Dietary Reduction Of Post Prandial Hyperglycemia In Diabetes Biology Essay

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Abstract:

Aim: In management of metabolic syndrome and type 2 diabetes the role of diet is important. Indian diet contains large amount of sugar and starches that set off unpredictable blood sugar fluctuations, increasing the risk of diabetic complications. The aim is to study the effect of Mulberry tea as it is known to contain 1-deoxynojirimycin (DNJ), a potent glycosidase inhibitor and has been hypothesized to suppress abnormally high postprandial blood glucose levels.

Method: The study is designed in follow-up diabetic patients, 20 diabetics as controls were given plain tea and 28 patients were given mulberry tea containing DNJ to measure effect based on FBS and PPBS.

Fasting blood glucose sample was collected, followed by standard breakfast and one cup of 70ml tea with 1 teaspoon of sugar. The postprandial blood glucose was measured again at 90minutes in all 48 patients.

Results: Fasting value in control group 178.55±35.61 and cases 153.50±48.10. After consumption of plain tea and mulberry tea the postprandial value was287.20±56.37 and 210.21±58.73 respectively the significance is t=4.492; p<0.001 and the effect size is very large(1.31).

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Conclusion: Mulberry tea suppresses postprandial rise of blood glucose levels.

Introduction:

Type 2 diabetes mellitus has remained as an international health care crisis and it has been increasing very rapidly world wide. Due to its high prevalence and potential deleterious effect, diabetes is a major medical concern. The greatest absolute increase in the number of people with diabetes will be in India. 31.7 million diabetes cases were reported in the year 2000 and it is predicted that it will become 79.4 million in 20301Recent developments in the last few years to understand the pathophysiology of diabetes mellitus have fuelled new approaches to the diabetic therapy. Further more strong evidence from randomized prospective studies demonstrates the benefits of glycemic control in diabetic care2,3. Glycemic control will help prevent the onset as well as the delay in progression of the long term micro vascular complications of diabetes mellitus3.

Diabetes mellitus is a metabolic disease of endocrine system and it is characterized by primary hyperglycemia due to the dysregulation of plasma glucose titer and promotes biochemical disturbances causing oxidative stress and chronic inflammatory process4 Diet is a critical factor in controlling diabetes mellitus. However, in the south Indian homes the right diet and lifestyle choices are difficult for many patients because of the large amount of sugars and finely processed carbohydrates that constitute the diet. In recent years, there has been a growing interest in natural remedies that can help manage type 2 diabetes. One od the natural ingredients that has shown promise is the mulberry leaf 5. Mulberry leaves are the food source of silkworms and have been used for generations in traditional Chinese medicine as a cooling herb to remove excess heat from the body. The leaf is also used in some Indian foods 6.

The mulberry plant, 'Morus Alba' is a short-lived, fast-growing and small to medium sized mulberry tree, which grows to 10-20 m tall. Mulberry contains 1-deoxynojirimycin (DNJ), and some of its derivatives which are considered as alpha glucosidase inhibitors 7. Alpha glucosidases are the enzymes that catalyses the cleavage of glycosidic bonds in oligosaccharides. By inhibiting this enzymes can prolong the carbohydrate absorption process and flatten the blood glucose levels. Thus the mulberry tea has therapeutic and preventive effect.

It is already proved that morus alba leaf extract suppresses the elevation of blood glucose levels in rats8. Also it is proved the DNJ enriched powder suppresses postprandial blood sugar 9. Even though there are reports of the glucose lowering effect of mulberry extract, this is the first study of itsuse as a simple tea among south Indians. So mulberry tea may play an important role in reducing the postprandial blood glucose level. Therefore a study has been taken up among type-2 diabetic patients to observe the change in blood glucose following consumption of mulberry tea vs. plain tea.

MATERIALS AND METHODS

The study design was to select follow-up diabetic patients taking oral anti diabetic drugs with metabolic syndrome at Sri Jayadeva institute of cardiovascular sciences and Research, to measure both fasting blood glucose followed by routine standard breakfast and one cup of 70ml tea with 1 teaspoon of sugar. The postprandial blood glucose was measured in 48 patients after prior consent and Institute Regulatory Board approval. Mulberry leaf extract tea 'mulbericha green' was provided by Karnataka state sericulture research and development institute, Bangalore.

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Method: First morning sample of fasting blood was collected for glucose estimation. The patient was instructed to consume standard breakfast two 'idlies'with 'chatni'. Idlie contains fermented mixture of ground rice and beans. Each Idli will provide approximately 1.67gms of protein, 0.14gms of fat, 9.12 gms of carbohydrates, 0.21gms of minerals, 44.5kcal of energy and 0.09gms of fibre. Chutney is the coconut paste and spiced up with chillies. The mulberry tea was prepared by adding a teaspoon of 'mulbericha green' to one cup of hot water and addition of one teaspoon sugar and given to the patient to drink. Similarly the control group also consisted of diabetic patients and were given normal tea. After 90 minutes the second blood sample was collected for measurement of postprandial blood glucose. Analysis was carried out on Roche Hitachi 912 analyzer. The study was approved by the Ethical committee of Sri Jayadeva institute of cardiology.

Statistical Methods: Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean  SD (Min-Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5 % level of significance, Student t test (two tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups Inter group analysis. Student t test and Chi-square test to test the homogeneity of samples based on parameters on categorical scale between two groups.

Effect Size

=

No effect (N)

d<0.20

Small effect (S)

0.20 <d<0.50

Moderate effect (M)

0.50 <d<0.80

Large effect (L)

0.80<d<1.20

Very large effect (VL)

d>1.20

RESULTS

This is a case control study testing the effect of mulberry tea on post-prandial blood glucose on 48 diabetic patients divided in a test group (n=28) and a control group (n=20). The subject received a standardised breakfast together with tea with a teaspoon of sugar. The tea was made from either mulberry leaf extract (test subjects) or "normal" (black - I presume) tea (controls). Blood glucose (BG) was measured in the fasting state before breakfast and after 90 minutes in the post-prandial state. Post prandial blood glucose after 90 minutes was found to be lower in the test subjects than the controls.

The age of the subjects selected for the study was between 30-70 years. The mean age of control was 53.80±11.15 and cases 51.61±8.59. Samples are age matched with P=0.445The selected subjects involved both males and females. The control group contains 50% males and 50% females. The cases involved 57.1% males and 42.9& females. Samples are gender matched with P=0.624.

Table 1: Comparison of age distribution

Age in years

Controls

Cases

No

%

No

%

30-40

3

15.0

3

10.7

41-50

4

20.0

11

39.3

51-60

8

40.0

9

32.1

61-70

5

25.0

5

17.9

Total

20

100.0

28

100.0

Mean ± SD

53.80±11.15

51.61±8.59

Samples are age matched with P=0.445

Gender

Controls

Cases

No

%

No

%

Male

10

50.0

16

57.1

Female

10

50.0

12

42.9

Total

20

100.0

28

100.0

Samples are gender matched with P=0.624

The fasting and post prandial blood sugar was measured and tabulated. The mean fasting blood sugar in controls was 178.55±35.61 and that in cases was 153.50±48.10.the mean post prandial blood glucose level shows interesting results. The mean post prandial glucose levels in controls was 287.20±56.37 and in cases 210.21±58.73.The difference was highly significant with p<0.001 and a very large effect size.

Table 2: Levels of FBS and PPBS in controls and Cases

Variables

Controls

Cases

Significance

Effect size

FBS

178.55±35.61

(129-262)

153.50±48.10

(93-278)

t=1.972;p=0.055

0.57(M)

PPBS

287.20±56.37

(159-380)

210.21±58.73

(118-341)

t=4.492;p<0.001

1.31(VL)

Discussion:

This focus of this study is the reduction in post prandial blood glucose in diabetic patients. The ingestion of mulberry tea immediately after a standard diet significantly reduced the increase in blood glucose observed over the initial 90 min of testing in control and study group. Brownlee10 proposed that generation of reactive oxygen species is the common pathway responsible for diabetes complications, and glucose fluctuations are associated with increased markers of oxidative injury11. Thus, reductions in blood glucose fluctuation with mulberry extract might reduce diabetes complications.

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In diabetes management different medications are prescribed to reduce glucose levels. This is still a challenge to the medical system. Inhibition of carbohydrate absorption is a major fact to reduce the blood glucose level12. Acarbose and miglitol are the hypoglycemic drugs acts by the inhibition of alpha glucosidase13 . But the use of these drugs leads to bloating gas and diarrhea14. These symptoms are not observed in our study with mulberry tea. So the mulberry tea is free from common side effects due to the use of drugs.

Mulberry extract contains not only the hypoglycemic agents but also have other beneficiary effects. Mudra etal reported mulberry extract contains compounds such as fagomine which induces insulin secretion and antioxidants that reduce lipid peroxidation5. The mulberry leaf extract appears to play an important role in reducing the risk factors associated with type 2 diabetes, because it promotes better blood glucose control and weight management, when fewer carbohydrates and sugars are absorbed into the bloodstream.

As herbal preparations have more acceptances over pharmaceuticals among south Indians and Mulberry tea being a natural product extracted from morus alba. The mulberry plant derived extract are easy to include as a food beverage. In our study we used the extract as a tea since it is a common drink used after food. So mulberry tea which tastes like normal tea can be easily substituted.

Mulberry extract is said to inhibit intestinal brush boarder enzyme alpha glucosidase. The most important carbohydrates in food, such as starch and sucrose, are hydrolyzed to monosaccharide, such as glucose and fructose, by alpha glucosidase, and then absorbed into the blood, thereby increasing blood glucose value. Alpha glucosidase inhibitors works as to prolong carbohydrate absorption process and flatten blood glucose levels.

Conclusion:

In this study Mulberry tea shows the hypoglycemic effect after a standard breakfast. This can be explained by the alpha glucosidase inhibitory activity of mulberry tea by one of its active component 1-deoxynojirimycin (DNJ).So mulberry tea can be used as an anti diabetic natural drink.