Effectiveness of fenugreek in reducing hyperglycaemia among patients with type II diabetes mellitus in selected private hospital at Madurai, Tamilnadu, India.

INTRODUCTION

Diabetes mellitus is a syndrome with metabolic vascular and neuropathic components that are interrelated. It is syndrome caused by an imbalance between insulin supply and demand. It is characterized by hyperglycaemia and associated with abnormal carbohydrate, fat and protein metabolism. These metabolic abnormalities lead to the development of specific forms of renal, ocular, neurologic and cardiovascular complications.

Type II diabetes, formerly known as adult onset or Non-insulin dependent diabetes mellitus is the most common form of diabetes. This form of diabetes usually begins with insulin resistance, a condition in which muscle and liver cells do not use insulin properly. Being overweight and inactive increases the risk of developing Type II diabetes. In the absence of effective interventions, the prevalence of Type II diabetes in all populations is likely to rise as a result of aging, increase in life expectancy, sedentary lifestyle, increase in the prevalence of obesity, lack of physical exercise and appropriate diet.

Diabetes can lead to decreased quality of life, increase in mortality and acute metabolic complications. Hyperlipidemia, hypertension, peripheral vascular disease, blindness, nephropathy and neuropathy are some of the potential consequences of living with diabetes.

Fenugreek commonly known as methi seeds, give a tangy flavour to the dishes it is used in. The medicinal uses of fenugreek seeds have been known since ancient times. In the Greek and Latin pharmacopoeias, fenugreek seeds are described as possessing anti diabetic properties. In recent times, several preclinical and clinical studies have confirmed the anti diabetic action of fenugreek seeds. In addition, fenugreek seeds are assumed to have nutritive and restorative properties and they also stimulate the digestive process. Gel fibre present in fenugreek seeds, reduces the rate of glucose absorption and may also delay gastric emptying, thereby preventing the rise in blood sugar levels following a meal.

NEED FOR THE STUDY

Diabetes is a major threat to global public health that is rapidly getting worse, and the biggest impact is on adults of working age in developing countries. At least 171 million people worldwide have diabetes. This figure is likely to more than double by 2030 to reach 366 million.

The vulnerable groups to this pandemic are population of developing countries, minority ethnic groups and socio economically disadvantaged communities in industrialized countries.

The pandemic involves essentially Type II diabetes which comprises of about 85 % of all diabetes mellitus cases.

It has been estimated that in 1995, 19.4 million individuals were affected by diabetes in India and these numbers are expected to increase to 57.2 million by the year 2025.

Fenugreek helps in improving digestive tract functions and should be regularly used as a cleansing agent. It further says, fenugreek helps in cleaning ama and clogged mucous in respiratory and digestive systems. Fenugreek is also useful to healing of different ulcers in digestive tract. Fenugreek is claimed to give protective coating to digestive tract thus helping in giving relief.

Nurses should be knowledgeable of complimentary therapies as integrative medicine approach is consistent with the holistic approach. As nurses work very closely with their clients and cultural viewpoints and existential issues. It is also important for nurses to keep abreast of the current research being done in this area to provide accurate information not only to the clients, but to other health care professionals also. More research studies are needed to validate the effectiveness of complementary therapies, so the researcher intended to do further research on the effectiveness of fenugreek in maintaining blood sugar among patient with diabetes mellitus.

A study was conducted by Manjiri Ranade and Nikhil Mudgalkar in January 2017 to assess the impact of ingestion of fenugreek seed on fasting blood glucose levels and glycosylated hemoglobin (HbA1C) levels in patients of Type 2 diabetes mellitus controlled with diet, exercise and oral hypoglycemic agents (OHAs) or insulin. A total of sixty patients were enrolled in the study divided into two groups each containing thirty patients. One group of patients received 10 gm of fenugreek seeds soaked in hot water every day, while the second group did not received. Statistical analysis shows that there is significant reduction in fasting blood glucose levels in the 5th month in the study group (P = 0.0421) while significant reduction in HbA1C in the 6th month (P = 0.0201). In conclusion A simple complementary addition of fenugreek seeds can have a synergistic effect along with diet control and exercise on fasting blood glucose and HbA1c but is of delayed occurrence.

A study was conducted on March 2019 by Rania A Najdi, Magda M Hagras to ascertain if fenugreek compared with glibenclamide had any impacts on controlling blood glucose in patients with uncontrolled type II DM on conventional therapy.A total of 12 patients with uncontrolled DM and on metformin were recruited and divided into two groups. Patients in group 1 received 2 g fenugreek per day, whereas those in group 2 received glibenclamide 5 mg once daily. The impacts of fenugreek on the glycemic control and lipid profile were measured before initiation of the regimen and then after 12 weeks. Only 9 of the 12 study participants completed the study. Fenugreek at 2 g/day caused an insignificant drop in fasting blood glucose (P = 0.63), but the fasting insulin level increased significantly (P = 0.04). The ratio of high- to low-density lipoprotein was significantly decreased from before to after treatment (P = 0.006). In conclusion Fenugreek did not cause any notable adverse impacts on hepatic and renal functions throughout the study.Fenugreek could be used as adjuvant therapy to anti-diabetic drugs to control blood glucose, and further studies are needed.

Antidiabetic effect of fenugreek with possible mechanismsFenugreek seed extracts have been reported to exhibit antidiabetic potential by delaying both gastric emptying time and rate of glucose absorption. It reduced uptake of glucose in the small intestine mainly due to its high fiber content that slows the metabolism of carbohydrates and lowered blood glucose (Patel et al., 2012).It also restores the function of pancreatic tissues, protecting β cells, evaluating serum insulin level possibly through the regeneration of β cells or stimulation of insulin release by the existing β islet cells (Bera et al., 2013). Besides it corrects the insulin-sensitive carbohydrate metabolic enzymes activities, serum lipid profiles, prevents lipid peroxidation, restores glutathione and superoxide dismutase (liver and pancreas), enhances insulin sensitivity, improving insulin action at cellular level, and recovers the level of HbA1c by utilization of glucose in peripheral tissues where by maintain the blood glucose level (Gauttam and Kalia 2013).

STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of fenugreek in reducing hyperglycaemia among patients with type II diabetes mellitus in selected private hospital at Madurai.”

OBJECTIVES

1. To assess the pre and post test blood sugar level of patient with type II diabetes mellitus after administration of fenugreek in experimental group.

2. To assess the pre and post test blood sugar level of patient with type II diabetes mellitus without administration of fenugreek in control group.

3. To compare the post test blood sugar level among patients with type II diabetes mellitus in experimental and control group

4. To find out the effectiveness of fenugreek administration in reduction of blood sugar level among patients with type II diabetes mellitus in experimental group.

5. To compare the post-test blood sugar level among patients with type II diabetes mellitus in experimental group day 7th and 15th.

6. To find out the association between experimental group post-test blood sugar level and selected demographic variables.

DELIMITATIONS:

• Subjects with type II diabetes mellitus on oral hypoglycaemic agent and dietary regimen, who are coming to the diabetic department in a selected private hospital at Madurai during data collection period.

• Only ten grams (2tsp) of fenugreek soaked in 100 ml of water for 12 hours is administered orally for 15 days.

• The data collection was limited to a period of six weeks.

MATERIALS AND METHODS

Research approach: The quantitative research approach.

Research design: Pre-test pos-test control group quasi experimental design.

Setting: The study was conducted at Kiruba Hospital, Madurai.

Sample: Patients with type II diabetes mellitus who were selected purposively from the Kiruba Hospital, Madurai. Sampling technique: Purposive or judgemental sampling technique.

Sample size: The total sample size was 60 among the 30 patients who were in experimental group and 30 patients were in control group.

Sampling criteria:

Inclusion Criteria:

• Subjects with type II diabetes mellitus in the age group 35 to 65 years.

• Subjects with type II diabetes mellitus only on oral hypoglycaemic agent.

• Both male and female clients.

• Subjects speaking and understanding Tamil / English.

Exclusion Criteria:

• Subjects who are not willing to participate.

• Subjects with complications like cardiovascular disease, foot ulcer, paralysis, GI problem, sinusitis and asthma etc.

• Any variation in the treatment during the data collection.

Description of tool

The tool is divided into 2 parts

Part I

The demographic variables such as name, age sex, educational status, occupation and information related to disease condition, history of hospitalization, family history of diabetes mellitus and dietary pattern and duration of illness.

Part II

The second tool was assessment of patients blood sugar levels by bio physiological measurement (glucometer).

Intervention protocol

The subjects were divided into experimental and control groups. First three weeks experimental group participants were selected. Initially the subjects were interviewed in order to collect demographic data. The researcher explained the procedure to the clients afterwards assessed their blood sugar level by using glucometer followed by fenugreek 2 teaspoon (10gms) packet was packed separately given for seven days and explained that one packet should be soaked with 100ml of water everyday night and it should be taken next day early morning in the empty stomach. This was followed for 7 days and they were asked to come on 7th day to check the blood sugar level, again 10 gms fenugreek pack was given for 7 days and checked the blood sugar level on 15th day by using glucometer. Next 3 weeks control group participants were selected, here the researcher did the pre-test by using glucometer to check the blood sugar level afterwards not administering fenugreek checked the blood sugar level on 15th day by using glucometer.

RESULTS AND DISCUSSION :

Table 1 Shows regarding fasting blood sugar level 15 out of 30 (50%) had 241-280 mg/dl in pre test where as 3 out of 30 (10%) were between 241-280mg/dl in post test in the experimental group

In the control group 7 out of 30 (23.3%) had 241-280mg/dl of blood sugar level in pre test, where as 8 out of 30 (26.75%) had 241-280mg/dl in post test.

The above findings summarizes that fenugreek intake has significant beneficial effect in glycaemic control

Table 2 summarizes that in the experimental group, the mean post test blood sugar level i s lesser than the mean post test 229.5 blood sugar level 178.2 is lesser than the mean post test 229.5 blood sugar level of control group. The obtained „t" value 5.53 is statistically significant at 0.05 level. This indicates that the mean difference of 51.3 is a true difference and has not occurred by chance. So the researcher accepts the research hypothesis and rejects the null hypothesis.

EXPERIMENTAL GROUP

Fig. 1: Distribution of blood sugar level before and after administration of fenugreek intake in experimental group

MAJOR FINDINGS OF THE STUDY:

• This study has proved that the mean blood sugar level after administration of fenugreek in experimental group samples with diabetes mellitus was lower than the mean blood sugar level of control group.

• There was no association between post test blood sugar level of experimental group and age, sex, occupation, education, duration of illness and dietary pattern.

CONCLUSION:

This study concluded that fenugreek maintains blood sugar level among patients with diabetes mellitus.

RECOMMENDATIONS:

• The study can be conducted by using large populations to generalize the findings.

• A longitudinal study can be conducted to assess the effectiveness of fenugreek in maintaining blood sugar level.

• This study can be done as a comparative study in different settings.

• The effectiveness of fenugreek can be tested among diabetes who are on insulin administration.

• A follow-up study can be done to find out whether the patients are practicing fenugreek intake regularly.