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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 49-52

Integrated management of type 2 diabetes mellitus: Therapeutic potential of Ayurvedic mode of management


1 Division of Endocrine And Metabolic Disorders, ICMR Advanced Centre for Reverse Pharmacology in Traditional Medicine, Kasturba Health Society's Medical Research Centre, Mumbai; Symbiosis International University, Pune, Maharashtra, India
2 Division of Endocrine And Metabolic Disorders, ICMR Advanced Centre for Reverse Pharmacology in Traditional Medicine, Kasturba Health Society's Medical Research Centre, Mumbai, India
3 Department of Endocrinology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, India

Date of Submission11-Oct-2013
Date of Decision21-Oct-2013
Date of Acceptance31-Oct-2013
Date of Web Publication30-Dec-2013

Correspondence Address:
Nutan Nabar
ICMR Advanced Centre for Reverse Pharmacology in Traditional Medicine, Kasturba Health Society's Medical Research Centre, 17, Khandubhai Desai Road, Vile Parle (West), Mumbai 400 056, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9906.123928

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  Abstract 

A 71-year-old patient, an Ayurvedic physician, attended the Endocrine Outpatient Department of Nair Hospital,Mumbai. He was interviewed for Drug Utilisation for the project of Ayurvedic Pharmacoepidemiology of Diabetes. The patient had type 2 diabetes mellitus for 10 years and was hypertensive since 20 years. He was on a conventional treatment for diabetes, hypertension, dyslipidaemia and angina pectoris. In addition, he integrated Ayurvedic management for his Madhumeha. His self-medication was with Marketed Ayurvedic Antidiabetic Formulations classically indicated for diabetes viz Chandraprabha and Arogyavardhini. He also took once daily the juice of the following ingredients - Aloe vera, Triticum aestivum, Momordica charantia, Lagernira siceraria and Allium sativum. He underwent a weekly whole body massage (Abhyangam) and a daily foot massage with Narayan Tail. Since past 10 years he practised pranayama and suryanamaskar for an hour daily. His glycaemic control has remained very good with the glycosylated haemoglobin value of 5.9%. The serum chemistry showed normal values for creatinine, blood urea nitrogen and triglycerides. The serum cholesterol value was 233 mg/dl. The laboratory data and physical health of the patient suggested that the integrative care achieved good glycaemic control. In India, many patients resort to multi-system

Keywords: Ayurvedic pharmaco-epidemiology, diabetes mellitus, drug utilisation study, integrative medicine, marketed anti-diabetic ayurvedic formulations, reverse pharmacology


How to cite this article:
Nabar N, Lele M, Vaidya R, Varthakavi P. Integrated management of type 2 diabetes mellitus: Therapeutic potential of Ayurvedic mode of management. J Obes Metab Res 2014;1:49-52

How to cite this URL:
Nabar N, Lele M, Vaidya R, Varthakavi P. Integrated management of type 2 diabetes mellitus: Therapeutic potential of Ayurvedic mode of management. J Obes Metab Res [serial online] 2014 [cited 2019 May 26];1:49-52. Available from: http://www.jomrjournal.org/text.asp?2014/1/1/49/123928


  Introduction Top


India has got a rich heritage of Ayurveda as a way of life and health. The system of Ayurveda has served the Indian population for thousands of years with the objective of "Swasthasya swasthyarakshanam aaturasya vyadhiparimoksha" [1] (To maintain the health of the healthy and to cure the diseases of the sick). The four ingredients of Ayurvedic therapy are the physician, the attendant (nurse), medicines/non-drug measures and the patient. This is a unique model of management of chronic diseases including diabetes. Recently the concept of 'personalised'/individualised multi-modality management has emerged in modern medicine. [2] Ayurveda already had this approach to holistic management. Since 1990, the path of integrative medicine has been developed and adopted and has been taken up in the curriculum of many medical colleges. [3] Integrative medicine is not a mere ad hoc combination of conventional medicine with any traditional or complementary and alternative medicines (CAM), but it has to be evidence-based care for the total health of a patient using therapeutic modalities of diverse systems of medicine. [4]

Diabetes is a huge health-challenge and an economic burden to the world. Diabetic patients are often inclined to try traditional or CAM modalities for the control of diabetes and its complications. [5] Some of them aim to reduce the side-effects of conventional anti-diabetic drugs and some resort to it for a relief of the persistent symptoms despite therapy. [6]

Diabetes and pre-diabetes are known in Ayurveda with a precise description of the disease and its complications. [7] Diverse herbal and herbo-mineral formulations are recommended for diabetes mellitus besides yoga, exercise and specific diets (vyayam and pathyapathya). [8],[9]


  Case Report Top


This was a case report of a 71-year-old male patient, who was an Ayurvedic physician, diagnosed to have hypertension for 20 years and diabetes mellitus for 10 years. He also had a past history of stable angina. He was on the standard doses of atenolol, enalapril, atorvastatin and as needed of isosorbide dinitrate. When he was diagnosed to be a diabetic, he started Chandraprabha 500 mg t.d.s./p.o. Despite 3 months of Chandraprabha treatment he did not achieve glycaemic control. For the latter he attended the out-patient unit of the Department of Endocrinology, Nair Hospital. He was prescribed a dose of 1000 mg t.d.s. of metformin. With a good glycaemic control, after 2 months the dose of metformin was reduced to 500 mg b.d. and he is still on the same dose for 10 years.

He continued to take Chandraprabha, reducing its dose to 250 mg b.d. He had added Arogyavardhini 250 mg for the last 5 years. He continued to have good glycaemic control. At 1 year back, he devised an Ayurvedic green drink with ingredients shown in [Table 1]. He consumed half a glass of the blended juice daily with one fruit of Emblica officinale. For the last 6 months, he has added juice of 1 lemon, 2 inch piece of ginger with honey. He takes regular meals and is not on any strict diet. He has continued to have weekly whole body massage and daily feet massage with Narayan Taila. He does not go for walking as an exercise, but for 1 h daily he does suryanamaskar, pranayama and yoga for 10 years. His blood pressure is under control (110/70 mm of Hg). He feels quite energetic and currently has no complaints. His glycaemic control has remained good with metformin 500 mg b.d. plus the Ayurvedic drugs and yoga.

His current investigations show the following values: Fasting blood sugar 100 mg/dl, post-lunch sugar 117 mg/dl, glycosylated haemoglobin 5.9%, serum cholesterol 233 mg/dl, serum triglycerides 124 mg/dl, serum creatinine 0.7 mg/dl and blood urea nitrogen 19 mg/dl. He has no obvious diabetic complications and has remained stable as to his cardiovascular health for 10 years.
Table 1: Formulation for self‑medication

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Table 2: Phytopharmacological activities of the ingredients of the juice

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  Discussion Top


The long-term glycaemic control in diabetic patients is a challenging problem even with the availability of a wide spectrum of anti-diabetic drugs and insulin. [10] Any non-drug measure or complementary drug which can safely achieve long-term glycaemic control is always being sought. In India, the opportunities for an integrative trans-discipline therapy are possible because of our pluralistic health care. Ayurveda has a holistic view of the pathogenesis and management of diabetes including the use if yoga and mantras. [11] Prameha is a pre-condition of Madhumeha and needs to be well attended to. [12] Thousands of diabetic patients, in India, self-medicate with Ayurvedic drugs/plants/vegetables and also undergo yoga, pranayama, suryanamaskar, massage etc., in addition to the conventional treatment. [13] However, there is a lack of documentation of such clinical cases. Ayurvedic pharmaco-epidemiology, observational therapeutics and reverse pharmacology offer innovative paths to evaluate the response to integrative care. Case reports can be a good first step in this direction.

The present case report shows that an Ayurvedic physician had a long-term control of diabetes with integrative therapy. Primary and secondary failures with metformin are well-known in practice. [14] A total dose of 500 mg b.d. is not known commonly to achieve glycaemic control for a period of 10 years.

Madhumeha is a systemic disease with a dominance of the vata dosha. For the latter, oil massage is the key modality of treatment. Studies have shown that massage of the whole body reduces glucose levels, increase insulin and insulin like growth factor 1. [15],[16] It is also well-known that yoga, Pranayam and Suryanamaskaras help in reducing blood sugar in diabetic patients. [17]

Several - experimented and clinical - studies have shown anti-diabetic activity of single plants or Ayurvedic formulations of classical or proprietary nature. [18],[19],[20] In our nationwide study of diabetes - the Council of Scientific and Industrial Research-New Millennium Indian Technology Leadership Initiative project - was conducted as per the Reverse Pharmacology path for two formulations with commonly used anti-diabetic plants Phyllanthus emblica and Curcuma longa. [21] The ingredients used for self-medication by the Ayurvedic physician in this case report are being used for centuries. Their usage and safety records are well-documented. [22] [Table 2] lists the phytopharmacological activities of the ingredients of the juice. [23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37] The demonstrated anti-diabetic activity of these ingredients in published scientific literature suggests the need to investigate further by Reverse Pharmacology path. The data that would emerge can provide evidence-based integrative potential for patients. This can lead to better clinical service and opportunities for novel phytopharmaceuticals for the patients with either non-communicable or communicable diseases.[38]


  Acknowledgement Top


We thank Dr. S M Bhoite, an Ayurvedic physician, BAMS (Nagpur) for co-operating for the case report. We are grateful to Shri Dhirubhai Mehta, President of Kasturba Health Society, for his continuous interest in our research endeavour.

 
  References Top

1.Acharya JT. Charak samhita. Chakrapani tika. 5 th ed. Varanasi: Choukhambha Sanskrut Sansthan; 2001. p. 186(Cha.Su. 30-26).  Back to cited text no. 1
    
2.Bell I, Caspi O, Schwartz G, Grant K, Gaudet T, Rychener D, et al. Integrative medicine and systemic outcomes research: Issues in the emergence of a new model of primary health care. Arch Intern Med 2002;162:133-40.  Back to cited text no. 2
    
3.Otani MA, Barros NF. The integrative medicine and the construction of a new health model. Cien Saude Colet 2011;16:1801-11.  Back to cited text no. 3
    
4.Rees L, Weil A. Integrated medicine: Imbues orthodox medicine with the values of complementary medicine. Br Med J 2001;322:119-20.  Back to cited text no. 4
    
5.Meharotra R, Bajaj S, Kumar D. Use of complementary and alternative medicine by the patients with diabetes mellitus. Natl Med J India 2004;17:3243-5.  Back to cited text no. 5
    
6.Nabar N, Vaidya R, Narayana DB, Raut A, Shah S, Patwardhan B, et al. Marketed ayurvedic antidiabetic formulations: Labeling, drug information and branding. Indian Pract 2013;66:631-41.  Back to cited text no. 6
    
7.Nabar N, Dave D, Vaidya R, Agashe S, Talwalkar S, Shah S, et al. Prevalence of the metabolic syndrome in the first degree relatives of the Type 2 diabetic patients. Indian Pract 2012;65:681-7.  Back to cited text no. 7
    
8.Acharya JT. Charak samhita. Chakrapani tika. 5 th ed. Varanasi: Choukhambha Sanskrut Sansthan; 2001. p. 211-6.  Back to cited text no. 8
    
9.Shashtri RD, editor. Bhaishajya ratnawati. 18 th ed., Vol. 37. Varanasi: Choukhambha Sanskrit Sansthan; 2007. p. 719-42.  Back to cited text no. 9
    
10.Venkataraman K, Kannan AT, Mohan V. Challenges in diabetes management with particular reference to India. Int J Diabetes Dev Ctries 2009;29:103-9.  Back to cited text no. 10
    
11.Karambelkar VW. Atharva veda and ayurveda. 1 st ed. Varanasi: Choukhambha Krishnadas Academy; 2005. p. 38.  Back to cited text no. 11
    
12.Sharma PV. Sushrut samhita, Nibandha sangraha tika. 7 th ed. Varanasi: Choukhambha Orientalia; 2002. p. 294.  Back to cited text no. 12
    
13.Ernst E. Prevalence of use of complementary/alternative medicine: A systematic review. Bull World Health Organ 2000;78:253-7.  Back to cited text no. 13
    
14.Brown JB, Conner C, Nichols GA. Secondary failure of metformin monotherapy in clinical practice. Diabetes Care 2010;33:501-6.  Back to cited text no. 14
    
15.Ezzo J, Donner T, Nickols D, et al. Is massage useful in the management of diabetes? A systematic review. Diabetes Spectr 2001;14:218-24.  Back to cited text no. 15
    
16.Field T, Diego M, Hernandez-Reif M, Dieter JN, Kumar AM, Schanberg S, et al. Insulin and insulin-like growth factor-1 increased in preterm neonates following massage therapy. J Dev Behav Pediatr 2008;29:463-6.  Back to cited text no. 16
    
17.Malhotra V, Singh S, Singh KP, Sharma SB, Madhu SV, Gupta P, et al. Effects of yoga asanas and pranayama in non-insulin dependent diabetes mellitus. Indian J Tradit Knowl 2004;3:162-7.  Back to cited text no. 17
    
18.Vaidya AB, Antarkar DS, Joshi BS. Traditional remedies for diabetes mellitus: Trails, trials and trilateral quest. Diabetes Bull 1989;9:186-91.  Back to cited text no. 18
    
19.Vaidya AB, Vaidya RA, Shah S, Nabar N, Sarkar S. Current status of indigenous drugs and alternative medicine in management of diabetes. In: Tripathy BB, Chandalia HB, Mohan V, editors. RSSDI text book of diabetes mellitus. 2 nd ed., Ch. 47. Hyderabad: Mudrika Graphics; 2008. p. 695-716.  Back to cited text no. 19
    
20.Vaidya AD. Reverse pharmacology correlates of ayurvedic drug action. Ramnath chopra award oration. Indian J Pharmacol 2006;38:311-5.  Back to cited text no. 20
  Medknow Journal  
21.Completion report of CSIR NMITLI Diabetes project 2002-2007. Herbal based formulations in type 2 diabetes mellitus with DM-FN01 and DMFN02, MRC-KHS, Mumbai.  Back to cited text no. 21
    
22.Gogate VM. Ayurvedic pharmacology and therapeutic uses of medicinal plants (Dravyagunavidnyan-Translation). Mumbai: Academic Team Bhavan's SPARC, Bharatiya Vidya Bhavan; 2000. p. 514, 309.  Back to cited text no. 22
    
23.Yongchayndha S, Runqpitaanqsi V, Bunavapraphatsara N, Chokechaijaroenpom O. Antidiabetic activity of Aloe vera L juice 1. Clinical trial in new cases of diabetes mellitus. Phytomedicine 1996;3:241-3.  Back to cited text no. 23
    
24.Rajasekaran S, Ravi K, Sivagnanam K, Subramanian S. Beneficial effects of Aloe vera leaf gel extract on lipid profile in rats with streptozotocin diabetes. Clin Exp Pharmacol Physiol 2006;33:232-7.  Back to cited text no. 24
    
25.Rajasekaran S, Sivagnanam K, Subramanian S. Modulatory effects of Aloe vera on leaf extract on oxidative stress in rats treated with streptozotocin. J Pharm Pharmacol 2003;57:241-6.  Back to cited text no. 25
    
26.Kothari S, Jain AK, Tonpay SD. Effects of fresh Triticum aestivum grass juice on lipid profile of normal rats. Indian J Pharmacol 2008;40:235-6.  Back to cited text no. 26
[PUBMED]  Medknow Journal  
27.Kulkarni SD, Tilak JC, Achaya R, Rajurkar NS, Devasagayan TP, Reddy AV. Evaluation of the antioxidant activity of wheat grass (Triticum aestivum L) as a function of growth under different conditions. Phytother Res 2006;20:218-27.  Back to cited text no. 27
    
28.Shirunde A. Phytochemical and pharmacobiological screening of wheat grass juice (Triticum aestivum). Int J Pharm Sci Rev Res 2011;9:159-64.  Back to cited text no. 28
    
29.Joseph B, Jini D. Antidiabetic activity of Momordica charanta (bitter melon) and its medicinal potency. Asian Pac J Trop Dis 2013;3:93-102.  Back to cited text no. 29
    
30.Grover JK, Yadav SP, Pharmacological actions and potential uses of Momordica charantia. J Ethnopharmacol 2004;93:123-32.  Back to cited text no. 30
    
31.Meera S, Nagarjuna C. Antistress ad immune modulatory activity of a queous extract of Momordica charantia. Pharmacogn Mag 2009;5:69-73.  Back to cited text no. 31
    
32.Singh S, Gill NS, Arora R. Study of anti oxidant activity of Lagenarin siceraria seeds. Int J Nat Prod Sci 2012;spl issue 1:22 4.  Back to cited text no. 32
    
33.Saha P, Mazumdar U, Haldar P, Kundusen S, Naskar S. Antihyperglycemic activity of Lagenaria siceraria aerial parts on streptozotocin insuced diabetes in rats. Diabetol Croat 2012;40:49-60.  Back to cited text no. 33
    
34.Tyagi N, Sharma GN, Hooda V. Phytochemical and pharmacological profile of Lagenaria siceraria: An overview. Int Res J Pharm 2012;3:1-4.  Back to cited text no. 34
    
35.Thomas M, Al-Amin Z, Al Quttan K, Shaban L, Ali M. Anti-diabetic and hypolipidemic properties of garlic (Allium sativum) in streptozotran-induced diabetes rats. Int J Diabetes Metab 2007;15:108-15.  Back to cited text no. 35
    
36.Dankert J, Tromp T, de vries H, Kalsen H. Anti microbial activity of crude juices of Alluium ascatonicun, Allium cepaand Allium sativum. Zentralbl Bikteriol orig A 1979;245:  Back to cited text no. 36
    
37.229-39.  Back to cited text no. 37
    
38.Hiyasat B, Sabha D, Gotzinger K, Kempfert J Rauwald J, Mohr F, et al. Anti platelet activity of Albium ursinum and Allium satiumn. Pharmacology 2009;83:197-204.  Back to cited text no. 38
    



 
 
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Introduction
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Acknowledgement
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