Diabetes Mellitus refers to a group of common metabolic disorders that share the phenotype of hyperglycemia.The major etiological factors of the disease are reduced insulin secretion,decreased glucose utilization,and increased glucose production. Polyuria(frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger)are the main characteristic symptoms of this disease. It is one of the initial diseases described in Egyptian manuscripts. In Ancient Ayurvedic texts this disease is described as Madhumeha, a Vataj sub-type of the disease Prameha, characterized by passing of excessive amount of turbid urine:- “

तत्राविलप्रभूतमूत्रलक्षणााःसिव एि प्रमेहााः” ……सु.नि.6/6 

 à¤¸à¤¾à¤®à¤¾à¤¨à¥à¤¯à¤® लक्षणम तेशाम प्रभूतआविलमत्रूता..( अ. ह. नि. १०/७ )

 The incidence of Diabetes has risen dramatically in the recent times presumably because of reduced activity levels and increasing obesity,and the aging of the population which are also the main etiological factors for this disease. According to latest WHO data an estimated 422 million people suffer from DM globally. The global prevalence of diabetes among adults has risen from 4.7% in 1980 to 8.5% in 2014.3 The prevalence of this disease increases with the age, however in the recent times it is seen that it has started effecting the younger age groups and even adolescents are suffering from DM. India actually has the highest number of diabetics of any one country in the entire world and is emerging as diabetic capital of the world. According to International Diabetes Federation, there were 69.1 million cases of diabetes in India in 2015. Hyperglycemia in Diabetes mellitus result either from insulin insufficiency or insulin dysfunction. Type I diabetes (insulin dependent) is caused due to insulin insufficiency because of lack of functional beta cells. Patients suffering from this are therefore totally dependent on exogenous source of insulin while patients suffering from Type II diabetes (insulin independent) are unable to respond to endogenous insulin and can be treated with dietary changes, exercise and medication. Type II diabetes is the more common form of diabetes constituting 90% of the diabetic population.

 NEED OF STUDY: The need of conducting study on this topic could be justified by the following: 

✓ In 2012, an estimated 1.5 million deaths were directly caused by diabetes and another 2.2 million deaths were attributable to DM.

✓ WHO projects that diabetes will be the 7th leading cause of death in 2030.

✓ Reduction in life expectancy, rising incidence of blindness, end stage renal disease (ESRD), stroke, heart attacks, limb amputations and increase in share of national health services budget are some of the critical issues related to the disease being faced worldwide. 

 REVIEW OF LITERATURE:

 AYURVEDIC REVIEW: The disease has been extensively described in ancient Ayurvedic texts of all times including Brihattrayi and Laghuttrayi. Others include Yogratnakar, Vangasen, Chakradatta, Bhaishajya-Ratnavali etc. This disease has been included in Ashtamahagadas by acharya Charaka, Sushruta and Vagbhatta.6 The elaboration of Prameha includes its Nidan, Poorvaroopa, Roopa, Upshaya, Samprapti and Chikitsa. Vitiated tridoshas affects dhatus including Abaddha Meda, Rakta, Shukra, Ambu, Vasa, Lasika, Majja, Rasa, Ojas and Mansa leads to development of the disease and the main site of pathogenesis being the basti or the mootrashya (urinary bladder). Srotas involved are mootravaha and medovaha. The specific symptomatology of twenty types of Prameha’s has been described for diagnostic purpose. The complicated state of the disease in Ayurveda could be read under the heading prameha pidikas. 

BRIEF SUMMARY

MODERN REVIEW

 Almost all the text books of western(modern) medicine have mentioned Diabetes and its complications. Etiopathogenesis of the disease along with their symptoms, treatment, prognosis and management is described in detail.Evidences are available in Ayuveda and modern medical sciences which justify the correlation of Madhumeha to Diabetes mellitus. Type-1A Diabetes Mellitus results from autoimmune beta cell destruction while individuals with Type-1B Diabetes Mellitus lack immunological markers indicative of an autoimmune destructive process of beta cell. Type 2 DM is a heterogeneous group of disorders characterised by variable degrees of insulin resistance, impaired insulin secretion, and increased glucose production. 

TRIAL DRUGS REVIEW: Indigenous compound formulation used for the trial is MADHUMEHADAMAN CHURNA & PHALTRIKADI KWATHA. 

1. PHALTRIKADI KWATHA : This indigenous compound drug formulation is described in Charak chikitsa for the treatment of Prameha . The contents of the formulations are as follows;

 à¤«à¤²à¤¤à¥à¤°à¥€à¤•à¤® दारूनिषा विशालाम मुस्ताम च नि:क्िाथ्य निशाम सकलकाम पीबेत कशायम मधुसप्रं युक्तम सिवप्रमेहेशुसमधु तेषु। (Ch. chikitsa 6 )

2. MADHUMEHADAMAN CHURNA: The description of this drug is available in Rastantrasaar for the treatment of madhumeha . The contents of the formulations are as follows;

   1- Gudmaar

   2- Karpaas beej

   3- Jambu beej

   4- Bilwa

   5- Nimbapatra 

DIAGNOSTIC CRITERIA:

 Diagnosis will be made on the basis of symptoms given in ancient texts and modern literature. Laboratory investigations and clinical findings shall be considered for making diagnosis. WHO criteria for diagnosis of pre diabetics condition are as follows: 

 â€¢ Fasting plasma glucose 7.0 – 8.4 mmol/L (125- 150 mg/dl) 

ʉۢ Two hour plasma glucose 11-13.8 mmol/L (199- 250mg/dl) during an oral glucose tolerance test.

Note 1. Random is defined as without regard to time since the last meal. 

➢ Fasting is defined as no caloric intake for at least 8 hrs

 âž¢ The test should be performed using a glucose load containing the equivalent of 75g anhydrous glucose dissolved in water.

 INVESTIGATIONS: Routine Investigations: Routine investigation will be done before treatment and after treatment.

 âž¢ CBC 

➢ LFT

 âž¢ KFT 

➢ Lipid profile 

➢ Urine-routine and microscopic examination 

Specific investigations: Specific investigation will be done every month.

 âž¢ FBS, PP,

     RBS – will be assessed every 15 days

 âž¢ HbA1c (Glycosylated Haemoglobin) – will be assessed before and after treatment.

Follow up Blood sugar - Every 15th day.