Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 174426

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2007 | Month : December | Volume : 1 | Issue : 6 | Page : 511 - 520 Full Version

Effects of a Composite of Tulsi Leaves, Amla, Bitter Gourd, Gurmur Leaves, Jamun Fruit and Seed in Type 2 Diabetic Patients


Published: December 1, 2007 | DOI: https://doi.org/10.7860/JCDR/2007/.137
MITRA A

School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, Pin code-721 302, India.

Correspondence Address :
Mitra A. Assistant Professor, School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, Pin code-721 302, India. Tel.: 91-322-282656/282657(R), fax: 91-322-282631, e-mail: amitra@adm.iitkgp.ernet.in

Abstract

Traditional treatment applies different herbal principles used as a composite in food, serving as an effective measure against different diseases like diabetes in economically backward rural India lacking in health service infrastructure. The present study intends to observe the effects of a composite of Tulsi (Ocimum Sanctum) leaves, Amla (Emblica Officinalis), Bitter Gourd (Momordica Charantia), Gurmur (Gymnema sylvestre) leaves and Jamun (Syzygium Cumini) fruit and its seed, on mild diabetic patients. 120 patients whose Fasting Blood Sugar values is below 180mg/dl and without any complications of diabetes, and free from other diseases, are screened out of 2607 cases from hospitals at and around Kharagpur by random selection (lottery), divided into two groups of 60 patients each (lottery). The experimental group receives the composite of the above substances mixed with Soybean Sattu and used as a breakfast item for three months. The parameters like fasting blood sugar and lipid profile values for both experimental and control groups are measured at monthly intervals and compared statistically. Insulin resistance pictures are calculated. Application of the composite results in reduction of fasting blood sugar, bad cholesterols and Insulin resistance and increase in good cholesterol. Normal distribution method is used to analyse the data. The composite in this study causes beneficial changes in the blood bio-chemic parameters with reduction of Insulin resistance in the patients and needs to be supported by long-term experimentations.

Keywords

Type 2 diabetes [C19.246. 300]+, Composite, Tulsi Leaves, Amla, Bitter Gourd, Gurmur Leaves, Jamun Fruit and Seed

Introduction
India, facing a diabetic explosion, the exact cause being unknown and both genetic and life style factors being blamed, has the worlds Largest diabetic population – about 25 million, and the number is predicted to rise to 35 million by 2010 and to 57 million by 2025 (1). Rural India is urbanizing rapidly. A recent sample study of Medavakkam town near Chennai, which is a village a decade ago shows that the prevalence of diabetes rise from 2.4 per cent to 5 per cent within five years of urbanization (2). The Chennai Urban Population Study (CUPS) records in 1997 shows 12 per cent prevalence of diabetes in the Chennai population which is 70 per cent higher to what is being reported 14 years ago (3). The Chennai Urban Rural Epidemiology Study (CURES) records a prevalence of 16% diabetic (4). This rising trend puts a significant health burden due to diabetes in India (5). The urbanization tendency of rural India puts the incidence of diabetes with all its complications and mortality on the rise (6),(7). Rural India lacks development in different sectors including health service infrastructures. Food based control to different diseases can serve as an alternative, particularly if it is economically and socio-culturally viable and acceptable (8). Different herbal principles or foods are traditionally used in India in treating diabetes and other diseases. Ayurvedic practices recommend Tulsi (Ocimum Sanctum), Amla (Emblica Officinalis), Bitter Gourd (Momordica Charantia), Gurmur (Gymnema sylvestre), and Jamun (Syzygium Cumini) etc. for diabetic patients (9),(10),(11),(12), (13). For every 1-percentage point drop in glycolated haemoglobin (A1C), e.g. from 9 to 8 percent, there is a 35 percent reduction in the risk for diabetes-related complications and lowering the risk of fatal and nonfatal heart attacks by 18 percent (14). Different dietary ingredients having anti-diabetic potentials can act in synergism leading to wider range of control in diabetic patients and as such the study is particularly important in rural Indian context in reducing the incidence of diabetes related complications (15). The composite being used here has added advantages of inducing beneficial changes in blood pressure values (16). The study thus helps particularly the rural Indian mass in preventing the complications of diabetes.

Material and Methods

Selection of Subject (Patients):
For the present study, based on the data available in hospitals, 2607 patients suffering from Type 2 diabetes are identified. From these 2607 patients 723 patients are screened based on the following criteria- they do not require drugs until now (fasting blood sugar within140mg/dl), agree to participate and develop diabetes within past 3 years. They are free from any diabetic complications and symptomatically normal. They are also having no signs of any other diseases except the altered bio-chemical parameters due to diabetes. Out of these 723 patients, 120 patients are randomly selected (lottery) mainly based on financial reasons (inadequacy of funds). They are divided into two groups by random selection of 60 patients each, one for experimentation and other for control (Table/Fig 1). The patients are informed details of the study, including benefits and risk involved, in vernacular. Ethical clearance is obtained from the Institute authority by presenting the matter before the competent committee with a clear understanding that risk process being involved is minimum and all food processes being used in the study are traditional ones and to be used in the traditional route. The research team prior to use will taste food processes being used in the study. It is important that plants and herbal remedies currently in use or mentioned in literature of recognized Traditional System of Medicine is prepared strictly in the same way as described while incorporating GMP norms for standardization. So it may not be necessary to undertake phase I studies. However, it needs to be emphasized that since the substance to be tested is already in use in Indian Systems of Medicine or has been described in their texts, the need for testing its toxicity in animals has been considerably reduced. Neither would any toxicity study be needed for phase II trial unless there are reports suggesting toxicity or when the herbal preparation is to be used for more than 3 months (17). Different herbal composite are already being tested nationally and internationally and two Ayurvedic doctors are present in the research team. Written consents of the patients are obtained for the study. The patients are not receiving any lipid lowering and anti-hypertensive or any other drug therapies before and during the study.

Anthropometrical, Clinical and Bio-chemical characters of Volunteers: Anthropometrical, Clinical and Bio-chemical characters of Volunteers are shown in (Table/Fig 2) expressed in Mean ± SD). In the experimental group body weight is 72 ± 3 kg at the beginning and 72± 2 kg at the end while in the control group it is 66 ± 3kg (beginning) and 66± 2 kg at the end. Body mass index in the experimental group is 24.4 ± 3.4 units initially and 24.3 ± 3.3 units finally while in the control group body mass index is 24.5 ± 2.1 units (beginning) and 24.3 ± 1.9 units (end). These variations are due to non-identical conditions prevailing at the time of experimentation. Systolic blood pressure in the experimental group is146 ±12 mm of Hg (beginning) and 130± 14 mm of Hg (end) while in the control group systolic blood pressure is140 ±14 mm of Hg at the beginning and 138 ± 14 mm of Hg at the end. Diastolic blood pressure in the experimental group is 100 ± 12 mm of Hg (beginning) and 92 ± 8 mm of Hg (end) while in the control group diastolic blood pressure is 94 ± 8 mm of Hg at the beginning and 92± 10 mm of Hg at the end. The exact cause of this is unknown, possibly strict monitoring of diet with a fixed schedule may cause it. The research team strictly monitors the prescribed diet schedule, which consists of 65% of carbohydrates, 15% of fats and 20% of proteins (18).

Clinically both the groups show no abnormality,<

Results

Clinical, anthropometrical and bio-chemical evaluations of the patients before the study are as follows:
Age- 48.29 ± 4.56 years (Mean ± SD)
Sex- Males 62, Females 58
Weight- 69.3 ± 3.5 kg
BMI- 24.5 ± 3.29
At the end of the study it is being found that volunteers’ weight become 69.3 ±3.2 kg and their BMI is being found to be 24.3 ± 3.1. These variations are statistically insignificant.
As the patients are from diverse socio-cultural backgrounds with varied food-intake, life-styles, socio-cultural beliefs etc, the variations in the initial readings of blood parameters in patients are noted. Clinical parameters are evaluated at the end of the study. All the parameters remain as before except Blood Pressure values, which show decrease in systolic Blood Pressure by 16 mm of Hg, diastolic blood pressure by 8 mm of Hg and mean pressure by 10 mm of Hg. SGPT values in the experimental group increase by 5 units in the 2nd week and it remain stationary after that. Anthropometrical, Clinical and Bio-chemical characters of Volunteers are shown in (Table/Fig 2).

Results of analysis of blood samples for plasma glucose and lipid profile are being presented in (Table/Fig 4). A close study of blood biochemical parameters shown in (Table/Fig 4) reveals that whereas there is only negligible changes in patients receiving normal diet – TLC changing from 188±8 to 187±6 while there has been substantially beneficial changes in patients receiving the composite – TLC values being reduced from 182±6 to 168±5. HDLC values in patients receiving normal diet varies from 48±3 to 46±3 while HDLC values show increasing trend in patients receiving the composite from 45±4 to 49±3. LDLC values show marginal changes in patients receiving normal diet from 114±6 to 116±3 whereas in patients receiving the composite LDLC is being reduced from 110±7 to 94±5. VLDLC values are within 28±5 to 28±4 in patients receiving normal diet while VLDLC values are reduced from 27±5 to 22±4 in patients receiving the composite. TG values vary in patients receiving normal diet from 138±7 to 138±5 while in patients receiving the composite TG vales are reduced from 135±8 to 110±7. FBS values in patients receiving normal diet vary from 152±7 to 155±3 while in patients receiving the composite FBS is being reduced from 154±6 to 139±8. HBA1c values being measured show in experimental group it is being reduced from 6.5 ± 0.2 to 6.2 ± 0.2 while it remain at 6.4 ± 0.3 in the control group.

Analysis of fasting serum insulin values in the group receiving the composite is 35±6 µiu/ml (initially) and it is 27±4 µiu/ml at the end of study and the corresponding changes in the group receiving normal diet was from 42±6 µiu/ml to 43±5 µiu/ml. Further studies are required to explain the changes. (Table/Fig 4) show homeostasis model assessment of insulin resistance (HOMA 2-IR) values of the two groups in order to determine insulin sensitivity values of the patients respectively – one receive normal diet and the other receive diet with composite. In the former group mean insulin resistance is 5.9± 0.4 initially and is 5.8± 0.2 after the study. In the other group of patients, mean insulin resistance is 4.9± 0.2 initially to 3.9± 0.6 at the end of the study showing reduction in insulin resistance by the composite.

Discussion

The herbal composite used in the present study shows significant improvement in several biochemical parameters. Thus the composite shows hypoglycemic effect as being revealed by the reduction of fasting blood sugar level from 154 ± 6 to 139±8 (p=0.020). Insulin resistance is also reduced by the composite, a conclusion drawn after comparing the homeostasis model assessment 2 values of experimental and control groups.

Apart from the blood sugar lowering effect, beneficial changes in lipid profile have also been observed. Thus, administering the composite over a period of 3 months leads to an increase of HDLC being accompanied by reduction in TLC, LDLC, VLDLC and TG. The study is done in a closed community, the rural and semi-urban Bengali population, having commonalities in food intake and common life-style patterns. It may be mentioned that the herbal composite used shows no adverse effects or toxic reactions. Our findings reiterate the importance of life style in the genesis and management of diabetes in rural and semi-urban Bengali population. Moisture content of medicinal plants ranged from 11.76 percent in fenugreek seeds to 93.43 percent in Momordica Charantia. Syzygium Cumini seeds contained minimum crude protein (4.16%) while fenugreek seeds were richest source of it (25.8%) followed by Momordica Charantia (20.53%). Ether extractable fat content of medicinal plants ranged from 0.49 to 6.53 percent in Momordica Charantia and fenugreek seeds respectively. Ash content of Momordica Charantia fruit was very high (9.89%) while it was lowest in Syzygium Cumini seeds (21.6%). Crude fibre content of medicinal plants ranged from 1.28 (Syzygium Cumini seeds) to 10.92 percent (Momordica Charantia). Total carbohydrate content ranged from 58.13 in fenugreek seeds to 90.85 percent in Syzygium Cumini seeds (31). Emblica Officinalis is rich in Tannin and Vitamin C while Ocimum Sanctum contains Eugenol, Luteolin Apigenin. Syzygium Cumini is rich in flavonoids and polyphenolic compounds; Momordica Charantia contains a polypeptide p-insulin similar to bovine insulin in normalizing the blood sugar level, and, therefore, has been used as a folk medicine for diabetes. Gymnema sylvestre contains gymnemic acid and atomic arrangement of gymnemic acid molecules is similar to that of glucose molecules. Gymnemic Acid molecules fill the receptor locations on the taste buds thereby preventing activation of taste buds by sugar molecules present in the food, thus, curbing the sugar craving. Similarly, gymnemic acid molecules fill the receptor location in the absorptive external layers of the intestine thereby preventing the sugar molecules absorption by the intestine, which results in low blood sugar level (32). Regarding the probable mechanism of such hypoglycemic and lipid lowering effects, the chemical constituents particularly the flavonoids and polyphenolic compounds present in the composite are largely responsible. However, a thorough study is necessary to find out all the active principles in the composite before a definite conclusion can be drawn.

Our findings are being based upon the study, which is limited to a three-month period. As blood samples are drawn from different patients, having different socio-cultural backgrounds, considering the diversity of Indian population in intake of food, life-styles, socio-cultural beliefs etc, the variations in the readings of different blood parameters in different patients are to be considered before any long-term experimentation on a broader spectrum of people is formulated. Future studies from our laboratory will be aimed towards that direction.

Mitra and Bhattacharya report that diabetogenic nature of rural diet in Bengal and importance of life style in the genesis of diabetes in rural Bengali population (33). Different workers have found the role of genetic factors in causation of diabetes and the insulin resistance spectrum in Indians (3

Conclusion

The socio-economic development of rural India is leading to more prevalence of diabetes and diseases being related to Insulin Resistance Syndromes, particularly obesity, dyslipidaemia, hypertension, atherosclerosis, and coronary artery disease. Hence neutraceutical or food-based therapies are more appropriate as it is traditionally and culturally accepted and can reach majority of the population. A composite of different anti-diabetic herbal preparations are tried in the study and is being found to be effective not only in changing the blood bio-chemic parameters but also the overall picture of Insulin resistance. The study needs to be supported by long-term experimentations.

Acknowledgement

The author is indebted to Prof. A.K. Nanda of Mathematics and Statistics Department for statistical workouts, Prof. H.N. Mishra and Prof. T. K. Goswami of Agriculture and Food Engineering Department and also Prof. S. Dey, Head of Bio-Technology Department, all in IIT, Kharagpur for the help and use of the laboratory facilities. The author is grateful to Dr. D. Gupta, Dr. S. Chowdhury, Mr. L. K. Pradhan, Mr. S. Mondal, Mr. A .K .Roy, Mr. R.R. Mishra, Mr. L. Chingri, Mr. K. Pattanayek, of B. C. Roy Technology Hospital and Prof. A. K. Roy, Head of School of Medical Science and Technology and Doctors of that School for assistance in the monitoring process and for continuous help in the work. The author acknowledges gratefulness to Dr. Arunava Mitra of Crompton Greaves Limited for financial assistance and active participation in the project. The author is indebted to Prof. A. K. Basak. Head, Chemistry Department for his expert suggestions, help and active participation. The author is also indebted to Dr. D. Gunasekharan, Registrar, IIT-Kharagpur for his expert suggestions, help and active participation. The author deeply expresses gratitude to the family members of the volunteers and also to the volunteers for their help and active participation and eagerness to contribute in spite of the pain suffered during the project.

References

1.
Sicree R, Shaw J, Zimmet P Diabetes and impaired glucose tolerance. In Diabetes Atlas. International Diabetes Federation. Third Edition. Gan D, Ed, International Diabetes Federation, Belgium. Page: 15-103 (2006).
2.
The Hindu, (2004) Online edition, Friday, Jul 02, 2004.
3.
Mohan, V., Shanthirani, S., Raj D., Premalatha, G., Sastry, N.G. and Saroja, R. (2001) Intra-urban differences in the prevalence of the metabolic syndrome in southern India — the Chennai Urban Population study (CUPS No. 4). Diabetic Medicine, 18 (4): 280–287.
4.
Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A and Mohan V (April 2005) Awareness and Knowledge of Diabetes in Chennai -The Chennai Urban Rural Epidemiology Study [CURES - 9]. Journal of Association of Physicians in India, 53:283-287.
5.
Bhaskaran VP, Rau NR, Acharya S, Raj R, Chinnappa SM and Koshy AT (2003) Study of the direct costs incurred by type-2 diabetes mellitus patients for their treatment at a large tertiary-care hospital in Karnataka. India Journal of the Academy of Hospital Administration, 15(2): 7 –12.
6.
Narendran V, John RK, Raghuram A, Ravindran RD, Nirmalan PK and Thulasiraj RD (2002) Diabetic retinopathy among self reported diabetics in southern India: a population based assessment. British Journal of Ophthalmology, 86:1014-1018.
7.
Mohan V, Shanthirani CS, Mohan D, Raj D, Unnikrishnan RI and Datta M (February 2006) Mortality Rates Due to Diabetes in a Selected Urban South Indian Population - The Chennai Urban Population Study [CUPS -16]. Journal of Association of Physicians in India, 54:113-117.
8.
Mitra Analava (2002) Neutraceuticals for control of non-insulin dependent diabètes mellitus. Ph. D. Dissertation, IIT Kharagpur.
9.
Chopra RN, Nayar SL, Chopra IC. Glossary of Indian Medicinal plants. CSIR, New Delhi, (1956).
10.
Bhattacharya S, Chirangeebee Banoushadhi. Ananda Publishers Private Limited Calcutta, (1977).
11.
Asolkar LV, Kakkar KK, Chakre OJ Second supplement to glossary of Indian Medicinal plants with active principles. Part II & I, (1992).
12.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3] [Table / Fig - 4]

JCDR is now Monthly and more widely Indexed .