Diabetes and Unani Medicine

In Unani medicine, the discussion on diabetes is based mainly on the signs and symptoms. Increase in thirst and micturition have been described unanimously by every Unani scholar as cardinal symptoms of diabetes and they had described diabetes by various terms like Dulaab, Istisqa-e-Amnas, Mo’attisha, Dawwarah, Barkariyyah, Zalaqul kulliya, ziyasqoos and Qaramees. Presently, Ziabetus is the terminology used for diabetes, in general, and Ziabetus Shakri for diabetes mellitus.

Etiology

The etiology of disease is considered to be seated in the kidneys and the liver. Ziabetus is caused by one of more of the following factors:

  1. ̒ mizāj ārr kulya (Hot derangement in the temperament of kidneys)
  2. Barūdat-i-kabid wa kulya (Cold Derangement in Temperament of Kidneys and liver)
  3. u̒ f al-Kulya (Renal insufficiency)
  4. Ittisā̒ al-kulya wa Majrā-i-Bawl (Dilatation of Kidneys and urinary tract)

Classification

According to the presence or absence of sugar in the urine, Ziabetus is divided into two types:

  1. Ziabetus Sada: it is also called Ziabetus ghair shakari. It is characterized by excessive thirst and excessive urination but there is no sugar in the urine.
  2. Ziabetus Shakari, it is characterized by excessive thirst and urination and presence of sugar in the urine. In this disease patient has excessive thirst and takes plenty of water and passes all the water he consumed without any metabolic change.

According to the khiffat and shiddat (intensity) of the sign and symptoms, it is also divided into two types:

  1. Ziabetus Haar: Acute symptoms of the Ziabetus with abrupt onset occur like excessive thirst (polydipsia) and increase urination (polyuria) with other symptom and sign of su-i-mizaj haar like heat in flanks and dryness of the body, due to su-i-mizaj haar sada of kidneys.
  2. Ziabetus Barid: In which the thirst and frequency of urine is comparatively less. In this disease Mizaj of kidneys disturbed so they absorb water from blood and send to the urinary bladder immediately due to weakness in quwwate masika (retentive power). So kidneys attract the water from the circulation, liver, stomach and intestine because of which patient has the immoderate thirst (polydipsia).

Pathogenesis

Jalinoos described it as a disease specific to kidneys because of weakness in their retentive ability. He has expressed the thought that the weakness of quwwat-e-mughayyarah may be a causative factor of diabetes. He mentioned that, when hot temperament is associated with moisture, then absorption (into the kidneys) is less, urine is dark in colour and viscous and, if cold temperament is predominant along with dryness, then the power of absorption is very strong and this is the most lethal form of diabetes.
Zakariya Razi mentions in Al-Hawi Fil- Tib states that this disease is basically caused due to abnormal hot temperament of the kidneys. This hot temperament affects the bladder also. Due to the increased heat, the kidneys absorb a lot of fluids from the gastro-intestinal tract. Also, due to weakness of quwwat-e-masika, the kidneys are not able to retain these fluids and they are immediately diverted to the bladder, and excreted as such. The loss of fluids is again responsible for increasing the already abnormal hot temperament. This gives rise to a vicious cycle of intake and excretion, and the disease is, therefore, difficult to treat.
According to Ibne Nafees in diabetes, quwwate- masika of the kidneys is weakened due to the abnormal hot temperament, therefore, they are unable to retain the fluids in the body and the quwwat-e-dafi’a is stimulated and it expels the fluids immediately after intake. Thus, the cycle of absorption (into the kidneys) and excretion continues”. On this basis, it has been named dulaab (water-wheel) and dawwarah (rotatory, revolving, whirling etc).

Line of Treatment

  1. Correction of Su’-i-mizaj
  2. Removal of predisposing cause

Ilaj (Treatment)

Therapeutic approaches for Ziabetus in Unani medicine can be broadly classified into three main categories.

  1. Dietary modifications
  2. Lifestyle modifications
  3. Pharmacotherapy

Dietary modifications

  • Avoid refined cereals.
  • Give more weightage to fibrous foods.
  • Avoid fatty foods.
  • Avoid junk, fast and sugary foods.
  • Restrict red meat and liquor.
  • Foods should be cooked in vinegar.
  • They should reduce the amount of food.
  • Hot spices should be added in ghiza (food) e.g. Filfil Daraz, Zeera, Lehsun because they have Mulattif

Lifestyle modifications

  • Physical exercise of appropriate intensity and duration is recommended.
  • Excessive sleep, because of its effect in promoting the phlegmatic humour, should be avoided.
  • Avoid sedentary lifestyle.
  • Stress, strain and anxiety should be avoided.
  • Avoidance of humid and cold environments is recommended.

Ilaj bil Dawa (pharmacotherapy)

Single and compound formulations for the treatment of Ziabetus mentioned in Unani literature are as:

capture-unani

Studies conducted in National Institute of Unani Medicine on Diabetes Mellitus

Clinical Evaluation of Safoof  Ziabetus in Management of Ziabetus Shakri

 Hamid Ali (2007)

 Guide: Dr. Mohd Anwar

 Co-guide: Dr. Tanzeel Ahmad

Background and Objectives: Ziabetus Shakri (Diabetes Mellitus Type II) has become a global problem in spite of advances in medical science. Globally, it affects about 246 million people. It leads to various complications like blindness, kidney failure, coronary artery disease and gangrene of lower extremities. Owing to these complications, the researchers of different system of medicine are concentrating on development of new anti diabetic drugs. Different anti diabetic drugs of main stream medicine have potent and effective hypoglycemic action, but the long term use of these drugs result in various side effects. Therefore there is dire need to develop safe and effective drug for the management of Ziabetus Shakri. Thus, this study was planned to evaluate the efficacy of Safoof Ziabetus in the management of Ziabetus Shakri on scientific parameters.

Methods: A randomized single blind placebo controlled trial was conducted on 50 newly diagnosed patients of Ziabetus Shakri. They were randomly divided into test group and placebo group. Test group comprising of 30 patients was given test drug- Gurmar Booti (Gymnema Sylvester) and Gilo khushk (Tinospora cardifolia); while placebo group of 20 patients were given placebo in a dose of 6gm thrice a day in a capsule form orally with water, 15 minute before meal along with planned diet and exercise for the period of 45 days. All the cases were assessed for subjective and objective parameters. The data were analyzed statistically by using Student’s‘t’ test.

Results: This study showed good response on blood sugar level in patients treated with Unani formulation. Average reduction of 56.83 mg/dl (32.80 %) in fasting and 67.23 mg/dl (26.94 %) in post prandial blood sugar was observed. On comparing before treatment observations of fasting blood sugar and post prandial with their corresponding after treatment observations, with the help of Student’s ‘t’ test, reduction was found significant(p<0.05).

Interpretation and Conclusion: This study revealed that the test drug has good response in reducing fasting and post prandial blood sugar. No adverse effects were observed during and after trial. Thus, it can be concluded that the test drug was significantly effective in comparison to placebo control in Ziabetus Shakri.

Keywords: Safoof Ziabetus; Ziabetus Shakri; Diabetes Mellitus

Study of Diabetic Nephropathy and Evaluation of Unani formulation in its Management

Sarfaraz Ahmad (2011)

Guide: Prof. Mansoor Ahmad Siddiqui

Background and Objectives: Diabetic nephropathy is a syndrome characterized by a secondary renal disease in patients with diabetes mellitus. It is the leading cause of kidney disease in patients and affects approximately 30 % of type 1 and 20 %of type 2 diabetic patients. Diabetic Nephropathy is clinically defined by the presence of persistent proteinuria of >500mg /day in a diabetic patient who has concomitant diabetic retinopathy and hypertension and in the absence of clinically and laboratory evidence of other kidney or renal tract disease. It is single most common cause of end stage renal disease, persists as a huge cause of patient morbidity, and carries an equally heavy economic burden f or society. It is high time that safety and efficacy of Unani drugs should be validated on scientific parameters. Hence, a clinical trial was conducted with the objective of providing safe, effective and economic drug in the management of Diabetic Nephropathy.

Methods: A single blind, standard controlled randomized trial was conducted on 30 patients, randomly assigned into two groups, test (group A) and control (group B), comprising 20 patients in test and 10 patients in control group. A polyhedral Unani formulation Jawarish Zaruni (excluding sugar) in the form of capsule was given to the test group while in case of control group, standard drug (Enalapril) was administered in a day orally for 45 days. All the patients were assessed for subjective and objective parameters. The results were analyzed statistically using Friedman test with dunn’s multiple pair comparison test, Wilcoxon matched pair test, paired ‘t’ test for intragroup and Kruskall Wallis , Mann Whitney test, Unpaired ‘t’ test for intergroup comparison.

Results: The test group exhibited statistically significant effect in reducing microalbuminuria, 24 hours urinary protein and improved subjective parameters; fatigue, leg edema, in comparison to standard drug. No clinically significant side effects were observed in test groups and overall compliance to the treatment was satisfactory.

Interpretation and Conclusion: The study demonstrated that the test drug exhibited response on objective parameters, microalbuminuria, and 24 hours urinary protein and on subjective parameters. Thus, it can be concluded that the test drug is safe, effective and validates the use of test formulation in the treatment of Diabetic nephropathy.

Keywords: Diabetic Nephropathy; Unani formulation; Randomized Controlled Trial

Study of Diabetic Peripheral Neuropathy and Therapeutic evaluation of Unani formulation in its Management

Nusrath Fathima (2011)

Guide: Dr. Mohd Anwar

Background and Objectives: Diabetic Peripheral Neuropathy is one of the most frequent and troublesome complication of diabetes mellitus. It is triggered by persistent hyperglycemia which should not be underestimated, because the progress of the disease may lead to foot ulcers, followed by gangrene that may require amputation. The reported prevalence report of diabetic peripheral neuropathy is 10-26%. Unfortunately, current therapies that reduce symptoms of diabetic peripheral neuropathy do not prevent progression of the disease. Therefore, search of safe and effective drugs for its management is quiet necessary. In Unani system of medicine, Habbe Azaraqi, a compound formulation, used for the treatment of Wajaul asab, may prove useful in this condition but its efficacy has not been evaluated so far, on scientific parameters, particularly for the management of diabetic peripheral neuropathy. Therefore, a randomized single blind standard controlled trial was conducted to evaluate the efficacy of Habbe Azaraqi in diabetic peripheral neuropathy.

Methods: A randomized standard controlled trial was carried out on 30 diagnosed patients of diabetic peripheral neuropathy.  The patients were randomly divided into test and control groups comprising 20 patients in test group and 10 patients in control group. Group A was given Habbe Azaraqi, 500mg in tablet form, twice a day, whereas patient of group B were treated with standard drug Methylcobalamine, 500mg once a day for a period of 45 days. In order to maintain glycemic index, Glibenclamide 5 mg twice a day was given in both groups for the same duration. The subjective parameters and TCNS were assessed fortnightly and results were analyzed statistically by using Kruskall-Wallis test with Dunn’s multiple comparison test, and repeated measures ANOVA, while APT was assessed before and after treatment with paired‘t’ test and Mann-Whitney U test in inter group.

Results: The test drug exhibited statistically significant improvement in pain (p<0.05), numbness (p<0.001), burning sensation (p<0.001), and paresthesia (p<0.05) in subjective parameters in intra group comparison, whereas it was not significant in inter group comparison. In objective parameters TCNS and VPT both were statistically significant in intra group comparison (p<0.05), while TCNS was also significant in inter group comparison (p<0.005) in test with respect to control, but VPT was not significant in inter group comparison.

Interpretation and Conclusion: The study reveals that the test drug has good response in relieving symptoms of subjective parameters of diabetic peripheral neuropathy, as compared to control drug. No side effects or toxicity was seen during and after trial. Thus, it can be concluded that the test drug is effective and safe in the management of diabetic peripheral neuropathy. Further, it may be recommended for delaying complications of diabetic peripheral neuropathy.

Keywords: Diabetic Peripheral Neuropathy; Unani formulation; Randomized Controlled Trial

Clinical Study of Ziabetus Shakri (Diabetes Mellitus Type II) and Evaluation of Efficacy of Unani Formulation in its Management

Qutubuddin (2012)

Guide: Dr. Mohd Anwar

Background and Objectives: Ziabetus Shakari (Diabetes Mellitus Type) is a serious chronic metabolic disorder. It has a significant impact on health, quality of life and life expectancy of patients, as well as on the health care system. It is a multi systemic illness associated with a variety of complications. The complications of untreated or ineffectively treated diabetes include retinopathy, nephropathy and peripheral neuropathy. Although currently available hypoglycemic agents are effective in controlling blood sugar level, but do not prevent the progression of the disease; therefore Unani drugs with antihyperglycemic activities are increasingly sought by diabetic patients and physicians. Therefore, this study was planned to evaluate the efficacy of a Unani formulation in the management of Ziabetus Shakari on scientific parameters

Methods: A randomized single blind standard controlled study was carried out on 40 diagnosed patients of diabetes mellitus. They were randomly allocated into two groups test (A) and control (B), comprising 20 patients in each group. Group A was given test drug in the dose of 3 gm twice a day in the form of tablet (4 tablets twice a day each tablet weighing 750 mg) containing Satte Gilo (Tinospora cardifolia), Tabasheer (Bambusa bambos) and Magaze Kanwal Gatta (Nelumbo nucifera).While patients of Group B were treated with the control drug, Diabecon 2 tablets orally twice a day. The patients of both the group were treated for a period of 45 days and assessed at an interval of 15 days for any improvement or deterioration in the symptoms of disease.  All the patients were advised a planned diet and moderate exercise in both groups and kept under strict observation. The assessments for subjective and objective parameters were done fortnightly. The results were analyzed statistically by using Friedman test, Kruskal-Wallis with Dunn’s multiple comparison test, Wilcoxon matched pairs test, Repeated measures ANOVA with post test, Paired and unpaired ‘t’ tests.

Results: Test drug exhibited significant effect on subjective parameters like polyuria, progressive weakness (p< 0.05), in polydipsia, unexplained weight loss (p< 0.01), and in tiredness (p< 0.01); while there was no effect on other subjective parameters such as polyphagia, dizziness and pruritus. On objective parameters there was significant effect observed on urine sugar (p< 0.01) and HbA1C (p< 0.05), while there was no significant effect found on FBS and PPBS (p >0.05).

Interpretation and Conclusion: The study revealed that test drug exhibits good response on most of subjective parameters such as polyuria, polydipsia, tiredness, progressive weakness and unexplained weight loss; and on objective parameters such as urine sugar and HbA1C.    appeared to be efficacious in management of diabetic neuropathy and exhibited significant effects in improvement of neuronal function. No adverse effects or toxicity has been reported during or after the trial. Thus, it can be concluded that test drug is safe and effective in relieving the symptoms and maintaining glycemic index in the patients of diabetes mellitus and can be used for the management of diabetes.

Key words: Ziabetus Shakri; Diabetes Mellitus Type-2; FBS; PPBS; HbA1C; Unani Medicine.

Evaluation of Efficacy of Jadwar and local application of Roghan-e-Sosan in Sensory Neuropathy of Foot in Diabetic Patients

Zaffar Husain (2014)

Guide: Dr. Mohd Anwar

Background and Objectives: Diabetic neuropathy is the most common and devastating complication of diabetes mellitus leading to great morbidity and mortality, resulting in a huge economic burden for diabetes care. The prevalence of diabetic neuropathy varies from 10% within 1 year of diagnosis of diabetes to 50% of patients with diabetes for more than 25 years. Chronic persistent hyperglycaemia is the main culpable factor and should not be overlooked because the progression of the disease may lead to diabetic foot. Unless there is aggressive intervention, amputation becomes the end point. Current treatment options are not specific for the underlying cause of nerve damage. Therefore search of safe and effective management of diabetic neuropathy is the need of the hour. In Unani system of medicine, Habbe-e-jadwar and Roghan-e-sosan have been used for the management of neuropathic pain but their efficacy has yet to be proven on scientific parameters.

Methods: a randomized standard controlled study was carried out on 30n diagnosed patients of diabetic neuropathy, randomly allocated to Control and Test group, comprising 15 patients each group respectively. Patients of control group were given Habb-e-azaraqi, 500mg twice daily as a standard drug and the Test group was given Habb-e-jadwar, 375 mg twice daily and local application of Roghan-e-sosan over feet twice daily for 45 days. The objective parameters i.e. VPT, TCNS and VAS were statistically analyzed by applying Student’s “t” test, two tailed dependent for intergroup comparison and the two tailed independent for intergroup comparison, Levene’s test was applied to assess the homogeneity of variance.

Results: Both test and control groups exhibited statistically significant difference in objective parameters. VPT showed statistically significant difference (p<0.05) in intra group comparison in both groups while in TCNS and VAS showed strongly significant difference (p<0.001)in intra group comparison in both groups. The intergroup results are not significant (p> 0.05) i.e. efficacy of both groups was similar in improvement.

Conclusion: The study revealed that both test and control drugs appeared to be efficacious in management of diabetic neuropathy and exhibited significant effects in improvement of neuronal function. No adverse effects or toxicity has been reported during or after the trial. Thus, it can be concluded that both, test and control drugs are safe and effective in management of diabetic neuropathy.

Keywords: Diabetic neuropathy; Vibration perception threshold; Habb-e-jadwar; Roghan-e-sosan; Habb-e-Azaraqi; Unani system of Medicine

Effect of Tahlab (Spirulina) in Ziabetus Shakri (Type-2 DM) A Randomized Controlled Study

Md. Anzar Alam (2015)

Guide: Prof. Mansoor Ahmad Siddiqui

Background and objectives: Diabetes Mellitus is a common metabolic disease affecting approximately 150,000,000 people worldwide. Despite of advancements in management of diabetes, its relative co-morbidities and mortality is increasing globally. Therefore search for safe and effective management is the thrust area for the researchers. Unani scholars claimed the effectiveness of several antidiabetic drugs, and all such drugs needed to be validated scientifically. Hence a clinical trial was conducted with the objective of providing safe and effective management of diabetes.

Methods:  this study was conducted as single blind randomized standard controlled on 40 diagnosed patients of diabetes mellitus with the test (n=30) and control (n=10) groups for 45 days. Test group received 7 gm of Tahlab powder twice a day and control received metformin (500mg) 1 tablet twice a day. Subjective and objective parameters were assessed on 0, 15th, 30th and 45th day.

Results: Test drug exhibited significant effect on subjective parameters like polyuria, polydipsia, polyphagia and tiredness in comparison of control group. Effect on objective parameter FBS was found highly significant (p< 0.003), and PPBS was moderately significant with (p< 0.013), while no effect was observed on urine sugar and HbA1C. The results were assessed statistically using two tailed student t test, paired proportion test and Fischer exact test

Interpretation and Conclusion: The study revealed that test drug exhibits good response on most of subjective parameters such as polyuria, polydipsia, polyphagia and tiredness, and on objective parameters such as FBS and PPBS in comparison to control group.  No adverse effects or toxicity has been reported during or after the trial. Thus, it can be concluded that test drug is safe and effective in relieving the symptoms and can be used for the management of diabetes.

Key words: Ziabetus Shakri; Tahlab; Spirulina; Diabetes Type-2

Evaluation of Hypoglycemic Activity of Pakhanbed (Bergenia ligulata) in Experimentally induced Diabetes in Animal Model

Mohammed Nasmeer (2012)

Guide: Dr. Najeeb Jahan

Background and objectives: Diabetes mellitus is the third leading cause of death after heart disease and cancer in many developed countries. Its prevalence is about 6% worldwide and the number of cases, presently estimated at more than 150 million, is predicted to be doubled by 2025. Therefore the demand of safe and effective drugs dot the treatment of DM is on the rise. Present study was carried out to evaluate the hypoglycaemic effect of rhizome pakhanbed, a well known drug of Unani medicine, in experimental animals.

Methods: The study was carried out in Wistar rats of either sex weighing 150-200 gms. The animals were divided in to 5 groups (I, II, III, IV and V) of 10 animals each. Group I served as plain control and given distilled water. Group II, III, IV and V were injected single dose of Streptozotocin, 50 mg/kg in 0.01M citrate buffer after overnight fasting. Group II was kept as negative control after induction of diabetes. Group III, IV and V were given pakhanbed extract 120.75 mg/kg and glibenclamide 600 µg/kg b.w. respectively. Blood samples were taken at 0th, 10th, 28th, and 56th days, the effect of the test drug was observed on body weight, fasting blood glucose (FBG), post-prandial blood glucose (PPG), urine output, urine sugar and hepatic glycogen content in vivo; and by alpha amylase inhibitory assay in in vitro. Physicochemical studies of the drug were also done. The findings were also calculated statistically by using repeated measures ANOVA tests with Chi-square/Fischer Exact test.

Observation and results: The 50% hydroalcoholic extract of the rhizome of pakhanbed demonstrated significant increase in body weight of rats of group III, IV and V by 7.35% (p<0.01), 31.0% (p<0.01), 11.8 (p<0.01), respectively. On the 28th day FBG, PPG were reduced significantly in group III and group IV at p< 0.05 and p<0.1 respectively. On 56th day the reduction in FBG and PPG were strongly significant in group IV (P<0.01) when compared with group III and IV and was towards plain control. Percentage deceases in urine output and urine sugar were found to be significant on 28th day. Hepatic glycogen levels were found to be resettled towards plain control in group II and Alpha-amylase inhibitory activity of the test drug was not significant in vitro study but was found to inhibit α-glucosidase enzyme. Physic chemical studies showed that presence of alkaloids, reducing sugars, flavanoids, glycosides phenols, terpenes, sterols and saponins.

Interpretation and Conclusion: The test drug has shown to increases body weight and glycogen content; to reduce FBG, PPG, urine output and urine sugar and to inhibit α-glucosidase enzyme in dose dependent manner. Since all these activities are suggestive of hypoglycaemic effect and the presence of active constituents which have been reported to have anti-diabetic activity, validate that the test drug possesses significant hypoglycaemic effect.

Keywords: Diabetes mellitus; Pakhanbed; Bergenia ligulata; Streptozotocin; Glibenclamide

 

Evaluation of Hypoglycemic Activity of Qurs Tabasheer in Experimentally Induced Diabetes in Animal Model

Md Nazamuddin (2013)

Guide: Prof. Abdul Wadud

Co-Guide: Dr. Najeeb Jahan

Background and objectives: Diabetes mellitus is the third leading cause of death in many developed countries. Its prevalence is about 6% worldwide and the number of cases, presently estimated at more than 150 million, is predicted to be doubled by 2025. Though, this disease is not completely curable but can be controlled by using anti hyperglycemic drugs. The available conventional drugs for the management of these diseases successfully control hyperglycemias but their long term use is associated with a number of adverse effects and is quite expensive. Thus search of safe and cost effective anti-hyperglycemic drugs is the need of time. Alternative treatments for diabetes have become increasing popular for the last several years. Presently, there is growing interest in herbal remedies for the treatment of diabetes mellitus, Unani medicine also offers safe anti hyperglycemic drugs.

Methods: Present study was carried out by the method of Rakietan et al (1963) and Van Zwieten (1963) with some modification in the treatment schedule. Wistar rats of either sex; weighing 150-200g were divided into 5 groups of 8 animals each as plain control, negative control, test group A, test group B and standard control. Group I served as plain control and the animals in this group were given distilled water throughout the day. Group II served as negative control and the animals in this group were received inj. Streptozotocin (i.p.) 50 mg/kg in 0.1M citrate buffer, after overnight fasting. Groups III, IV and V were injected single dose of inj. Streptozotocin (i.p.) 50 mg/kg in 0.1M citrate buffer, after overnight fasting. Animals of group III and IV were given Qurs tabasheer 583/kg, and 1166/kg, respectively. Animals of group V were given Glibenclamide 600 g/kg. Blood samples were taken on 0th, 10th, 28th and 56th days. The effect of test drug was assessed by measuring body weight, fasting blood glucose (FBG), post prandial blood glucose (PPG), hepatic glycogen content, lipid profile and glycosylated hemoglobin. The data were analyzed statistically by using repeated measures ANOVA tests with Turkey-Kramer Multiple comparison test.

Observations and Results: The test drug demonstrated significant increase in body weight of rats of group III, IV and V by 8.28% (p<0.01), 33.74% (p< 0.01), 14.61% (p<0.01) respectively. On 56th day the FBG was significantly decreased in group III and IV when compared to group II. The PPG also significantly decreased in group IV (p<0.05) when compared to group II. Hepatic glycogen level was found to be resettled towards plain control in group III, lipid profile and glycosylated hemoglobin came towards normal in the test group. The values of HbA1C significantly decreased (p<0.01) in test group III and IV with respect to group II. Administration of test drug and standard drug to diabetic rats restored the HbA1C to almost control levels.

Conclusion: The test drug increased body weights of animals and glycogen content; reduced FBG, PPG; total cholesterol, triglycerides, LDL and VLDL and HbA1C in a dose dependent manner. Since all these activities are suggestive of antiglycemic effect, therefore in light of above findings, it can be concluded that the test drug may be considered as a hypoglycaemic agent.

Keywords: Diabetes Mellitus; Unani Medicine; Qurs tabasheer; Glibenclamide

 

STANDARD MANUFACTURING PROCEDURE OF QURSE TABASHEER–A HERBOMINERAL UNANI ANTIDIABETIC FORMULATION

Waris Ali, Hamiduddin

Introduction: Qurse (Tablet) is one of the most suitable dosage forms due to its easy portability, stability and accuracy of dose etc. Unani tablets contain diverse crude drugs which require specific manufacturing procedures for good quality of finished products to be maintained. In this work Qurse Tabasheer containing six ingredients, Tabasheer (Siliceous concretions) , Gule Surkh (Rosa damascena Mill. flower), Gulnar (Punica granatum Linn. flower), Tukhme kahu (Lactuca  sativa Linn. seeds), Tukhme khurfa (Portulaca oleraceae  Linn. seeds ) and Gile Armani was taken up for study due to its important indication in diabetes, hummae hadda and diarrhea . Objective of this study was to develop standard operating procedure (SOP) for its manufacturing stages.

Materials and Methods: Ingredients were identified by the experts. For process standardization total 18 batches were generated for the optimum working process related to the powder size, quantity of binder, granulation, temperature and duration for drying and compression on the basis of trial and error. All the batches were assessed three time for friability, hardness and disintegration time and final ideal batch was selected on the basis of normal set parameters. And ideal working condition was documented as SOP for manufacturing procedure. This final ideal batch was again repeated to check the reproducibility.

Results: Friability, hardness and disintegration time of selected final ideal batch and repeated final ideal batch was (0.0730±.01764, 0.09±0.0057), (4.10±.050, 4.03±0.087) and (26.16±0.5376, 25.57±0.4860) respectively and it was found within the set limit. Pre-compression parameters were fine, weight of tablet was 793.7 ± 4.755 and weight variation was <5%.

Conclusion: This work may be of utility in improving the quality when comparing parameters as it shows reproducible results. This SOP may be used for future reference for production of ideal Qurse Tabasheer quality wise.

Key words: Standard manufacturing procedure, Qurse Tabasheer, Unani, Tablets

Prevalence of Diabetes Mellitus Type 2 and Assessment of Knowledge regarding Diabetes among Diabetic Patients in Field Area of NIUM, Bangalore

Mohd Saquib (2007)

Guide: Dr. Asifuddin Mufti

Co-Guide: Dr. Zarnigar

Background and objective: The cognizance of diabetes mellitus to the mankind is very old. Diabetes mellitus is a worldwide health problem. Global burden of diabetes mellitus is continuously to rising. World health organization estimated that there were 171 million diabetic individuals in the world in 2000 and projected it to be 366 million in 2030. Major contribution was pointed towards developing countries like India. India has the largest number of diabetic individual in the world and is called as diabetic capital of the world. There were approximately 31.7 million diabetic people in India in 2000 and it is expected to touch 79.4 million in 2030. The objectives of the study were to know the prevalence of diabetes mellitus type-2 in a selected area, to make people aware about the diseases, its complications, control and prevention.

Methods: This study was a population based cross sectional study conducted in Padarayanpura, field practice area of NIUM Bangalore. Every sixth house was surveyed in the area and a total of 640 adults (aged>20 year) from 128 houses participated in the study. Through pretested and semi structured questionnaire, information related to demography, anthropometry, personal history, medical history and knowledge of diabetes was obtained. Venous blood samples were drawn for the assessment of fasting blood glucose.

Results: The overall prevalence of Type-2 DM in the population under study was found as 14.53%. Prevalence among men was 13.53%, whereas among women it was 15.67% (p= 0.4439). Prevalence of Type 2 DM was higher among the age group > of 60 years i.e. 40.45% (p<0.0001), professionals 18.75% (p=0.06), illiterates 23.87% (p=0.0037), three generation family 15.55% (p=0.85), smokers 18.95% (p=0.35) and married 17.23% (p=0.0001) as compared to their respective groups. Prevalence among high, middle and low socio economic subjects was 15.91%, 15.79% and 11.52% respectively (p=0.369). Prevalence among subjects with BMI > 25 was 15.24% and < 25 was 13.78% (p=0.65).  Among the 45 known diabetic cases 55.56% had poor knowledge, 28.89% average knowledge and only 15.55% had good knowledge. Females had poorer knowledge about the disease as compared to males.

Interpretation and Conclusion:  These findings confirm an increase in prevalence of diabetes type 2 among males, females, all age groups, all socioeconomic and all education groups. Knowledge and awareness regarding diabetes is still inadequate both in males and females. Massive diabetes prevention and education programme are needed in area under study.

Keywords: Diabetes Mellitus; Prevalence; Knowledge regarding Diabetes

 

An Epidemiological Study on Risk Factors among Type-2 Diabetes Mellitus Patients Attending NIUM Hospital, Bangalore

Mohd Sajid (2009)

Guide: Dr. Mohd Zulkifle

Co-guide: Dr. Abdul Haseeb Ansari

Background and objective: Diabetes mellitus with its devastating consequence has assumed epidemic proportion in many countries of the world including India, due to unfavorable modification of life style and dietary habits. An account of its prevalence at different location and population will help in determining the factors consistent with it, and will also help in deciding the course of action in respect of its prevention and management. Therefore, present study was planned with an objective to identify the prevalence of risk factors in diabetic patients, visiting NIUM hospital, Bangalore.

Method: The study was cross sectional, hospital based survey conducted at NIUM, Bangalore. Only diagnosed cases of Type 2 DM of either sex between ages of 25-70 years were selected for the study. Total 166 patients participated and a pre structured schedule was employed for the assessment of etiological (risk) factors of Type 2 DM among them. The duration of study was 12 months.

Results: The study demonstrated that prevalence of Type 2 DM was higher in male (57.23%) as compared to their counterpart. There was a higher prevalence (26.51%) among the age group of 45-54 years. The prevalence of Type 2 DM in upper lower social class was 57.23%, in non alcoholic 87.95% and in tea/coffee users it was 83.74%. The prevalence among patients with nil exercise was 59.63% while it was found 32.54% among smokers and tobacco chewers. In the present study 9.85% female patients gave the history of gestational hyperglycemia. 47.60% patients were found with positive family history of diabetes mellitus and 13.86% had the family history of obesity. A significantly higher prevalence of 90.37% was found in non vegetarian / on mixed diet, 89.15% patients were using refined oil and 49.40 % were moderate workers. The prevalence of Type 2 DM among over weight was 42.78% whereas 16.26% patients were found obese. 63.86% exhibited mental and / or physical stress.

Interpretation and conclusion: The findings of this cross sectional study revealed strong association of Type 2 DM with, being male, elderly, of low social class, non alcoholic, smokers and tobacco chewers, over weight and obese. Moderate work, nil exercise, mental and / or physical stress were also observed as significant risk factors. Tea / coffee consumption and use of refined oil were surprisingly associated with Type 2 DM. The present study revealed an increased prevalence with positive family history of diabetes and obesity. There was no definite association with gestational hyperglycemia.

Keywords: Unani Medicine; Type-2 DM; Prevalence; Risk factor

Prevalence of Ziabetus Shakri (Type 2 Diabetes Mellitus) and Dietary Habits among Senior Citizens attending NIUM Hospital, Bangalore

Abdul Azeez Rizwana (2015)

Guide: Dr. Arish Mohammad Khan Sherwani

Background and objectives: Prevalence of type 2 diabetes mellitus is increasing rapidly around the world. India is second in ranking having a higher prevalence of diabetes mellitus and the numbers are increasing at an alarming rate. Dietetics plays major role to control type 2 DM. The study was designed with the objectives to study the prevalence of type 2 diabetes mellitus among the elderly and to assess the dietary habits among them.

Methodology: this hospital based, cross sectional study was conducted among the elderly aged 60 years and above, including senior citizen of either sex, newly diagnosed and known cases of type 2 DM attending community medicine OPD, geriatric OPD, IPD and biochemistry lab with support of good referral practices of NIUM hospital, during stipulated period of study. Prevalence of Ziabetus Shakri was assessed among varied socio-demography. The chi square test was used to determine the most possible causal association between dietary habits and Ziabetus Shakri. Person correlation coefficient had used to evaluate the relationship between variables including dietary habits and modern diagnostic tools of investigations by using 95% confidence level.

Results: The prevalence of Ziabetus Shakri (type 2 diabetes mellitus) was found 45.6% as a whole. The highest and lowest prevalence of type 2 diabetes mellitus found among 60-65 years and above 75 years, respectively. Prevalence among males was 30% and females were 15.6%. A sub type of meal quantity namely, more which exhibited strongly significant relationship with FBS >126mg/dl, PPBS > 200mg/dl and HbA1C > 6.5 (p=0.000**). Increased three time main meal frequency showed strongly significant correlation with FBS >126mg/dl (p=0.002**) and PPBS >200mg/dl (p=0.001**). South Indian meal pattern showed strongly significant relationship with PPBS > 200mg/dl (p=0.001**). BMI >25 kg/m2 showed strongly significant correlation with high risk group of IDRS among populace of overall senior citizens (p=0.000**). Holistic cold mizaj (according to ajnas e ashra) of all senior citizens exhibited relationship with type 2 DM. Saudavi mizaj 196 (78.4%) was preponderant among all senior citizens.

Interpretation and Conclusion: Results confirmed an increased prevalence of Ziabetus Shakri among senior citizens. These results concluded association of dietary habits. Dietary modifications are an integral part of diabetic care and geriatrics. Meal quantity showed significant correlation with FBS, PPBS and HbA1c. PPBS level was higher among south Indian meal pattern. Newly screened cases of type 2 DM showed paramount importance of extension of screening programme in elderly.

Keywords: Elderly; Dietetics; Ziabetus Shakri; Dietary habits; IDRS; Risk factors

Study on Majoon Arad Khurma and its Granules Prepared with Stevia, with reference to the Standardization and Toxicity Evaluation

Mateen Ahmad Khan (2012)

Guide: Prof. Irshad Ahmad

Background and objective: Majoon Aarad Khurma which is widely use as an effective aphrodisiac is prepared as sugar as base. It is contraindicated in diabetes patients who are suffering from sexual dysfunctions. Preparation of medicine which are sugar free should be innovated or designed to meet the demand of the diabetic patients. Therefore the present study is aimed to develop granules of Majoon Aarad Khurma with natural sweetening agent Stevia rebaudiana. Granules are more convenient and comfortable in usage and dispensing. Granules uphold the same principles and maintain the same characteristics as traditional dosage forms.

Methods: In present study an important Unani formulation i.e. Majoon Aarad Khurma has been modified into granules using Stevia rebaudiana as a sweetener and safety and toxicity of the granules of Majoon Aarad Khurma has also been evaluated. Majoon Aarad Khurma and granules of Majoon Aarad Khurma were prepared and subjected to physicochemical evaluation with reference to the standards mentioned in physicochemical standards of Unani formulations by CCRUM.

For toxicity evaluation of granules of Majoon Aarad Khurma the study was carried out in swiss mice of either sex weighing 25-35 gm were randomly assigned to four groups (1, 2, 3, 4) of 7 mice each. Each group was administered orally with the doses 0.398, 5.73, 9.73, & 16.69 g/kg B.wt. respectively, of the hydro-alcoholic extract dissolved in distilled water. After the administered of test drug all the animals were observed continuously for gross behaviour and mortality at 0 min, 30 min, 60 min, 120min, 240 min, and 24 hrs.

Results: Both the test drug samples Majoon Aarad Khurma and granules of Majoon Aarad Khurma were evaluated for physicochemical parameters as recommended and almost all the values of both the test drugs were found within the standard limits. The acute toxicity study was done on swiss mice of either sex using hydro-alcoholic extract of granules of Majoon Aarad Khurma orally, no behavioral changes and mortality was found during 24 hours observation period.

Interpretation and Conclusion: Granules possessed the same principles and maintained same characteristics as traditional dosage form of Majoon Aarad Khurma. The granules of Majoon Aarad Khurma were found to be more stable convenient and comfortable in usage and dispensing and also safe, light, efficacious, cost effective, and quality controlled. Stevia rebaudiana natural sweetening agent which was used as base for granules was evaluated for its toxicity in animal models and no toxicity was found, hence Stevia rebaudiana can be used as safe and efficacious sweetening agent in preparation of granules as well as in other Unani formulations.

Keywords: Aphrodisiac, Diabetes; Granules; Stevia rebaudiana; Sweetening agent

Development of Sugar Free Granular Dosage Form with Ingredients of Jawarish Jalinoos, its Standardization and Stability Evaluation

Shahnawaz (2016)

Guide: Dr. Khaleequr Rahman

Background and objective: Jawarish Jalinoos is a semisolid formulation used to treat chronic debilitating disorders, geriatric problems and to strengthen the digestive power. However, because of high amount of sugar in this formulation it is not suitable in diabetes mellitus, obesity and patients on restricted calorie intake. Therefore, in this study  sugar  free  granular  dosage  form  (GJ)  was  developed,  standardized  and evaluated  under  accelerated  stability  condition.  Further Jawarish Jalinoos was also evaluated under accelerated stability condition.

Methods: Sugar free granules were developed with the ingredients of Jawarish Jalinoos using stevia extract and evaluated for their physico-chemical characteristic. Further granular  dosage  form  and Jawarish Jalinoos were kept in stability chamber at 40±2ºC/75±5%RH for six months and analysed at zero, one,  three  and  six  month  to  determine  their  shelf  life.   Another pack of both formulations was evaluated for photostability at 1.2 million lux hour illumination with UV energy of 200Watt hours/square meter.  Grimm’s statement of predictive factor 3.3 of accelerated storage period for zone IV was used to calculate the shelf life of tested products.

Results: Physico-chemical parameters i.e. organoleptic characters, moisture content, density,   ash  value,  alcohol  and  water  soluble  matter,  successive  extractives,  pH, sugar content,  total  alkaloid, HPTLC and microbial load were  determined and found supportive in establishing the standard.  Accelerated and photo stability evaluation of granular dosage form and Jawarish Jalinoos showed less than 5% change in physico-chemical parameters.  HPTLC showed  inconclusive  changes  and  microbial  load  was  under  limit  as  described  in WHO  guidelines.  The shelf life of granular dosage form and Jawarish Jalinoos was calculated as 20 months by using Grimm’s statement.

Conclusion: This  study  generated  standard  data  for  GJ  probably  useful  for  future reference.  Granular dosage form and Jawarish Jalinoos have shelf life of 20 months.  Further preclinical, clinical and long term stability studies of GJ are recommended.

Keywords: Accelerated stability study; Granules; Jawarish Jalinoos; Photo stability; Shelf life; Unani system of medicine.

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