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ORIGINAL ARTICLE
UDC 612.392.72:615 SCSTI 76.31.29
DOI: 10.24412/2707-6180-2021-63-19-23
COMPARISON OF HYPOGLYCEMIC FRUITS WITH ALLOPATHIC MEDICATION
D. MARWAT1, A.A. AZMF, A. HUSSAIN3, SH.MURAD1, A. SHAFIQUE4, M. ARIF1
'Islamabad Medical and Dental College, Islamabad, Pakistan 2Islam Med College, Sialkot, Pakistan 3The International Center for Chemical and Biological Sciences, Karachi, Pakistan 4MCC Pharmacy, Islamabad, Pakistan
Shah Murad - https://orcid.org/0000-0003-0259-2524
Citation/
библиографияльщ сттеме/ библиографическая ссылка:
Marwat D, Azmi AA, Hussain A, Murad Sh, Shafique A, Arif M. Comparison of hypoglycemic Fruits with Allopathic Medication. West Kazakhstan Medical Journal. 2021;63(1):19-23. doi: 10.24412/2707-6180-2021-63-19-23
Марват Д, Азми АА, Хуссейн A, Мурад Ш, Шафик А, Ариф М. Гипогликемияльщ жемктерд1
аллопатикальщ препараттармен
салыстыру. West Kazakhstan Medical Journal.2021;63(1):19-23.doi: 10.24412/2707-6180-2021-63-19-23
Марват Д, Азми АА, Хуссейн A, Мурад Ш, Шафик А, Ариф М.Сравнение
фруктов
с
гипогликемических аллопатическими препаратами.
West Kazakhstan Medical Journal. 2021;63(1):19-23. doi: 10.24412/27076180-2021-63-19-23
Comparison of hypoglycemic Fruits with Allopathic Medication
D. Marwat1, A.A. Azmi2, A. Hussain3, Sh. Murad1, A. Shafique4, M. Arif1 'Islamabad Medical and Dental College, Islamabad, Pakistan 2Islam Med College, Sialkot, Pakistan
3The International Center for Chemical and Biological Sciences, Karachi, Pakistan 4MCC Pharmacy, Islamabad, Pakistan
Diabetes mellitus is a chronic, lifelong condition that affects your body's ability to use the energy found in food. There are three major types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. Diabetes mellitus is a chronic disease caused by inherited and/or acquired deficiency in production of insulin by the pancreas, or by the ineffectiveness of the insulin produced. Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves. Too much sugar in your blood can lead to serious health problems. Type-2 diabetes mellitus, which accounts for 90-95% of those with diabetes, previously referred to as non-insulin-dependent diabetes, or adult-onset diabetes, encompasses individuals who have insulin resistance and usually have relative , rather than absolute, insulin deficiency. At least initially, and often throughout their lifetime, these individuals do not need insulin treatment to survive. Metformin is oral antidiabetic drug having lesser morbid effects as compared to other oral antidiabetic agents. We have compared hypoglycemic potential of herbal hypoglycemic agent Figs or Injeer with Metformin. It was single blind correlational research conducted at Jinnah Hospital Lahore-Pakistan from April to August 2018. Fifty diabetic type-II patients of were selected for research. Approved and explained consent was taken by all patients. They were divided in two groups, 25 patients in each group. Group-I patients were advised to take 250 mg Metformin thrice daily for two months. Group-II patients were advised to take 10 grams of Injeer (Figs) in three divided doses for two months. Their base line fasting blood glucose level was taken and kept in record. They were advised to visit the OPD of the hospital fortnightly. They were also advised to check their fasting plasma glucose level daily at the morning by using Glucometer (provided by Acon Pharmaceutics Ltd). After two months when results were compiled and statistically analyzed, it was observed that Metformin decreased blood sugar level 27.6 % and Figs decreased 13.5 %. It was concluded from the study that Figs can decrease blood glucose level significantly, but when compared to Metformin, this change is about half fraction of the Metformin. Keywords: high serum glucose, lipids, mortality CAD, hyperlipidemia.
Гипогаекимияльщ жемiстердi аллопатикальщ препараттармен салыстыру
Д. Марват1, А.А. Азми2, А. Хуссейн3, Ш. Мурад', А. Шафик', М. Ариф1 'Исламабад медицина жэне стоматология колледж^ Исламабад, Пэюстан 2Ислам медицина колледж^ Сиалкот, Пэюстан зрылыми-зерттеу институты, Карачи, Пэюстан 4MCC фармокология, ISD, Пэюстан
^ант диабета - б^л агзаньщ тамак кщ>амындагы энергияны пайдалану кабшетше эсер ететш созылмалы ауру. ^ант диабетшщ уш непзп TYрi бар: 1 типт кант диабета, 2 типт кант диабета жэне гестациялык кант диабета ^ант диабета - б^л ^щы безшщ инсулин eндiрiсшщ тукым куалайтын
о
Shah Murad.
e-mail: shahhmurad65@gmail. com
Received/ Келт tyctí/ Поступила: 11.
Accepted/
Басылымра к,абылданды/ Принята к публикации: 11.03.2021
ISSN 2707-6180 (Print) © 2020 The Authors Published by West Kazakhstan Marat Ospanov Medical University
жет1спеушш1гшен немесе eндiрiлген инсулиннщ тшмазд1гшен туындаган созылмалы ауру. Мундай тапшылы; ;андагы глюкоза концентрациясыныц улгаюына экеледа, бул ез кезегшде, кептеген агза жуйесшщ бузылуына, атап айт;анда ;ан тамырлары жэне жуйке жуйесшщ бузылуына экелiп согады. Гипергликемия денсаулыкда елеулi проблемалар тудыруы MYMкiн. Адамдардьщ 90-95% - ында кездесетiн II типт ;ант диабет бурын инсулинге тэуелдi ;ант диабет немесе егде жастагылардыц ;ант диабет деп аталатын жэне инсулинге тeзiмдi жэне эдетте салыстырмалы, абсолюттi инсулин тапшылыгы жо; адамдарды ;амтитын. Ец болмаса, бастащы кезецшде кейде eмiр бойы бул адамдар eмiр суру Yшiн инсулинмен емдеудi ;ажет етпейдi. Метформин - бас;а пероральдi диабетке ;арсы дэршермен салыстырганда патологиялы; эсерi аз пероральдi диабетке ;арсы препарат. Бiз еимдж iнжiрдiц гипогликемиялы; потенциалын метформинмен салыстырды;. Бул 2018 жылдыц сэуiр-тамыз айларында Пэюстанныц Лахор ;аласындагы Джинна ауруханасында ЖYргiзiлген ;арапайым корреляциялы; зерттеу болды. Зерттеу Yшiн II типтi ;ант диабетiмен ауыратын 50 пациент iрiктелдi. Бекiтiлген жэне TYсiндiрiлген келiсiм барлы; пациенттерден алынды. Олар эр;айсысы 25 пациенттен туратын екi тоща белшдг I топтагы пациенттерге екi ай бойы KYнiне Yш рет 250 мг метформиндi ;абылдау усынылды. II топтагы пациенттерге екi ай шщде Yш дозада 10 грамм инъекция (iнжiр) цабылдау усынылды. Олардыц ораза цандагы глюкозаныц негiзгi децгей елшенш, тiркелдi. Оларга ауруханага екi аптада бiр рет амбулаториялы; негiзде баруга кецес берiлдi. Сондай-а;, оларга KYн сайын тацертец аш ;арынга плазмалы; глюкозаны глюкометрмен (Acon Pharmaceutics Ltd усынган) тексеруге кецес берiлдi. Нэтижелер жиналып, статистикалы; тургыдан талданган ею айдан кейн метформин ;андагы ;антты 27,6% - га, iнжiрдi 13,5% - га темендеткеш бай;алды.
Зерттеуден алынган цорытынды iнжiр цандагы глюкоза децгейш едэуiр тeмендетуi MYMкiн, бiра; метформинмен салыстырганда бул eзгерiс метформиннщ жартысына жуыгын курайды.
Негiзгi свздер: цан сарысуындазы глюкозаныц жогары децгеш, липидтер, ЖЖА eniMi, гиперлипидемия.
Сравнение гипогликемических фруктов с аллопатическими препаратами
Д. Марват1, А.А. Азми2, А. Хуссейн3, Ш. Мурад1, А. Шафик4, М. Ариф1 'Исламабадский медицинский и стоматологический колледж, Исламабад, Пакистан
2Исламский медицинский колледж, Сиалкот, Пакистан зНаучно- исследовательский институт, Карачи, Пакистан 4MCC фармокология, ISD, Пакистан
Сахарный диабет - это хроническое заболевание, которое влияет на способность организма использовать энергию, содержащуюся в пище. Существует три основных типа диабета: диабет 1 типа, диабет 2 типа и гестационный диабет. Сахарный диабет - это хроническое заболевание, вызванное наследственным и / или приобретенным дефицитом выработки инсулина поджелудочной железой или неэффективностью вырабатываемого инсулина. Такой дефицит приводит к увеличению концентрации глюкозы в крови, что, в свою очередь, повреждает многие системы организма, в частности кровеносные сосуды и нервы. Гипергликемия может привести к серьезным проблемам со здоровьем. Сахарный диабет II типа, который встречается у 90-95% людей, ранее называвшийся инсулинозависимым диабетом или диабетом взрослого возраста, включает людей с инсулинорезистентностью и обычно относительным, а не абсолютным дефицитом инсулина. По крайней мере, на начальном этапе, а часто и на протяжении всей жизни, этим людям не требуется лечение инсулином, чтобы выжить. Метформин - пероральный противодиабетический препарат, обладающий меньшим патологическим действием по сравнению с другими пероральными противодиабетическими средствами. Мы сравнили гипогликемический потенциал растительного гипогликемического средства инжир с метформином. Это было простое слепое корреляционное исследование, проведенное в больнице Джинна, Лахор, Пакистан, с апреля по август 2018 года. Для исследования были отобраны 50 пациентов с диабетом II типа. Утвержденное и объясненное согласие было получено со всех пациентов. Они были разделены на две группы по 25 пациентов в каждой. Пациентам I группы рекомендовалось принимать метформин по 250 мг трижды в день в течение двух месяцев. Пациентам группы II рекомендовалось принимать 10 граммов инжира в три приема в течение двух месяцев. Их базовый уровень глюкозы в крови
натощак измеряли и регистрировали. Им посоветовали посещать больницу амбулаторно раз в две недели. Им также посоветовали проверять уровень глюкозы в плазме натощак ежедневно утром с помощью глюкометра (предоставленного Acon Pharmaceutics Ltd). Через два месяца, когда результаты были собраны и статистически проанализированы, было замечено, что метформин снизил уровень сахара в крови на 27,6%, а инжир - на 13,5%. Из исследования был сделан вывод, что инжир может значительно снизить уровень глюкозы в крови, но по сравнению с метформином это изменение составляет примерно половину доли метформина.
Ключевые слова: высокий уровень глюкозы в сыворотке крови, липиды, смертность от ИБС, гиперлипидемия.
Introduction
The most common form of diabetes is called type 2, or non-insulin dependent diabetes. This is also called "adult onset" diabetes, since it typically develops after age 35. However, a growing number of younger people are now developing type 2 diabetes. People with type 2 are able to produce some of their own insulin. Often, it's not enough. And sometimes, the insulin will try to serve as the "key" to open the body's cells, to allow the glucose to enter. But the key won't work. The cells won't open. This is called insulin resistance. Often, type 2 is tied to people who are overweight, with a sedentary lifestyle. Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia) [1]. Normally, body breaks down the sugars and carbohydrates eat into a special sugar called glucose. Glucose fuels the cells in body. But the cells need insulin, a hormone, in bloodstream in order to take in the glucose and use it for energy. With diabetes mellitus, either body doesn't make enough insulin, it can't use the insulin it does produce, or a combination of both [2]. Since the cells can't take in the glucose, it builds up inblood. High levels of blood glucose can damage the tiny blood vessels in kidneys, heart, eyes, or nervous system. That's why diabetes -- especially if left untreated -- can eventually cause heart disease, stroke, kidney disease, blindness, and nerve damage to nerves in the feet [3]. Currently, six classes of oral antidiabetic drugs (OADs) are available: biguanides (e.g., metformin), sulfonylureas (e.g., glimepiride), meglitinides (e.g., repaglinide), thiazolidinediones (e.g., pioglitazone), dipeptidyl peptidase IV inhibitors (e.g., sitagliptin), and a-glucosidase inhibitors (e.g., acarbose) [4]. Metaformin marketed under the trade name Glucophage among others, is the first-line medication for the treatment of type 2 diabetes. This is particularly true in people who are overweight. It is also used in the treatment of polycystic ovary syndrome. Limited evidence suggests metformin may prevent the cardiovascular disease and cancer complications of diabetes. It is not associated with weight gain. It is taken by mouth [5]. Metformin is generally well tolerated. Common side effects include diarrhea, nausea, and abdominal pain. It has a low risk of developing low blood sugar. High blood lactic acid levels is a concern if prescribed inappropriately and in overdose. It should not be used in those with liver diseaseor kidney problems. While there is no clear harm if used during pregnancy insulin
is generally preferred for gestational diabetes. Metformin is in the biguanide class. It works by decreasing glucose production by the liverand increasing glucose use by body tissues [6-9]. Fig is a tree. The fruit is commonly eaten. The fruit and leaves are used to make medicine [10]. Raw figs are a good source (14% of the Daily Value, DV) of dietary fiberper 100 gram serving (74 calories), but otherwise do not supply essential nutrients in significant content. In a 100 gram serving providing 229 calories, dried figs are a rich source (> 20% DV) of dietary fiber and the essential mineral,manganese (26% DV), while several other dietary minerals are in moderate-to-low content [11]. Figs contain diverse phytochemicals, including polyphenols such as gallic acid,chlorogenic acid, syringic acid,(+)-catechin, (-)-epicatechin and rutin. Fig color may vary between cultivars due to various concentrations of anthocyanins, with cyanidin-3-O-rutinoside having particularly high content [12,13].
Methods
Design of research work was correlational, and was conducted at Jinnah Hospital, Lahore from April to August 2018. Fifty diabetic patients (Diabetes Mellitus type-II) were selected from Jinnah hospital to conduct research study. Inclusion criteria was age limit from 25 to 70 years of both gender, male and female whose hyperglycemia was controlled and moderate in state. We excluded those diabetic patients whose hyperglycemia was uncontrolled, unstable, fragile due to use of allopathic or herbal hypoglycemic agents. Patients were divided in two groups. Group-I (25 diabetic patients) was advised to take 250 mg of Tablet Glucophage 250 mg (Metformin) half an hour before taking meal, thrice daily for two months. Group-II patients (25 diabetic patients) were advised to take Injeer (Figs) 10 grams daily in three divided doses half an hour after each meal for two months. Their baseline fasting glucose level was determined by Glucometer (On Call Extra made by ACON Lab 1190059) at start of research work. They were advised to check and keep in record their fasting blood glucose level every day early in the morning. They were advised to take their normal meal without any supplement or high glucose-contained baked or high glucose containing natural fruits. They were advised to come at hospital for follow up or any query regarding drug compliance. Data were expressed as the mean ± SD and "t" test was applied to determine statistical significance as the difference. A probability value of <0.01 was considered as significant and P<0.001 was considered
Table 1 explaining before and after treatment values, percentage change and statistical significance of diabetic patients with two different drugs
Drug group At day-0 At day-60 change % change p-value
Group-I (Metformin ) n=23 230.04±1.99 166.66±2.05 63.4 27.6 <0.001
Group-II (Figs) n=25 219.22±1.67 189.67±1.04 29.5 13.5 <0.01
KEY: All values were measured in mg/dl, Dose of Metformin was 250 mg thrice daily, dose of Figs was 10 grams in three divided doses, n= sample size, p-value <0.01 was considered as significant and p-value <0.001 was considered as highly significant change.
as highly significant.
Results
Results of treatment with two different drugs on fasting blood glucose of DM-II patients are shown in following table. Two patients withdrew from group-I due to their personal problems so biostatistical data was applied for 23 patients in this group. In group-I which was on metformin 27.6% glucose reduction was observed which is statistically highly significant change in the parameter in estimated time.
In group-II which was on Figs treatment 13.5% glucose reduction was observed which is statistically significant change in the parameter in estimated time. Table 1
Discussion
Chronic diabetes conditions include type 1 diabetes and type 2 diabetes. Potentially reversible diabetes conditions include prediabetes — when your blood sugar levels are higher than normal, but not high enough to be classified as diabetes — and gestational diabetes, which occurs during pregnancy but may resolve after the baby is delivered. Allopathic medications are just for good survival of the patients victimized. These drugs have adverse effects which can lead to less compliance of patients. Now a days herbal medications are going to replace allopathic drugs due to their ethnic related doctrine and having lesser adverse effects. In our research Metformin decreased fasting blood glucose 63.4 mg/dl in two months therapy which is equal to 27.6 % decrease. Biostatistically this change in mean values are highly significant which match with results of study conducted by Hubbard et al. [14] who proved almost same effects of Metformin on fasting blood sugar levels in 103 diabetic patients suffering from Diabetes Mellitus type-II. Dunn et al. [15] described, that Metformin interrupt carbohydrates absorption from gastrointestinal tract. Our results are in contrast with results of study conducted by Spiller et al. [16] who observed and proved only 24.8 mg/ dl reduction in 22 diabetic male patients when Metformin was used at dose of 250 mg twice daily for three weeks.
This contrast in results may be due to less concentration of drug used. Hundal et al. [17] agree with already accepted theory of Metformin's hypoglycemic mechanism that inhibition of hepatic gluconeogenesis is main cause for blood glucose level reduction. Triggle et al. [18] labelled Metformin drug as first choice hypoglycemic agent in type-II diabetic patients. In our research results Figs or Injeer decreased fasting blood sugar about 29.5 mg/dl in two months therapy in 25 diabetic patients of Type-II which is statistically significant decrease in the parameter. These results match with results of study conducted by Mawa et al. [19] who proved that about 30.87 mg/dl of blood glucose may be decreased when Figs are used for three months with regular intake of this fruit with each meal i.e. thrice daily. Perez et al. [20] proved almost same changes in fasting blood glucose in 117 diabetic patients suffering from Type-II DM. Perez et al. [21] wrote that these fruits can lower fasting sugar level even more than this reduction proved, if used in enough amount and in research controlled environment. Our results do not match with results of research work conducted by Serraclara et al. [22] who proved very small amount of blood glucose reduction in 12 patients suffering from DM type-II, even they used 500 mg of Metformin thrice daily for one month. Contrast in these results are or may be due to lesser exposure of drug and small sample size. Lyme et al. [23] warned in their research work's conclusion that Metformin can cause morbid effects if given concurrently with Insulin. He has encouraged to use Metformin with Figs without any fear of morbid hypoglycemia.
Conclusions
We concluded from this research that hypoglycemic agents of herb origin i.e. Figs may be good antidiabetic agent but these agents have half fraction of hypoglycemic effects when compared with allopathic drug Metformin.
Acknowledgement: We acknowledge management of the hospital for supporting this research work.
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Conflict of interest: No conflict of interest regarding this work Funding: No any financial support was availed regarding this study.
