This cross-sectional study was conducted between July 2017 to June 2018 at Department of Biochemistry, Government Medical College and Hospital, Banda with all ethical norms (IEC/GMCBANDA/2017/003 Dated 16^th May, 2017). Twenty five diabetic patients (less than 5 years of duration of NIDDM) who were vegetarian, doing sedentary activity and not taking drugs in the age group of 40 to 50 years were contacted from Banda city for this study. These patients were included in the study after they gave written informed consent. All participating subjects (vegetarian, not taking any drugs and without any complications of diabetes), who were then explained the study design and purpose of the study.

In this study, FSP was given to the patients with diabetes mellitus and its impact on blood glucose level was observed. The FSP was prepared from fenugreek seeds collected from a shop where herbal preparations were available as suggested by ayurvedic physician. This FSP was used as herbal supplement in the study. Fasting and postprandial blood glucose levels (estimated by Glucose Oxidase-Peroxidase (GOD-POD) method) of the patients were monitored at regular monthly intervals for duration of three months. The initial blood glucose level after an overnight fast (fasting) and postprandial (2 hours after meals) were measured and recorded. A 5 gm FSP was given to the patients on empty stomach early in the morning every day. Before beginning the study and at the end of every month, the blood glucose level (fasting and postprandial) was measured consecutively for three months. Thus blood glucose level (fasting and postprandial) checked four times during study. The patient’s personal and family history, physical examinations and blood tests data was collected.

The results were statistically analysed for logical interpretation of the results. Statistical Package for Social Sciences (SPSS, version 17.0) computer software package was used for statistical analysis of the data.

Out of total 25 diabetic patients, male were 13 (52%) and female were 12 (48%). [Table/Fig-1] shows the fasting and postprandial blood glucose level of diabetic patients during three months. The fasting and postprandial blood glucose level after consuming FSP in the first month was 117.72 mg/dL and 152.92 mg/dL, respectively. After 2 months, the fasting and postprandial blood glucose level was 109.04 mg/dL and 157.44 mg/dL. After 3 months, the fasting and postprandial blood glucose level was 94.32 mg/dL and 119.28 mg/dL. The fasting blood glucose level after using FSP was reduced to 94.32 mg/dL from 130.92 mg/dL and postprandial blood glucose level was reduced to 119.28 mg/dL from 172.84 mg/dL.

The data presented in [Table/Fig-2] showed the statistical analysis of effect of FSP on blood glucose level during fasting state. The number of patients was 25 and DF was 48. Table showed the level of significance when initial blood glucose level was compared with blood glucose level after one, two and three months of using FSP during fasting state. The mean±SD of initial blood glucose level was 130.92±35.13. After one, two and three months of using FSP, level of blood glucose was 117.72±24.93 (p>0.05), 109.04±18.41 (p=0.01) and 94.32±14.25 (p<0.01), respectively.

[Table/Fig-3] showed the statistical analysis of effect of FSP on blood glucose level during postprandial state. Table showed the level of significance when initial blood glucose level was compared with blood glucose level after one, two and three months of using FSP during postprandial state. The mean±SD of initial blood glucose level was 172.84±35.13. After one, two and three months of using FSP, level of blood glucose was 152.92±43.37 (p>0.05), 157.44±42.54 (p>0.05) and 119.28±22.25 (p<0.01), respectively.

These results [Table/Fig-1] indicate that FSP contains a high percentage of galactomannan which directly or indirectly with other constituents like 4-hydroxy isoleucine, decreases blood glucose level by stimulation of existing β cells of pancreas [8]. The findings are further supported by a study which links the incorporation of 4.0 gm to 7.0 gm fenugreek seeds in to recipe have a positive effect in controlling blood glucose levels after 3 months of incorporation due to activity [8]. In a study, fenugreek appears to slow down the absorption of sugars in the stomach and stimulate insulin ultimately resulting the decrease in blood sugar level in people with diabetes [6].

In another supporting evidence a study reported that adding 100 grams of defatted fenugreek seed powder to the daily diet of patients with diabetes significantly reduced their fasting blood glucose levels and improved glucose tolerance [6]. Fenugreek has a lowering effect on glycaemic index when added to rice and wheat diets either due to delayed gastric emptying and increased intestinal transit time or by stimulation of β-cells of pancreas [9]. In addition, fenugreek decreases glucose absorption and inhibits starch digestion due to presence of galactomannans and soluble fiber [10]. Adding fenugreek in the diet of diabetic patients 15 minutes before the meal causes a significant reduction in glycaemic index and is beneficial to NIDDM patients for long term control of hyperglycaemia related complications [9-11].

Similarly, observations of this study indicated significant reduction in FBS, PPBS [Table/Fig-2,3] and HbA1c levels after administration of fenugreek seeds in diabetic patients who were vegetarian, nonalcoholic with sedentary lifestyle [12]. A review and meta-analysis suggests that fenugreek seeds may contribute to better glycaemic control in persons with diabetes mellitus with a similar magnitude of effect as intensive lifestyle [13,14]. Fenugreek is widely available at very low cost and generally accepted in diet in resource poor countries such as India where a large proportion of persons with diabetes in the world reside.

The overall changes seen with respect to the hypoglycaemic effect of fenugreek powder could be attributed to the various bioactive phytochemicals present in it. The presence of polyphenols and flavonoids play a major role in activating the insulin release and uptake by its receptors [9]. Further, the reduced absorption due to delayed gastric emptying and antioxidant action might have contributed towards a better glycaemic control over a period of time. Therefore, fenugreek may be a promising complementary option for the clinical management of diabetes mellitus.

NIDDM patients with complications were not included in this study.

In this study, it was concluded that use of FSP lowers the blood glucose level. The regular use of this powder is advocated for diabetics in control of blood glucose levels. Such use of FSP can serve as an effective, supportive therapy in the prevention and management of long term complications of diabetes.