INTRODUCTION:

India is the epicentre of diabetes and, by 2017, India constituted the second largest populace of 73 million patients, after China (International Diabetes Federation 2017). Over the past couple of decades, especially since the new economic reforms, the lifestyle modification of an average Indian has undergone an across- the-board alteration (Ramachandran 2007).¹

Instantaneous urbanisation and socio-economic transitions, viz. rural to urban migration, low exercise regimen, lifestyle disorder, etc., have resulted in an escalation of diabetes prevalence in India over the last couple of decades^2-5

According to the Diabetes Atlas 2006 published by the International Diabetes Federation, the number of people with diabetes in India currently around 40.9 million is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken. The most disturbing trend is the shift in age of onset of diabetes to a younger age in the recent years. This could have long lasting adverse effects on the nation's health and economy. Early identification of at risk individuals using simple screening tools like the Indian Diabetes Risk Score (IDRS) and appropriate lifestyle intervention would greatly help in preventing or postponing the onset of diabetes and thus reducing the burden on the community and the nation as a whole. Consequently, diabetes is rapidly emerging as a global health care problem that threatens to reach pandemic levels by 2030, the number of people with diabetes worldwide is projected to increase from 171 million in 2000 to 366 million by 2030. Millions of Cases of Diabetes in 2000 and Projections for 2030, with Projected Percent Changes. This increase will be most noticeable in developing countries, where the number of people with diabetes is expected to increase from 84 million to 228 million⁶

In addition, Type II Diabetes Mellitus and obesity is becoming increasingly more prevalent among people in India. The serious spread of disease can cripple the nation’s fiscal and human resources; therefore, it’s the time to act now and do as much as possible to cover almost all aspects of the disease. The overwhelming burden of the disease threatens to stunt economic growth and undermine the benefits of improved standards of living and education. Proper education and awareness programs developed according to the need of the society can improve the knowledge of patients and change their attitude⁷

NEED FOR THE STUDY:

Incidence and Prevalence:

The 42nd World Health Assembly noted that Type-II Diabetes Mellitus has been already a significant public health concern and the problem is growing especially in the developing country. Various studies have shown that the highest incidence of diabetes in India is mainly because of a sedentary lifestyle, lack of physical activity, obesity, stress and consumption of diet rich in fat, sugar and calories. With the advent of highly addictive computer with Video games, sedentarinism is now affecting the children and youth, as they tend to spend more time in front of Television sets or computers than playing out- doors. The results of prevalence studies of diabetes mellitus in India were systematically reviewed with 4 emphasis on those utilizing the standard WHO criteria for diabetes diagnosis. The prevalence of disease in adult was found to be increasing currently 4 to 11.6% of India’s urban dwellers and 2.4% to 3% of rural population potential for further rise in prevalence of Diabetes Mellitus in the coming decades.⁸

Death and Disability:

WHO reported that there were 1.2 lakhs diabetes related deaths in India in 1999 to 2000. For every 10 seconds, 2 new diabetic cases are diagnosed and every 10 seconds a person dies from diabetes related causes in the world. An estimation given by American Diabetes Association, its incidence is increasing rapidly and it is estimated that by 2030, this number will almost double. People with Diabetes are 25 times more likely to develop blindness, 17 times more likely to develop kidney disease, 30-40 times more likely to undergo amputation, 2-4 times more likely to develop Myocardial Infarction and twice as likely to suffer a stroke as non-diabetics. Diabetes is currently the fifth most common reason for death in the world. Around 1 in 8 people between 20 and 79 years old have their death attributed to diabetes and it is expected to rise. The life expectancy on average now is reduced by More than 20 years for people with Type 1 diabetes Up to 10 years for people with Type 2 diabetes However, these figures are based on historical data, and with improvements in modern care taking place, the figures presented could be subject to change in the coming decades¹⁰

STATEMENT OF PROBLEM:

An Experimental study to assess the effectiveness of ‘Giloy juice’ for reducing blood glucose level among Diabetic type-II Adults in selected community area, Bhilai, C.G.

OBJECTIVE:

· To assess the pre-test blood glucose level among Diabetic Type-II Adults in experimental and control group.

· To assess the effectiveness of Giloy juice among Diabetic Type-II Adults in experimental group.

· To assess the post-test blood glucose level among Diabetic Type-II Adults in experimental and control group.

· To find out the association between post-test blood glucose level among Diabetic Type-II adults with selected socio demographic variables.

HYPOTHESIS

1. H0- There will be no significant difference in blood glucose level among Diabetic Type-II Adults between experimental and control group.

2. H1- There will be significant difference between pre-test and post-test blood glucose level among Diabetic Type-II Adults in experimental group.

3. H2- There will be significant difference in blood glucose level among Diabetic Type-II adults between experimental and control group.

4. H3-There will be significant association between post test blood sugar level among Diabetic Type-II Adults with their selected socio demographic variables.

CONCEPTUAL FRAMEWORK:

A conceptual framework is a process of ideas which are framed and utilized for the development of a research design. It helps the researcher to know what data needs to be collected and gives direction to an entire research process. It directs action towards the explicit goal. Based on the previous studies, undertaken by “National Centre of Biotecnology Information” ‘Giloy’ is known to have Anti-diabetic property.

Burning Extra Glucose- Helps in maintain Blood Sugar Level. Indirectly helps in the Natural production of the Insulin. Which aid as hypoglycaemic agent.

The study based on the concept that administration of 20 ml of Giloy juice with equal amount of water to Diabetic type-II adults will help to reduce blood glucose level. The conceptual framework used for this study was based on “Wiedenbach’s Helping ART of Clinical Nursing Theory [1964]” as a base of developing conceptual framework. ErnestinWiedenbach proposes helping the art of clinical nursing theory in 1964 for nursing which describes a desired situation and way to attain it.

METHODOLOGY:

Research aaproach:

Research Design:

True experimental, one group pre test-post test research design

Population:

Target population:

In present study the target population included were adult with diabetes mellitus type-II residing at Bhilai.

Accessible population:

The population selected for this study wasadult with diabetes mellitus type-II residing at kohka Bhilai, Chhattisgarh.

Setting of the Study:

The setting for the present study was ward-9 purani basti kohka nagar nigam Bhilai, (C.G.)

Sample:

The sample of the study comprised of 40 subjects who were having diabetes mellitus type-II.

Sampling Technique:

Probability-simple random sampling technique was adopted to select the subjects.

Sample Size:

Total 60were 20 are in experimental group and 20 are in control group which fulfills the required criteria.

Variables:

According to POLIT AND HUNGLER, “A variables, as the name implies something that vary or it can be any quality of an organism, group or situation that makes different values”. Two types of variables are identified in the study. They are dependent variable and independent variables.

Dependent variable:

Dependent variable wasblood glucose level.

Independent variable:

Independent variable was Giloy Juice.

Sampling Criteria:

The following criteria are set to select samples:-

Inclusion Criteria:

Those who are willing to participate in the study.

· Those who are residing at Bhilai and able to understand Hindi.

· Confirmed evidence of Diabetic Type-II within 5yrs.

· Those whose age is 35-65years of age.

Exclusion Criteria:

· Type-II Diabetic adults with other systemic problem like renal disease, malignant hypertension, cardiac disorder.

Type-II Diabetic adults have taken other then Oral Anti-Diabetic medicines.

· The adult Clients who are consuming alcohol and tobacco within 6-12 months.

· Clients already administrating Giloy Juice prior to the start of the study.

Description of the Tools:

The self structured questionnaire and observational schedule is organized in two sections:

Criterion Measures:

Scoring for section B: -

Level of Blood glucose assessment

· Below average: <10mg/dl

· Average: >10-20mg/dl.

Methods of Data Collection:

The data collection was done for 4 weeks period. After obtaining information and willingness from the study participants the study was conducted at puranibasti of kohka, Bhilai (C.G) with total samples 40.

Data Analysis and Interpretation:

Analysis of pre-test and post-test blood glucose level by using mean and standard deviation of experimental group:

Types of Blood Glucose Test	Pre-Test			Post-Test
	Total Mean	Mean	SD	Total Mean	Mean	SD
Fasting	2745	137.25	6.01	2436	121.8	5.44
Post Prandial	5178	258.9	16.14	4850	242.5	15.4

It shows that the Pre-test fasting blood glucose level was 2745, total mean 137.25 respectively, The standard deviation of pre-test fasting blood glucose level was 6.01 and post-test fasting blood glucose level was 2436, total mean 121.8 respectively. The standard deviation of post-test fasting blood glucose level was 5.44.

Pre-test postprandial blood glucose level was 5178, total mean 258.9 respectively. The standard deviation of pre-test postprandial blood glucose level was 16.14 and post-test postprandial blood glucose level was 4850, total mean 242.5 respectively. The standarddeviation of post-test postprandial blood glucose level was 15.4.

Shows that there was highly significant difference between pre-test and post-test blood glucose level of diabetic type-II adult after taking Giloy juice as calculated ‘t’ value 15.22(df.19) was greater than table value 2.09 at 0.05 level of significance in experimental group.

There was significant difference between pre-test and post-test blood glucose level of diabetic type-II adult after taking Giloy juice as calculated ‘t’ value 06.19(df.19) was greater than table value 2.09 at 0.05 level of significance in control group

Hence, Giloy juice is effective for reducing blood glucose level among Diabetic type-II Adults":

Major Findings of Study:

The data was collected, analysed and interpreted in term of objectives. Descriptive and inferential statistics were utilized for the data analysis. The level of significance set for testing the hypothesis was 0.05 using ‘t’ test. The major findings of the study were presented under following:

Section-I: Description of socio demographic variables in frequency and percentage:

1. Illustrates that in accordance with age of the Diabetic type II Adult, a sizeable majority of them belongs to 09(45%)46-55year of age in experimental and 08(40%)35-45 year were belongs to control group, 07(35%)56-65 year of age in experimental group and 05(35%)46-55 year were belongs to control group, 04(20%)35-45 years of age in experimental group and 05(25%)56-55 year were belongs to control group.

2. Illustrates that in accordance with gender of diabetic type-II adult, a sizeable majority of them were belongs to 12(60%) male in experimental group and 11(55%) male in control group and were belongs to 09(45%) female in control group and 08(40%) female in experimental group.

3. Illustrates that accordance with Religion a sizeable majority of them were belongs to 13(65%) Hindu in control group, 10(50%) Hindu were belongs to experimental group and 06(30%) Christian were belongs to experimental group, 04(20%) Christian was in control group and 03(15%) Muslim were belongs to 74 experimental group, 02(10%) Muslim were in control group and 01(5%) others were belongs to both experimental and control group.

4. Illustrates that accordance to marital status of Diabetic type-II Adult, a sizable majority of them were belongs to 15(75%) non-vegetarians in experimental group and were belongs to 10(50%) non-vegetarians in control group, 4(20%) vegetarians in both experimental and control group, 6(30%) eggitarian in control group and 1(05%) in experimental group.

5. Illustrates that accordance to duration of illness of diabetic type-II adult, a sizable majority of them were belongs to 08(40%) 2year duration in control group and were belongs to 07(35%) 2year duration in experimental group and 06(30%) 3year duration were in control group, 03(15%)3year duration in experimental group and were belongs to 04(20%)1year in experimental group, 03(15%)1year duration in control group and were belongs to 04(20%)4year duration in experimental group ,02(10%)4year duration in control group and were belongs to 02(10%)5year duration in experimental group , 01(05%)5year duration in control group.

6. Illustrates that accordance to type of family of diabetic type-II adult, a sizable majority of them were belongs to 12(60%) joint family in experimental group,08(40%) joint family in control group and were belongs to 07(35%) extended family in control group, 06(30%) extended family in experimental group and were belongs to 05(25%) nuclear in control group, 02(10%) nuclear family in experimental group.

7. Illustrates that accordance to body mass index of diabetic type-II adult, a sizable majority of them were belongs to 08(40%) underweight in control group ,06(30%) underweight in experimental group and were belongs to 06(30%) overweight in experimental group,04(20%) overweight in control group and were belongs to 05(25%) healthy weight in experimental group, 03(15%) healthy weight in control group and were belongs to 05(25%) obesity in control group, 03(15%) obesity in experimental group.

8. Illustrates that accordance to habit of doing exercise of diabetic type-II adult, a sizable majority of them were belongs to 17(85%) not perform exercise in experimental group, 06(30%) not perform in control group and were belongs to 14(70%) perform exercise in control group ,03(15%) perform exercise in experimental group

9. Illustrates that accordance to family history of diabetic mellitus of diabetic type-II adult, a sizable majority of them were belongs to 12(60%) having history in control group, 07(35%) having history in experimental group and were belongs to 13(65%) no history in experimental group, 08(40%) no history in control group.

10. Illustrates that accordance to allergic to herbal product of diabetic type-II adult, a sizable majority of them were belongs to 20(100%) no allergy in experimental group, 14(70%) no allergy in control group and were belongs to 6(30%) having allergy in control group, 0(00%) in experimental group

Section II: - Overall analysis of pre and post test score by using mean, mean percentage and standard deviation.

· It shows that the Pre-test fasting blood glucose level was 2745, total mean 137.25 respectively. The standard deviation of pre-test fasting blood glucose level was 6.01 and post-test fasting blood glucose level was 2436, total mean 121.8 respectively. The standard deviation of post-test fasting blood glucose level was 5.44.

· Pre-test postprandial blood glucose level was 5178, total mean 258.9 respectively. The standard deviation of pre-test postprandial blood glucose level was 16.14 and post-test postprandial blood glucose level was 4850, total mean 242.5 respectively. The standard deviation of post-test postprandial blood glucose level was 15.4.

· Pre-test fasting blood glucose level was 2887, total mean 144.35 respectively, The standard deviation of pre-test fasting blood glucose level was 7.3 and post-test fasting blood glucose level was 2764, total mean 138.2 respectively. The standard deviation of post-test fasting blood glucose level was 9.7.

· Pre-test postprandial blood glucose level was 5201, total mean 260.05 respectively. The standard deviation of pre-test postprandial blood glucose level was 17.5 and post-test postprandial blood glucose level was 5104, total mean 255.2 respectively. The standard deviation of post-test postprandial blood glucose level was 1.4.

Section III: Unpaired ‘t’ test analysis to Comparison of pre test and post test blood glucose level among Type II diabetic adults in experimental and control group.

· Reveals that there was minimal significant difference between fasting pre-test blood glucose level of diabetic type-II between experimental and control group as calculated ‘t’ value 3.48(df.19) was greater than table value 2.09 at 0.05 level of significance.

· Reveals that there was highly significant difference between fasting post-test blood glucose level of diabetic type-II between experimental and control group as calculated ‘t’ value 6.41(df.19) was greater than table value 2.09 at 0.05 level of significance.

· Reveals that there was no significant difference between postprandial pre-test blood glucose level of diabetic type-II between experimental and control group as calculated ‘t’ value 0.21(df.19) was greater than table value 2.09 at 0.05 level of significance.

· Reveals that there was significant difference between post-prandial post-test blood glucose level of diabetic type-II between experimental and control group as calculated ‘t’ value 3.42(df.19) was greater than table value 2.09 at 0.05 level of significance.

· There is no significant association between post -test blood glucose level and religion of subject as the calculated chi square value is 2.76(df-3) is less than the table value of chi square 7.82 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and dietary pattern of subject as the calculated chi square value is 3.50(df-2) is less than the table value of chi square 5.99 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and duration of illness of subject as the calculated chi square value is 4.7(df-4) is less than the table value of chi square 9.49 at 0.05 level of significance. 79

· There is no significant association between post-test blood glucose level and type of family of subject as the calculated chi square value is 0.21 (df-2) is less than the table value of chi square 5.99 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and body mass index of subject as the calculated chi square value is 1.0(df-3) is less than the table value of chi square 7.82 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and habit of doing exercise of any exercise of subject as the calculated chi square value is 0.19(df-1) is less than the table value of chi square 3.84 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and family history of diabetes mellitus of subject as the calculated chi square value is 0.64(df1) is more than the table value of chi square 3.84 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and allergic to any herbal product of subject as the calculated chi square value is 0.2(df1) is more than the table value of chi square 3.84 at 0.05 level of significance.

Chi square analysis for association between the post-test post prandial blood glucose level with selected socio-demographic variables of experimental group.

· There is no significant association between post-test blood glucose level and age of subject as the calculated chi square value is 0.16(df-2) is less than the table value of chi square 5.99 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and gender of subject as the calculated chi square value is 1.25(df-1) is less than the table value of chi square 3.84 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and religion of subject as the calculated chi square value is 3.33(df-3) is less than the table value of chi square 7.82 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and dietary pattern of subject as the calculated chi square value is 2.98(df-2) is less than the table value of chi square 5.99 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and duration of illness of subject as the calculated chi square value is 2.93(df-4) is less than the table value of chi square 9.49 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and type of family of subject as the calculated chi square value is 0.5 (df-2) is less than the table value of chi square 5.99 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and body mass index of subject as the calculated chi square value is 0.4(df-3) is less than the table value of chi square 7.82 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and habit of doing exercise of any exercise of subject as the calculated chi square value is 1.04(df-1) is less than the table value of chi square 3.84 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and family history of diabetes mellitus of subject as the calculated chi square value is 0.29(df-1) is more than the table value of chi square 3.84 at 0.05 level of significance.

· There is no significant association between post-test blood glucose level and allergic to any herbal product of subject as the calculated chi square value is 0.8(df-1) is more than the table value of chi square 3.84 at 0.05 level of significance.

Hence, Hypothesis H₂is accepted.

CONCLUSION:

Type II Diabetes which is characterized by high blood glucose in the context of impairment of insulin secretion and defects in insulin action is becoming a major worldwide health problem.

Approximately, 346 million people worldwide have diabetes, and among which 90% of all cases suffer from Type II diabetes. Most mortality among diabetic patients is the result of cardiovascular disease and this may be largely the result of increased atherosclerosis following by hyperlipidemi. From the above review and by own observation, I found that that the Giloy juice is very effective to reduce blood glucose level in Diabetic type-II patients. Very few studies supporting the benefit of Giloyjuice. Thus the investigator plan to conduct the study evaluate the effectiveness of “ Giloy Juice” for reducing blood glucose level among Type II diabetic mellitus adults, as it is an easily available, rich in calcium, protein and phosphorus , high fiber, having a low glycaemia index, low cost food item and has an increased effect in reducing blood glucose level.

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Received on 24.06.2022 Modified on 01.08.2022

Int. J. Nur. Edu. and Research. 2022; 10(4):361-368.

DOI: 10.52711/2454-2660.2022.00083

Fasting Blood Glucose Test	Experimental Group		Experimental Group		Unpaired ‘T’ Test Value	Unpaired ‘T’ Test Value	At 0.05 Level of Significnt
Fasting Blood Glucose Test	Mean	SD	Mean	SD	Unpaired ‘T’ Test Value	Unpaired ‘T’ Test Value	At 0.05 Level of Significnt
Pre-Test	137.2	±5.44	144.3	±7.3	3.48	2.09	Minimal significant
Post test	121.8	±6.01	138.2	±9.7	6.41	2.09	Highly significant

Fasting Blood Glucose Test	Experimental Group		Experimental Group		Unpaired ‘T’ Test Value	Unpaired ‘T’ Test Value	At 0.05 Level of Significnt
Fasting Blood Glucose Test	Mean	SD	Mean	SD	Unpaired ‘T’ Test Value	Unpaired ‘T’ Test Value	At 0.05 Level of Significnt
Pre-Test	258.9	±16.4	260.0	±15.4	0.21	2.09	No significant
Post-test	242.5	±17.5	255.2	±17.6	3.42	2.09	significant

Group	Blood glucose level	Mean	Standard deviation	DF	Paired-t test value	Table ‘t’ value at 0.05 level of significance
Experimental Group	Pre-test	137.2	±5.44	19	14.05	2.09
Experimental Group	Post-test	121.8	±6.01	19	14.05	2.09
Control Group	Pre-test	144.3	±7.3	19	06.73	2.09
Control Group	Post-test	138.2	±9.7	19	06.73	2.09