RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA
ANNEXURE II
PERFOMA FOR REGISTRATION OF SUBJECT FORDISSERTATION
CANDIDATE
1. NAME OF THE : JISMY ROSE JOSE
AND ADDRESS I YEAR MSc. NURSING
BGS COLLEGE OF NURSING,
APOLLO BGS HOSPITAL,
MYSORE
2. NAME OF THE INSTITUTION : BGS COLLEGE OF NURSING
MYSORE
3. COURSE OF STUDY AND SUBJECT : I YEAR MSc. NURSING
MEDICAL SURGICAL NURSING
4.DATE OF ADMISSION OF COURSE : 15-6-2010
5. TITLE OF THE TOPIC : “SELF INSTRUCTIONAL
MODULE REGARDING
COMPLEMENTARY THERAPY
ON DIABETES MELLITUS”.
6. BREIF RESUME OF THE INTENDED WORK:
INTRODUCTION
"Your lifestyle - how you live, eat, emote, and think - determines your health. To prevent disease, you may have to change how you live."
-Brian Carter
Diabetes Mellitus is a chronic systematic disease characterized by either a deficiency of insulin or a decrease ability of the body to use insulin1. The main types of diabetes mellitus are: Type 1 diabetes (previously known as insulin-dependent or childhood-onset diabetes) is characterized by a lack of insulin production. Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) is caused by the body’s ineffective use of insulin. It often results from excess body weight and physical inactivity. Type 2 Diabetes Mellitus is, by far, the most prevalent type diabetes, accounting for over 90% of patient with diabetes. Gestational diabetes is hyperglycemia that is first recognized during pregnancy2.
Diabetes affects the pancreas, and endocrine gland due to a sympathetic-parasympathetic imbalance in the body3.so along with treatments complementary therapy also helps to control the blood glucose level .complementary therapy includesdiet, relaxation, exercise, herbsetc. In this diet includes fenugreek, aloe Vera, bitter melon, Gymnema etc.
Over the last few decades, traditional societies in many developing countries have experienced rapid and unplanned urbanization, which has led to lifestyles characterized by unhealthy nutrition, reduced physical activity and tobacco consumption. These unhealthy lifestyles are associated with common modifiable risk factors for chronic diseases such as hypertension, diabetes mellitus, dyslipidemia and obesity. It is expected that by 2020 in developing countries, noncommunicable diseases (NCDs) will account for 69% of all deaths. The prevalence of diabetes mellitus will almost double in the next 25 years and at least 75% of those affected will be in developing countries. The burden of disease will be worse in these countries, as the majority of sufferers are expected to be relatively young, of lower socioeconomic status and to suffer from severe disease of premature onset4.
Diabetes has been recorded in the annals of medical history since ancientEgyptian times when the papyrus of Ebers dated at 1550 BC recommended dietaryremedies for those passing abundant urine. Early Sanskrit and Romanliterature also included references to 'honeyed urine' and a 'mysterious affection'where thirst was unquenchable and death inevitable. Although many researchers have theorized about the cause of the illness,diabetes remains a mysterious and debilitating disease with an unknownetiology5.
Today in this advanced world there a lot of diseases which require treatment outside the hospital settings also. Complementary therapy philosophy focuses on the individual and achieving balance and harmony to assist the body to heal itself and considers the patient to be an active participant in their care. The potential threat to quality of life under chronic nature of diabetes many people turn to complementary therapies to assist them to cope and control the disease. In fact it could be said that complementary therapy is an attempt to address the health problems of our time6.
Complementary therapy may speed up the pace of healing but it is not necessarily the cure. There are different kinds of complementary therapies available today but the most common ones include exercise, aromatherapy, diet, massage, and reflexology. These therapies are performed alongside conventional medical treatments.
Diabetes is a very common disorder that affects the way the body uses food for energy in which the complementary therapy is applicable. Therapy for diabetes mellitus mainly includes yoga and visualization.
A nurse is a healthcare professional who, in collaboration with other members of a health care team, is responsible for: treatment, safety, and recovery of acutely or chronically ill individuals; health promotion and maintenance within families, communities and populations; and, treatment of life-threatening emergencies in a wide range of health care settings. Nurses perform a wide range of clinical and non-clinical functions necessary to the delivery of health care. As the field of nursing is advancing at a rapid rate it is the responsibility of these nurses to be updated regarding emerging areas of health.
In this present scenario, complementary therapy is very effective because it reduces the glycemic potential to the normal level. Hence in my study I will be assessing whether the nurses are having adequate knowledge regarding complementary therapy on diabetes mellitus.
NEED FOR THE STUDY
Diabetes Mellitus is a serious health problem throughout the world and its prevalence is increasing rapidly .The international diabetes federation recently published findings revealing that in 2007, the country with the largest numbers of people with diabetes is india7.
According to WHO, The prevalence of diabetes for all age-groups worldwide was estimated to be2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people 65 years of age.
In India, there are going to be eighty percent of all diabetics from the entire world population concentrated here - this makes India the diabetic capital of the world. India continues to be the “diabetes capital” of the world and by the year 2010 about 50.8 million people in the 20 to 79 age group in the country will have diabetes.
The number of people suffering from diabetes in the Americas is expected to reach the 6 5 million mark by the year 2025. Currently, diabetes affects between 10% and 15% of the adult population in Latin America and the Caribbean. Diabetes is related to premature mortality. Furthermore diabetes increases morbidity from chronic complications affecting the retina, kidneys and nervous system8.
Developing countries
Rising prevalence of Diabetes Mellitus especially Type-2 DM in Urban population is a serious concern. The countries with the largest number of people with diabetes are and will also be in the year 2025, India, China and the U.S.1 With the increasing prevalence of diabetes especially in the middle age group populations who are commonly affected in India,2 the chances of developing micro & macro vascular complications are very high & it is going to bring enormous burden on the family, society & the health care providers involved in the management of diabetes due to high morbidity & mortality. In a study of 3010 diabetics by Ramachandran. A,3 the prevalence of micro vascular complications was, Retinopathy 23.7%, Nephropathy 5.5%, Neuropathy – 27.5% & prevalence of CHD 11.4 % & PVD was 4%. In our own study from North Delhi Diabetes Centre comprising 720 type-2 Diabetics, Retinopathy was seen in 21.2 %, micro albuminuria in 41%, Peripheral Neuropathy in 15.3 %, CAD in 7% & PVD was in 7.4% of Patients9.
Some other alarming diabetes statistics include the fact that there is one person in the world dying of diabetes every ten seconds. Also, there will be two new diabetic cases in the world being identified every ten seconds. And, what’s worse, these statistics also tell us that by the year 2025, there will be seven million new diabetic cases in the world.
We all look forward to a time when as much emphasis is given to the healing process as to the disease process.It would be given naïve to consider that our current technologies, wonder drugs, and collective store of medical wisdom holds all the answers for our health needs and wellbeing .Some complementary therapies may prove to be a valuable means to stimulate and support the healing response.We cannot afford to “throw out the baby with the bath water” as the old saying goes. But should rather approach new therapies.So we the nurses should have theknowledge regarding complementary therapy to educate the patients who is suffering with uncontrolled diabetes mellitus and help them to practice in their life
6.2 REVIEW OF LITERATURE
A study was conducted to assess the effects of different doses of fenugreek on type 2 diabetes mellitus in India. Eighty patients were chosen randomly from the rural population suffering from mild Type 2 Diabetes with dyslipidemia. Fenugreek seed powder, in doses of 25 g, 50 g, 75 g and 100 g/day mixed with water as a drink, was consumed by patients for 2 years. The preparations were made salty or sour, according to individual choice, to mask the bitter taste. It was observed that blood sugar came down and the reduction in blood sugar level maintained a direct relationship with doses of fenugreek given up to 75 g/day.Blood glucose estimations over the study period showed a significant decline in fasting blood glucose levels, and the decline corresponded to the dose of fenugreek. In patients receiving 25 g of fenugreek, FBS values from 192 ± 11mg/dl to 174 ± 7 mg/dl after 2 years (p=0.075). Those who are receiving 50 g of fenugreek, FBS values from 182 ± 6 mg/dl to 167 ± 7mg/dl over a period of 2 years (p=0.075). In patients receiving 75 g dose, FBS from 153 ± 7mg/dl to 125 ± 10 mg/dl after 2 years (p=0.025). The patients receiving 100 g of fenugreek, FBS from 155 ± 10 mg/dl to 130 ± 7 mg/dl after 2 years (p=0.025).Comparison of the study and control group showed that fenugreek had significant effect in lowering blood sugar10.
A placebo-controlled study were conducted at the Medical Plant Information Centre, faculty of Pharmacy, Mahidol University in Bangkok investigated the application of Aloe Vera juice derived from the preserved gel in the treatment of patients suffering from diabetes mellitus.In the first study(1), 72 patients (aged 35-60 years) with a high fasting blood sugar level and a typical diabetic glucose tolerance test result were assigned to a treatment or placebo group, and were matched according to age, sex and weight. The patients in the treatment group received one tablespoon of Aloe Vera juice (80%) twice a day for 42 days. The Aloe Vera juice was prepared at the Faculty of Pharmacy at Mahidol University in Thailand from Aloe Vera gel with the addition of flavorings and preservatives.Fasting blood glucose levels were measured weekly and triglyceride and cholesterol levels every two weeks.The results showed that the average (mean) blood glucose level of the patients in the Aloe juice group was significantly reduced from the second week of the study and continued to fall throughout the treatment period, whereas there were no changes reported in the placebo group. Furthermore, in the treatment group, blood glucose levels fell from an average of 250.36 (+/- 7.65mg %) to 141.92 (+/-4.12mg %) by day 42. Triglyceride levels also fell significantly in the Aloe group after two weeks from 220.31 (+/- 11.40mg %) on day 1 to 122.72 (+/- 5.46mg %) by day 42. Once again, no significant changes were observed in the placebo group11.
A systematic review of herbs and dietary supplements for glycemic control wasconducted inBoston. Data were extracted in a standardized manner, and two independent investigators assessed methodological quality of randomized controlled trials using Jadad scale. A total of 108 trials examining 36 herbs (single or in combination) and 9 vitamin/mineral supplements, involving 4,565 patients with diabetes or impaired glucose tolerance, met the inclusion criteria and were analyzed. There were 58 controlled clinical trials involving individuals with diabetes or impaired glucose tolerance (42 randomized and 16 nonrandomized trials). Most studies involved patients with type 2 diabetes. Of these 58 trials, the direction of the evidence for improved glucose control was positive in 76% (44 of 58). Study concluded that herbs appear to be generally safe12.
A study to assess the hypoglycemic action of different doses of nopal (Opuntia streptacantha Lemaire) in patients with type II diabetes mellitus was conducted in Mexico to assess the relationship between the doses of O. streptacantha Lemaire and its acute hypoglycemic action in diabetics, eight patients with type II diabetes mellitus were studied. Four tests were performed to each patient with the intake of: (a) 400 ml of water, (b) 100 g (c) 300 g and (d) 500 g of broiled stems of O. streptacantha Lemaire. Serum glucose was measured at 0, 60, 120 and 180 minutes. Maximal decrease of serum glucose was noticed at 180 minutes, with a mean of 2.3, 10, 30.1 and 46.7 mg/dl less than basal value with 0, 100, 300 and 500 g respectively (P = NS, less than 0.05, less than 0.001 and less than 0.001 respectively). A significant direct correlation (r = 0.690, P less than 0.001) was noticed between the doses and the hypoglycemic effect13.
A study to find out if yoga asana (postures) could help diabetes by releasing insulin from the pancreas in New Delhi was conducted. Twenty healthy young volunteers were randomly selected and given four sets of yoga postures to perform. Each volunteer performed the yoga sets in random order for five days with a two day interval between consecutive sets of asana. Blood samples were collected on days 4 and 5 of each set of asana for measurement of glucose and insulin levels before the asana, within 10 min after performing the asana, and 30 min after ingestion of 75 g glucose, which in turn was ingested immediately after the second blood sample. A standard 75 g oral glucose tolerance test (OGTT) was also done before and after the study. On the days of the pre-study or post-study OGTT, no asana were done. The serum insulin levels after the asana were lower (P<0.05) than those before the asana. However, the serum insulin level 0.5 h after the post-asana oral 75 g-glucose challenge was higher (P<0.05) in Set IV than the 0.5 h postprandial insulin level in the pre-study OGTT; the same trend was observed in other sets as well although statistically not significant. The observations suggest that the performance of asana led to increased sensitivity of the B cells of pancreas to the glucose signal. The increased sensitivity seems to be a sustained change resulting from a progressive long-term effect of asana. The study is significant in that it has for the first time attempted to probe the mechanism by which yoga asana help diabetes mellitus14.