EFFECTIVENESS OF FENUGREEK POWDER ON FASTING BLOOD GLUCOSE LEVEL AMONG PATIENTS WITH
TYPE 2 DIABETES MELLITUS ATTENDING SELECTED DIABETIC CENTRES, SALEM
By
Ms. JUDY JOSEPH Reg.No: 30099402
A DISSERTATION SUBMITTED TO
THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE
DEGREE OF MASTER OF SCIENCE IN NURSING
(MEDICAL SURGICAL NURSING)
APRIL – 2011
CERTIFICATE
Certified that this is the bonafide work of Ms. JUDY JOSEPH, Final year M.Sc.(Nursing) Student of Sri Gokulam College of Nursing, Salem, submitted in partial fulfillment of the requirement for the Degree of Master of Science in Nursing to The Tamil Nadu Dr. M.G.R. Medical University, Chennai under the Registration No. 30099402.
College Seal:
Signature: _____________________________________
PROF. A. JAYASUDHA, M.Sc (N)., Ph.D., PRINCIPAL,
SRI GOKULAM COLLEGE OF NURSING, 3/836, PERIYAKALAM,
NEIKKARAPATTI, SALEM - 636 010.
EFFECTIVENESS OF FENUGREEK POWDER ON FASTING BLOOD GLUCOSE LEVEL AMONG PATIENTS WITH
TYPE 2 DIABETES MELLITUS ATTENDING SELECTED DIABETIC CENTRES, SALEM
Approved by the Dissertation Committee on: 20-12 -2010
Signature of the Clinical Speciality Guide:………...
Mrs. N. ANITHA, M.Sc., (N)
Assoc. Professor , Head of the Department, Department of Medical Surgical Nursing, Sri Gokulam College of Nursing
Salem-636 010
Signature of Medical Expert: ………...
Dr. K.SELVAKUMARI, M.D., Consultant Physician,
Sri Gokulam Hospital, Salem-636 004.
____________________________ ____________________________
Signature of the Internal Examiner Signature of the External Examiner
with date with date
ACKNOWLEDGEMENT
God the giver of all good, my gratitude , for keeping the lamp of determination and perseverance lit all throughout this course of study and for making me believe in the beauty of this endeavor.
I wish to express my deep sense of gratitude and thanks to our honorable Managing Trustee, Dr. K. Arthanari, M.S., Sri Gokulam College Of Nursing, Salem for the opportunity and all the facilities he has provided to undertake the course in his esteemed institution.
I am extremely grateful to P rof. A. Jayasudha, M.Sc. (N), Ph.D, Principal, Sri Gokulam College Of Nursing Salem for her scholastic suggestions, encouragement and valuable guidance. It was a privilege to complete this study under her expert supervision. Her contributions were indeed an asset for the valid completion of this work.
I wish to thank Dr. K. Tamizharasi, Ph.D., Vice-Principal, Sri Gokulam College of Nursing for her expert opinion and suggestions towards completion of this project.
I express my heartfelt thanks to clinical specialty Guide Mrs. N. Anitha, M.Sc.(N)., Assoc. Profess or and Head of the Department, Department Of Medical Surgical Nursing, Sri Gokulam College of Nursing for her constant guidance, encouragement, resolute support and patient correction during the entire course of study.
I express my special bouquet of thanks to my Co-guide Mrs. B. Sumathy, M.Sc. (N) Lecturer, Department of Medical Surgical Nursing for her ever willing help, constant support and untiring correction. Her firm belief that a better way can always be found has influenced my approach to this research.
I humbly thank Mrs. Hepsi Charles, M.Sc. (N), Mrs. Bhuvana, M.Sc.(N), Ms. S. Kanmani, M.Sc.(N), Mrs. V. Kavitha, M.Sc. (N) Lecturers in Medical Surgical Nursing for their timely help and guidance throughout my study.
I extend my thanks to Dr. K. Se lvakumari, M.D., Consultant Physician for her valuable guidance and suggestion towards this study.
I am grateful to Dr. Alagianambi, M.D., Diabetologist, for the help and guidance extended from time to time throughout the study.
I express my sincere thanks to my class coordinator Mrs. Lalitha Vijay, M.Sc. (N), Assoc. Professor for the guidance at every possible level.
I would like to extend my gratitude to all Faculty Members, Sri Gokulam College of Nursing, Salem for this research work would never have taken shape without their inspiration and the limitless help.
My heartfelt thanks to Dr. Yuvraj, M.D. Managing Director, M.G. D iabetic Centre and Dr. RajaGaneshan, M.D. Managing Director, Sushrutha Clinic for the opportunity provided to conduct the study in their esteemed centre.
I would like to express my thanks to Mr. R. Baskar, M.L.I.S., M.Phil, Sri Gokulam College of Nursing, Salem for his helpful attitude and uninterrupted support to trace quality information and relevant literature needed to complete this research study.
I would like to acknowledge the input received from Mr. Shivkumar, M.Sc., M.Phil., Ph.D., Biostatistician for his assistance in statistical analysis and data inter pretation.
I am thankful to Fr. Johny, M.A., B.Ed., Lecturer, whose editing suggestions and precise sense of language were decisive towards the completion of this dissertation.
I wholeheartedly thank the Patients who willingly agreed to cooperate during data collection period. Without them it would have been impossible to complete this study.
I extend my loving thanks to all my classmates especially to Ms.V.Tamizhselvi who enabled me to bypass the more persistent and inevitable obstacles and at the same time to have a wonderful time along the way.
I thank My Pare nts, In-laws and Sister who have communicated the determination and sense of purpose to me which has stood me in good stead to carry out my duties with responsibility all throughout.
Life has blessed me with an understanding, foresighted and value oriented husband in the person of Mr. Binu Kunnel Baby who persuaded me to pursue postgraduate studies. For his supportive presence all alo ng I am ever grateful to him.
This study drew upon the knowledge and help, experience and expertise of many persons of good will, though too numerous to name, each one of them is remembered for their individual contributions without which the realization and presentation of this research would not have been possible.
ABSTRACT
A study was conducted to evaluate the effectiveness of Fenugreek Powder on Fasting Blood Glucose Level among Patients with Type 2 Diabetes Mellitus. A quantitative evaluative approach with quasi experimental design was used. Through Non probability convenience sampling technique 60 patients were selected, among them 30 patients from M.G. Diabetic Centre for experimental group and 30 from Sushrutha Diabetic centre for control group were assigned. On first day fasting blood glucose of both experimental and control group was assessed using Glucometer. The patients of experimental group were given 25 gm of fenugreek powder twice a day for 21 days and on 22nd day fasting blood glucose level was assessed for both the groups using the same glucometer. The data was analyzed using descriptive and inferential statistics. Findings revealed that majority 22(73.33%) in experimental group and 21(70%) in control group possess family history of first degree relatives with diabetes mellitus. Highest percentage 26(86.6%) and 23(76.6%) in experimental and control group were receiving sulfonylurea. During pre test 22(73.3%) patients in experimental group and 19(63.3%) in control group had moderate hyperglycemia whereas in post test after the administration of fenugreek powder, 23(76.66%) patients of experimental and 14(46.66%) of control group had mild hyperglycemia. This reveals that the fasting blood glucose level in experimental group was reduced as compared to control group. The calculated ‘z’ value (2.7) at p<0.05 level is greater than table value (1.96), which proves that fenugreek powder was effective in reducing fasting blood glucose level. There was no significant association between the blood glucose level and demographic variables in experimental group whereas in control group duration of diabetes mellitus and duration of drug therapy were found to have association at p<0.05 level.
TABLE OF CONTENTS
CHAPTER CONTENT PAGE NO
I INTRODUCTION 1-10
? Need for the study 3
? Statement of the problem 5
? Objectives 5
? Operational definitions 6
? Assumptions 6
? Hypotheses 6
? Delimitations 7
? Projected Outcome 7
? Conceptual framework 7
II REVIEW OF LITERATURE 11 -19
? Literature related to Type 2 Diabetes-Mellitus 11
? Literature related to Effectiveness of
Fenugreek in reduction of blood glucose level
15
III METHODOLOGY 20 -26
? Research approach 20
? Research design 20
? Population 22
? Description of setting 22
? Sampling 22
? Variables 23
? Description of the tool 23
? Validity and reliability 24
? Pilot study 24
? Method of data collection 25
? Plan for data analysis 25
IV DATA ANALYSIS AND INTERPRETATION 27 -39
V DISCUSSION 40 -43
VI SUMMARY, CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS
44 -48
BIBLIOGRAPHY 49 -51
ANNEXURES i-xx
LIST OF TABLES
TABLE NO.
TITLE PAGE
NO.
3.1 Interpretation of scoring procedure 24
4.1 Frequency and percentage distribution of patients with type 2 diabetes mellitus according to their biographic variables
28
4.2 Frequency and percentage distribution of patients with type 2 diabetes mellitus according to associated risk factors related variables
30
4.3 Frequency and percentage distribution of patients with type 2 diabetes mellitus according to illness related variables
32
4.4 Comparison of pre and post test fasting blood glucose level among patients with type 2 diabetes mellitus in experimental and control group
35
4. 5 Comparison of mean, standard deviation and mean diffe rences of pretest and post test fasting blood glucos e level in patients with type 2 diabetes mellitus in experimental and control group
36
4. 6 Effectiveness of fenugreek powder on fasting blood glucose level among patients with type 2 diabetes mellitus in experimental and control group
37 4.7 Association between the fasting blood glucose level among
patients with Type 2 diabetes mellitus and their selected de mographic variables in experimental and control group.
38
LIST OF FIGURES
FIGURE NO. TITLE PAGE NO.
1.1 Conceptual Frame Work Based on Rosenstoch’s Health Belief Model (1974)
9
3.1 Schematic Representation of Research Methodology 21 4.1 Distribution of patients with type 2 diabetes mellitus
according to the existing fasting blood glucose level
33
4.2 Distribution of patients with type 2 dia betes mellitus according to the post test fasting blood glucose level
34
LIST OF ANNEXURES
ANNEXURE.
NO.
TITLE
PAGE NO.
A.
Letter seeking permission to conduct a research study
i
B. Tool for data collection iii
C.
Letter requesting opinion and suggestion of experts for content validity of the research tool
xiv
D Certificate of validation xv
E. List of Experts xvi
F. Certificate of editing Xviii
G Photos xix
CHAPTER I INTRODUCTION
“Wounds - that don’t heal, Nerves - that don’t feel, No food - I can eat at ease, What a disease I have???
I have diabetes………”
- Rajan
Diabetes Mellitus is a chronic metabolic disorder, characterized by elevated level of glucose in blood (hyperglycemia) resulting from defects in insulin secretion, insulin action or both. It is a silent disease which is called as ‘Madhumeha’ in Ayurveda. It is of two types namely type 1-Insulin Dependent Diabetes Mellitus and type -2 Non Insulin Dependent Diabetes Mellitus. Type 1 Diabetes patients produce very little or no insulin and they daily require insulin injection, where as Type 2 patients cannot use insulin effectively hence it can be managed by life style modification but oral drugs are often required and less frequently insulin in order to achieve good metabolic control. (Suzanne, 2008)
Diabetes is a major threat to global public health that is getting worse day by day and the biggest impact is on adult of working age in developing countries like India. The statistical report reveals that 7% of world’s adult population is affected by diabetes and this number is likely to be double by 2030. (World Health Organization, 2002)
Diabetes is now emerging as king of all diseases for reasons such as multisystem involvement, complex metabolic abnormalities and varied clinical presentation. It cause substantial morbidity and mortality primarily through
cardiovascular, eye and kidney diseases as well as limb amputation. (Vadivukkarasi Ramanadin, 2010)
The day will come when nations will be judged neither by their military or economic strength nor by the splendor of their capital cities but by the wellbeing of the people, their level of health, nutrition and education. If we indeed want to strive for better health of our people, the holistic management of diabetes needs to be preached as well as practiced. (UNICEF, 2000)
The life of every person with diabetes is unique. Patients with diabetes commonly feel overwhelmed, frustrated or burned out by the daily hassles of disease and unending, burdensome life long self care demands. This results in poor quality of life incorporating the individual’s subjective perceptio n of physical, emotional and social wellbeing including both cognitive and emotional component. (Pradeep, 2001) The sequelae of diabetes or complications are responsible for reduction in the life expectancy of diabetic patients by about one third. The complications are neuropathy, retinopathy, arteriosclerosis, nephropathy, digestive disorders, oral complications and increased susceptibility to infections. (Rob Hicks, 2006)
Management of Diabetes Mellitus is an expensive course due to life long drug therapy. The expense is estimated to be $336.6million per year. Economic burden is the root cause for lack of willingness to follow therapeutic regimen and increase physical and psychological suffering. Nature’s pharmacy is the best one and one must not forget that for every drug that benefits a patient, there is a natural substance that can achieve the same effect at lowest cost without adverse effects. (Carl C. Pfeiffer, 2005)
Need for the Study
Health is a basic need that determines wealth and happiness of an individual. It is essential for the satisfaction of basic human needs. Each and every individual wants to lead their life without illness. Every person is free to live according to his own ways. Sometimes the people adopt many irregular ways of living that they do not understand the value of health until it is lost. The changing life style and technological advancement have paved the way for emergence of various disorders. Diabetes mellitus is one among such disorder. (Lakhwinder Kaur, 2009)
At present diabetes affects 246 million people world wide and is expected to affect some 380 million by 2025 at the rate of two people every 10 seconds. Another 7 million people develop diabetes every year. Every 10 seconds a person dies from diabetes related causes and an estimated 3.8 million death per year are linked directly to diabetes including cardiovascular disease made worse by diabetes related lipid disorders and hypertension. Every 10 seconds two new cases of diabetes are diagnosed. Statistics related to India reveals that in the year 2000, there were 32 million diabetic patients and it is projected to rise to 80 million by the year 2030. This exploding epidemic has made India “World Diabetes Capital”. (World Health Organization, 2010)
Several botanical and biological products claim to lower blood glucose or help in avoiding complications of diabetes, and some of these are being used by people with diabetes. Product thought to lower blood glucose level include gymnema, fenugreek and bitter melon. (Laura Shane, 2005)
Fenugr eek (Trigonella Foenum Graecum) is a member of the pea family which is one of the oldest medicinal plant. It has been used for numerous indications including labour induction, aiding digestion, as antiseptic for local inflammations and
to treat upper respiratory tract infections as well as a tonic to improve metabolism and health. The most recent studies have revealed the blood-cholesterol and blood glucose lowering properties of fenugreek. (Wintson J. Craig, 2010)
Fenugreek, a native of Middle East, is commonly known as methi seeds, which gives a tangy flavor to the dishes. It contains 4-hydroxyisoleucine amino acid that stimulates the pancreas to release insulin as well as increases tissue sensitivity to insulin. In addition it reduces blood sugar through enzyme sucrase-alpha -amylase which slows the breakdown of carbohydrate into sugar. (Niamath, 2006)
The treatment of diabetes involves a sustained reduction of hyperglycemia by biguanides and other drugs. However fenugreek, one of the oldest medicinal plants have been suggested as a rich source of potentially useful antidiabetic drug available at a low cost without any unwanted side effects. (Abdel Barry, 2003)
A randomized control trial study conducted on dietary fiber and its metabolic benefit in prevention and treatment of diabetes mellitus. The samples were given 25 grams of fenugreek powder once daily with breakfast for three weeks The result showed that 39%of those treated with insulin (83 out of 212 subjects) could stop insulin and 71%of those on Oral Hypoglycemic Agents (140 out of 197 subjects) could discontinue their use.(Anderson, 2002)
In a quasi experimental study in university of Lucknow researcher found that 4-hydroxyisoleucine an unusual amino acid has as anti hyperglycemic and antidyslipidemic agent. The study assessed 97 participants and result revealed significant decreased in the plasma triglyceride level by 33% (p<0.02), total cholesterol by 22 %( p<0.02) and blood sugar level by 14 %( p<0.02). The study concluded that fenugreek can be used as an antihyperglycemic and antidyslipidemic agent. (Narendra.T, et.al, 2006)
A double blind study conducted in university of Beijing including 60 type 2 diabetic patients who were treated with 25gm of fenugreek seed powder for a period of three weeks. The result revealed significant reduction in blood sugar, urine sugar and serum cholesterol level at p<0.05 level. (Shang, M.Cai, 2000)
The investigator through her clinical and community experience and literature review understood diabe tes as a major threat not only to patients but for the nation as a whole due to economic burden and decreased productivity. Life long drug therapy and lack of health insurance makes it much more difficult to manage. From her own learning experiences of complementary and alternative therapy researcher developed an interest to conduct a study regarding adjunct treatment for diabetes mellitus to lessen the physiological and economical burden of disease and benefit the poor population of country.
Statement of the Problem
A Study to Evaluate the Effectiveness of Fenugreek Powder on Fasting Blood Glucose Level among Patients with Type 2 Diabetes Mellitus attending Selected Diabetic Centres, Salem.
Objectives
1. To assess the existing fasting blood glucose level in patients with Type 2 Diabetes Mellitus in experimental and control group.
2. To evaluate the effectiveness of fenugreek powder on fasting blood glucose level among patients with Type 2 Diabetes Mellitus in experimental and control group.
3. To associate the pre test fasting blood glucose level in patients with type 2 diabetes mellitus and their selected demographic variables in experimental and control group.
Operational Definitions 1. Effectiveness
Effectiveness is statistically significant change in fasting blood glucose level measured by standardized glucometer after providing fenugreek powder for 21 days to patients with Type 2 diabetes mellitus
2. Fenugreek
A herbal seed, which was powdered and given 25 gm each with lunch and dinner, dissolved in butter milk or water to patients with Type 2 diabetes mellitus of experimental group.
3. Fasting Blood glucose level
The value of glucose in blood after 8 hours of fasting among patients with type 2 diabetes mellitus, which was evaluated by Glucometer.
4. Type 2 diabetes mellitus patients
Patients diagnosed to have type 2 diabetes mellitus and receiving Oral Hypoglycemic Agent at the time of study.
Assumptions
1. Natural adjunct therapy will play an important role in control of blood glucose level among type 2 diabetic patients.
2. Fenugreek will have an effect on blood glucose level among patients with type 2 diabetes mellitus
Hypotheses
H1 There will be significant difference in fasting blood glucose level in patients with Type 2 diabetes mellitus receiving fenugreek powder at p< 0.05 level in experimental and control group.
H2 There will be significant association between the fasting blood glucose level among patients with Type 2 diabetes mellitus with their selected demographic variables of experimental and control group at p < 0.05level.
Delimitations
1. The study was limited to patients with Type 2 diabetes mellitus who are on oral hypoglycemic agents.
2. The study was limited to patients attending diabetic OPD in Sri Gokulam Hospital, Salem.
3. The study was limited to assessment of fasting blood glucose level among patients with type 2 diabetes mellitus.
4. Data collection period was limited to 4 weeks.
Projected Outcome
1. This study will help to evaluate the effectiveness of fenugreek powder on fasting blood glucose level among patients with Type 2 diabetes mellitus.
2. The finding of the study will help the nurse to understand the importance of fenugreek powder in controlling fasting blood glucose level in patients with Type 2 diabetes mellitus in hospital and community set up.
3. The study will improve knowledge of patients with Type 2 diabetes mellitus about adjuvant therapy.
Conceptual Framework
The conceptual frame work adapted for the study was based on Rosenstoch’s Health Belief Model (1974). Health Belief Model provides a way of understanding and predicting how client behave in relation to the health and how they will comply with health care therapies. The model considers the individuals perception of
susceptibility, modifying factors and likelihood that he/she will take recommended actions.
In this study individual perception refers to patient’s awareness about disease and his own risk of developing complications.
Modifying factors are demographic variables such as age, sex, education, family history, occupation, type of work, dietary pattern, sleeping hours, Body Mass Index, duration of disease, type of oral hypoglycemic agent and duration of drug therapy.
Cues to action refer to symptoms experienced by patients, advices from Diabetologists, health talks and information received from newspaper, radio and television regarding diabetes mellitus.
Pre-assessment of blood glucose is done for both experimental group and control group to compare with post test assessment results after intervention. Patients of experimental group were given fenugreek powder along with oral hypoglycemic agents whereas control group received only oral hypoglycemic agents.
The post test assessment reveals that there is significant reduction in fasting blood glucose level of experimental group due to adjunct fenugreek powder intake as compared to control group who received oral hypoglycemic agent alone.
Likelihood of action is continuous intake of fenugreek powder along with oral hypoglycemic agent by experimental group perceiving the benefits of fenugreek powder in maintaining fasting blood glucose level.
Individual Perception
Modifying factors
Likelihood of action
Patients know that they have diabetes and the
risk of developing complications
Demographic variables Educational status, Occupation, Type of work, Dietary pattern Sleeping hours,
Type of oral hypoglycemic agent,
Duration of drug therapy Body mass index
Perceived threat to disease Patients
? experienced symptoms of hyperglycemia
? attended health talks at diabetic centre during each visit
? reminded about disease severity and complications by Diabetologists
? got information’s from newspaper, radio and television
P R E T E S T
Experimental Group Explained benefits of adjunct treatment
with fenugreek and Pre assessment of fasting blood glucose level
Control group Pre assessment of
fasting blood gluc ose level
Oral hypoglycemic
agent
&
Fenugreek intake as per
instructions
Oral hypoglycemic
agent
P O S T
T E S T
Significant Reduction in
fasting blood glucose
level
&
Patients expressed willingness to continue the adjunct treatment
No significant
change in fasting
blood glucose
level Assessment of fasting
blood glucose level by Glucometer
FIGURE-1.1: CONCEPTUAL FRAM E WORK BASED ON ROSENSTOCH’S HEALTH BELIEF MODEL (1974)
Summary
This chapter dealt with introduction, need for the study, statement of the problem, objectives, hypotheses, operational definitions, assumptions, delimitations, projected outcome and conceptual framework.
CHAPTER II
REVIEW OF LITERATURE
Literature review involves the systematic identification, location, scrutiny and summary of written material that contains information on a research problem. It provides basis for future investigations , justifies the need for the study, throws light on the feasibility of the study.
This chapter attempts to present a review of studies done, methodology adopted and conclusion attained by earlie r investigator, which helps to study the problem in depth. The sources to obtain more information on the selected topic were textbook, published journal, editorials, conference proceeding, published, unpublished thesis and internet search.
The available literature was organized under following headings:
? Literature related to Type 2 Diabetes-Mellitus
? Literature related to Effectiveness of Fenugreek in reduction of blood glucose level
Literature related to Type 2 Diabetes Mellitus
Plamen Penev, (2008) conducted a controlled trial study at University of Chicago on effect of insufficient sleep on blood sugar level, where a group of healthy middle aged men and women were included. Here researcher observed two controlled 14 day periods of sedentary living with free access to food and 5.5 or 8.5 hour bedtimes. When the subjects had their bedtimes decreased from 8.5 hours to 5.5 hours, they showed changes in sugar test. The findings of the study revealed that the unhealthy aspects of lifestyle combined with reduced duration of sleep, increase risk of developing diabetes as a result of increased insulin resistance.
Meena Verma, (2006) has done an experimental study to assess the effect of increasing duration of type 2 diabetes mellitus on insulin sensitivity at MY Hospital, Indore. The study comprised of 76 subjects, divided into 3 groups based on difference in duration of diabetes 1 year, 2-5 year and more than 5 year old diabetic patients. The insulin level and HbA1c level increased with duration of diabetes with mean value of 10.0 ± 2.9, 18.4 ± 3.2, 25.95 ± 3.8 consecutively , which proved that insulin resistance increased with duration of diabetes mellitus.
Mohan, (2006) reported in his longitudinal population based study regarding incidence of diabetes mellitus in selected urban South Indian population that the incidence rate of diabetes mellitus was 20-22 per 1000 person per year.
Francine Ratner Kaufman, (2006) conducted a descriptive survey on type 2 diabetes mellitus in children and young adult and found that type 2 diabetes mellitus has changed from a disease of our grandparents and parents to a disease of children.
Results showed the influence of hereditary component of diabetes mellitus as most of the children with type 2 diabetes mellitus had a family member with type 2 diabetes mellitus. About 45-80% children had a parent with type 2 diabetes mellitus and 74- 90% reported at least one affected first or second degree relative.
Montgomen, et.al, (2005) conducted a cohort study at National Public Health Institute, Finland with the objective to predict relation between type 2 diabetes mellitus and different foods. The samples were chose from 30 different communities of Finland. A total of 4304 non diabetic men and women of 40-59 years participated in the study. The study findings showed reduced risk associated with higher the intake of green leafy vegetables, fruits, and berries and suggested consumption of high fiber diet for prevention of diabetes mellitus.
Almada, e t.al, (2005) conducted a study in Denmark to investigate the prevale nce of type 2 diabetes mellitus. Samples were selected randomly. The findings of the study revealed that men have higher fasting blood glucose and triglyceride level as compared to women. Hence men are more at risk of developing diabetes mellitus.
Hu.G.Lindstorm, (2004) conducted a prospective study to find association between obesity, BMI and risk of type 2 diabetes mellitus at Department of Epidemiology and Health Promotion, Finland. The researcher followed 2017 men and 2352 women aged between 45and 64 years without a history of diabetes .Single and joint association of physical activity, body mass index and blood glucose level with risk of type 2 diabetes were examined using Coz proportional hazards models.
During a mean follow up of 9.4 years, there were 120 incident cases of type 2 diabetes mellitus which showed the multivariate adjusted positive association between BMI and the risk of type 2 Diabetes Mellitus. The study concluded that BMI and obesity are critical factors in diabetes prevention.
Nojiman , e t.al, (2003) assessed the effectiveness of aerobic exercise training on oxidative stress among patients with type 2 diabetes mellitus at Japan. The purpose of the study was to determine whether moderate intensity exercise training reduces oxidative stress in patients with type 2 diabetes mellitus over 12 month. The findings showed aerobic exercise training improved glycemic control and reduced oxidative stress in patient.
Eve Van Cauter, (2003) conducted a study includin g 27 healthy, non obese adults aged 23-42 years at Endocrinology Section of the Department of Medicine at the University of Chicago. Out of 27 participants, 14 were “normal” sleepers , whose average week day sleep duration was under 7.5-8.5 hours, while 13 were chronic
“short” sleepers, who sleep below 6.5 hours per week day at an average. The
participants were monitored for 8 consecutive nights and their sleep was recorded.
Over the course of study, the short sleepers averaged 5 hours and 16 minutes per night while the normal sleepers averaged 8 hours of sleep per night. On the final day glucose tolerance test revealed that insulin sensitivity in the short sleeper was almost 40% lower than normal sleeper which revealed that chronic sleep curtailment impairs the ability of insulin responsiveness.
National Urban Diabetic Survey Report, (2003) revealed that the incidence rate of diabetes mellitus was 57.2 per1000population per year which ranged from 35.8 per 1000 per year to 87.3 per 1000 per year. The prevale nce rate is increased to 14 from 7.4.
Barnard, e t.al, (2002) has written an article regarding the effect of vegetarian diet without a weight loss and exercise component. She described that there is significantly greater weight loss and decreased cholesterol level reported in patients on vegetarian diet. On positive side avoiding these risk factors one can lead a healthy life without diabetes mellitus.
M.Van Dam, (2002) conducted a study in United States to find out the role of diet in the development of type 2 diabetes mellitus. Prospective cohort study design was adopted and 42,504 male health professionals without any associated illness were included in this study. During 12 years of follow up, the researcher documented 1321 cases of type 2 diabetes mellitus. The findings of the study suggested that a western dietary pattern is associated with a substantially increased risk for type 2 diabetes mellitus in men.
Jean Francois Yale, (2001) in a randomized double blind placebo controlled trial study evaluated the effect of thiazolidinediones on HbA1C level in patients treated with maximum tolerated doses of sulfonylureas and metformin.The setting of
the study was 16 outpatient clinic in Canada, 200 patients with type 2 diabetes mellitus had been selected. The findings of the study revealed that thiazolidinediones 400mg per day, when added to sulfonylurea and metformin, significantly decreased HbA1C level insulin resistance at p<0.001. Thiazolidinediones may therefore offer an effective alternative to patients treated with sulfonylureas and metformin to achieve glycemic control.
Madras Diabetes Research Centre, (2000) conducted a study on a group of 10000 consecutive diabetic patients visiting this centre during a three year period found that 545 patients were young diabetic defined as those with an age at diagnosis of 30 years or less . Out of total 545 young diabetic patients, 314 (57.7%) were classified as Non Insulin Dependent Diabetes Mellitus patients and 119((22%) as Insulin Dependent Diabetes Mellitus and remaining as Maturity related Diabetes Mellitus patients.
Literature related to Effectiveness of Fenugreek in reduction of blood glucose level
Central Drug Research Institute, (2010) conducted a study regarding properties of fenugreek. The report confirms that anti hyperglycemic and anti dyslipidemic properties of fenugreek is due to 4-hydroxyisoleucine an unusual amino acid. The result indicate that 4-hydroxyisoleucine exhibits significant potential as an anti-diabetic agent by suppressing progression of type 2 diabetic states that is suggested by enhancement of insulin sensitivity and glucose uptake in peripheral tissues.
Kassaian, (2009) conducted a clinical trial with 24 type 2 diabetic patients.
The patients were given 10 grams /day powdered fenugreek mixed with yoghurt for three months. Findings showed that fasting blood glucose decreased up to 25% -30%.
The study concluded that fenugreek powder is an effective measure to keep the blood glucose level under control.
Analava Mitra, e t.al, (2006) conducted an evaluative study to assess the effectiveness of fenugreek among type 2 diabetic mellitus patients in rural Bengal.
The study included 50 type 2 diabetic patients .The result showed a significant decline in fasting blood glucose level and decline correspond to the dose of fenugreek. In patients receiving 25 gm of fenugreek blood glucose was lowered by 15 mg/dl whereas patients receiving 50gm of fenugreek blood glucose reduced by 20 mg/dl.
Janice Kumar, (2005) says that the ancient Ayurveda and folk writings of India too look for some herbal cures for mild cases of diabetes mellitus. Herbs found to be effective against diabetes. Fenugreek is an effective curative herb for this problem. A table spoonful of fenugreek leaf juice taken early in the mor ning for about three months has been found to cure early stages of diabetes mellitus. The powder of fenugreek seeds taken twice a day with curd is also effective to find positive results.
Srinivasan, (2005) conducted a review in Department of Central Food Technological Research Institute, Mysore regarding diet as a cornerstone in the management of diabetes mellitus. Spices are the common dietary adjunct that contributes to the taste and flavor of foods. Besides, species are also known to exert several beneficial physiological effects including the anti-diabetic influence. This review considers all the available information, where spices, their extracts or their active principles were examined for treatment of diabetes. Among the spices, fenugreek seeds have been experimentally documented to possess antidiabetic property.
Shekelle et.al, (2005) conducted a study in Southern California Evidence Based Practice centre, USA, to evaluate and synthesize the evidence on the effect of Ayurvedic therapies for diabetes-mellitus. The study design was a systemic review of trials. The result of the study was that certain herbs G.Sylvestre, C.Indica, Fenugreek and Eugenia jambolana were effective in controlling diabetes when used for Ayurvedic treatment.
Kaviarasan.S, et.al, (2004) conducted a study in Annamalai University, Tamilnadu to evaluate the protective effect of a polyphenol rich extract from the seeds of fenugreek against hydrogen peroxide induced oxidation in normal and diabetic human erythrocytes. Red Blood Cells incubated with increasing amounts of fenugreek seeds extract and challenged with hydrogen peroxide were analyzed for hemolysis and lipid per oxidation. Red Blood Cells from diabetic subjects were more susceptible to oxidative hemolysis and lipid per oxidation than those from normal subjects. Pre oxidation with polyphenol rich extract significantly reduced the oxidative modifications in both the groups. The findings demonstrate the potent antioxidant properties of fenugreek seeds.
Cicero , et.al, (2003) distributed a questionnaire to all herbalist asking information about the herbal remedy and dietary supplement to control hyperglycemia. Fenugreek was among ten more frequently suggested herbal remedies.
Gupta.A, et.al, (2001) in quasi experimental study including 25 newly diagnosed patients with type 2 diabetes mellitus with fasting blood glucose less than 200 mg/dl. The first group of 12 patients were given fenugreek seed powder and rest 13 were assigned to control group. The mean fasting blood glucose after 2 months for experimental and control group were 137.5 ± 41.1 and 148.3 ± 44.1.This proved that
the adjunct use of fenugreek seeds improves glycemic control and decrease insulin resistance in mild type 2 diabetes mellitus.
Sharma, e t.al, (2000) conduc ted a prospective one arm study of dietary fenugreek in 60 patients with type 2 diabetes mellitus of different severity levels.
Among these 40 patients were taking oral hypoglycemic drugs. Each subject underwent 7days of control diet followed by 4 weeks of 25 gm fenugreek seed powder intake in a soup. Diet of each patient was similar in calorie and nutrient composition except for higher fiber content in fenugreek diet. Mean blood glucose level decreased from baseline 241 to 199 mg/dl and 179 to 149 mg/dl as an average.
Prasanna, (2000) conducted a clinical study in University of Hyderabad to find out the hypolipidemic effect of fenugreek in hypercholestrolaemic patients.
Fenugreek seeds were powdered and used for study. The patient’s were divided into three groups of six each as followed group – I received placebo 50 grams (rice powder and Bengal gram powder in equal measures).Group II received placebo 25 grams and 25 grams fenugreek. Group III, received fenugreek 50 grams. The results revealed, there was no significant change in lipid profile of group I pa tient in group II and group III, serum cholesterol triglyceride and Very Low Density L ipoprotein levels were significantly decreased when compared to group I. Fenugreek powder given orally before food in 25 grams and 50 grams doses twice a day may have hypolipidemic effect in hypercholestrolaemic patients. The study concluded that fenugreek has a hypolipidemic effect and can be used to reduce blood cholesterol.
Sowmya, e t.al, (2000) conducted a study in the A.N.G.R. Agriculture University, Hyderabad to evaluate the effectiveness of germinated fenugreek seeds on serum cholesterol. 20 adults of both sexes at the age group of 50-60 years were selected. Subjects were divided into two groups and were given 12.5 grams and 18.5
grams of germinated fenugreek powder for a period of one month. The findings revealed that the group consumed 18.5 grams of germinated seeds presented significant reduction of total cholesterol and Low Density L ipoprotein level.
Summary
In this chapter the investigator has discussed about literature related to type 2 diabetes mellitus and effectiveness of fenugreek on blood glucose level.
CHAPTER III METHODOLOGY
This chapter describes the methodology adopted to assess the effectiveness of fenugreek powder in reducing fasting blood glucose level among patients with type 2 diabetes mellitus.
Research Approach
Quantitative Evaluative Research Approach was adopted for the study.
Research Design
The research design adopted for this study was Quasi Experimental pre and post test Design. The design can be represented as,
E = O1 X O2
C = O1 O2
E = Experimental group consists of 30 patients with Type 2 Diabetes Mellitus.
C = Control group consists of 30 patients with Type 2 Diabetes Mellitus.
O1= Pre test assessment of fasting blood glucose level with glucometer X = Oral administration of fenugreek powder
O2 = Post test assessment of fasting blood glucose level with glucometer
Fig -3.1: Schematic Representation of Research Methodology Sample and sample size
Patients with type 2 diabetes mellitus visiting selected diabetic centres and meeting inclusion
criteria
Experimental group n=30 Control group n = 30
Setting
Experimental group - M.G.Diabetic Centre Control group - Sushrutha Diabetic Centre
Post Assessment of Fasting Blood Glucose Data Collection
Experimental Group
Assessment of fasting blood glucose level Administration of 25gm fenugreek
powder twice a day
Data Analysis and Interpretation Descriptive and inferential statistics
Control Group Assessment of fasting
blood glucose level Research Approach
Quantitative Evaluative Approach Research Design
Quasi experimental Pre and Post test Design
Sampling technique Nonprobability convenience
Population
Patients with type 2 diabetes mellitus in Salem
Population
The population of this study comprises patients with type 2 diabetes mellitus in Salem. The total number of patients visiting M.G.Diabetic Centre per day is 40-50 and Sushrutha diabetic center are 15-20.
Description o f the Setting
The investigator selected M.G. Diabetic Centre for experimental group and Sushrutha Diabetic Centre for control group. M.G.Diabetic Centre and Sushrutha Diabetic Centre are 10-15 km. away from Sri Gokulam College of Nursing. The setting was selected on the basis of geographical proximity, availability of patients, economy of time and money, access and feasibility in terms of co-operation by the Diabetologists.
Sampling
? Sample
The sample of this study comprises of patients with type 2 diabetes mellitus visiting these diabetic centres, Salem during the study period and those met sampling criteria.
? Sample size
The investigator selected 60 patients with Type 2 diabetes mellitus.
Among them, 30 patients of M.G.Diabetic Centre were assigned to experimental group and other 30 patients of Sushrutha Diabetic Centre were assigned to control group.
? Sampling technique
Non Probability Convenience Sampling Technique was used in this study.
? Criteria for sample selection
The sample selection is based on following inclusion and exclusion criteria.
Inclusion criteria :
? Patients with type 2 diabetes mellitus receiving Oral Hypoglycemic Agent.
? Patients who are willing to participate in the study.
? Patie nts available during data collection period.
Exclusion criteria :
? Patients on anticoagulant therapy.
? Patients with any other adjunct treatment.
Variables
Independent variable: Fenugreek powder
Dependent variable : Fasting Blood glucose level Description of the Tool
It consists of following sections:
Section-A
A structured interview schedule was used to collect information regarding demographic data such as age, sex, family history of diabetes mellitus, type of work, dietary pattern, duration of diabetes mellitus, type of oral hypoglycemic agent, duration of drug therapy and body mass index.
Section-B
Assessment of fasting blood glucose level by using glucometer. Glucometer is a standardized electronic instrument to measure level of glucose in blood. According to the reading of glucometer, the patients were classified into various categories of hyperglycemia. According to the categories the scores were given.
Table 3.1- Interpretation of scoring procedure
Observation Blood glucose value(mg/dl) Score
Normal 70-110 0
Mild Hyperglycemia 111-180 1
Moderate hyperglycemia 181-250 2
Severe hyperglycemia 251-320 3
Very severe hyperglycemia Above 320 4
Validity
Validity of the tool was obtained from 4 experts from Medical Surgical Nursing, 2 from Community Health Nursing, 1 Diabetologists, 1 Physician and 1 Dietitian.
Reliability
Fasting blood glucose level was measured using standardized glucometer.
Manufacturer’s instructions were followed while operating the device.
Pilot Study
Pilot study was conducted to find out the feasibility of the study. A formal permission was obtained from the concerned authority of the diabetic centre. It was conducted with a sample size of 6 patients with Type 2 diabetes mellitus, 3 from SKS Diabetic Centre assigned to experime ntal group and 3 from Agraharam diabetic centre selected for control group. The collected data was analyzed by using descriptive and inferential statistics. The pilot study revealed that the tool is feasible and practicable.
Method of Data Collection Ethical consideration:
Prior to collection of data written permission was obtained from the managing director of M.G.Diabetic Centre and Sushrutha Diabetic Centre, Salem.
Informed consent was obtained from patients.
Procedure :
The data was collected over a period of 4 weeks from 05.07.2010 to 01.08. 2010. In first week the investigator selected 30 samples for experimental group from M.G.Diabetic Centre and 30 samples for control group from Sushrutha Diabetic Centre. First the investigator introduced her self to the patients and explained the purpose of the study. After obtaining the consent the investigator checked the fasting blood glucose level using glucometer on first day and provided 42 packs of 25 gm fenugreek powder to patients of experimental group with instruction regarding intake of fenugreek powder with butter milk or water before lunch and dinner. A data sheet was given to the patients of experimental group, to maintain regarding intake of fenugreek powder. The investigator did the follow up through home visit and phone calls. For the control group patients , the investigator assessed the fasting blood glucose level on first day and advised to continue the prescribed treatment. Post test fasting blood glucose level was assessed using glucometer on 22nd day for both experimental and control group. The collected data was analyzed by using descriptive and inferential statistics.
Plan for Data Analysis
Descriptive statistics (frequency, percentage, mean &, standard deviation) will be used to assess the fasting blood glucose level. Inferential statistics of ‘z’ test will be used to find out the effectiveness of fenugreek powder and Chi-square test will be
used to find out the association between the blood glucose level and their selected demographic variables.
Summary
This chapter dealt with research approach, research design, population, description of setting, sampling, variables, description of tool, validity and reliability, pilot study, data collection procedure and plan for data analysis.
CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
This chapter describes analysis and interpretation of data collected to evaluate the effectiveness of fenugreek powder on fasting blood glucose level among patient with type 2diabetes mellitus. The collected data was organized, tabulated and analyzed by using descriptive and inferential statistics as follows.
Section- A Distribution of patients with Type 2 diabetes mellitus according to the demographic variables.
Section-B a. D istribution of patients with Type 2 diabetes mellitus according to the existing fasting blood glucose level.
b. Distribution of patients with Type 2 diabetes mellitus according to post test fasting blood glucose level.
Section-C a. Comparison of pre and post test fasting blood glucose level among patients with type 2 diabetes mellitus in experimental and control group.
b. Comparison of mean, Standard deviation, and mean difference of fasting blood glucose level among patients with Type 2 diabetes mellitus in experimental and control group.
Section-D Hypotheses Testing
a. Effectiveness of fenugreek powder on fasting blood glucose level among patients with Type 2 diabetes mellitus.
b. Association of the fasting blood glucose level of patients with Type 2 diabetes mellitus in experimental and control group with their selected demographic variables in experimental and control group.
Section-A
Distribution of Patients with Type 2 Diabetes Mellitus of Experimental and Control Group According to Their Demographic Variables
Table -4.1
Frequency and percentage distribution of patients with type 2 diabetes mellitus according to their biographic variables
n=60 Experimental Group
(n=30)
Control group (n=30) S.
No . Demographic variables
f % f %
Age in years
? 30-40years 10 33.33 6 20
? 41-50years 8 26.67 10 33.33
? 51-60years 4 13.33 6 20
1
? 61-70years 8 26.67 8 26.67
Sex
? Male 22 73.33 17 56.67
2
? Female 8 26.67 13 43.33
Educational status
? No formal education 10 33.33 7 23.33
? Primary school 6 20 9 30.00
? High school 5 16.67 7 23.33
? Higher secondary school 6 20 4 13.34
? Diploma 3 10 - -
? Graduate - - 2 6.67
3
? Post graduate - - 1 3.33
Occupation
? Home maker 8 26.67 11 36.67
? Government employee 6 20 2 6.67
? Private employee 6 20 6 20
? Self employment 6 20 9 30
4
? Retired 4 13.33 2 6.66
Table 4.1 represent that in experimental group 10 (33.33%) patients with type 2 diabetes mellitus were between 30-40 years and in control group 10 (33.3%) belong to age group of 41-50 years, 22(73.33%) of experimental group and 17(56.6%) of control group were males, 10(33.33%) of experimental group had no formal education whereas in control group 9(30%) completed primary school, 8 (26.67%) of experimental group and 11(36.67%) of control group were home maker
Table -4.2
Frequency and percentage distribution of patients with type 2 diabetes mellitus according to associated risk factors related variables
n=60 Experimental
group (n=30)
Control group (n=30) S.
No . Associated risk factor related variables
f % f %
Family history of diabetes mellitus
? No family history 5 16.67 6 20
? First degree relative 22 73.33 21 70
1
? Second degree relative 3 10 3 10
Type of work
? Sedentary 19 63.33 12 40
? Moderate 9 30 16 53.33
2
? heavy 2 6.67 2 6.67
Dietary pattern
? Vegetarian 6 20 9 30
? Lacto vegetarian 14 46.67 13 43.33
? Ovo vegetarian 8 26.67 4 13.33
3
? Non vegetarian 2 6.66 4 13.34
Sleeping hours per day
? Below 6 hours 20 66.67 16 53.33
? 6-7 hours 8 26.67 12 40
4
? 8-9 hours 2 6.66 2 6.67
Body Mass Index
? 18.5-24.9(normal ) 13 43.33 13 43.33
? 25-29.9(overweight) 16 53.33 13 43.33
5
? 30-34.9(obesity grade I) 1 3.34 4 13.34
Table 4.2 represent that in experimental group 22(73.33%) and in control group 21(70%) possess family history of first degree relative, 19(63.33%) patients of experimental group were sedentary worker whereas in control group 16(53.33%)were moderate worker, 14 (46.67%) of experimental group and 13(43.33%) of control group were lacto-vegetarian, 20 (66.67%) of experimental group and 16 (53.33%) of control group had a sleeping pattern of less than 6 hours per day, and 16 (53.33%) of experimental group and 13(43.33%) of control group were found to be overweight with Body Mass Index of 25-29.9.
Table -4.3
Frequency and percentage distribution of patients with type 2 diabetes mellitus according to illness related variables
n=60 Experimental
group (n=30)
Control group (n=30) S.
No . Illness related variables
f % f %
Duration of diabe tes mellitus
? Less than one year 6 20 6 20
? 1-3 years 10 33.33 12 40
? 4-6 years 5 16.67 6 20
1
? More than 6 years 9 30 6 20
Type of oral hypoglycemic agent receiving
? sulfonylurea 26 86.67 23 76.67
2
? Biguanides 4 13.33 7 23.33
Duration of drug therapy for diabetes mellitus
? Less than one year 8 26.67 8 26.67
? 1-5 years 16 53.33 18 60
3
? More than 5 years 6 20 4 13.33
Table 4.1 represent that in experimental group 10(33.33%) and in control group 12(40%) were suffering form diabetes mellitus for1-3 years, 26 (86.67%) of experimental group and 23(76.67%) of control group were consuming sulfonylurea, 16 (53.33%) of experimental group and 18(60%) of control group were under drug therapy for last 1-5 years.
Section - B
Distribution of Patients with Type 2 Diabetes Mellitus according to The Existing Fasting Blood Glucose Level
23.33%26.66%
73.33%
63.33%
3.33%
10%
0 10 20 30 40 50 60 70 80 90 100
Percentage of patients
Mild Hyperglycemia Moderate Hyperglycemia Severe Hyperglycemia FASTING BLOOD GLUCOSE LEVEL IN PRE-TEST OF EXPERIMENTAL AND
CONTROL GROUP
Experimental group Control group
Fig -4.1 Percentage distribution of patients with type 2 diabetes mellitus according to their existing fasting blood glucose level
The above figure represents the overall pre-test fasting blood glucose level.
None of them had very severe hyperglycemia in experimental and control group.
None of them had normal fasting blood glucose level in experimental and control group, whereas 7(23.33%) in experimental group and 8(26.66%) in control group had mild hyperglycemia, 22( 73.33%) in experimental group and 19( 63.3% ) in control group had moderate hyperglycemia whereas 1(3.3%) in experimental group and 3(10%) in control group had severe hyperglycemia.
Distribution of Patients with Type 2 Diabetes Mellitus according to The Post-test Fasting Blood Glucose Level
6.66%
0%
76.66%
46.66%
13.33%
43.33%
3.33% 10%
0 10 20 30 40 50 60 70 80 90 100
Percentage of patients
Normal Mild
hyperglycemia
Moderate hyperglycemia
Severe hyperglycemia
FASTING BLOOD GLUCOSE LEVEL IN POST-TEST OF EXPERIMENTAL AND CONTROL GROUP
Experimental group Control group
Fig -4.2: Percentage distribution of patients with type 2 diabetes mellitus according to the post test fasting blood glucose level
The above figure represents the overall post-test blood glucose level. None of them had very severe hyperglycemia in experimental and control group.
In experimental group 2(6.66%) had normal blood glucose level, 23(76.66%) in experimental group and 14(46.66% ) in control group had mild hyperglycemia, 4(13.33%) in experimental group and 13(43.33%) in control group had moderate hyperglycemia whereas 1(3.3%) in experimental group and 3(10%) in control group had severe hyperglycemia.
Se ction –C
Comparison of pre and post test fasting blood glucose level among patients with type 2 diabetes mellitus in experimental and control group
Table 4.4
Frequency and percentage distribution of pre and post test fasting blood glucose level among patients with type 2 diabetes mellitus in experimental and control group
n=60 Experimental group
(n=30)
Control group (n=30)
Pre test Post test Pre test Post test Blood glucose
level
f % f % f % f %
Normal - - 2 6.66 - - - -
Mild 7 23.3 23 76.66 8 26.6 14 46.66
Moderate 22 73.3 4 13.33 19 63.3 13 43.33
Severe 1 3.3 1 3.33 3 10 3 10
Very severe - - - -
The above table shows that, in experimental group during pre test, 22 (73.3%) of patients had moderate hyperglycemia, 7(23.3%) ha d mild hyperglycemia, 1(3.3%) had severe hyperglycemia and in control group 19 (63.3%) of patients had moderate hyperglycemia, 8(26.6%) had mild hyperglycemia, 3(10%) had severe hyperglycemia while during post test in experimental group 23(76.66%) had mild hyperglycemia, 4(13.33%) had moderate hyperglycemia, 1(3.33%) had severe hyperglycemia and 2(6.66%) had normal blood glucose level and in control group 14(46.66%) had mild hyperglycemia, 13(43.33%) had moderate hyperglycemia, 3(10%) had severe hyperglycemia. This shows that there was significant reduction in fasting blood glucose level in experimental group after administration of fenugreek powder.
Table -4.5
Comparison of mean, standard deviation and mean differences of pretest and post test fasting blood glucose level among patients with type 2 diabetes mellitus in experimental and control group
n=60 Pre test Post test
Groups
Mean SD Mean SD
Mean Difference
Experimental group (n=30)
181.16 29.68 169.17 28.78 11.99
Control group (n=30)
193.36 28.68 189.2 28.69 4.16
Table 4.4 shows that in experimental group the pre test mean score was 181.16
±29.68 while post test mean score was 169.17± 28.78 and the mean difference was 11.99. In control group the pretest mean score was 193.36±28.68 whereas post test mean score was 189.2±28.69 and the mean difference was 4.16. This shows that the intervention was effective in reducing fasting blood glucose level in patients with type 2 diabetes mellitus.
Section D Hypotheses Testing Table -4.6
Effectiveness of fenugreek powder on fasting blood glucose level among patients with type 2 diabetes mellitus in experimental and control group
n=60 Post test
Groups
Mean SD
‘z’ value
Experimental Group (n=30) 169.17 28.78
Control Group (n=30) 189.2 28.69 2.7*
Table value=1.96;* Significant at p<0.05 level
Table 4.5 represents the overall post test fasting blood glucose level of experimental and control group patients. For the experimental group the mean post test score was 169.17?28.78 where as in the control group the mean post test score was 189.2?28.69. The calculated ‘z’ value (2.7) at p<0.05 level is greater than table value (1.96). Hence the research hypothesis H1 is retained. It was evident that fenugreek powder was effective in reducing fasting blood glucose level among type 2 diabetic patients.
Table -4.7
Association between the pre test fasting blood glucose level among patients with Type 2 diabetes mellitus and their selected demographic variables in experimental and control group.
n=60 Experimental group
(n=30)
Control group (n=30) S.
No. Demographic variables
df ?2 Table
value
df ?2 Table
value
1 Age in years 6 4.699 12.0 6 6.465 12.0
2 Sex 2 1.532 5.99 2 0.281 5.99
3 Family history of diabetes mellitus
4 9.483 9.49 4 6.187 9.483
4 Type of work 4 7.233 9.49 4 3.827 9.49
5 Dietary pattern 6 3.904 12.0 6 7.500 12.0
6 Sleeping hours per day 6 3.926 12.0 4 5.553 9.49
7 Body mass index 4 6.101 9.49 4 6.874 9.49
8 Duration of diabetes mellitus
6 4.140 12.0 6 16.473* 12.0
9 Type of oral
hypoglycemic agent receiving
2 2.698 5.99 2 3.192 5.99
10 Duration of drug therapy for diabetes mellitus
4 2.338 9.49 4 12.091* 9.483
* Significant at p<0.05 level
In experimental group, there is no significant association between the fasting blood glucose level and the demographic variables .Hence the research hypothes is H2
is rejected .
In control group, there is no significant association between the fasting blood glucose level and the demographic variables .except duration of diabetes mellitus and
duration of drug therapy. Hence the research hypothesis H2 is retained with respect to duration of diabetes mellitus and duration of drug therapy.
Summary
This chapter dealt with data analysis an interpretation in the form of statistical values based on the objectives, frequency and percentage of fasting blood glucose level among patients with type 2 diabetes mellitus and their selected demographic variables. The ‘z’ test was used to evaluate the effectiveness of fenugreek powder on fasting blood glucose level. The Chi-square analysis was used to find out the association between the fasting blood glucose level among patients with type 2 diabetes mellitus and their selected demographic variables.
CHAPTER V DISCUSSION
This aim of present study was to evaluate the effectiveness of Fenugreek powder on fasting blood glucose level among patients with type 2 Diabetes Mellitus attending selected Diabetic centre, Salem.
Demographic Variables
? In experimental group and control group 10(33.33%) patients were in age group of 30-40 years and 41-50 years.
? Majority 22(73.33%) and 17(56.67%) of patients in experimental and control group were male .
? In experimental group 10(33.33%) had no formal education whereas in control group 9(30%) of patients completed primary school.
? In experimental group and control group 8(26.67%) and 11(36.6%) of patients were home maker.
? In experimental group and control group 22(73.33%) and 21(70%) possess first degree relative with diabetes mellitus.
? In experimental group 19(63.33%) were sedentary worker and in control group 16(53.3%) were moderate worker.
? In experimental group and control group 14(46.6%) and 13(43.3%) patients were lacto vegetarian.
? In experimental group 20(66.6%) and control group 16(53.3%) were having sleeping pattern of less than 6 hours.
? In experimental group and control group 16(53.3%) and 13(43.3%) were found to be overweight according to their Body Mass Index.
This finding of the present study was supported by a study conducted by Janine Janosky and Silva Asslanjan , (2005) which revealed that 86% of patients with type 2 diabetes mellitus were overweight as per the Body Mass Index (25-29.9).
Assessment of fasting blood glucose level among patients with Type 2 diabetes mellitus
In experimental group during pre test 73.3% patients had moderate hyperglycemia, 23.3% had mild hyperglycemia and 3.3% had severe hyperglycemia.
In control group 63.3% patients had moderate hyperglycemia , 26.6% had mild hyperglycemia and 10% had sever e hyperglycemia.
Researcher felt that majorit y of patients were having high fasting blood glucose level. A need was felt to incorporate adjunct treatment with drug therapy to maintain blood glucose level.
Effectiveness of fenugreek powder in reducing fasting blood glucose level among patients with Type 2 diabetes mellitus
Figure-4 represents that during post test 23(76.66%) patients had mild hyperglycemia, 4(13.33%) had moderate hyperglycemia, 2(6.66%) had normal blood glucose level and 1(3.33%) had severe hyperglycemia in experimental group. In control group 14(46.66%) had mild hyperglycemia, 13(43.33%) had moderate hyperglycemia and 3(10%) had severe hyperglycemia.
Table 4.3 shows that the pre test mean score of experimental group was 181.16±29.68. The post test mean score was 169.17± 28.78. In control group the pre test mean score was 193.36±28.68 and the post test mean score was 189.2±28.69. The value is 2.7 which is significant at p<0.05 level, and the research hypothesis H1 is
