A CLINICAL STUDY TO EVALUATE THE ANTIHYPERGLYCEMIC ACTIVITY OF BHANDIRA

Introduction: Madhumeha (Diabetes mellitus) is a life style related, multifactorial disease with multiple facets involving all the Srotas, Dhatus and the Ojas. Madhumeha is a Vataja variety of Prameha, which manifests either due to Margavarana or due to Dhatu Kshaya. Diabetes mellitus is a clinical syndrome characterized by Hyperglycemia due to absolute or relative deficiency of insulin. Diabetes and its complication pose a major threat to future public health resources throughout the world. In this study an effort has been made to evaluate the Madhumehahara karma (Antihyperglycemic activity) of Bhandira (Clerodendrum infortunatum auct Non Linn) Materials and methods: The present study was an open labelled, single arm, clinical study in Madhumeha (Diabetes mellitus) (n=30) selected using convenience sampling technique with pre and post design conducted in a tertiary Ayurveda healthcare centre attached to a teaching institute, situated at the district headquarters in South India. 32 patients fulfilling the inclusion criteria suffering from Madhumeha w s r to Diabetes mellitus were selected with the intervention of Bhandira patra vati 3 Twice in a day (BD) for 30 days. Results: The effect of therapy was assessed before and after treatment, the results were statistically analyzed; it showed significant changes in subjective parameters like praboota mutrata, avila mootrata, kshudadikya, karapada daha, and Objective parameter- Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS), Fasting Urine Sugar (FUS), Post Prandial Urine Sugar (PPUS) Conclusion: Bhandira patra vati in a dose of 3 BD before food has shown better efficacy in subjective parameters like praboota mutrata, avila mootrata, kshudadikya, karapada daha, and Objective parameter like- FBS, PPBS, FUS, PPUS KEY WORDS: Madhumeha, Anti-hyperglycaemic, Bhandira patra vati

Gestational Diabetes and Dietary Management with Split Meal Technique

Gestational diabetes and dietary management with split meal technique was studied with 90 sample which were collected through purposive sampling. Among 90 GDM patients were categorized into 2 equal groups I.e, Experimental group and control group. Control group consists of (n=45) and Experimental group also consists of (n=45). Anthropometric measurements, Biochemical assessment, and Diet survey were taken as parameters. Positive results were obtained in Experimental group. Significant decrease observed in weight, BMI, blood sugar and urine sugar in Split meal technique group. The results were decreased (from160.11 to 133.36 mg/dl in fasting blood sugar, 2.25 - 0.35 mg/dl urine sugar, 67.58- 64.11 kg in body weight).

Beta Thalassemia Major with Diabetes Mellitus: A Case Report

Thalassemia results from defects in normal hemoglobin production, and represents the most common inherited anemia worldwide. Diabetes is a complication of b-thalassemia major. We report a case of Diabetes mellitus in a known case of beta thalassemia major. Patient had undergone Splenectomy 1 year back. Patient is taking chelating agent Defasirox 1000mg orally once a day in the morning. Family history reveals, born through third degree consanguineous marri age. The patient was then subjected for laboratory examination reveals BSL was high, urine ketone 2+,urine sugar 3+, ABG was normal, HbA1c was 13 & 3 month old report of serum ferritin 1200 ng/dl. Multidisciplinary management was instituted. Blood sugar level got controlled over subcutaneous insulin. Patient may have landed in Diabetic ketoacidosis but was promptly diagnosed & treated. This case is presented for its rarity. As the life expectancy of patients with thalassaemia increases, this will also expose our patients potentially to many more years of hyperglycaemia and diabetes. Sustaining metabolic control and controlling cardiovascular risk factors will be critical in the future for preventing complications due to diabetes.

The beneficial effects of the composite probiotics from camel milk on glucose and lipid metabolism, liver and renal function and gut microbiota in db/db mice

Background Probiotics may have beneficial effects on patients with type 2 diabetes mellitus (T2DM). We separated 4 lactobacillus and 1 saccharomycetes from traditional fermented cheese whey (TFCW) and prepared composite probiotics from camel milk (CPCM) and investigated their effects on glucose and lipid metabolism, liver and renal function and gut microbiota in db/db mice. Methods CPCM was prepared in the laboratory and 40 db/db mice were randomly divided into 4 groups as metformin, low-dose and high-dose group and model group, and treated for 6 weeks. In addition, 10 C57BL/Ks mice as normal control group were used for comparison. Fasting blood glucose (FBG), body weight (BW), oral glucose tolerance test (OGTT), glycated hemoglobin (HbAlc), C-peptide (CP), triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), 24 h urinary microalbumin (24 h malb), urine ketone, urine sugar, pancreas and liver tissue and intestinal flora were tested. Results Compared to diabetic group, high dose CPCM significantly decreased FBG, OGTT, HbAlc and IRI, plasma TC, TG, LDL-C, 24 h malb, urine ketone and urine sugar, increased CP, HDL-C levels, improved the liver and kidney function, protected the function of islets, also increased intestinal tract lactic acid bacteria and Bifidobacterium, decreased Escherichia in db/db mice. Conclusion CPCM decreased FBG, OGTT and HbAlc, increased CP, modulated lipid metabolism and improved liver and kidney protected injury in db/db mice, which may be related to various probiotics acting through protecting the function of islets and regulating intestinal flora disturbance.

Role of Panchatikta Panchaprasutik Niruha Vasti in Prediabetes A case report

Background: Prediabetes is an intermediate state of hyperglycemia with glycaemic parameters above normal but below the diabetes threshold. In Ayurveda, it is correlated with Prameha Poovaroopavastha. The risk of developing diabetes remains high with an annual conversion rate 5-10%. Many other studies have shown that the efficacy of lifestyle intervention in diabetes prevention with a relative risk reduction of 40-70% in prediabetes adults. If we treat this disease in early stage then it checks the further pathogenesis of disease. Aim and objectives: The aim of this study was to observe the efficacy of Panchatikta Panchaprasutik Niruha Vasti enema including Palliative treatment in prediabetes. Methods: It is a single case study of 55 years old male patient who was diagnosed with prediabetes correlated as Prameha Poorvaroopa from 1 year approached to Ayurvedic hospital and was treated Panchatikta Panchaprasutik Niruha Vasti. The treatment was continued for consecutive 15 days. Results: After 15days changes were observed in symptoms as well as reduction was seen in blood and urine sugar level and overall quality of life of patient was improved. Conclusion: Patient got satisfactory relief in symptoms as well as objective parameters after 15 days.

P5007Acute natriuretic activity of sodium-glucose cotransporter 2 inhibitor in heart failure patients with type 2 diabetes mellitus

Background Sodium-glucose cotransporter 2 (SGLT2) inhibitor promotes diuresis and reduces the risk of hospitalization for heart failure (HF). However, the mechanisms of diuretic effects of SGLT2 inhibitor in HF patients with type 2 diabetes mellitus (T2DM) remain under investigation. Purpose The purpose of this study was to investigate the mechanisms of acute diuretic effects of SGLT2 inhibitor and to identify its predictor in HF patients with T2DM. Methods We prospectively enrolled 40 hospitalized HF patients with T2DM (68±13 years, 63% male, and hemoglobin A1c 7.1±0.9%) between July 2014 and June 2018. All patients received ipragliflozin at a dose of 50 mg once daily after breakfast. They underwent 24-hour urine test and first-morning blood and urine tests before and after ipragliflozin therapy. Results Urine volume significantly increased from 1,365±511 ml/day on day 0 to 1,698±595 ml/day on day 3 (p<0.001). Multivariate linear regression analyses showed that the increase of 24-hour urine sodium but not urine sugarwas significantlyand independently associated with the increase of 24-hour urine volume (β-Coefficient=0.80; P<0.001). Univariate and multivariate logistic regression analyses showed that higher dosage of furosemide-equivalent loop diuretics and lower level of first-morning urine sodium concentration (per 1 mEq/L) at baseline were significantly associated with the diuretic effect of ipragliflozin therapy, and the latter independently predicted increase of 24-hour urine volume (Table). Predictors for increase of urine volume Univariate Multivariate Odds ratio (95% CI) P value Odds ratio (95% CI) P value Dosage of furosemide, mg 1.09 (1.01–1.18) 0.04 – – HbA1c, % 1.45 (0.56–3.78) 0.44 Fasting blood glucose, mg/dL 1.02 (0.99–1.04) 0.24 eGFR, mL/min/1.73m2 1.01 (0.97–1.05) 0.65 Plasma BNP, pg/mL 1.00 (0.99–1.01) 0.12 Left ventricular ejection fraction, % 0.98 (0.94–1.02) 0.24 First-morning urine sugar, mg/dL 1.20 (0.96–1.50) 0.12 First-morning urine sodium, mEq/L 0.96 (0.93–0.99) 0.02 0.96 (0.93–0.99) 0.02 24-hour urine sugar, g/day 3.49 (0.13–93.40) 0.46 24-hour urine sodium, mEq/day 0.98 (0.96–1.01) 0.20 eGFR, estimated glomerular filtration rate; BNP, brain natriuretic peptide. Conclusion SGLT2 inhibitor has acute natriuretic activity and may restore loop-diuretic resistance in HF patients with T2DM. Acknowledgement/Funding None

Clinical evaluation of an Ayurvedic Formulation in the management of Avaranajanya Madhumeha (Type 2 Diabetes Mellitus)

A research plan has been developed in the present study to address the problems associated with Avaranajanya Madhumeha (type 2 diabetes). This research plan is based on the treatment methods of Ayurveda (ancient Indian medicine) and utilization of modern scientific methods as research tools. A specific ayurvedic herbo-mineral formulation has been prepared in Ghansatt (solid extract) form; the selected eight herbs and one herbo-mineral have anti-hyperglycemic (PRAMEHA HARA) and antihypercholestermic (MEDOHARA) properties with rejuvenative (RASAYANA) effects as described in classical ayurvedic methods. 15 diagnosed type II diabetes mellitus patients were selected through accidental sampling. Ayurvedic formulation was prescribed to type II diabetes patients for one year along with dietary restrictions. Diabetic diagnostic parameters of these patients like Fasting Blood Sugar (FBS), Post Patrum Blood Sugar (PPBS), Glycocylated Hemoglobin (HbA1C) and Urine Sugar Fasting were monitored every three months; these were measured before and after intervention. The obtained data were statistically analyzed through paired t-test. There was significant reduction in FBS level, PPBS level, HbA1C level and urine fasting sugar level in type 2 diabetes patients who completed the clinical trial successfully. Thus, ayurvedic formulation treatment lead to an overall significant reduction in blood sugar and urine sugar levels in type II diabetes patients. No side effects were noted during the study period. This study suggests that the ayurvedic formulation had very good hypoglycemic effects proved by clinical improvement and bio-chemical analysis of diabetes parameters in the treatment of type II diabetes mellitus.

Validity and Reproducibility of a Self-Administered Food Frequency Questionnaire for the Assessment of Sugar Intake in Middle-Aged Japanese Adults

We evaluated the validity and reproducibility of estimated sugar intakes using a food frequency questionnaire (FFQ) among middle-aged Japanese adults in the Japan Public Health Centre-Based Prospective (JPHC) study. In subsamples of the JPHC study (Cohorts I and II in multiple areas), we computed Spearman’s correlations of FFQ results with urine sugar concentrations and dietary records (DR) for validity; we evaluated correlations between two FFQs for reproducibility. During 1994–1998, participants (Cohort I: n = 27 [men], n = 45 [women]) provided two (spring and fall) 24-h urine samples and completed 7-consecutive-day DR per season (I: n = 99, n = 113; II: n = 168, n = 171) and two FFQs (147 food items) at yearly intervals (I: n = 101, n = 108; II: n = 143, n = 146). Sugar intakes from FFQ were correlated with urinary sugar (de-attenuated correlations: 0.40; 95%CI: 0.19, 0.58). After adjustment for sociodemographic and lifestyle variables, correlations between FFQ and DR for men and women were 0.57 (0.42, 0.69) and 0.41 (0.24, 0.55) (I) and 0.56 (0.44, 0.65) and 0.34 (0.20, 0.47) (II), respectively. Correlations between FFQs for men and women were 0.63 (0.49, 0.73) and 0.55 (0.41, 0.67) (I) and 0.66 (0.55, 0.74) and 0.63 (0.52, 0.72) (II). In conclusion, our study showed moderate FFQ validity and reproducibility for sugar intake evaluation.