-150mg% though 220 old and 34 new cases had fasting blood sugar >290mg% while post prandial blood sugar in 264 old and 780 new cases were with 200-250mg% though 119 old and 18 new cases were with >500mg%. HbA1C was 7-9 in 428 old and 156 new cases while >13in 361 old and 119 new cases (Table 2). Out of all 245 old and 10 new cases had haemoglobin <10gm% 2094 old and 80 new cases were with altered hepatic function while 205 and 165 old cases were with altered renal and lipid profile respectively (Table 3).

Figure 1 Bar diagram showing distribution as per sex.

Figure 2 Pie diagram showing distribution of patients as per their treatment status.

Figure 3 Bar diagram showing distribution as per consumed therapeutics.

Figure 4 Distribution of patients as per their disease status.
Key words: Non complicated diabetes mellitus, A; Diabetes with hypertension, B; Diabetes with Neuropathy, C; Diabetes with Nephropathy, D.

Figure 5 Graph showing pattern of blood glucose and lipid status of the patients.

Age group

 Number of patients

 Male

Female

22-27

130

80

27-32

260

120

32-37

480

210

37-42

490

250

42-47

520

390

47-52

370

470

Table 1 Distribution of patients as per age and sex

Parameters

 Number of patients

 

 

Old patients

New patients

 

Male

Female

Total

Male

Female

Total

HbA1C:

7-9

210

218

428

98

58

156

9-11

640

310

950

250

260

510

11-13

511

270

781

236

229

465

>13

245

116

361

60

59

119

Blood sugar(mg%):

Fasting:

130-150

213

109

322

60

60

120

150-170

196

132

328

102

110

212

170-190

243

108

351

114

129

243

190-210

132

72

204

80

70

150

210-230

149

69

218

72

60

132

230-250

280

138

418

64

52

116

 250-270

120

86

206

76

60

136

270-290

129

124

253

54

53

107

>290

144

76

220

22

12

34

Post prandial:

200-250

176

88

264

38

40

78

250-300

332

249

581

162

134

296

300-350

310

188

498

148

144

292

350-400

295

105

400

134

130

264

400-450

248

168

416

102

49

151

450-500

160

82

242

48

53

101

>500

85

34

119

12

6

18

Table 2 Showing Diabetic profile of the patients on admission

Parameters

 Number of patients

 

 

Old patients

New patients

 

Male

Female

Total

Male

Female

Total

Haematological:

Haemoglobin:

< 10 gm %

156

89

245

6

4

10

>10 gm %

1450

825

2275

638

602

1240

Hepatic profile:

Serum bilirubin

;

<1mg%

320

106

426

600

570

1170

>1mg%

1286

808

2094

44

36

80

SGOT:

<30 IU

320

106

426

440

210

650

>30 IU

1286

808

2094

204

396

600

SGPT:

<30 IU

320

106

426

440

210

650

>30 IU

1286

808

2094

204

296

600

Renal profile:

Serum creatinine

<1.5 mg

1450

865

2315

639

599

1238

>1.5 mg

156

49

205

5

7

12

Blood Urea

<26mg

1450

865

2315

639

599

1238

>26mg

156

49

205

5

7

12

Urine:

Albumin

Present

156

49

205

3

2

5

Absent

1450

865

2315

641

604

1245

RBC

Absent

1450

865

2315

641

604

1245

Present

156

49

205

3

2

5

Lipid profile:

Total Serum Cholestrol

<200mg

1246

749

1995

629

576

1205

>200mg

360

165

525

15

30

45

Table 3 Distribution of patients as per basic bio parameters

Result

All patients of both group show progressive decline in fasting and post prandial blood sugar HbA1C and lipid profile and attains normoglycemic state by 6th month of therapy (Table 4&5, Figure 6‒8). In addition all old cases on Insulin shows progressive decline in insulin dose and completely withdrawn by 6th month of therapy (Figure 9), in addition all cases also had decline in OHA dose with complete normalisation of haematological, hepatic and renal profile with improved quality of life. No patients had any withdrawal presentation (Table 6)

Figure 6 Graph showing decline in continuing antidiabetics in old cases.

Figure 7 Graph showing achievement of normoglycemic state in both old and new cases.

Figure 8 Schematic presentation of Effect of low caloric diet on GLP and GIP secretion.

Figure 9 Schematic presentation of GLP and GIP effect.

Bio parameters

Number of patients

 

Old cases

New cases

BLOOD SUGAR (mg%)

Fasting :

80-100

2230

980

100-120

290

270

120-140

Non

Non

>140

Non

Non

Post prandiol

140—150

2190

1160

150- -160

330

90

160-170

Non

Non

170-180

Non

Non

180-200

Non

Non

>200

Non

Non

 LIPID PROFILE (mg%)

Serum Cholestrol :

150-170

225

131

170-190

2170

1060

190-210

125

59

>210

Non

Non

RENAL PROFILE

Blood Urea :

<26mg%

2520

1250

>26mg%

Serum creatine

<1.5mg%

2520

1250

>1.5mg%

Non

Non

Urine :

Albumin

Present :

Non

Non

Absent :

2520

1250

RBC:

Present

Non

Non

Absent

2520

1250

HEPATIC PROFILE

SGOT:

<30 IU

2520

1250

>30IU

Non

Non

SGPT:

<30 IU

2520

1250

>30 IU

Non

Non

Alkaline phosphatase :

<140

>140

Non

Non

Table 4 Outcome of the study

HbA1C

Number of patients

 

1st

2nd

3rd

4th

5th

6th

>13

480

56

45

38

12

0

11-13

1246

944

870

620

324

0

9-11

1460

1010

960

540

402

0

7-9

984

903

395

890

1120

0

5-7

0

655

1020

1012

884

330

 3-5

0

202

480

670

1028

3440

Table 5 Showing pattern of HbA1C

Response in clinical presentation improvement:

Particulars

Remarks

Diabetic triad:

None

Hypertension

Completely controlled

All

Neuropathic manifestation

Tingling numbness

None

Burning hand & feet

None

Pain in extremity

None

Nephrological manifestation

Polyuria

None

Oliguria

None

Swelling of the body

None

Puffiness of face

None

Exertional dyspnoea

None

Obesity

None

Table 6 No patients had any withdrawal presentation

Discussion

Increasing incidence of diabetes mellitus among Indian due to changed life style, dietary habits, emergence of non nutrient in dietary products and economical burden induced stress, designated India as World capital of Diabetes. In addition current survey of 2019 more than 30% Bihar population is affected with Diabetes mellitus.1‒4 Increasing tolerance to high blood sugar created doubt of multifocal pathogenesis of hyperglycaemia and been approved as hepatopancreatic etiopathogenesis. In spite of increasing incidence and its sequel even with OHA and Insulin supplementation,13‒19 pose a challenge to healthy longevity, but in present study with modified life style, 100 calories initial diet, restriction of fast food and unconscious eating with supplementation of herbal composite Cap META Reg in 3770patients shows marked decline in blood sugar, serum lipid , HbA1C. Progressive decline in Insulin supplementation achieving complete withdrawal of Insulin and declined OHA dose with normoglycemic status in 6months therapy with better quality of life without any adversity and reversal of lipid, hepatic, and renal profile. This marked clinical efficacy can be explained as – Minimal initial diet prompt secretion of incretin (GLP), and GIP which induce Insulin secretion from Pancreatic Beta Cells, restricted dietary allowance and food grain rice and potato decreases amount of non nutrient enzyme inhibitor (Figures 8&9) while constituent of META Reg20Gymnema sylvestre, Sygium cumini, Coccinia grandis, and Trigonella foenum graceum invigorate Pancreatic Beta cells to synthesize Insulin, Ficus bengalensis, Tribulus terresteris, Calotropis gigantea, and Picrorhiza kurroo modulate hepatic parenchyma to increase glucose utilization and glycogenesis Terminalia arjuna and Sida rhombifolia modulate lipid metabolism and helps decline raised lipid profile, increase cardiac blood supply and its tonicity, thus takes care of cardiac healthy state. Momordica charantia, and Rubia cordifolia increases insulin receptor sensitivity, Aegle marmelos decline absorption of carbohydrate and lipid from intestine while Opuntia delleni modulate neuro endocrinal path way for needed insulin release (Figure 10). Thus this combo prescription ensure diabetic control with improved quality of life.

Figure 10 Schematic presentation of Herbal composite effect.

Conclusion

Though diabetic incidence is increasing in geometric progression and failure of existing modern molecule, change in life style, dietary intake and its regime, moderate exercise and Cap META Reg in dose of 1 cap 30 minutes before breakfast, lunch and dinner, a new hope for diabetic control and better control of quality of life.

Acknowledgments

None.

Conflicts of interest

The authors declare no conflict of interest.

Funding

None.

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