A QUASI EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF ROASTED FENUGREEK SEED POWDER ON BLOOD GLUCOSE LEVEL AMONG CLIENT
WITH TYPE – II DIABETES MELLITUS IN SILLUVAMPATTI RURAL AREA AT ERANAPURAM, NAMAKKAL
M.Sc. (NURSING) DEGREE
BRANCH - IV COMMUNITY HEALTH NURSING PGP COLLEGE OF NURSING AND RESEARCH, NAMAKKAL
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
OCTOBER - 2019
A QUASI EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF ROASTED FENUGREEK SEED POWDER ON BLOOD GLUCOSE LEVEL AMONG CLIENT WITH
TYPE – II DIABETES MELLITUS IN SILLUVAMPATTI RURAL AREA AT ERNAPURAM,NAMAKKAL.
____________________ ___________________
INTERNAL EXAMINER EXTERNAL EXAMINER
A QUASI EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF ROASTED FENUGREEK SEED POWDER ON BLOOD GLUCOSE LEVEL AMONG CLIENT WITH TYPE – II DIABETES MELLITUS IN SILLUVAMPATTI RURAL AREA AT ERANAPURAM, NAMAKKAL
Professor in nursing Research : ___________________________
Prof: Mrs. Shenbaga Lakshmi V.M.Sc (N) Principal,
Obstetrics and gynaecological Nursing, PGP College of Nursing & Research, Namakkal.
Research Guide : __________________________
Prof: Mr. Chithravel, V.M.SC (N), Vice – Principalcum HOD,
Community Health Nursing,
PGP College of Nursing & Research, Namakkal.
Medical Expert : ___________________________
Dr. Boopathiraja. S. M.D(S), Ayush Medical Officer,
Govt Upgraded primary health Centre, Ernapuram, Namakkal.
A DISSERTATION SUBMITTED TO THE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE
DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER - 2019
PGP COLLEGE OF NURSING AND RESEARCH
(Affiliated To The Tamilnadu Dr.Mgr Medical University)
KARUR MAIN ROAD, NAMAKKAL-637207, TAMILNADU - 637207.
PHONE : 04286 - 267404
CERTIFICATE
This is to certify that this thesis, A QUASI EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF ROASTED FENUGREEK SEED POWDER ON BLOOD GLUCOSE LEVEL AMONG CLIENT WITH TYPE – II DIABETES MELLITUS IN SILLUVAMPATTI RURAL AREA AT ERNAPURAM, NAMAKKAL submitted by AMALADEVI.M II Year M.Sc. NURSING, PGP College of Nursing and Reasearch in Partial fulfillment of the requirement for the degree of master of science in Nursing under the Tamilnadu Dr.M.G.R Medical University in her original wor carried out under our guidence.
This thesis or any part of it has not been previously submitted for any other Degree or Diploma.
Date:
Place:
Prof:Mrs.V.SHENBAGALAKSHMI H.SC Principal PUP College Nsg & Research Namakkal
DECLARATION
I hereby declare that this thesis entitled is the A QUASI EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF ROASTED FENUGREEK SEED POWDER ON BLOOD GLUCOSE LEVEL AMONG CLIENT WITH TYPE – II DIABETES MELLITUS IN SILLUVAMPATTI RURAL AREA AT ERNAPURAM,NAMAKKAL out come of the original research work undertaken and carried out by me under the guidance and direct supervision of research advisor, and clinical specialty guide PROF. Mr. CHITHRAVEL.V.M.Sc (N) Department of community health Nursing, PGP College of Nursing & Research, Namakkal
I also declare that the material of this thesis has not formed in any way the basis for award of any other Degree, Diploma or Associate fellowship previously of the Tamil Nadu Dr.MGR Medical University
Date : AMALADEVI.M
Place : M.Sc NURSING II YEAR
PGP COLLEGE OF NURSING & RESEARCH
NAMAKKAL
ACKNOWLEDGEMENT
The satisfaction and pleasure that accompany a successful completion of any task would be incomplete without mentioning those people who made it possible to achieve them. I would like to express my deep sense of appreciation and gratitude to the following experts and helping hands.
Great and mighty is the lord, our god to whom all thanks and praise are due for all wisdom, knowledge and strength rendered and for showering upon me his loving mercies, kindness, blessings and abundant grace which strengthen me in each and every step throughout this research and my life.
I am extremely grateful to Dr. Palani G. Periyasamy, M.A, M.A, Ph.D.,(USA), Chairman and correspondent for providing support and required facilities for the successful completion of this study.
It is my privilege to express my sincere gratitude to Mrs. Visalakshi Periyasamy, BBA,Vice – Chairman, PGP COLLEGE OF NURSING AND RESEARCH, NAMAKKAL for providing valuable support and required facilities for the successful completion of this study.
It is sense of honour and pride for me to place on record, my respectful thanks to prof: Mrs.
ShenbagaLakshmi.V.M.Sc(N), Principal, PGP COLLEGE OF NURSING AND RESEARCH, for being an ever continuing and never ending source of inspiration in all my professional activities.
I am immensely indebted to express my sincere gratitude and honour to Prof: Mr. Chithravel.
V.M.Sc(N), Vice – Principal, HOD of community health Nursing, as my guide and begin my research life.
He is a perennial river of innovative ideas. From the beginning to the end of the study he has always been there on any day and any time and helped me in overcoming all difficulties. I owe to express my sincere gratitude for his valuable suggestions, untiring and patient corrections without which this dissertation would not have the present form and shape.
I must record my grateful thanks to Dr. Boopathiraja .S. M.D(S), Ayush medical officer of upgraded govt.primary health centre for their suggestion guidance throughout my study. I owe my sincere thanks to Dr. Suresh. M.D(S),Ayush medical officer, primary health Centre in velayuthampalayam for their valuable suggestions.
My deepest gratitude and immense thanks to Ms.PRASHI ANTONY M.Sc. (N), Asso. professor, Department of Psychiatric Nursing, PGP college of Nursing and reserch, for her immense patients, gentle reminders, timely and guidance throughout the study.
I acknowledge the commendable and meticulous effort of Mr. Karthik.N M.Sc, B.Ed., MCA., M.Phil., M.Sc. (Yoga) Assistant Professor in statistics, for giving necessary guidance for statistical analysis, who allotted time for me whenever I needed his guidance inspite of his busy schedule.
I extend my sincere thanks to all my respectful professors, associate professors and lecturers of PGP COLLEGE OF NURSING AND RESEARCH for this valuable suggestions and guidance during the proposal throughout the study.
My special thanks to librarian and library staffs of PGP COLLEGE OF NURSING AND RESEARCH, NAMAKKAL for extending library facility throughout the study.
I express my heartfelt gratitude to my precious and lovable father
Mr.Muthuveeran.M from the moment I was born, till date he always there for me to guide and care for me at any time. With immense pleasure I would like to single out my lovable husband Mr. Kirubaharan .G, MBA, B.Sc. (FD), for his immense support, courageous words and boundless help. It is very essential to mention his wisdom and helping nature without whom this would have been a dream for me.
My Sincere Gratitude to MR.Rajesh, BCA., Shri Jeyam Computers, Vengamedu, Karur for typing computing and printing.
Last but not the least, I express my thanks to all my colleagues for their constant encouragement, guidance and assistance.
Once again thanks for each other to shared excitement of exploration and the stimulation and mutual esteem associated with the collaboration.
Thanks to all.
ABSTRACT
A QUASI EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF ROASTED FENUGREEK SEED POWDER ON BLOOD GLUCOSE LEVEL AMONG CLIENT WITH TYPE – II DIABETES MELLITUS IN SILLUVAMPATTI RURAL AREA AT
ERNAPURAM,NAMAKKAL
OBJECTIVES OF THE STUDY
1. To assess the pre test level of fasting blood glucose among client with Type II Diabetes Mellitus in experimental and control group.
2. To assess the Post test level of fasting blood glucose among client with Type II Diabetes Mellitus in experimental and control group.
3. To evaluate the effectiveness of roasted fenugreek seed powder on the level of fasting blood glucose among client with Type II Diabetes Mellitus in experimental and control group.
4. To find the association between the fasting blood glucose level and the selected demographic variables before the intervention.
Conceptual frame work : On modified model of Wiedenbach’s helping art
of clinical nursing theory (1964)
Research design : Quasi Experimental Pre and Post test control group design
Type II diabetes mellitus Pretest Intervention Post test Experimental : 01 X 02
Control : 01 - 02
Population : Clients with Type II diabetes mellitus, aged between 31-60 years
Sample size : 60 Type II diabetes mellitus clients, 30 in
Experimental group and 30 in control group
Sampling technique : Silluvampatti rural area at Ernapuram, Namakkal
Tool : Demographic variable and clinical variable Data collection : Quasi experimental, pretest and posttest
Control group design was used. The timing of Data collection was 4 weeks. Roasted fenugreek
seed powder was given t type II diabetes
mellitus clients for 20 days. The level of fasting blood glucose was checked by using
glucometer.
Data Analysis : Descriptive Statistics (numbers, percentage mean and standard deviation)inferential statistics (unpaired 't' test, Paired 't' test and chi-square) were used to test the research hypothesis.
MAJOR FINDINGS OF THE STUDY
1. Experiment group type II diabetes mellitus clients had experienced adequate improvement in fasting blood glucose level. when compared with control group.
2. There was significant difference in the level of fasting blood glucose between control and experimental group. So that the administration of roasted fenugreek seed powder helps to reduce the level of fasting blood glucose among clients with type II diabetes mellitus.
3. There was a significant association between the level of fasting blood glucose
with selected demographic variables in experimental group.
CONCLUSION
Fenugreek had proved its effect on reduction of fasting blood glucose level among clients with type II diabetes mellitus. Proper education should be given to the clients to promote their health and well-being.
TABLE OF CONTENTS CHAPTER
NO CONTETNTS PAGE
NO
I
Introduction Need for the study Statement of the problem Objectives of the study Research hypothesis Operational definition Assumption
Delimitation Projected outcomes Conceptual frame work
II
REVIEW OF LITERATURE
Literature related to incidence and prevalence of type II diabetes mellitus.
Literature related to effectiveness of roasted fenugreek seed powder on level of blood glucose among clients with type II diabetes mellitus.
III
RESEARCH METHODOLOGY Research approach
Research design Variables under study Study settings
Population
Sample and sampling technique Sample size
Sampling criteria
Description of research tool Scoring procedure
Validity and reliability of the tool Pilot study
Data collectin procedure Plan for data analysis
IV Data analysis and interpretation V Result and discussion
VI
Summary, conclusion, findings, implications and recommendations
Summary of the study Significant findings Conclusion
Nursing implications Recommendations References Appendices
LIST OF TABLES
TABLE
NO TITLE PAGE
NO 4.1.1 Frequency and percentage distribution of client with Type II Diabetes mellitus
according to their age
4.1.2 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Gender
4.1.3 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Marital status
4.1.4 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Religion
4.1.5 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Educational Status
4.1.6 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Occupation
4.1.7 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Monthy Income
4.1.8 Frequency and percentage distribution of client with Type II Diabetes mellitus according to Following diabetic diet
4.1.9 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their practicing exercise
4.1.10 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Duration of Illness
4.1.11 Frequency and percentage distribution of client with Type II Diabetes mellitus according to their Family History of diabetes
4.2.1
Frequency and percentage distribution of pretest level of fasting blood glucose among clients with type II diabetes mellitus in the experimental and control group
4.3.1
Frequency and percentage distribution of post test level of fasting blood glucose among clients with type II diabetes mellitus in the experimental and control group
4.4.1
Comparison of frequency and percentage distribution of pre and post test level of fasting blood glucose score among clients with type II diabetes mellitus in experimental group and control group
4.4.2
Comparison of mean score, standard deviation, mean difference and paired‘t’
value of the pretest and post test level of blood glucose in experimental group
4.4.3 Comparison of pretest and post test level of fasting blood glucose in Control group
4.4.4 Comparison of post test fasting blood glucose level between experimental and Control group
5.1.1
Association between the post test levels of fasting blood glucose among client with Type II Diabetes Mellitus with their selected demographic variables in experimental group
LIST OF FIGURES
FIGURE
NO TITLE PAGE
NO 1. Conceptual framework - widenbach's helping art of clinical nursing theory (1964)
2. Schematic representation of Research Methodology
3. Percentage Distribution of Clients with Type II Diabetes according to their sex 4. Percentage distribution according to their marital status
5. Percentage distribution of clients wit type II Diabetes Mellitus according to their Religion
6. Percentage of clients with type II Diabetes according o their educational status 7. Percentage Distribution of clients with type II diabetic according to their
Following diabetic diet
8. Percentage distribution of clients with Type II Diabetic according to their duration illness.
9. Percentage Distribution according to their Family History of Diabetes.
10. Percentage distribution of clients with type II Diabetic pretest level of fasting blood glucose level
11. Percentage distribution of Type II Diabetic Clients according to their post test level of fasting blood glucose level
12. Percentage distribution of Fasting blood glucose level of clients wit type II Diabetes Mellitus preand post test in experimental and control group
LIST OF APPENDIX
APPENDIX TITLE PAGE. NO
I
Letter Seeking experts opinion for content validity of tool
II List of experts opinion for content validity of Research tools
III Letter Seeking Permission to conduct a study
IV
Tools (English)
Part – A : Demographic Variables Part – B : Clinical Variables
( Blood glucose Assessment by using glucometer)
IV (B)
Tools ( Tamil)
Part – A : Demographic Variables Part – B : Clinical Variables
( Blood glucose Assessment by using glucometer)
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CHAPTER –I
CHAPTER -- I INTRODUCTION Background of the Study
Good health is a pre requisite of human productive and development process. In the past most individuals and societies viewed good health or wellness as the opposite or absence of disease. Health is a multidimensional concept and must be viewed from broader perspective.
An assessment of the client‟s state of health is an important aspect of nursing. (Chythra 2015) The 4 main types of non communicable diseases are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructed pulmonary disease and asthma) and diabetes. WHO said non communicable diseases were silent killers, had insidious onset disease is diabetes mellitus. Diabetes is a major health problem that is approaching epidemic proportions globally. (Manju Sharma 2014)
India leads the world with the largest number of diabetic subjects earning the dubious distinction of being termed the "diabetes capital of the world". According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken.(Mohan V2007)
Diabetes was first described in Egyptian culture in 15th century as “too great emptying of urine”. Hindu physicians in the Ayurveda developed the first clinical test for diabetes. They observed that flies and ants were attracted to the sweet tasting urine of people afflicted with certain diseases. Indian physicians around the same time identified the disease and classified it as
„madhumeha‟ or honey urine as they observed that the urine would attract ants.(Raman.A.2007) Diabetes mellitus (DM) also known as simply diabetes is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period .This high blood sugar produces the symptoms of frequent urination, increased thirst and increased hunger. Untreated diabetes can cause many complications. Acute complications include Diabetic Ketoacidosis and Non
Ketotic Hyperosmolar coma. Serious long time complications include heart disease, stroke, kidney failure, foot ulcers and damage to the eyes.(Suddarth’s & Brunner,2014)
Consequently, diabetes is rapidly emerging as a global health care problem that threatens to reach pandemic levels by 2030; the number of people with diabetes worldwide is projected to increase from 171 million in 2000 to 366 million by 2030. Millions of Cases of Diabetes in 2000 and Projections for 2030, with Projected Percent Changes. This increase will be most noticeable in developing countries, where the number of people with diabetes is expected to increase from 84 million to 228 million.(WHO 2018)
As of January 2011, 25.8 million children and adults have been diagnosed with Type II diabetes (American Diabetes Association). Type II diabetes is a disease that causes high blood sugar levels due to a malfunction within the body to properly use insulin. The role of insulin is to lower and control blood sugar levels so they do not get too high. Type II diabetes is more common in people over the age of sixty, but the younger generation is becoming more prone to this disease. It is estimated that roughly one in 400 under the age of twenty have Type II diabetes, which is about 0.26% of the population (American Diabetes Association).
Individuals with type-2 diabetes are at a high risk of developing a range of debilitating complications such as cardiovascular disease, peripheral vascular disease, nephropathy, changes to the retina and blindness that can lead to disability and premature death.
Type 2 diabetes mellitus (T2DM) is a significant global public health problem affecting more than 285 million people worldwide. Over 70% of those with Type 2 Diabetes Mellitus live in developing countries, and this proportion is increasing annually. Within the next few years the diagnoses of Type II diabetes is expected to double. Evidence suggests that lifestyle and other nonpharmacological interventions can delay and even prevent the development of Type 2 Diabetes Mellitus and its complications.(Rawal LB,et al 2012)
According to the World Health Organisation (WHO), diabetes is currently one of the biggest health concerns that the world is faced with. WHO defines diabetes as “a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces”. Insulin is a hormone that regulates blood sugar. A
common effect of diabetes is Hyperglycemia or increased blood sugar. Diabetes causes some serious health issues including blindness, kidney failure, stroke and heart diseases. Type 1 diabetes occurs when the body produces insufficient quantities of insulin. It is usually detected more in children. Type 2 diabetes occurs when the body does not effectively use the insulin produced. This is very frequently due to lack of physical activity, obesity, or incorrect dietary habits. Gestational diabetes occurs among pregnant women. In about 90 percent of cases, it is Type 2 diabetes that people are suffering from. The occurrence of Type 2 diabetes or Diabetes Mellitus may be prevented or delayed by adopting a healthy lifestyle.(Luckman &Soronsens 2011)
Keeping blood sugar at normal levels is essential to maintaining a high quality of life with a diagnosis of diabetes. The body maintain healthy blood glucose levels by making lifestyle changes, like sticking to a diet of foods with little processed foods and high amounts of fiber, such as whole grains, vegetables, and fruits, choosing lean protein sources and healthy fats, and avoiding excessive processed meat, boxed and processed foods, and sweetened beverage, being active at least half an hour a day, at least five days a week.
Fenugreek is an annual crop plant and the biological name is Trigonella foenum graecumis family „Fabaceae‟, its common name is “methi”. It is an herb cultivated for its seeds majorly in Mediterranean countries. In India, it is mainly cultivated in regions of Rajasthan (maximum production), Tamil Nadu, Gujarat, Madhya Pradesh, Punjab and Uttar Pradesh. Apart from the flavouring properties of its seeds, it has been able to mark its presence in Ayurvedic system of medicines since ages, owing to its nutritional and therapeutic benefits. It is a rich source of fibers, proteins, vitamin A and C, iron and calcium. It is a highly recommended medicinal plant for treatments of various dysfunctions and diseases. (Swaminathan.M.2016)
Fenugreek is another promising antidiabetic drug . It was also confirmed that consuming fenugreek as a dietary supplement in the prediabetic patients could efficiently reduce the outbreak of type 2 diabetes . Additionally, it was further reported that the socked fenugreek seeds can act as adjuvant in mitigating the type 2 diabetes and also in non insulin dependent diabetes and serum lipids in type I diabetes . And it is well evidenced that the fenugreek seeds are antidiabetic in nature.(Madar Z,Stark AH2017)
In some of studies of animals and humans with both diabetes and high cholesterol levels, fenugreek appeared not only to regulate blood sugar levels but also lower levels of harmful cholesterol. However, in studies of those who did not have diabetes, a similar effect was not reported (8). It has been said that he seeds are rich in protein and contain a unique major free amino acid 4-hydroxysoleucine , which has been characterized as one of the active ingredients in fenugreek seeds. The effect of 4-OH-ILe is both dose and glucose dependent and has been shown to stimulate insulin secretion and improve glucose tolerance in normal and diabetic animals as the result of direct β-cell stimulation. It is said that fenugreek, reveals a potential benefit in diabetes either in a mixture of water or milk products or in cooking.( Pandey A 2017)
It has been reported that the fenugreek are effective in lowering blood glucose levels in diabetic patients. Even after being cooked, its medicinal properties are still preserved. Examined the effect of fenugreek as an adjunct therapy with metformin in diabetic patients. In this study, Group 1 and group 2 were given 500 mg of metformin twice a day while group 2 received 500 mg metformin along with 1 g of fenugreek thrice a day. After 12 weeks, the results showed a significantly greater reduction in fasting and postprandial blood sugar levels in group 2 than in group 1. (Akaram KosHi,et al 2018)
Haeri et al.(2012) reported that fenugreek, assisted by 4-hydroxyisoleucine, increases insulin secretion in hyperglycemic conditions and increases sensitivity to insulin and promotes anti-diabetic effects . Furthermore, Losso et al. (2009) reported that eating baked goods, such as bread, made with fenugreek flour can help reduce insulin resistance in people with type 2 diabetes and ultimately improve carbohydrate metabolism. It has even been reported that the anti-diabetic effect of fenugreek is comparable to the effect of the anti-diabetic drugs glibenclamide and metformin , and is more effective than sitagliptin.
In the other hand, the potential effects of this herb have not been approved yet and due the lack of sufficient clinical studies, it is premature to actively recommend use. Therefore, it is essential to increase the level of awareness among diabetic patients and health care providers regarding The effect of fenugreek on type2 diabetes has been trying to be established all over the world and for this purpose researchers has been conducting a lot of projects.
NEED FOR THE STUDY
Diabetes is considered a life style disease because it is not something you were born with it is something you bring upon yourself, stress, don't enough exercise, eating too much of the wrong foods, pregnancy or family history cause this particular disease.
Diabetes mellitus is a common and chronic disease concern globally associated with a ten-year shorter life expectancy. Type 2 diabetes is dominant in developing countries and accounts to around 85%–90% worldwide.ISSN Results showed that worldwide, nearly 98 million people in India may have type 2 diabetes by 2030.(India Today web Desk 2018)
Using data from the International Diabetes Federation and 14 cohort studies (representing more than 60 per cent of the world population with type 2 diabetes), researchers estimated the burden of type 2 diabetes in 221 countries and territories between 2018 and 2030. They estimated the potential number of insulin users, amount of insulin required, and the burden of diabetes complications under varying levels of insulin access and treatment targets (from 6.5 per cent to 8 per cent HbA1c, a measure of blood glucose), in adults aged 18 or older. The researchers calculated that compared to current levels of insulin access if universal global access was achieved, the number of people with type 2 diabetes worldwide using insulin in 2030 would double (from around 38 million to 79 million).(Leona M and Harry B Helmsely 2018)
India is currently in the age of man-made and degenerative diseases. This age is characterised by a life expectancy close to 50-60 years and unhealthy lifestyles which promote diseases like cardiovascular disease and hypertension. India, the second most populous country of the world, has been severely affected by the global diabetes epidemic. As per the International Diabetes Federation (2013), approximately 50% of all people with diabetes live in just three countries: China (98.4 million), India (65.1 million) and the USA (24.4 million). There is clear evidence to show that diabetes prevalence is rapidly increasing, especially in urban India.
According to the World Health Organization (WHO), India had 69.2 million people living with diabetes in 2015.At the same time, global insulin use is projected to rise from 526 million 1000- unit vials in 2018 to 634 million in 2030 and will be highest in Asia (322 million vials in 2030) and lowest in Oceania (4 million).(DIAPEDIA)
The type 2 non-insulin dependent diabetes mellitus is a silent, chronic unidentified killer among population. The prevalence of disease in adults is 2.4% in rural and 4.0 to 11.6% in urban dwellers. Recent studies have reported India with a current figure of 50.8 million, China with 43.2 million, USA with 26.8 million, Russia with 9.6 million, Brazil with 7.6 million, Germany with 7.5 million, Pakistan with 7.1 million, Japan with 7.1 million, Indonesia with 7 million and Mexico with 6.8 million(H K CCHOPRA 2017)
Ranjit Mohan Anjana et al (2015) conducted a cross-sectional study on Prevalence of diabetes and prediabetes in 15 states of India. Stratified multistage design was used to obtain a community-based sample of 57117 individuals aged 20 years or older. The sample population represented 14 of India‟s 28 states and one union territory. With sampling done between Jan 5, 2012, and July 3, 2015. The study findings shows that the overall prevalence of diabetes in all 15 states of India was 7·3% (95% CI 7·0–7·5). The prevalence of diabetes varied from 4·3% in Bihar (95% CI 3·7–5·0) to 10·0% (8·7–11·2) in Punjab and was higher in urban areas (11·2%, 10·6–11·8) than in rural areas (5·2%, 4·9–5·4). Prevalence reported is from Ernakulum in Kerala (19.5%) and the lowest from Kashmir valley (6.1%).
Diabetes has emerged as a great threat to the people of Tamil Nadu, with a prevalence of 15-18 per cent in urban areas and 6-8 per cent in rural areas. If India has the dubious distinction of being the diabetes capital of the world, with more than 72 million cases of diabetes recorded in the country in 2017, the day is not far when Tamil Nadu will become India‟s diabetes capital.
(Matthew Little 2017)
The prevalence of diabetes, a non-communicable disease (NCD), has been steadily increasing in the past few decades, especially in Tamil Nadu (10.4 per cent prevalence), “Every one in 10 persons is diabetic in Tamil Nadu,” as seen in INDIAB study of Indian Council of Medical Research. In a longitudinal cohort from Chennai, the incidence of diabetes was calculated as 20.2 per 1000 person years among subjects with prior normal glucose tolerance, and 64.8 per 1000 person years in those with prediabetes.(Lanthorn H 2018)
A recent study done on young adults (aged 26-32 years) in Vellore, Tamil Nadu has reported that the prevalence of type 2 diabetes was 3.7% in urban areas and 2.1% in rural areas.
The prevalence of impaired glucose tolerance (IGT) was 18.9% in the urban and 14.3% in rural
subjects revealing a large pool of pre diabetic subjects in the young age group on the averge of getting converted to diabetes. (V.Mohan.et,al.,(2008)
Amrita parsad et al(2015) conducted a cross sectional study on Prevalence of Obesity
and and to evaluate its relationship with hypertension, anemia and diabetes. The data was selected from Thattankuttai Population of Namakkal District. This study comprised of 215 subjects attending a local medical camp, aged between 18 – 80 yrs. Heights, weight, body mass index, systolic and diastolic blood pressure, random blood sugar, hemoglobin levels were monitored using standard methods. Results indicate that Prevalence of overweight and obesity was 14.4% and 60.46% respectively and it was predominant among women (62%) than men (59.7%). Systolic blood pressure, diastolic blood pressure and random blood sugar were significantly elevated in obese subjects than in normal BMI subjects (control). The results showed a higher trend of hypertension and diabetes and decreased trend of anemia with increase in body mass index.
Even though there is no cure for diabetes, proper treatment and glucose control enable people with type 2 diabetes to live normal. Many Research studies shows that diet and exercise can prevent or delay type 2 diabetes. Herbal plants are rich in pharmacologically active compounds and hence these medications are used in worldwide in many years. Many herbs have strong antidiabetic properties, and fenugreek is one among them. Although fenugreek is one of the most common herbs used for diabetes. (Patel DK 2012)
Out of 26 articles PubMed/Medline search Literature review on“trigonella foenum graecum for the management of Type II Diabetes. Based on the available literature, this review suggests that the fenugreek has the evidence-based antidiabetic effect, such as stimulating and/or regenerating effect on β cells along with the extrapancreatic effect that is effective in reducing blood glucose levels in diabetic patient. (A.Mooventhan L 2017)
One study Trusted Source found that a daily dose of 10 grams of fenugreek seeds soaked in hot water may help control type 2 diabetes. Another study Trusted Source suggests that eating baked goods, such as bread, made with fenugreek flour may reduce insulin resistance in people with type 2 diabetes.
An additional study showed that taking high doses of fenugreek every day for several weeks causes noticeable improvements in plasma glucose levels. But long-term plasma glucose levels weren‟t measured in this study. The National Institute of Health (NIH) states Trusted Source that at this point the evidence is weak for fenugreek‟s ability to lower blood sugar.(Rena Goldman 2017)
Multiple studies have been carried out to investigate the potential anti-diabetic benefits of fenugreek. Of these, several clinical trials showed that fenugreek seeds can improve most metabolic symptoms associated with both type 1 and type 2 diabetes in humans by lowering blood glucose levels and improving glucose tolerance.
In one study, researchers in India found that adding 100 grams of defatted fenugreek seed powder to the daily diet of patients with insulin-dependent (type 1) diabetes significantly reduced their fasting blood glucose levels, improved glucose tolerance and also lowered total cholesterol, LDL or „bad‟ cholesterol and triglycerides.In another controlled trial, incorporating 15 grams of powdered fenugreek seed into a meal eaten by people with type 2 diabetes reduced the rise in post-meal blood glucose, while a separate study found that taking 2.5 grams of fenugreek twice a day for three months lowered blood sugar levels in people with mild, but not severe, type 2 diabetes.(Sharma RD 2004)
Accordingly, diabetes related complications are also on the rise and contribute significantly to overall morbidity and mortality. The low levels of education and poor awareness of the disease in the country are enhancing its impact on health of the population. Hence the investigator has selected the”fenugreek” for reducing blood glucose level among Type II diabetes mellitus adults, as it is an easily available, rich in fiber, having a low glycemic index, low cost food item and has an increased effect in reducing blood glucose level.
STATEMENT OF THE PROBLEM
A quasi experimental study to evaluate the effectiveness of roasted fenugreek seed powder on blood glucose level among client with Type II Diabetes Mellitus in Silluvampatti rural area at Ernapuram Namakkal.
OBJECTIVES OF THE STUDY
1. To assess the pre test level of fasting blood glucose among client with Type II Diabetes Mellitus in experimental and control group.
2. To assess the Post test level of fasting blood glucose among client with Type II Diabetes Mellitus in experimental and control group.
3. To evaluate the effectiveness of roasted fenugreek seed powder on the level of fasting blood glucose among client with Type II Diabetes Mellitus in experimental and control group.
4. To find the association between the fasting blood glucose level and the selected demographic variables before the intervention.
HYPOTHESIS
H1: The mean post test level of fasting blood glucose level would be significantly lower than the pre test level of fasting blood glucose in the experimental group and control group at p level <0.05
H2: There would be a significant effectiveness of roasted fenugreek seed powder on the level of fasting blood glucose among clients with type II diabetes mellitus in the experimental group at p level <0.05
H3: There would be a significant association between the post test level of fasting blood glucose with their selected demographic variables among clients with type II diabetes mellitus in the experimental group at p level <0.05
OPERATIONAL DEFINITION
EFECTIVENESS
In this study it refers to the outcome of roasted fenugreek seed powder in reducing blood glucose level among Type II Diabetic Adults. and it is measured by bio- physiological measures (Glucometer). Normal level of fasting blood sugar level is 120-140mg/ dl.
ROASTED FENUGREEK SEED POWDER:
In this study roasted fenugreek powder was prepared by roasting the fnuegreek and prepare powder by grinding method and administered it before breakfast by mixing 25 gram of roasted fenugreek powder with 100ml of water. And then the subjects were instructed to take orally for 20 days. Only the experimental group was treated with fenugreek.
FASTING BLOOD GLUCOSE:
In this study, it refers to the level of blood glucose which should be checked in an empty stomach. Normal level of fasting blood glucose level is 110-140 mg/dl.
TYPE II DIABETES MELLITUS
As per the study, it refers to the clients who are diagnosed to have non- insulin dependent diabetes mellitus by a diabetologist.
ASSUMPTION :
Diabetic clients may be using some of the home remedies for the control of diabetes.
Roasted Fenugreek seed powder taken continuously (15 days) will lower the level of blood glucose.
Clients with diabetes mellitus will accept the fenugreek seed powder as an alternative modality to maintain the blood glucose level.
Complications of diabetes are preventable.
DELIMITATION:
The study is delimited to:
Only 60 non insulin dependent diabetic clients in a Silluvampatti rural area at Namakkal.
The client aged between 31 to 60 years.
The data collection period was limited to 6 weeks.
PROJECTED OUTCOME
The study will reveal that intake of fenugreek powder reduces the blood glucose level among patients with type II diabetes mellitus. The nurse can use fenugreek as a complementary medicine in the treatment of type II diabetes mellitus, which will be a health promotion activity in the general population.
CONCEPTUAL FRAMEWORK
A conceptual framework is a process of ideas which are framed and utilized for the development of a research design. It helps the researcher to know what data needs to be collected and gives direction to an entire research process.
The study is based on the concept that administration of 25 grams of roasted fenugreek in 100 ml of water to Type II Diabetic Patients will reduce blood glucose level. The investigator adopted the Wiedenbach‟s Helping Art of Clinical Nursing Theory(1964) as a base for developing the conceptual framework. Ernestin Widenbach proposes helping the art of clinical nursing theory in 1964 for nursing which describes a desired situation and way to attain it. It directs action towards the explicit goal.
THIS THEORY HAS 3 FACTORS
Central purpose
Prescription
Realities i) Central Purpose
It refers to what the nurse wants to accomplish. It is the overall goal towards which a nurse strives.
ii) Prescription
It refers to the plan of care for patients. It will specify the nature of action that will fulfill the nurse‟s central purpose.
iii) Realities
It refers to the physical, physiological, emotional and spiritual factors that come into play in situation involving nursing action. The five realities identified by Wiedenbach‟s are agent, recipient, goal, means and framework.
The conceptual framework of the nursing practice according to this theory consists of three steps as follows:
Step I: Identifying the need for help Step II: Ministering the needed help
Step III: Validating that the need for help was met.
Step I: Identifying the need for help
This step involves determining the need for help. The Type II Diabetic adults were identified based on demographic variables (Age, Sex,Education, Occupation, Family Income, Family history, duration of illness,medication used and exercise) inclusive and exclusive criteria, simple random sampling technique was used to assign the adults in experimental and control group.
Step II: Ministering the needed help
25 grams of roasted fenugreek seed in powder form mixed with 100 ml water was given to experimental group daily in the morning half an hour before breakfast for 20 days.
Agent : Investigator
Recipient : Type II Diabetic adults Goal : To reduce blood glucose level
Means : : 25 grams of roasted fenugreek powder Framework : Silluvampatti Village.
Step-III: Validating that need for help was met.
It is accomplished by means of post assessment of blood glucose level. It is followed by an analysis of the findings.
SUMMARY
This chapter deals with introductions, need for the study, statement of the problem, objectives of the study, operational definition, assumption, hypothesis, delimitation and conceptual frame work.
Fig:
conc
eptual framework base
d on
modified model of Wiedenbach’s helping art of clinical nursing theory (1964)
CENTRAL PURPOSE CONTROL OF BLOOD SUGAR
IDENTIFYING THE NEED FOR HELP
VALIDATING THE NEED FOR HELP
MINISTERING THE NEED FOR HELP DMOGARFIC
VARIABLES Age, Education, Family Income, Religion, Type Of Family, Dietary Pattern, Duration Of Illness.
Pre Assessment Of Blood Glucose Level For Experimental
And Control Group
EXPERIMENTAL GROUP 25 Grams Of Roasted Fenugreek
With 100ml Of Water
CONTROL GROUP Existing Treatment
Post Assessment Of Blood Glucose Level
For Experimental
And Control Group
Experimental Group Improvement In Fasting
Blood Glucose Level is adequate
Control Group Minimal Improvement In
Fasting Blood Glucose Level
CHPATER-II
CHPATER-II
REVIEW OF LITERATURE
A literature review is “a systematic, explict and reproducible method for identifying, evaluating and synthesizing the exisiting body of completed and recorded work produced by researchers, scholars and practitioners.” (Arlene Fink, 2015).
The literature related to the present study is organized under the following headings:
I. Literature related to incidences and prevalence of type II diabetes mellitus.
II. Literature related to effectiveness of roasted fenugreek seed powder on level of blood glucose among clients with type II diabetes mellitus.
I CLASSIFICATION
Literature related to incidence and prevalence of type 2 diabetes mellitus
The Chennai urban population study (CUPS ) 2018 conducted cross- sectional studies on the prevalence of diabetes in India. The baseline study was completed in 1997. Follow-up examination was performed after a mean period of 8 years. At follow-up, 501 [47.0%] subjects had moved out of these colonies and were lost to follow-up. Of the remaining 564 individuals, 513 [90.9%] provided blood samples for biochemical analysis. Regression analysis was done using incident diabetes as dependant variable to identify factors associated with development of diabetes or pre-diabetes. Among subjects with normal glucose tolerance (NGT) at baseline [n=476], 64 (13.4%) developed diabetes and 48 (10.1%) developed pre- diabetes (IGT or IFG). The incidence rate of diabetes was 20.2 per 1000 person years and that of pre-diabetes was 13.1 per 1000 person years among subjects with NGT. Of the 37 individuals who were pre-diabetic at baseline, 15 (40.5%) developed diabetes [incidence rate: 64.8 per 1000 person years], 16 (43.2%) remained as pre-diabetic and 6 (16.2%) reverted to normal during the follow-up period. Regression analysis revealed obesity [Odds Ratio (OR): 2.1, p=0.001], abdominal obesity [OR: 2.23, p<0.001] and hypertension [OR: 2.57, p<0.001] to be significantly associated with incident diabetes. The Indian Diabetes Risk Score (IDRS) showed the strongest association with incident diabetes [OR: 5.14, p<0.001]. The study shows that the incidence of diabetes is very high among urban south Indians. While obesity, abdominal obesity and hypertension were associated with incident diabetes, IDRS was the strongest predictor of incident of diabetes in this population.
R. Gopika (2018) conducted a study on social and biological factor of type 2 diabetes mellitus. In this study 400 blood serum samples were collected from various laboratories and diabetic centre in and around Tirupur, Tamil Nadu, India. Blood glucose level was estimated like Fasting Blood Glucose (FBG), Post Prandial Blood Glucose (PPBG), HbA1c and lipid content. Totally 215 (53.7%) samples were positive for diabetic. This study revealed that type 2 diabetic patients followed up in the diabetic center in Tirupur District, showed a high rate of chronic complications which often occurred in a mid age between 41 to 60 years and also hypertension and high cholesterol was not a major influence for diabetic complications. Numerous socio demographic and biological factors were significantly associated with the high rate of complications. Social and clinical factors significantly associated with high rate of complications were age between 41 to 60 years (74.87 %), male gender (61.86
%), the absence of family history of diabetes (72.09 %), and low glycated hemoglobin (HbA1c) level (79.99%).
T Gadadharan Vijayakumar et al (2017) conducted a 10-year prospective cohort study on Incidence of type 2 diabetes mellitus and prediabetes in Kerala, India.
study was carried out in two urban wards of central Kerala. The individuals who participated in the baseline survey in 2007 were again invited for a follow-up study in 2017. The data was analyzed using IBM SPSS Statistics for windows (version 21.0).
Logistic regression analysis was used to estimate odds ratios and 95% confidence intervals. Findings are based on the 10-year follow-up data from 869 participants from the cohort. The study result shows that the overall follow-up and response rate of the study was 68.9 and 86.9% respectively. During the follow-up period, 190 people (21.9%) developed Type 2 Diabetes Mellitus. The incidence rate of Type 2 Diabetes Mellitus and impaired fasting glucose (IFG) were 24.5 per 1000 person years and 45.01 per 1000 person years respectively. Nearly 60% of participants with baseline IFG were converted to T2DM group in the follow-up period. Age > 45 years, family history of Type 2 Diabetes Mellitus, BMI ≥ 25 kg/m2 and presence of central obesity emerged as important risk factors for incident T2DM. the study concluded that high incidence of prediabetes over diabetes observed in this study shows an epidemic trend of Type 2 Diabetes Mellitus in Kerala, India. It requires an immediate public health action.
Dr.P.S.Singh et al (2017) reported in study to determine the prevalence of diabetes mellitus in rural community, Western Uttar Pradesh by health camp and door to door approach. All the adults were given 75gm of glucose dissolved in 200ml water which was drunk over a period of up to5 minutes and the 2-hourpost load capillary blood glucose was estimated. Diabetic status was confirmed by taking blood samples for fasting and postprandial blood sugar levels in a fluoride vacutainer. Fasting plasma glucose ≥126mg/dl and or 2-hour postprandial glucose ≥200mg/dl were taken as the diagnostic criteria for diagnosis. The study result shows thatpPrevalence of type 2 diabetes in the rural population was found to be 8.03%. Prevalence was higher in female population (9.91%) as compared to males (6.79%). 19.74 % of participants over 70 yrs of age were diabetics while diabetes was present only in 2.95% of participants in the age group of 25-39 year. The maximum number of diabetes were in the age group of 50-59 years. 10.04 % of participants were diagnosed to be Prediabetics. 35.77% of the diabetics were newly diagnosed. The Present study concluded that there is high prevalence of type 2 diabetes in rural area of western Uttar Pradesh, India.
Karthikeyan Maniarasu (2017) reviewed in a cross sectional study on Prevalence of Certain Chronic Complications of diabetes among type 2 diabetic patients in rural population of kancheepuram district, tamil nadu. The study carried out in sixteen out of fifty six health care centers in Kancheepuram district in Tamil Nadu by cluster sampling method using the semi-structured questionnaire, with medical record, physical examination and biochemical investigation to identify chronic kidney disease and co-morbid conditions of type 2 diabetes. A Disability Neuropathy Score (DNS) of more than zero and negative monofilament/vibration tests were used to classify patients as having signs of peripheral neuropathy. The study result shows that prevalence of Ischemic heart disease and stroke were 7.8% and 0.5%
respectively. Prevalence of stage I kidney disease based on the KDO-QI guidelines using the estimated GFR and urine PCR values was 30.7% , while chron-ic kidney disease (i.e., stage II or III or PCR>0.2) was seen in 10.4% patients. Based on the DNS scoring chart 59% of them had peripheral neuropathy while 19% of them had signs of peripheral neuropathy. Participants with at least one chronic complication of diabetes (excluding retinopathy) were 32.8 percent. Prevalence of hypertension was 61.4%. and Hyperlipidemia was 85.9% ,while high LDL, TGL was seen with 60.9%
and 64.6% respec-tively, low HDL among 83.9 % of patient. The study concluded that the high prevalence of undiagnosed microvascular complications in known diabetics treated at primary care emphasis a strong need for routine screening for complications of diabetes and to create awareness on its early detection and prevention of progression.
Geetha A. et al (2017) conducted a cross sectional study on the impact of family history of diabetes among type 2 diabetes mellitus patients in an urban area of Kancheepuram district, Tamil Nadu. By Using purposive sampling technique, 215 diabetic patients were selected as study participants. The study result shows that among the study participants, 62.3% were females. The mean age of the participants was 56.08±10.04. Nearly 68.8% of Type 2 Diabetes Mellitus patients had family history of Diabetes, among them 25.1% of them had diabetic mother and 15.3% had diabetic father. Among the study group of Type 2 Diabetes Mellitus patients, 51.6%
had diabetic complications. The family history of diabetes with age of onset and complications had statistically significant association among the study group. The study Conclued that persons with positive family history of diabetes are more prone to early onset of diabetes and developing complications. So appropriate behavioural changes and modification must be practiced to delay or prevent the occurrence of the disease. Early diagnosis and treatment is a must to prevent the complications in the vulnerable people.
Vanishree Shriraam et al (2016) questionnaire-based cross-sectional study on Prevalence and practices of type 2 diabetes at Chennai. Systematic random sampling technique used for selecting every 5th patient attending the diabetic Out- Patient (OP) in a tertiary medical college hospital. The study result shows that there were 366 participants with median age of 60 years. Around 96% reported any one symptom of hypoglycemia, but 78% had eaten following the episode and got relieved of the symptoms. Weakness (76.2%) and dizziness (74%) were the most common symptoms reported by the patients. A quarter of them reported having severe attacks requiring somebody's assistance. Most patients resorted to timely meals (85%) to avert future attacks. Patients who took insulin along with oral hypoglycemic agents (OHAs) were at a higher risk (OR = 2.3) for hypoglycemia compared to patients taking only OHAs (P < 0.01). the [resent study concluded that the reported prevalence
of hypoglycemia among type 2 diabetes patients is quite high. This finding reiterates the importance of enquiring and educating every diabetic patient about hypoglycemic episodes during every health visit.
K.NitheshKumar (2015) conducted a community based cross sectional study on prevalence of type 2 diabetes mellitus and its associated risk factors among adult residents of rural Khammam. study carrird out period from 1stJanuary to 31stDecember 2015. Atotal of 910 persons aged 30 years or more were included in study. The study Result shows near about 74 (8.1%) were diagnosed as type -2 diabetes mellitus. The prevalence of Diabetes Mellitus was 16.22% in 30-40 years age group, 24.32% in 41-50 years age group, 43.34% in 51-60 yearsage group and 16.2%
in 61-70 years age group which shows that Diabetes Mellitus increases with age and the association between age and prevalence of type 2 Diabetes Mellitus was found to be statistically significant. The study concluded that there is a need to increase awareness of type–2 diabetes mellitus in the general population. Health education should be given in terms of risk factors of diabetes.
Ganesh Shanmugasundaram et al(2015) concluded in a cross- sectional record based study study on prevalence of type 2 diabetes mellitus among people attending medical camps in South Chennai, India. The study included 1056 people attending medical camps conducted by Sree Balaji Medical College and Hospital , in various locations of South Chennai. The study result shows that among study population, 453 (42.9%) were males and 603 (57.1%) females. The overall prevalence of diabetes was 11.8%. Tambaram area showed highest prevalence of 27.3%.
Prevalence in males (12.4%) versus females (11.4%) [p- 0.647], above 45 years (12.6%) versus below 45 years (10.4%) [p- 0.303], and urban (13.2%) versus rural (11%) [p- 0.291]. Mean RBS values > 45 years (141.21) versus < 45 years (122.57) [p- 0.0001]. Positive correlation between age and blood sugar levels were observed (r
= 0.07; p < 0.05). This study concluded that Prevalence of diabetes was 11.8% which is higher than the existing documented prevalence of 10.4%. Hence more awareness creation and preventive measures needs to be targeted in this population to reduce the disease burden.
Ritesh P Kundap (2015) conducted a cross sectional survey on assessment of prevalence of diabetes among rural population of pune district, india. House to house
visits were paid and 255 residents of 20 and above years of age were interviewed using Indian diabetes risk score (IDRS). Those who screened positive on the score were tested for fasting blood sugar by Glucometer method. Results: The prevalence of diabetes among the study population was 10.5%. Among the 27 newly detected cases 18 had high risk and 9 had moderate risk on IDRS. The statistically significant risk factors were age, non-vegetarian diet, socio economic status and body mass index.
Conclusion: The prevalence of diabetes has started increasing in poor, illiterate and health ignorant rural population. They should be diagnosed at the earliest possible time using simple diagnostic tools like IDRS.
Sanjay Kumar Gupta et al (2010) conducted a study on Diabetes Prevalence and its Risk Factors in Rural Area of Tamil Nadu. The present study was conducted in the field practice area of rural health centers (Chunampett and Annechikuppam, Tamil Nadu), covering a population of 35000 from February to March 2008 by using a predesigned and pretested protocol to find out the prevalence and the risk of diabetes mellitus in general population by using Indian diabetes risk score.the study shows that the1936 respondents comprising 1167 (60.27%) females and 769 (39.73%) males were studied. Majority 1203 (62.50%) were Hindus. 1220 (63.%) had studied up to higher secondary. 1200 (62%) belonged to lower and lower-middle socio-economic class. A large number of the subjects 948 (50%) were below 35 years of age. Most of the respondents 1411 (73%) indulged in mild to moderate physical activity. 1715 (87.91%) had no family history of diabetes mellitus. 750 (39.64%) individuals were in the overweight category (>25 BMI). Out of these overweight persons, 64% had high diabetic risk score. It is observed that chances of high diabetic score increase with the increase in BMI.
Chythra R. Rao (2010) conducted a cross-sectional community-based survey on A study on the prevalence of type 2 diabetes in coastal Karnataka. The study was carried out on 1,239 respondents, using a two-stage, stratified, random sampling technique. Data was collected by a personal, face-to-face interview followed by blood sugar estimation using a glucometer. The study result shows that the overall prevalence of diabetes was 16%. Self-reported diabetes was 11.2%, while 4.8% of previously normal people were found to have high fasting capillary blood glucose levels. Increasing age showed two-fold, four-fold, and six-fold higher odds for 40 –
49, 50 – 59, and ≥ 60 years age group, respectively, as compared to the 30 - 39 year age group (P < 0.001). Nineteen percent of the males had diabetes, (OR = 1.38, 95%
CI = 1.01 – 1.88). In the high socioeconomic strata, 32% of the subjects had diabetes (P = 0.018 unadjusted odds ratio 3.29, 95% CI = 1.40 – 7.74). The present study concluded that the high prevalence of diabetes in this coastal population needs further evaluation.
In International Diabetes Foundation data released in 2009, estimated diabetes prevalence for 2010 is 285 million, representing 6.4% of the world's adult population, with a prediction that by 2030 the number of people with diabetes will have increased to 438 million. Considering this massive growth in Type 2 Diabetes Mellitus and its propensity after 10–15 years to lead to an insulin-deficient state, available evidence from studies is a compelling indication not to deny the benefits of continuous subcutaneous insulin infusion in selected Type 2 Diabetes Mellitus subjects. This article aims at suggesting guidelines based on clinical experience and cultural diversity for India and developing countries.
Ubink-Veltmaat LJ et al (2003) conducted a prospective population based study on Prevalence, incidence and mortality of type 2 diabetes mellitus revisited at Netherlands. Baseline population of 155,774 patients, registered with 61 general practitioners participating in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study findings shows that Age- and sex-adjusted prevalence of type 2 diabetes was 2.2% at baseline and 2.9% after 2 years of follow- up; for women and men it was 3.1 and 2.7% at follow-up, respectively. Patients aged
>70 years account for almost 50% of all type 2 diabetes patients. Age- and sex- adjusted mean annual incidence per 10,000 over 3 years was 22.7 overall; for women 23.1 and for men 22.2. Incidence--even though high--decreases after the age of 70 years. The mortality rate was 47.9/1000 and standardised mortality ratio 1.40. Based on these results, the estimated total number of subjects known with type 2 diabetes was 466,000 for The Netherlands in 2000; the number of patients with newly diagnosed diabetes 36,000. This study concluded that Prevalence and incidence rates exceed all estimates regarding known type 2 diabetes for The Netherlands. Elderly patients, aged 70 years and over, account for 50% of the type 2 diabetic population.
II CLASSIFICATION
Literature related to effectiveness of fenugreek seed powder on blood glucose level among adults with type 2 diabetes mellitus.
Akram Kooshki Zaher Khazaei (2018) conducted a Effects of fenugreek seed powder on stress-induced hyperglycemia and clinical outcomes in critically ill patients. Randomized controlled clinical trial consisting of 60 adult patients randomly divided into 2 groups (n=30 per group). The study was conducted in Sabzevar, Iran in April 2015. The intervention group received 3 g of fenugreek seed powder by gavage, twice a day, in addition to routine care. The control group received only routine care.
In the beginning, a daily evaluation of fasting and postprandial blood sugar was conducted for 10 days. Secondary components (prevalence of pneumonia; length of intensive care unit (ICU) stay, length of hospital stay, ventilator days, APACHE II score, and mortality rate) were measured until the time of hospital discharge or death.
Data were analyzed via SPSS v.20 using Student's t-test (paired and unpaired), chi- square test, repeated measure ANOVA, and Wilcoxon test.The study result shows that during 10 days of treatment, there was a significant fall in mean glucose levels in 2 groups. However, this improve was more significant in Intervention group in compared to control group (p<0.001).The present study suggests that daily diet with fenugreek seeds can be used as an add-on therapy with other medications in the management of stress induced hyperglycemia in critically ill patients.
Dr. Anasuya Boligarla et al (2018) conducted the study to evaluate the effect of Fenugreek seed powder on blood glucose along with nutritional status, Knowledge, Attitude and Practice in Type 2 Diabetic patients. 50 subjects were divided into group I (Standard Conventional Treatment) and group II (Standard Conventional Treatment and Fenugreek seed powder 25 g per day for a period of 3 weeks). The study results depict that the mean age was 50.87±10.76 years in males and 50.69± 10.85 in females. The mean duration of the disease was 5.62 ±5.54 yrs.
95.65% females had raised BMI >23 kg/m² compared to 76.1% in males. Similarly,
76% of females had a WHR above the cut off value as compared 47.61% to males.
The mean knowledge score was 7.85±1.21; attitude score was 35.75±4.07 and Practice score was 12.57±2.04. The Intervention group have shown significant reduction in FBS (P= 0.001) and PPBS (P=0.000). In the control group there was a significant reduction in the PPBS (P=0.007). However, the significance was more in the intervention group than control group. The present study concluded that high prevalence of general and central obesity in type 2 diabetic patients with good knowledge with poor practice towards diabetes management. Fenugreek seed powder supplementation has shown a significant improvement in the fasting and post prandial blood glucose levels. Thus, indigenous and natural food based intervention like fenugreek seeds can be used as an adjuvant in the management of diabetes.
R.D.Sharma(2018) carried out a study on Use of Fenuqreek seed powder in the management of non-insulin dependent diabetes mellitus .the study was included 60 non-insulin dependent diabetic patients. A prescribed diet with and without Fenugreek seed powder was given to patients for 7 days of a control period and for 24 weeks of the experimental period. During the experimental period twenty five grams of Fenugreek seed powder divided into two equal doses was added to the diet and served during lunch and dinner. Diet containing Fenugreek seed powder lowered fasting blood glucose levels and improved glucose tolerance. Insulin levels were also diminished. Twenty four hour urinary sugar excretion was reduced significantly (p <
0.001). Glycosylated hemoglobin measured at the end of the 8th week of Fenugreek seed powder administration was reduced significantly (p < 0.001). This shows that feeding Fenugreek seed powder is beneficial to diabetic subjects.
Manjiri Ranade et al (2017) carried out a Prospective, randomized control trial on A simple dietary addition of fenugreek seed leads to the reduction in blood glucose levels. Total sixty patients of Type 2 diabetes mellitus diagnosed at least 6 months prior and on OHAs and insulin were included in the study. Patients were randomized to receive 10 gm of fenugreek seeds soaked in hot water and another group was not. Strict dietary and exercise controls were followed as per the guidelines of American Diabetic Association protocols. The parameters assessed were demographic profile on the first visits and fasting blood sugar levels and HbA1C every month till 6 months. The study finding shows that A total of sixty patients were enrolled in the study divided into two groups each containing thirty patients. One group of patients received 10 gm of fenugreek seeds soaked in hot water every day, while the second group did not received. Statistical analysis shows that there is
