How is type 2 diabetes controlled by exercise and diet log,diabetes symptoms causes and treatments uk,food that reduce diabetes quickly - Tips For You


Type 2 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood.
Diabetes patients often neglect the most important treatment for saving lives: lowering cholesterol. When you have type 2 diabetes, your fat, liver, and muscle cells do not respond correctly to insulin. The most important way to treat and manage type 2 diabetes is with activity and healthy eating.
Checking your blood sugar levels yourself and writing down the results tells you how well you are managing your diabetes. If your blood sugar level is under control, you may only need to check it a few times a week. Work closely with your doctor, nurse, and dietitian to learn how much fat, protein, and carbohydrates you need in your diet.
Very obese patients whose diabetes is not well managed with diet and medicine may consider weight loss (bariatric) surgery. If diet and exercise do not help keep your blood sugar at normal or near-normal levels, your doctor may prescribe medication. You may need to take insulin if your blood sugar cannot be controlled with any of the above medicines. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. When I was medical student in 1959, we were taught that normal range of Fasting Blood Sugar (FBS) is 80 to 120 mg%. In the past 50 years, recommended FBS level range has been revised downwards to 80 to 110 mg% by many Diabetes Associations and Diabetologists. Remember that BS levels in any individual are constantly fluctuating depending upon food, medicine, and activities.
It is now generally agreed upon that Type 1 diabetes is because of inability in our body to produce insulin. However, it seems that tendency to suffer from type 2 diabetes is probably predestined with hereditary and other similar factors. The medical practitioner should provide ongoing advice for patients to avoid frank type 2 diabetes. Test Blood sugar levels often enough for you to be aware what diet and exercises are good for you. Try and eat fresh locally grown fruits and vegetables only; most of your calorie requirement should come from such fresh plant based diet. About MeI practiced orthopedic surgery for over 30 years and managed a private hospital of 200 beds for 15 years. Science, Technology and Medicine open access publisher.Publish, read and share novel research. Effectiveness of Fenugreek for Lowering Hemoglobin (HbA1c) in Patients with Self-Management of Type 2 Diabetes: A Randomized Controlled TrialRashid Ansari1 and Saiqaa Ansari2[1] School of Public Health, University of New England, Australia[2] School of Population Health, University of Queensland, Australia1. Type 2 diabetes: What is it?Diabetes is a chronic condition that affects the body's ability to convert sugar into energy. To provide even greater transparency and choice, we are working on a number of other cookie-related enhancements.
It’s no secret that sugar consumption and obesity are in some ways related, or that obesity and diabetes are in some ways related. In other words, this study shows that sugar itself, not obesity, causes type 2 diabetes in a way we can’t deny. The study not only controlled for all external factors like aging, obesity, exercise, etc., but it also satisfied the “Bradford Hill” criteria for causation. Diabetes can put you at risk for suffering from many skin conditions, some wanting medications while others not engaging in any specific treatment measures. Skin complications can range from the mild ones as itching to the more serious and troubling ones like vitiligo and Necrobiosis Lipoidica Diabeticorum (NLD). The first thing you need to do is to consult your doctor when you note any abnormality or change in skin. Diabetics can also have an allergic reaction to several things including medications, insulin and anti-hyperglycemic medications. Digital sclerosis affects mostly the type 1 diabetes which is not controlled appropriately.
Brining blood glucose levels back to a normal level is the main treatment measure to be adopted. Blood sugar control apparently does not play a role here, both before and after diagnosis of the condition. Prompt diagnosis can ensure timely treatment of a skin condition, before it can actually become a problem. It is important for diabetics to keep their skin clean and dry.  Even minor injuries and abrasions should be attended cautiously and monitored for infection or any other sign of deterioration. Keep learning about diabetes, its complications, and how to control and live well with the disease.
Based on your numbers, you may need to make changes to your meals, activity, or medicines to keep your blood sugar level in the right range. Your meal plans should fit your lifestyle and habits and should include foods that you like. People with type 2 diabetes may need to take special steps before, during, and after physical activity or exercise. Since these drugs help lower your blood sugar levels in different ways, your doctor may have you take more than one drug.
This is very important when you already have nerve or blood vessel damage or foot problems. You can get to a healthy weight by eating healthy foods, controlling your portion sizes, and leading an active lifestyle. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Presently though, the consensus seems to be that FBS at even 110 mg% is also high and that it should be below 100 and some even suggest that it should be below 90 mg%.
If we test a large number of non-diabetic persons for their FBS, it turns out to be 84 to 89 mg% on an average.
He is a staunch believer of keeping the blood sugar as low as possible (all experts do not agree with him because of risks of low blood sugars). Bernstein was born, the longevity of type 1 diabetics was considered to be less than 50 years. However, the label of being frank diabetic may probably be avoided for a long period of time and hence the possibility of complication reduced substantially. However, all day long many suggest that the blood sugar levels should be constantly kept below 100 mg% to prevent many complications by means of diet control, exercise and medications. It is a life long condition and the medical providers can advise and guide you but cannot be with you all the time. IntroductionThe incidence of type 2 diabetes is increasing worldwide, resulting in large measure from the increasing prevalence of obesity (Yale, 2000).
This allows sugar levels to build up in the blood, which can lead to heart disease, blindness and other serious complications.
It is intended for general information purposes only and does not address individual circumstances. Bittman likens the study’s results to the correlation between lung cancer and tobacco products that came in the 1960s, because the level of confidence for both studies is the same—meaning they’re both conclusive. Researchers were able to link dose, duration, directionality and prevalence, proving that there is, in fact, a cause and effect relationship here.
When it comes to avoiding skin complications and unfavorable outcomes of diabetes, the most crucial thing is blood sugar control. Sty (infection of the eyelids), boil (infections of the hair follicles), carbuncles and nail infections are some of the infections diabetics are likely to experience.
Fungal infections, as those mentioned here, are generally caused by a yeast-like fungus (Candida albicans). Atherosclerosis affects vessels that cause cardiovascular disease; vessels supplying blood to the skin can also be affected. They are similar to burn blister and usually found on fingers, toes, hands, feet and forearms.
Symptoms of this skin condition appear as thick, waxy (but tight) skin on hands, fingers and toes.
Medications may be used; it is difficult to arrive at a conclusive treatment measure fro NLD due to lack of knowledge about what causes this condition.
Many diabetic skin problems can be prevented through tight blood sugar control and routine examinations of the skin.
The affected limb may need to be amputated if these skin ulcers do not heal or become larger, deeper, or infected. Yet another observation is that those with FBS nearer to 84 are less likely to develop type 2 diabetes than those their FBS nearer to 89 mg%. With better understanding of diabetes, availability of different kinds of insulin, easy availability of BS meters and many other factors like lower Infant Mortality Rate, antibiotics and better nutrition, the longevity of type 1 diabetes has increased to almost 60 to 70 years. Even after that one can remain a “Diet controlled diabetic” and hence not needing any medications except keeping a strict diet and exercise regimen with weight control and exercises. Diabetes mellitus is a pandemic disease and is one of the main threats to human health (Narayan, 2005).
It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Though we know the pitfalls of sugar consumption and don’t view the study itself as a shock to the system, we do think seeing the facts outlined this clearly should help everyone think twice. The results of this study have reignited the spark in calls for sugar-limiting legislation, and because the degree of confidence is, as mentioned, as high as that of the cigarette-lung cancer connection, those calls will likely be answered. It not only helps in preventing a complication (including skin complication) but also treating the same in case of its occurrence. This fungus is usually found in warm and moist skin areas like fingers and toes, corners of the mouth and vagina. Antihistamines and decongestants are generally used to hinder the effect of chemicals involved in an allergic reaction. Necrobiosis Lipoidica Diabeticorum has association with diabetes mellitus, predominantly in the insulin dependants. Your legs are mostly affected if you have poor blood flow. Skin lotions can relieve itching to certain extent. High blood glucose can reduce your strength to fight invasions, including those on the skin. Attune with your doctor for becoming more aware of diabetic consequences and have regular checkups to get timely treatment. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. This indicates that the individual can delay development of frank type 2 diabetes by taking appropriate measures. He was lucky to have been born just after bovine insulin was found, which he was treated with. He is obviously doing something right to keep himself active and healthy and reaching almost 80 years of age. Diabetes UK estimates that over 600,000 people with type 2 diabetes don't know they have it. Never ignore professional medical advice in seeking treatment because of something you have read on the BootsWebMD Site. However, these have side effects and should be implemented with precaution.  Immunotherapy is another alternative treatment option. It is projected that this number will be increased by 72% to 333 million by 2025, and nearly 80% of these cases will be in the poorer industrialized countries (IDF, 2003).
A bacterial infection can be successfully treated with antibiotics implemented as cream or pill, as directed by your doctor. There are other ways to treat an allergic reaction depending on the severity and symptoms of the condition. Any duplication or distribution of the information contained herein is strictly prohibited. When the complications of diabetes are delayed, overall incidence of morbidity will also be decreased. According to a 2005 US Government estimate, approximately 21 million people in the United States have diabetes (Gerich, 2005). Diabetes may not have symptomsIn most cases type 2 diabetes doesn't cause any symptoms, or the symptoms are mild, which is why many people have it for years without knowing it, and why it's important to get tested. He is now coming to 80 years old and though has retired from teaching he is still practicing and presents a webinar on this subject on last Wednesday of every month. In 2002, diabetes was the sixth leading cause of death and had an estimated total cost of $132 billion (Hogan et al.
Warning sign: ThirstOne of the first symptoms of type 2 diabetes may be an increase in thirst. You should always consult your doctor when suffering from an allergic symptom as individual needs differ.


If you're overweight, losing about 7% of your total body weight can help lower your risk for heart disease. This is often accompanied by additional problems, including dry mouth, increased appetite, frequent urination – sometimes as often as every hour -- and unusual weight loss or gain. Type 2 diabetes is a disease characterized by a dual defect: 1) by insulin resistance which prevents cells from using insulin properly, and 2) degrees of reduced pancreatic insulin secretion. Warning sign: Blurred visionAs blood sugar levels become more abnormal, additional symptoms may include headaches, blurred vision and fatigue. Warning sign: InfectionsIn most cases, type 2 diabetes is not discovered until it takes a noticeable toll on health. A quarter of the population of Pakistan would be classified as overweight or obese with the use of Indo-Asian-specific BMI cutoff values. All carbohydrates raise blood sugar, so you should keep track of how many you eat every day.
Jafar et al (2006) have reported that prevalence of overweight was 25% and obesity was 10% in a large population-based sample of people over the age of 15 years in Pakistan.
Diabetes can cause damage to blood vessels and nerve endings in the genitals, leading to a loss of feeling and making orgasm difficult.
On the age-specific prevalence of overweight and obesity, they found that more than 40% of women and 30% of men aged 35–54 years were classified as overweight or obese. It has been suggested in a variety of observational and epidemiological studies that physical activity may play a significant role in the prevention of type 2 diabetes mellitus. Risk factors you can controlYour habits and lifestyle can affect your odds of developing type 2 diabetes. The relationships between physical activity and overweight are only beginning to be understood for the adult population, sedentary behaviours, particularly watching television (TV) and videos, surfing the internet have been found to be related to higher body mass index (BMI) for adult’s population (Struber, 2004). Eating at least two servings of fish a week may improve triglycerides and may also help lower the risks for heart problems. The literature linking physical activity levels with risk of overweight in adults is not consistent but physical activity is an important component of effective obesity treatments (Saelens, 2003).
Risk factors for womenHaving gestational diabetes when you're pregnant puts you seven times at greater risk of developing type 2 diabetes later on. The main health promotion intervention here is the public health education which highlights the importance of physical activity for the prevention of type 2 diabetes in the middle-aged population of sub-continent and particularly Pakistan, which is experiencing a rapid and substantial decline of physical activity levels as a result of poor eating habits, unhealthy food supply, expansion of television, computerization, and mechanization, more prevalent car ownership and sedentary behaviour. Checking your blood sugar levels at home will tell you how well you are managing your diabetes. In parallel with decreasing levels of physical activity, the prevalence of overweight and obesity has increased significantly in Pakistan and as a consequence, diabetes mellitus has become a major public health issue. Having a history of polycystic ovary syndrome (PCOS) can also cause insulin resistance that can lead to diabetes. Therefore, promoting an active lifestyle or regular exercise has become the highest public health priority in that country to overcome the onslaught of type 2 diabetes. Type 2 diabetes in childrenAlthough older people have a higher risk of getting type 2 diabetes, the condition is affecting more young people. If your blood sugar levels are under control, you may only to check them a few times a week.Which food contains the healthiest fats?The correct answer is A and B. Also, the search for dietary adjuncts along with usual medical care to treat this life altering disease has become more important and dietary supplements that can modulate glucose homeostasis and potentially improve lipid parameters would be desirable. Diabetes UK says around 35,000 children and young people in the UK have diabetes, with around 700 of these having type 2 diabetes. Avocados, nuts, and olive, canola, and peanut oils contain monounsaturated fat, which is good for your heart.
Fenugreek (Trigonella foenum-graecum Linn) is a dietary supplement that may hold promise in this regard and is one of the oldest medicinal plants, originating in India and Northern Africa and dating back to ancient Egyptian times (Jensen, 1992).In Pakistan and India, fenugreek is commonly consumed as a condiment (Yoshikawa et al. The leading risk factor for children is being overweight, often connected with an unhealthy diet and lack of physical activity. Once children are overweight, their chances of developing type 2 diabetes more than doubles.
Fenugreek seeds also lower serum triglycerides, total cholesterol (TC), and low-density lipoprotein cholesterol (LDL-C) (Al-Habori and Raman, 1998). Often a urine test is carried out first, and if it contains glucose, or a person is at risk of diabetes, one or more blood tests to check levels of glucose in the blood are performed.
The lipid-lowering effect of fenugreek might also be attributed to its estrogenic constituent, indirectly increasing thyroid hormones (Basch, 2003). The plant protein in fenugreek is 26%, so it might exert a lipid lowering effect (Sharma, 1986).
Since a high proportion of diabetic patients in sub-continent suffer from malnutrition, the use of fenugreek which is rich in protein and fiber (48%), has a distinct advantage in these patients (Sharma, 1986). How does insulin work?In healthy people, after a meal, food is broken down into a sugar called glucose, which is carried by the blood to cells throughout the body. This chapter addresses the effectiveness of fenugreek for lowering hemoglobin (HbA1c) in this randomized controlled trial and determines whether the intervention of taking fenugreek in combination of usual medical care lowers HbA1c in patients with type 2 diabetes. Cells use the hormone insulin, made in the pancreas, to help them process blood glucose into energy.
Even small sores or blisters can become big problems if infection develops or they don't heal.Which type of footwear should a person with diabetes avoid?The correct answer is A, B, and C.
Effectiveness trials such as this are critical in determining if the interventions are effective in the practical world in which patients live. People develop type 2 diabetes because the cells in the muscles, liver and fat cannot use insulin properly, called insulin resistance.
This randomized control trial addresses the research question “Is Fenugreek treatment with medical care for patients with type 2 diabetes more effective than usual medical care and can it help to lower the haemoglobin in patients with poorly controlled type 2 diabetes”?
Type 2 Diabetes: Metabolism mishapsIn type 2 diabetes, the cells cannot absorb glucose properly. Sneakers or any close-toed, comfortable shoes that fit well are the best choice to protect your feet.Which will treat low blood sugar?The correct answer is all of the above. Characteristics of type 2 diabetesType 2 diabetes is associated with certain ethnic groups, obesity, family history of diabetes, and physical inactivity, among other factors. If you've developed a condition called insulin resistance, the body makes insulin, but the muscle, liver and fat cells cannot use insulin, or do not respond to the insulin, properly.
With long-standing, uncontrolled type 2 diabetes, the pancreas will reduce the amount of insulin it produces.
Chronic, untreated hyperglycemia can lead to serious complications that include cardiovascular diseases, blindness, kidney failure, and stroke. Managing diabetes: DietFortunately, people with type 2 diabetes can significantly reduce the risk of damage to their bodies, including damage to the heart, kidneys, eyes and feet.
If you don't feel better in 15 minutes, and your blood sugar stays low, take another 15 grams.
Furthermore, very low values of blood glucose (hypoglycemia) for even a short duration can result in loss of consciousness and coma. The figure 1 shows the complications of type 2 diabetes which is a syndrome characterized by insulin deficiency, insulin resistance, and increased hepatic glucose production. People with type 2 diabetes should carefully monitor carbohydrate consumption, as well as total fat and protein intake and reduce calories.
These metabolic abnormalities are treated by use of various medications which are designed to correct one or more of these metabolic abnormalities (Saltiel & Olefsky, 2001). Managing diabetes: ExerciseModerate exercise, such as strength training or walking, improves the body's use of insulin and can lower blood sugar levels in people with type 2 diabetes.
Type 2 diabetes is most common in adults, although younger people are also developing this type of disease. Being active also helps reduce body fat, lower blood pressure and protect against heart disease.
It starts with a slow onset with thirst, frequent urination, weight loss developing over weeks to months.
Try to do at least 150 minutes of exercise a week, with some exercise on most days of the week.
It is also considered to run in families but it may happen with a person without a family history of diabetes as well. It can also increase glucose levels in your blood as part of your "fight or flight" response.
In its early stages, many people with type 2 diabetes can control their blood glucose levels by losing weight, eating properly and exercising.
Many may subsequently need oral medication, and some people with type 2 diabetes may eventually need insulin shots to control their diabetes and avoid the disease's serious complications (Saltiel & Olefsky, 2001). Instead of letting stress take its toll, try relaxation techniques such as deep breathing, meditation or just talking to a friend or relative. Even though there is no cure for diabetes, proper treatment and glucose control enable people with type 2 diabetes to live normal, productive lives. A major advance for people at risk of developing type 2 diabetes - such as family members of those with the condition - occurred recently when it was shown that diet and exercise can prevent or delay type 2 diabetes. Managing diabetes: MedicationWhen people with type 2 diabetes are unable to control blood sugar sufficiently with diet and exercise, medication can help. There are many types of diabetes medicines available and they are often used in combination.
Some work by stimulating the pancreas to make more insulin, while others improve the effectiveness of insulin, or reduce the liver's production of glucose, or block the digestion of starches. Managing diabetes: InsulinMany people with type 2 diabetes eventually develop 'beta-cell failure'.
This means the cells in the pancreas no longer produce insulin in response to high blood sugar levels. 2004), however, population-based data on the prevalence of diabetic retinopathy in Pakistan and on the visual impairment due to diabetic retinopathy is lacking and only the hospital-based data is available (Kayani et al. In this case, insulin therapy – injections or an insulin pump – must become part of the daily routine.
Diabetic nephropathy is present in 18% of people diagnosed with diabetes (DSG, 1993) and is a leading cause of end-stage renal disease (Molitch et al.
2003)Stroke: diabetes is associated with a 2- to 4-fold increase in cardiovascular mortality and stroke (Kannel et al. Whereas insulin pulls glucose into the cells, these medications cause the body to release insulin to control blood sugar levels. Glucose testingTesting your blood glucose level will let you know how controlled your blood sugars are and if you need to take action to change your treatment plan.
How often and when you test will be based on how controlled your diabetes is, the type of therapy used to control your diabetes and whether you are experiencing symptoms of fluctuating sugars.
Therefore, early detection and treatment of diabetes is essential in order to reduce the impact of its serious complications. Your diabetes team will suggest how often you should use a glucose meter to check your blood sugar. Common testing times are first thing in the morning, before and after meals and exercise and before bedtime. Development of type 2 diabetesDevelopment of type 2 diabetes is the result of multifactorial influences that include lifestyle, environment and genetics. Long-term damage: ArteriesOver time, untreated type 2 diabetes can damage many of the body's systems.
The disease arises when insulin resistance-induced compensatory insulin secretion is exhausted. People with diabetes are likely to develop plaque in their arteries, which reduces blood flow and increases the risk of clots.
A high-caloric diet coupled with a sedentary lifestyle is one of the major contributing factors in the development of the insulin resistance and pancreatic ?-cell dysfunction as shown in Figure 2. However, a predisposing genetic background has long been suspected in playing a contributing role in the development of type 2 diabetes. People with diabetes are up to five times more likely to develop heart disease or have a stroke.
Long-term damage: KidneysThe longer you have untreated diabetes, the greater the risk of developing kidney disease or kidney failure.
The metabolic syndrome is defined as a clustering of atherosclerotic cardiovascular disease risk factors that include visceral adiposity (obesity), insulin resistance, low levels of HDLs and a systemic proinflammatory state.
There are key components to the metabolic syndrome which include in addition to insulin resistance (the hallmark feature of the syndrome), hypertension, dyslipidemia, chronic inflammation, impaired fibrinolysis, procoagulation and most telling central obesity.3.
Long-term damage: EyesHigh blood sugar can damage the tiny blood vessels that bring oxygen and nutrients to the retina, a critical part of the eye.
Randomized controlled trials with fenugreekThe multiple trials in the past have shown conflicting results of the effect of fenugreek on the patients of type 2 diabetes. This is known as diabetic retinopathy and it can cause progressive, irreversible vision loss.
These studies showed some positive results on fasting serum glucose but did not examine hemoglobin (HbA1c) levels. People with diabetes are up to 20 times more likely to go blind than those without diabetes. Gupta et al (2001) reported the results of a small randomized, controlled, double-blind trial to evaluate the effects of fenugreek seeds on glycemic control.
The authors reported that there were no significant differences between groups in mean glucose tolerance test values at the study's end.


Long-Term Damage: Nerve PainOver time, uncontrolled diabetes and elevated blood sugars create a very real risk of nerve damage. Symptoms can include tingling, numbness, pain and a pins and needles sensation -- often in the fingers, hands, toes or feet. However, the trial may have been too small or brief to detect significant mean differences between groups. Raghuram et al (1994) reported the results of a randomized, controlled, crossover trial of fenugreek seeds in 10 patients with type 2 diabetes. In the fenugreek-treated patients, statistically significant mean improvements were reported for glucose-tolerance test scores and serum-clearance rates of glucose.
Sharma and Raghuram (1990) conducted two randomized, controlled, crossover studies in patients with type 2 diabetes. Significant mean improvements in fasting blood-glucose levels and glucose-tolerance test results were described in the fenugreek-treated patients.
Preventing type 2 diabetesOne of the most astonishing things about type 2 diabetes is that such a life-altering condition is often preventable. Moosa et al (2006) conducted study to evaluate the effect of fenugreek on serum lipid profile in hypercholesteremic type 2 diabetic patients and concluded that fenugreek seeds powder significantly reduced serum total cholesterol, triglyceride and LDL-cholesterol but serum HDL-cholesterol level elevation was not significant. Neeraja and Rajyalakshmi (1996) presented a case series including six men with type 2 diabetes and six without diabetes.
The cases suggested fenugreek reduced postprandial hyperglycemia primarily in subjects with diabetes, but less so in subjects without diabetes.
The studies conducted to date have been methodologically weak, lacking adequate descriptions of blinding, randomization, baseline patient characteristics, statistical analysis, and standardization data for the therapy used. Demonstrating the efficacy of fenugreek has also been confounded by inconsistencies in the preparations, dosing regimens, and outcome measures used in the trials. Moreover, none of the investigations have been conducted over the longer period (Basch, 2003). Method of patient selectionThe patients were recruited from the diabetic medical centre in rural area of Peshawar conducting the study of management of type 2 diabetes among the population aged 30-65 years. Patients having coexisting liver, kidney or thyroid disorder were not included in the study.
Diabetes Criteria for patientsThe well known standard screening test for diabetes, the fasting plasma glucose (FPG), is also a component of diagnostic testing. The FPG test and the 75-g oral glucose tolerance test (OGTT) are both suitable tests for diabetes; however, the FPG test is preferred in clinical settings because it is easier and faster to perform, more convenient and acceptable to patients, and less expensive. When it was found necessary, plasma glucose testing was also performed on individuals who have taken food or drink shortly before testing. Such tests are referred to as casual plasma glucose measurements and are given without regard to time of last meal. A confirmatory FPG test or OGTT was also completed on such patients on a different day if the clinical condition of the patient permits.
Laboratory measurement of plasma glucose concentration is performed on venous samples with enzymatic assay techniques, and the above-mentioned values are based on the use of such methods. The A1C test values remain a valuable tool for monitoring glycemia, but it is not currently recommended for the screening or diagnosis of diabetes. Pencil and paper tests, such as the American Diabetes Association’s risk test, may be useful for educational purposes but do not perform well as stand-alone tests. Capillary blood glucose testing using a reflectance blood glucose meter has also been used but because of the imprecision of this method, it is better used for self-monitoring rather than as a screening tool.
Determination of study sample size The study sample size was determined based on the assumption of the estimation of Standard Deviation (SD).
Therefore, the study design was selected to detect an effect size of 0.5 SD lowering of HbA1c. It was assumed that 15% patients might be lost to follow-up in control group over the period of three months and only 5 % patients will be lost to follow-up in intervention group. This assumption was based on the popularity of fenugreek seeds used by diabetic patients in sub-continent to manage their glycemic control. Study population and randomizationInitially 325 patients with type 2 diabetes were invited to pre-randomized interview, out of which only 210 patients were included in the actual trial.
Out of the 325 patients, 93 patients did not meet the inclusion criteria and 22 patients refused to participate in the trial. Finally, two hundred and ten (210) patients agreed to participate and signed informed consent documents at the clinic where they used to visit for their usual medical care for diabetes. Therefore, 102 patients were randomized to intervention group (fenugreek supplements) and 108 to the control group (usual medical care). The randomization code was developed using a computer random number generator in a block size of eight patients.
That helped to allocate patients to the intervention and control groups equally in each block – that is each patient would have an equal chance of allocation to either group. Once the randomization phase was completed, all patients were instructed to follow-up the usual medical care for their diabetes for the duration of the 90 days trial. The patients were allowed to adjust their usual medications as recommended by their doctors. In addition, each patient was asked to go for blood test for HbA1c on day 1 and then return to give blood sample after 90 days.
In addition, participants were advised not to take any other new treatments for the management of type 2 diabetes during the trial periods.
The control group in randomized controlled trial received medical care from a physician-coordinated team. This team included physicians, nurses, dietitians, and mental health professionals with expertise and a special interest in diabetes. It is essential in this collaborative and integrated team approach that individuals with diabetes assume an active role in their care.
The management plan in that group was based on individualized therapeutic alliance among the patient and family, the physician, and other members of the health care team. This plan has recognized diabetes self-management education as an integral component of care and in developing the plan, consideration was given to the patient’s age, work schedule and conditions, physical activity, eating patterns, social situation and personality, cultural factors, and presence of complications of diabetes or other medical conditions. Patient self-management was emphasized, and the plan emphasized the involvement of the patient in problem-solving as much as possible. A variety of strategies and techniques were employed to provide adequate education and development of problem-solving skills in the various aspects of diabetes management. During the implementation of the management plan it was assured that each aspect of diabetes management was understood and agreed on by the patient and the care providers and that the goals and treatment plan were reasonable.
Those patients randomized to take fenugreek (intervention group) received 100 gms fenugreek seeds powder from the pharmacy in the clinic.
They were instructed to take 50 gms doses twice a day at lunch and dinner time in addition to their normal medications for diabetes. Those patients randomized to usual medical care (control group) were instructed to take their normal medicines and follow-up with their doctor as per their normal schedule.
All participants were contacted again after 90 days (3-months) to give their blood sample for HbA1c testing.
At that time, a questionnaire was sent via e-mail to participants in both intervention and control groups to assess the progress of the fenugreek treatment and clinical care without fenugreek.
The clinical and demographic characteristics of the patients in the two groups were well balanced at randomization. A demographic measure included age, gender, weight, ethnicity, religion, marital status, previous episodes of glycemic control, previous and current treatments of type 2 diabetes. The table 3 gives baseline characteristics of intervention and control groups in RCT trial. Diabetes treatment with medicationsThe treatment options of type 2 diabetes is shown in figure 4 suggesting the specific areas of actions using medications which influence the various organs of the body to correct the metabolic abnormalities such as reducing the liver glucose production, slowing down absorption of sugars from the gut and reducing the insulin resistance. There are currently six distinct classes of hypoglycemic agents available to treat type 2 diabetes.
The patients in both the groups in RCT trials received medications recommended by their physicians.
The most common combinations among both the groups were Meglitinide (repaglinide) with Thiazolidendiones and Sulfonylurea with Biguanides.
Details of hypoglycaemic medications used in RCT trialThe diabetes medications mentioned in table 4 work in different ways but the main function of all these medications include lowering blood sugar levels; help improve the body’s use of glucose, decrease the symptoms of high blood sugar, help keeping patients with diabetes functioning normally and may prevent the complications, organ-damaging effects and premature deaths diabetes can cause. Since the drugs work in different ways, these are sometimes used in combination to enhance the effectiveness of treatment.
In this RCT trial Sulfonylurea was used in combination with Biguanide (metformin) and Meglitinide was used in combination with Thiazolidinedione. The main function of Sulfonylurea is to bind and inhibit the pancreatic ATP-dependent potassium channel that is normally involved in glucose-mediated insulin secretion. Like the sulfonylurea, meglitinide therapy results in significant reduction in fasting glucose as well as HbA1c.
The mechanism of action of the meglitinide is initiated by binding to a receptor on the pancreatic ?-cell that is distinct from the receptors for the sulfonylurea. Metformin is a member of this class and is currently the most widely prescribed insulin-sensitizing drug in current clinical use.
Metformin administration does not lead to increased insulin release from the pancreas and as such the risk of hypoglycemia is minimal. Because the major site of action for metformin is the liver its use can be contraindicated in patients with liver dysfunction.
Thiazolidinedione: The thiazolidinedione (pioglitazone) has proven useful in treating the hyperglycemia associated with insulin-resistance in both type 2 diabetes and non-diabetic conditions. The net effect of the thiazolidinedione is a potentiation of the actions of insulin in liver, adipose tissue and skeletal muscle, increased peripheral glucose disposal and a decrease in glucose output by the liver.
Diabetes treatment with diet and exerciseThe normal diabetes treatment addresses the issues related to unhealthy lifestyles, such as lack of physical activity and excessive eating, which are the main causes to initiate and propagate the majority of type 2 diabetes (Michael, 2007).
Studies have demonstrated strong relationship between excess weight and the risk of developing type 2 diabetes, hypertension, and hyperlipidemia.
Therefore, the objective of physicians is to motivate patients to lose weight and exercise to improve the control of diabetes and slow down or even reverse the natural course of the disease (Michael, 2007).However, it is difficult to overstate the importance of the relationship between lifestyle and the risk of developing type 2 diabetes. There are prospective studies which have demonstrated that lifestyle modification in the form of diet and regular moderate exercise sharply decrease the likelihood of developing type 2 diabetes in high-risk individuals who have impaired glucose tolerance or impaired fasting glucose. The effectiveness of this intervention superseded that of metformin therapy (Knowler et al. In this RCT trial, physicians compiled the flow scheme shown in Figure 5 which represents the method of treatment of type 2 diabetes by the combination of diet, exercise and medication for diabetes monitoring and control. It has been divided into two segments: for obese and normal weight patients and the combination of medication for both the groups of patients. Dietary consideration for patients (intervention and control group)It has been recommended that carbohydrate and monosaturated fat consumption for the patients with type 2 diabetes should comprise 60-70% of total calories. However, there is some concern that increased unsaturated fat consumption may promote weight gain in obese patients with type 2 diabetes and therefore may cause in reduction of insulin sensitivity (Bantle et al. The “glycemic index” is an attempt to compare the glycemic effects of various foods to a standard, such as white bread. Although several authors have proposed its clinical usefulness in controlling postprandial hyperglycemia, prospective studies have not demonstrated a clear improvement in hemoglobin (HbA1c) in patients using low-glycemic index diets (Michael, 2007).
The physicians in this trial have recommended the best mix of carbohydrate, protein, and fat that was adjusted to meet the metabolic goals and individual preference of the patients with diabetes in both the intervention and control groups.
It has been recommended for individuals with diabetes, that the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone (ADA, 2011). Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remain a key strategy in achieving glycemic control. Physical activity consideration for patients (intervention and control group)Physical activity is a key component of lifestyle modification that can help individuals prevent or control type 2 diabetes. It is considered that diet is probably more important in the initial phases of weight loss, incorporating exercise as part of a weight loss regimen helps maintain weight and prevent weight regain (Klein et al. In this trial, the message was given to both the groups that as little as 30 minutes of moderate physical activity daily may offer greater benefits to these patients in managing their diabetes.
It has also been reported that in patients with type 2 diabetes, structured regimens of physical activity for 8 weeks or longer improved HbA1c independent of changes in body mass (Sigal et al. The evidence supports the contention that controlling blood glucose through modification of diet and lifestyle should be mainstay of diabetes therapy.
It was found in this RCT that despite being one of the most time-consuming discussions with the patients in both the groups, this is probably the most important patient-physician discussion in regard to diabetes control and prevention of disease progression and complications. Statistical analysisWe analysed the primary outcome by an un-paired sample t-test (mean difference between baseline and final HbA1c). The statistical analysis was carried out on an intention to treat basis and that was subject to the availability of data at follow up as well as at entry level for individual patients. The differences between mean changes were tested by unpaired t tests, and ?2 tests (chi-squared test) were used to test for differences in proportions between the fenugreek treatment and clinical based treatment groups.



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Comments

  1. SAMIR789

    I ought to have been clear I used to be speaking about.

    28.06.2016

  2. salam

    Fiber, and beet pulp are.

    28.06.2016