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1.  Physico-chemical analysis of a Herbo-mineral compound Mehamudgara vati – A pilot study 
Ayu  2011;32(4):572-575.
Efforts have been made to lay down analytical standards for Mehamudgara vati (MMV), which were not found reported till date. Weight variation showed that 90% tablets of MV manufactured in the Gujarat Ayurved University Pharmacy were within acceptable range (323 mg ± 10%), pH 4.58, and disintegration time 17 min, whereas hardness was 1.25 kg/cm2. Loss on drying was found to be 9.3% w/w, acid insoluble ash was 0.9 %w/w, water soluble extract was 24.06% w/w and methanol soluble extract 14.1% w/w. Determination of iron as Fe2O3 was done as Lauha bhasma being the major ingredient of MMV. The result showed that iron content was reduced in the formulation (28.67%) as compared to that in Lauha bhasma (61.19%). In TLC, 5 spots each at 254 nm and 366 nm were found.
doi:10.4103/0974-8520.96136
PMCID: PMC3361938  PMID: 22661857
Lauha-bhasma; Mehamudgara vati; standardization; thin layer chromatography
2.  Evaluation of Saptarangyadi Ghanavati in the management of Apathyanimittaja Prameha w.s.r. to type-2 diabetes mellitus 
Ayu  2012;33(3):368-373.
Type-2 diabetes mellitus is a persistent health problem that requires innovative strategies to improve health and needs a multifactorial approach for the treatment. Saptarangyadi Ghanavati, a new formulated Ayurvedic compound consists of herbs with anti-diabetic potential, in addition to a folklore herb Saptarangi (Salacia chinensis) has been evaluated. In a total of 67 patients, 36 patients were of newly detected type-2 diabetes mellitus and 31 patients were of chronic type-2 diabetes mellitus and they were divided into group A and group B, respectively. Group A consisted newly detected subjects of type-2 diabetes and were not taking any regular medication and group B consisted of chronic cases of type-2 diabetes mellitus, who were taking modern ant-diabetic medication, but their blood-glucose level was not controlled to desired level. Patients in group A were administered Saptarangyadi Ghanavati each of 200 mg, 5 Vatis, 3-times a day-after breakfast, lunch, and dinner. Patients in group B were administered Saptarangyadi Ghanavati, in the same dose in addition to the concomitant anti-diabetic (Allopathic) medication. Serum insulin investigation, both fasting and post-prandial levels were evaluated in six patients of group B, showed a highly significant increase in first-phase insulin response. Glycosylated hemoglobin (serum HbA1c) evaluated in six patients of group A showed statistically significant reduction. There was also statistically significant reduction in the fasting blood sugar (FBS) and post prandial blood sugar (PPBS) parameters, both in newly detected cases as well as chronic cases of type-2 diabetes mellitus.
doi:10.4103/0974-8520.108825
PMCID: PMC3665094  PMID: 23723643
Anti-diabetic; insulin response; glycosylated hemoglobin; Saptarangyadi Ghanavati; type-2 diabetes mellitus
3.  PA03.07. A clinical comparative study of Matra Vasti and Vaitran Vasti in the treatment of Gridhrasi w.s.r to Sciatica 
Ancient Science of Life  2013;32(Suppl 2):S76.
Purpose:
Sciatica is a vata dominant vikar and vasti is a vata dominant chikitsa. Matra Vasti is a nirapad vasti and can be given in any condition without following the ahara and vihara, then what is need for Vaitran Vasti? So, here an effort was made to study the effect of Matra vasti and Vaitran Vasti separately in the treatment of Grihdrasi.
Method:
30 patients were randomly selected from the OPD and IPD of Kayachikitsa Department of Ayurvedic Medical College,Davanagere, Karnataka and were separated in two groups of 15 each,and a study was conducted. Along with vasti chikitsa oral medication was also given. Ekangvir rasa in the dose of 500mg B.D and Lashunadi vati in the dose of 2 tabs. B.D.
Result:
Results were evaluated on the basis of symptoms of types of Gridhrasi i.e vataja and vatakaphaja as mentioned in Charak Samhita which showed marked improvement in all the symptoms. A Ttest was performed which gave a significant result of (P<.001). Results were also seen on the basis of International Scale which resulted in improvement in functional ability and reduction in functional disability.
Conclusion:
It can be said that Vasti plays an important role in the treatment of Grihdrasi. In Vataja type Matra Vasti had played an supreme role as it helps in treating degenerative pathology and in Vatakaphaja type Vaitran Vasti had played a first rate role as it helps in treating inflammatory pathology.
doi:10.4103/0257-7941.123899
PMCID: PMC4147550
4.  Effect of Mahayavanala Roma Kshara and Dhanyaka Gokshura Ghrita in benign prostatic hyperplasia 
Ayu  2010;31(3):332-337.
Vatastheela is a disease of Mutravahasrotasa, one among the 12 types of Mutraghata disorders elaborated by Sushruta in his seminal work, the Sushruta Samhita. Vatastheela, as described in Ayurveda, closely resembles benign prostatic hyperplasia (BPH) of modern medicine in its signs and symptoms. It is a senile disorder and chiefly affects individuals above the age of 40 years. The symptoms are those of bladder outflow obstruction, with increased frequency of micturition, dribbling, hesitancy, and the features of chronic urinary retention. Surgical management has been accepted as the standard management but is associated with many disadvantages as well as complications, which may not be acceptable at this age. Conservative management with modern medicines is also not free from side effects. So, in this age-group, there is a need for much safer alternative method of management. In this regard, many works have been carried out and shown that the Ayurvedic approach, using natural medicines, is a far better approach. We carried out a comparative study of Mahayavanala Roma Kshara (MRK) and Dhanyaka Gokshura Ghrita (DGG), which are the compounds prescribed for Mutraghata in Ayurvedic literature. The patients were randomly selected from the OPD and IPD of IPGT and RA hospital, Jamnagar, Gujarat, and divided into two groups. In first group, one (500 mg) capsule of MRK was given twice a day with lukewarm water for 45 days; in second group, 10 gm of DGG was given orally twice a day with lukewarm water for 45 days. DGG showed significantly greater relief in the subjective parameters as per International Prostate Symptoms Score (IPSS) than MRK. However, reduction in the size of the prostate and in the volume of the post-void residual urine was found much better in the MRK group.
doi:10.4103/0974-8520.77168
PMCID: PMC3221067  PMID: 22131735
Benign prostatic hyperplasia; Dhanyaka Gokshura Ghrita; Kshara; Mahayavanala Roma Mutraghata; Mutravahasrotasa; Vatastheela
5.  PA01.19. Clinical evaluation of pandughni vati & dhatri lauha vati on garbhini pandu (iron deficiency anaemia in pregnancy 
Ancient Science of Life  2012;32(Suppl 1):S69.
Purpose:
The desire to have a healthy progeny is innate & very intense in every living being. The hectic life and tremendous stress in today's world has made the conception & continuation of pregnancy to term very difficult. Anaemia is one of the common disease conditions which affect a pregnant woman. In Ayurvedic classics anaemia in pregnancy is taken under the Rasa Pradoshaja Vikara. It is also a Santharpanotha Vikara.
Method:
Total 26 patients were registered from O.P.D. And I.P.D. of the department of Streeroga & Prasootitantra, out of them 4 patients were discontinued. They were randomly divided in to two groups; Group A (n 12) Pandughni Vati 2 tablets of 250mg tds and Group B (n 10) Dhatri Lauha Vati 1 tablet of 250mg tds. Dhatri Lauha Vati was selected for the present study due to its Pandughna, Prinana, Raktaprasadana properties. AYUSH department has developed a compound formulation Pandughni Vati. As a part of its clinical trials the same drug was selected for present study.
Result:
Group A The result observed in Shwasa (dyspnoea) (60%) and Hridrava (palpitation) (53.33%) were highly significant statistically (<0.001). Daurbalya (33.33%), Shrama (fatigue) (40%), Aruchi (anorexia) (28.57%) and Pindikodvestana (55.55%) were decreased significant statistically (<0.05) whereas in Panduta (pallor) (24%) it was not significant. In Group B, results observed were highly significant statistically (<0.001) in Panduta (pallor) (50%) and Shwasa (dyspnoea) (56.25%). The results in Shrama (fatigue) (61.54%), Hridrava (palpitation) (55.55%), Aruchi (anorexia) (42.85%), Pindikodvestan, (49.49%) were significant
Conclusion:
On comparing the effect of therapy study was finding better percentage improvement in-group B consistently in most of subjective and objective parameters. So it can be said that Dhatri Lauha Vati has somewhatbetter results, proving it better to Pandughni Vati.
PMCID: PMC3800949
6.  The hypolipidemic activity of Ayurvedic medicine, Arogyavardhini vati in Triton WR-1339-induced hyperlipidemic rats: A comparison with fenofibrate 
Background:
Hyperlipidemia is a major risk factor of coronary heart disease. Currently available hypolipidemic drugs have been associated with number of side effects. Arogyavardhini vati, an Ayurvedic polyherbal formulation has been used for liver disorders. Therefore, present study was designed to evaluate the effect of Arogyavardhini vati in Triton WR-1339-induced hyperlipidemia in rats.
Objectives:
Anti-hyperlipidemic activity evaluation of Arogyavardhini vati against Triton WR-1339-induced hyperlipidemia in rats.
Materials and Methods:
Overnight fasted male Wistar rats (150-200 g) were randomly divided into normal control group [4% Dimethyl Sulfoxide (DMSO), i.p.], positive control group (Triton WR-1339 in 4% DMSO, 400 mg/kg, i.p.), standard drug treated (fenofibrate 65 mg/kg, p.o. for 7 days after inducing hyperlipidemia) and Arogyavardhini vati treated (50, 100, 200 mg/kg, p.o. for 7 days after inducing hyperlipidemia). Rat doses were calculated by extrapolating the equivalent human dose (therapeutic dose, sub-maximum, and maximum dose). Serum total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein HDL, liver malondialdehyde (MDA), and glutathione (GSH) levels were estimated at end of experiments.
Results:
Arogyavardhini vati significantly decreased serum cholesterol, triglyceride, LDL, and C-reactive protein (CRP) and significantly increased serum HDL in a dose-dependent manner. Decreased MDA and increased GSH levels in liver were observed at all doses of Arogyavardhini vati (50, 100, 200 mg/kg) and fenofibrate-treated groups when compared with Triton-treated group. Atherogenic Index (AI) level was significantly decreased in fenofibrate and Arogyavardhini vati (200 mg/kg) treated rats when compared with normal control.
Conclusion:
Arogyavardhini vati, a traditionally used Ayurvedic medicine may be a useful therapy for hypercholesterolemia through reducing oxidative stress (decreasing MDA and increasing GSH) and lipid levels.
doi:10.4103/0975-9476.118707
PMCID: PMC3821191  PMID: 24250146
Arogyavardhini vati; atherogenic index; hypolipidemia; oxidative stress; Triton WR-1339
7.  A clinical comparative study of the management of chronic renal failure with Punarnavadi compound 
Ayu  2010;31(2):185-192.
India like any other country is facing a silent epidemic of chronic renal failure (CRF)- a facet of the health transition associated with industrialization partly fuelled by increase in sedentary lifestyle, low birth weight and malnutrition. Increasing figures by many folds seen is posing a difficult situation to overcome with respect to economy and health of the working and earning population of the nation. There is an urgent need to explore, highlight new interventions and modify modifiable risk factors as a basis for treatment strategies to prevent the development and progression of CRF. The present study was taken up to evaluate the role of trial formulation tab. Punarnavadi compound in the management of chronic renal failure. This was an open clinical comparative study in controlled circumstances wherein 67 patients were studied for two months in three groups- Group A (allopathic control), Group B (ayurvedic control) and Group C (ayurvedic test). It was a multi-centric study; patients were registered from Anandababa charitable dialysis centre, Jamnagar, Kayachikitsa O.P.D. of I.P.G.T. and R.A. Jamnagar and P. D. Patel Ayurveda hospital, Nadiad. Results were assessed on 15 parameters using Students (paired) ‘t’ test. Group A patients showed comparatively better results in eight parameters- weight, platelet count, serum urea, serum uric acid, serum sodium, potassium, chloride and total proteins. Parameter Hemoglobin% showed better results in Group B patients and in Group C patients comparatively better results in six parameters viz.- quality of life (breathlessness, weakness, general functional capacity), total count, serum creatinine and serum calcium - were observed. Throughout the study, trial drug tab. Punarnavadi compound did not show any adverse drug reaction. The results of this study will help in developing a cheap and safe treatment for the management of CRF.
doi:10.4103/0974-8520.72388
PMCID: PMC3215362  PMID: 22131708
Chronic kidney disease; chronic renal failure; Punarnavadi compound; ayurvedic management.
8.  Effect of Ayurvedic management in 130 patients of diabetic nephropathy 
Ayu  2011;32(1):55-58.
Diabetic nephropathy is a specific form of renal disease. It is a major cause of renal insufficiency and ultimately of death. The present study has been carried out to prove the efficacy of Ayurvedic drugs in the management of diabetic nephropathy, which can be helpful in reducing the need of dialysis and avoiding or delaying renal transplantation. A total of 130 patients of this disease were treated in IPD (Group A) and OPD (Group B). Ayurvedic formulations including Gokshuradi Guggulu, Bhumyamalaki, Vasa and Shilajatvadi Vati were given to all the patients for 2 months. Group A patients were given special planned food. Results were analyzed statistically using “t” test. In group A patients, highly significant reduction was found in the values of serum creatinine, blood urea and urinary excretion of albumin. Marked improvement was found in the patients’ general physical well-being, together with reduction in symptoms, in group A patients. This shows the importance of Pathyapathya in Ayurvedic management of the disease. This management may bring some new hope to the patients of diabetic nephropathy, which usually terminates to chronic renal failure and ultimately to death. Further studies are being carried out in this regard.
doi:10.4103/0974-8520.85727
PMCID: PMC3215418  PMID: 22131758
Ayurveda; diabetic nephropathy; albuminuria
9.  PA01.52. Clinical observation of Dietary Influence in patients of pre-diabetes 
Ancient Science of Life  2012;32(Suppl 1):S102.
Introduction:
Pre-diabetes is also known as early stage of Type 2 DM and it occupying greater significant importance in recent years by scientific community. Pre-diabetics are more prone to develop Type 2 Diabetes mellitus and its related macro & micro vascular complications. Its progression to Type 2 DM is approximately 25% over 3 to 5 years. Apathyanimittaja Prameha of Ayurveda is very near to contemporary concepts of Pre-diabetes/Type 2 Diabetes mellitus. The management of Pre-diabetes is still evolving in conventional system of medicine. In Ayurveda dietary factors are considered as an important component of genesis and management of diseases. It is quite true in case of Pre-diabetes. Based on the above hypothesis, it is decided to evaluate the efficacy of avoidance of certain dietary measures in a series of patients of Pre-diabetes. Aims and objectives: To study the hypoglycemic effect of avoidance of certain dietary measures on subjective & objectives parameters of Prediabetes.
Method:
After thorough interrogation and laboratory investigation 40 cases of Pre-diabetics were selected from OPD and IPD of Kayachikitsa, S. S. H, IMS, BHU, on a well-set proforma. The selected patients were recruited randomly into two group viz. (A) control group and (B) Avoidance of dietary measures for a period of 1 ½ years with three months of follow ups at 6 months interval.
Discussion:
This study reveals that patients of Group B not only have encouraging results in terms of metabolic correction but also seems to cut off its progression to Type 2 DM. The Group B patients have showed better percentage of fall in FBS level (19.58%), in comparison to PPBS (15.12%). The overall response was better in-group B, while Group A patients were more prone to develop Type 2 DM in near future.
Conclusion:
The leads available from this work open new Ayurveda inspired holistic approach to the management of Pre-diabetes & prevention of Diabetes Mellitus. Besides, it also has potential to improve immune status & metabolic correction in Young Pre-diabetics.
PMCID: PMC3800855
10.  Serodiagnosis of Mice Minute Virus and Mouse Parvovirus Infections in Mice by Enzyme-Linked Immunosorbent Assay with Baculovirus-Expressed Recombinant VP2 Proteins 
Mice minute virus (MMV) and mouse parvovirus (MPV) type 1 are the two parvoviruses known to naturally infect laboratory mice and are among the most prevalent infectious agents found in contemporary laboratory mouse colonies. Serologic assays are commonly used to diagnose MMV and MPV infections in laboratory mice; however, highly accurate, high-throughput serologic assays for the detection of MMV- and MPV-infected mice are needed. To this end, the major capsid viral protein (VP2) genes of MMV and MPV were cloned and MMV recombinant VP2 (rVP2) and MPV rVP2 proteins were expressed by using a baculovirus system. MMV rVP2 and MPV rVP2 spontaneously formed virus-like particles that were morphologically similar to empty parvovirus capsids. These proteins were used as antigens in enzyme-linked immunosorbent assays (ELISAs) to detect anti-MMV or anti-MPV antibodies in the sera of infected mice. Sera from mice experimentally infected with MMV (n = 43) or MPV (n = 35) and sera from uninfected mice (n = 30) were used to evaluate the ELISAs. The MMV ELISA was 100% sensitive and 100% specific in detecting MMV-infected mice, and the MPV ELISA was 100% sensitive and 98.6% specific in detecting MPV-infected mice. Both assays outperformed a parvovirus ELISA that uses a recombinant nonstructural protein (NS1) of MMV as antigen. The MMV rVP2 and MPV rVP2 proteins provide a ready source of easily produced antigen, and the ELISAs developed provide highly accurate, high-throughput assays for the serodiagnosis of MMV and MPV infections in laboratory mice.
doi:10.1128/CDLI.9.5.1025-1031.2002
PMCID: PMC120062  PMID: 12204954
11.  A practical approach for implementation of a basal-prandial insulin therapy regimen in patients with type 2 diabetes 
Basal-prandial insulin therapy is a physiologic approach to insulin delivery that utilizes multiple daily injections to cover both basal (ie, overnight fasting and between-meal) and prandial (ie, glucose excursions above basal at mealtime) insulin needs. While basal-prandial therapy with multiple daily injections is an important therapeutic option for patients with type 2 diabetes, there is a common perception that this therapy is difficult to initiate in the primary care setting. To address this issue, a panel of clinical experts convened to develop practical recommendations on how to initiate basal-prandial therapy in patients with type 2 diabetes, focusing on patient selection, simple dosing and titration, and monitoring. Patients with type 2 diabetes who are appropriate candidates for basal-prandial insulin therapy include those who: 1) are unable to achieve glycemic control on oral antidiabetic drugs, 2) are unable to achieve glycemic control on split-mixed/premixed insulin regimens, 3) are newly diagnosed but unlikely to respond to oral antidiabetic drugs alone (ie, the patient has severe hyperglycemia or a markedly elevated glycosylated hemoglobin A1C level for which oral antidiabetic drug therapy alone is unlikely to achieve goals), and 4) prefer this therapy due to socioeconomic or other individual considerations. Basal-prandial insulin can be initiated in a simple stepwise manner, starting first with the addition of basal insulin to the existing oral antidiabetic drug regimen, followed by the introduction of 1 prandial insulin injection to the basal insulin plus oral antidiabetic drug regimen (after basal insulin has been optimized). Subsequently, other injections of prandial insulin may be added when needed. Based on home glucose monitoring data, patients may be converted from split-mixed or premixed insulin regimens to basal-prandial regimens with similar ease. Basal-prandial therapy using newer insulin formulations, such as long- and rapid-acting insulin analogs, can be relatively simple to use in patients with type 2 diabetes and is an appropriate methodology for application by primary care clinicians.
doi:10.1186/1750-4732-1-9
PMCID: PMC1885266  PMID: 17448241
12.  Clinical evaluation of the efficacy of Dashanga Kwatha Ghana Vati in the management of Urdhwaga Amlapitta (Non-ulcer dyspepsia) 
Ayu  2012;33(2):219-223.
A study has been designed to evaluate the effectiveness of Dashanga Kwatha Ghana Vati in Urdhwaga Amlapitta (non-ulcer Dyspepsia). Randomized single blind, placebo controlled study was conducted in 138 patients attending O.P.D. of department of Basic Principles, I.P.G.T. and R.A., Gujarat Ayurved University, Jamnagar, and grouped into two. Both the groups consumed two tablets of either Dashanga Kwatha Ghana Vati or placebo, twice daily after food for a period of eight weeks. The patients were followed upto four weeks, 110 patients had completed the treatment and no adverse effects were reported during the treatment. Both groups had improved in the clinical symptoms and overall statistical significance was observed in the differences of scores between the two groups.
doi:10.4103/0974-8520.105241
PMCID: PMC3611627  PMID: 23559793
Dashanga Kwatha Ghana Vati; non-ulcer dyspepsia; Urdhwaga Amlapitta
13.  Rank Awareness in Group-Sparse Recovery of Multi-Echo MR Images 
Sensors (Basel, Switzerland)  2013;13(3):3902-3921.
This work addresses the problem of recovering multi-echo T1 or T2 weighted images from their partial K-space scans. Recent studies have shown that the best results are obtained when all the multi-echo images are reconstructed by simultaneously exploiting their intra-image spatial redundancy and inter-echo correlation. The aforesaid studies either stack the vectorised images (formed by row or columns concatenation) as columns of a Multiple Measurement Vector (MMV) matrix or concatenate them as a long vector. Owing to the inter-image correlation, the thus formed MMV matrix or the long concatenated vector is row-sparse or group-sparse respectively in a transform domain (wavelets). Consequently the reconstruction problem was formulated as a row-sparse MMV recovery or a group-sparse vector recovery. In this work we show that when the multi-echo images are arranged in the MMV form, the thus formed matrix is low-rank. We show that better reconstruction accuracy can be obtained when the information about rank-deficiency is incorporated into the row/group sparse recovery problem. Mathematically, this leads to a constrained optimization problem where the objective function promotes the signal's groups-sparsity as well as its rank-deficiency; the objective function is minimized subject to data fidelity constraints. The experiments were carried out on ex vivo and in vivo T2 weighted images of a rat's spinal cord. Results show that this method yields considerably superior results than state-of-the-art reconstruction techniques.
doi:10.3390/s130303902
PMCID: PMC3658782  PMID: 23519348
MRI reconstruction; compressed sensing; low-rank matrix recovery
14.  PA01.06. Clinico comparative study of shodhan purvak shaman & shaman chikitsa in management of aamvata 
Ancient Science of Life  2012;32(Suppl 1):S55.
Purpose:
To compare the effect of shodhan purvak shaman & shaman chikitsa in management of aamvata.
Method:
Above study was planned in two parts conceptual & clinical For clinical part 40 patients having disease aamvata were randomly selected from opd & ipd & were divided in two groups. In shodhan purvak shaman group shodhan basti & shaman vati were given. Which was selected from classic text of ayurveda. In Shaman group only shaman yog vati was administered to the patients. Total duration of treatment in both groups was of 8 weeks.
Result:
Shodhan purvak shaman therapy has given complete remission in 6 patients, major improvement was found in 9 patients, 4 patients in minor improvement category and one in un improved category. In shaman therapy complete relief was found in 3 patients, major improvement in 12 patients, in minor improved category there were 5 patients no patient was found in unimproved category.
Conclusion:
The results thus obtained were subjected to analytical statistical techniques to compare both modes of treatments. Critical assessment of total effect of therapies on individual patient reflects that shodhan therapy along with shaman vati was more effective in pacifying the symptoms of disease aamvata & bringing down the level of disease activity also as compared to shaman therapy alone. Mode of action of drug is discussed. No side effects were seen.
PMCID: PMC3800935
15.  Hemoglobin A1c Levels and Risk of Severe Hypoglycemia in Children and Young Adults with Type 1 Diabetes from Germany and Austria: A Trend Analysis in a Cohort of 37,539 Patients between 1995 and 2012 
PLoS Medicine  2014;11(10):e1001742.
In a cohort study, Beate Karges and colleagues find that the association between low hemoglobin A1C and severe hypoglycemia in children and young adults with type 1 diabetes has decreased over the period between 1995 and 2012.
Please see later in the article for the Editors' Summary
Background
Severe hypoglycemia is a major complication of insulin treatment in patients with type 1 diabetes, limiting full realization of glycemic control. It has been shown in the past that low levels of hemoglobin A1c (HbA1c), a marker of average plasma glucose, predict a high risk of severe hypoglycemia, but it is uncertain whether this association still exists. Based on advances in diabetes technology and pharmacotherapy, we hypothesized that the inverse association between severe hypoglycemia and HbA1c has decreased in recent years.
Methods and Findings
We analyzed data of 37,539 patients with type 1 diabetes (mean age ± standard deviation 14.4±3.8 y, range 1–20 y) from the DPV (Diabetes Patienten Verlaufsdokumentation) Initiative diabetes cohort prospectively documented between January 1, 1995, and December 31, 2012. The DPV cohort covers an estimated proportion of >80% of all pediatric diabetes patients in Germany and Austria. Associations of severe hypoglycemia, hypoglycemic coma, and HbA1c levels were assessed by multivariable regression analysis. From 1995 to 2012, the relative risk (RR) for severe hypoglycemia and coma per 1% HbA1c decrease declined from 1.28 (95% CI 1.19–1.37) to 1.05 (1.00–1.09) and from 1.39 (1.23–1.56) to 1.01 (0.93–1.10), respectively, corresponding to a risk reduction of 1.2% (95% CI 0.6–1.7, p<0.001) and 1.9% (0.8–2.9, p<0.001) each year, respectively. Risk reduction of severe hypoglycemia and coma was strongest in patients with HbA1c levels of 6.0%–6.9% (RR 0.96 and 0.90 each year) and 7.0%–7.9% (RR 0.96 and 0.89 each year). From 1995 to 2012, glucose monitoring frequency and the use of insulin analogs and insulin pumps increased (p<0.001). Our study was not designed to investigate the effects of different treatment modalities on hypoglycemia risk. Limitations are that associations between diabetes education and physical activity and severe hypoglycemia were not addressed in this study.
Conclusions
The previously strong association of low HbA1c with severe hypoglycemia and coma in young individuals with type 1 diabetes has substantially decreased in the last decade, allowing achievement of near-normal glycemic control in these patients.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Worldwide, more than 380 million people have diabetes, a chronic disorder characterized by high levels of glucose (sugar) in the blood. Blood sugar levels are usually controlled by insulin, a hormone produced by the pancreas. In people with diabetes, blood sugar control fails because they make no insulin (type 1 diabetes) or because the cells that normally respond to insulin by removing sugar from the blood have become insulin-resistant (type 2 diabetes). Type 1 diabetes, which tends to develop in childhood or early adulthood, is responsible for about 10% of cases of diabetes in adults and is treated with injections of insulin. Type 2 diabetes can usually be treated with diet, exercise, and antidiabetic drugs. With both types of diabetes, it is important to keep blood sugar levels within the normal range (good glycemic control) to reduce the long-term complications of diabetes, which include kidney failure, blindness, and an increased risk of cardiovascular disease.
Why Was This Study Done?
Patients with type 1 diabetes can achieve strict glycemic control using intensive insulin therapy, but such treatment is associated with a risk of severe or fatal hypoglycemia (low blood sugar). Past studies have found an association between low levels of hemoglobin A1c (HbA1c, a marker of average blood sugar levels over the past 2–3 months; a low HbA1c percentage indicates good glycemic control) and a high risk of severe hypoglycemia. Because of this inverse association, people at risk of severe hypoglycemia are advised to aim for an HbA1c of 7.5% or less, which puts them at risk of diabetic complications (most adults with diabetes aim for an HbA1c of 6.5% or less; people without diabetes have Hb1Ac readings below 6.05%). With recent improvements in insulin therapy, it is not clear whether the inverse association between the incidence of severe hypoglycemia and HbA1c levels still exists. In this trend analysis, the researchers investigate the association over time between HbA1C levels and the risk of severe hypoglycemia in a large cohort (group) of Austrian and German children and young adults with type 1 diabetes.
What Did the Researchers Do and Find?
The researchers analyzed data on Hb1Ac levels and on incidents of severe hypoglycemia and hypoglycemic coma collected from 37,539 children and young adults with type 1 diabetes between 1995 and 2012 by the DPV (Diabetes Patienten Verlaufsdokumentation) Initiative for diabetes care. The DPV cohort includes around 80% of all children and young adults with type 1 diabetes in Germany and Austria. Over the study period, the use of insulin analogs (compounds related to insulin that keep blood sugar levels steadier than regular insulin injections) and of insulin pumps (which deliver constant amounts of short-acting insulin analogs to the body) increased, and there was an increase in how often patients monitored their blood sugar level. Notably, between 1995 and 2012, the relative risk for severe hypoglycemia per 1% decrease in Hb1Ac declined from 1.28 to 1.05, and the relative risk for hypoglycemic coma per 1% decrease in Hb1Ac declined from 1.39 to 1.01. That is, the strength of the inverse association between severe hypoglycemia or coma and HbA1c decreased during the study period. Expressed another way, between 1995 and 2012, the relative risk for severe hypoglycemia and coma per 1% HbA1c decrease dropped by 1.2% and 1.9%, respectively, each year.
What Do These Findings Mean?
These findings reveal a substantial decrease since 1995 in the previously strong inverse association between low HbA1c levels and severe hypoglycemia and hypoglycemic coma in this cohort of young Germans and Austrians with type 1 diabetes. This decrease mainly occurred because of substantial reductions in the risk of hypoglycemia in patients with HbA1c levels between 6.0% and 7.9%, but the study provides no information about the drivers of this reduction. Moreover, these findings may apply only to young type 1 diabetes patients of European descent, and their accuracy may be limited by other aspects of the study design. However, by showing that HbA1c has become a minor predictor for severe hypoglycemia in this group of patients, these findings suggest that strict glycemic control in young patients with type 1 diabetes has become safer in recent years. Thus, it should now be possible to reduce the risk of long-term diabetic complications in such patients through achievement of near-normal glycemic control without increasing patients' risk of severe hypoglycemia.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001742.
The US National Diabetes Information Clearinghouse provides information about diabetes for patients, health care professionals, and the general public (in English and Spanish), including information on the HbA1c test and a description of a trial that compared the effects of intensive versus conventional treatment of blood glucose levels on the development of diabetic complications in patients with type 1 diabetes
The UK National Health Service Choices website provides information for patients and carers about type 1 diabetes, including a video that describes parents' experiences caring for a child with type 1 diabetes, and information about treating type 1 diabetes that includes a short video about HbA1c
The charity Diabetes UK provides detailed information about type 1 diabetes for patients and carers
The UK-based non-profit organization Healthtalkonline provides information about type 1 diabetes and young people, including interviews with young people about their experiences of the condition
MedlinePlus provides links to further resources and advice about type 1 diabetes (in English and Spanish)
Information about the DPV Initiative is available (mainly in German)
doi:10.1371/journal.pmed.1001742
PMCID: PMC4188517  PMID: 25289645
16.  Gene-Lifestyle Interaction and Type 2 Diabetes: The EPIC InterAct Case-Cohort Study 
PLoS Medicine  2014;11(5):e1001647.
In this study, Wareham and colleagues quantified the combined effects of genetic and lifestyle factors on risk of T2D in order to inform strategies for prevention. The authors found that the relative effect of a type 2 diabetes genetic risk score is greater in younger and leaner participants, and the high absolute risk associated with obesity at any level of genetic risk highlights the importance of universal rather than targeted approaches to lifestyle intervention.
Please see later in the article for the Editors' Summary
Background
Understanding of the genetic basis of type 2 diabetes (T2D) has progressed rapidly, but the interactions between common genetic variants and lifestyle risk factors have not been systematically investigated in studies with adequate statistical power. Therefore, we aimed to quantify the combined effects of genetic and lifestyle factors on risk of T2D in order to inform strategies for prevention.
Methods and Findings
The InterAct study includes 12,403 incident T2D cases and a representative sub-cohort of 16,154 individuals from a cohort of 340,234 European participants with 3.99 million person-years of follow-up. We studied the combined effects of an additive genetic T2D risk score and modifiable and non-modifiable risk factors using Prentice-weighted Cox regression and random effects meta-analysis methods. The effect of the genetic score was significantly greater in younger individuals (p for interaction  = 1.20×10−4). Relative genetic risk (per standard deviation [4.4 risk alleles]) was also larger in participants who were leaner, both in terms of body mass index (p for interaction  = 1.50×10−3) and waist circumference (p for interaction  = 7.49×10−9). Examination of absolute risks by strata showed the importance of obesity for T2D risk. The 10-y cumulative incidence of T2D rose from 0.25% to 0.89% across extreme quartiles of the genetic score in normal weight individuals, compared to 4.22% to 7.99% in obese individuals. We detected no significant interactions between the genetic score and sex, diabetes family history, physical activity, or dietary habits assessed by a Mediterranean diet score.
Conclusions
The relative effect of a T2D genetic risk score is greater in younger and leaner participants. However, this sub-group is at low absolute risk and would not be a logical target for preventive interventions. The high absolute risk associated with obesity at any level of genetic risk highlights the importance of universal rather than targeted approaches to lifestyle intervention.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Worldwide, more than 380 million people currently have diabetes, and the condition is becoming increasingly common. Diabetes is characterized by high levels of glucose (sugar) in the blood. Blood sugar levels are usually controlled by insulin, a hormone released by the pancreas after meals (digestion of food produces glucose). In people with type 2 diabetes (the commonest type of diabetes), blood sugar control fails because the fat and muscle cells that normally respond to insulin by removing excess sugar from the blood become less responsive to insulin. Type 2 diabetes can often initially be controlled with diet and exercise (lifestyle changes) and with antidiabetic drugs such as metformin and sulfonylureas, but patients may eventually need insulin injections to control their blood sugar levels. Long-term complications of diabetes, which include an increased risk of heart disease and stroke, reduce the life expectancy of people with diabetes by about ten years compared to people without diabetes.
Why Was This Study Done?
Type 2 diabetes is thought to originate from the interplay between genetic and lifestyle factors. But although rapid progress is being made in understanding the genetic basis of type 2 diabetes, it is not known whether the consequences of adverse lifestyles (for example, being overweight and/or physically inactive) differ according to an individual's underlying genetic risk of diabetes. It is important to investigate this question to inform strategies for prevention. If, for example, obese individuals with a high level of genetic risk have a higher risk of developing diabetes than obese individuals with a low level of genetic risk, then preventative strategies that target lifestyle interventions to obese individuals with a high genetic risk would be more effective than strategies that target all obese individuals. In this case-cohort study, researchers from the InterAct consortium quantify the combined effects of genetic and lifestyle factors on the risk of type 2 diabetes. A case-cohort study measures exposure to potential risk factors in a group (cohort) of people and compares the occurrence of these risk factors in people who later develop the disease with those who remain disease free.
What Did the Researchers Do and Find?
The InterAct study involves 12,403 middle-aged individuals who developed type 2 diabetes after enrollment (incident cases) into the European Prospective Investigation into Cancer and Nutrition (EPIC) and a sub-cohort of 16,154 EPIC participants. The researchers calculated a genetic type 2 diabetes risk score for most of these individuals by determining which of 49 gene variants associated with type 2 diabetes each person carried, and collected baseline information about exposure to lifestyle risk factors for type 2 diabetes. They then used various statistical approaches to examine the combined effects of the genetic risk score and lifestyle factors on diabetes development. The effect of the genetic score was greater in younger individuals than in older individuals and greater in leaner participants than in participants with larger amounts of body fat. The absolute risk of type 2 diabetes, expressed as the ten-year cumulative incidence of type 2 diabetes (the percentage of participants who developed diabetes over a ten-year period) increased with increasing genetic score in normal weight individuals from 0.25% in people with the lowest genetic risk scores to 0.89% in those with the highest scores; in obese people, the ten-year cumulative incidence rose from 4.22% to 7.99% with increasing genetic risk score.
What Do These Findings Mean?
These findings show that in this middle-aged cohort, the relative association with type 2 diabetes of a genetic risk score comprised of a large number of gene variants is greatest in individuals who are younger and leaner at baseline. This finding may in part reflect the methods used to originally identify gene variants associated with type 2 diabetes, and future investigations that include other genetic variants, other lifestyle factors, and individuals living in other settings should be undertaken to confirm this finding. Importantly, however, this study shows that young, lean individuals with a high genetic risk score have a low absolute risk of developing type 2 diabetes. Thus, this sub-group of individuals is not a logical target for preventative interventions. Rather, suggest the researchers, the high absolute risk of type 2 diabetes associated with obesity at any level of genetic risk highlights the importance of universal rather than targeted approaches to lifestyle intervention.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001647.
The US National Diabetes Information Clearinghouse provides information about diabetes for patients, health-care professionals and the general public, including detailed information on diabetes prevention (in English and Spanish)
The UK National Health Service Choices website provides information for patients and carers about type 2 diabetes and about living with diabetes; it also provides people's stories about diabetes
The charity Diabetes UK provides detailed information for patients and carers in several languages, including information on healthy lifestyles for people with diabetes
The UK-based non-profit organization Healthtalkonline has interviews with people about their experiences of diabetes
The Genetic Landscape of Diabetes is published by the US National Center for Biotechnology Information
More information on the InterAct study is available
MedlinePlus provides links to further resources and advice about diabetes and diabetes prevention (in English and Spanish)
doi:10.1371/journal.pmed.1001647
PMCID: PMC4028183  PMID: 24845081
17.  Effect of Boswellia serrata supplementation on blood lipid, hepatic enzymes and fructosamine levels in type2 diabetic patients 
Background
Type 2 diabetes is an endocrine disorder that affects a large percentage of patients. High blood glucose causes fatty deposits in the liver which is likely to increase in SGOT and SGPT activities. Significant increase in SGOT/SGPT and low HDL levels is observed in patients with diabetes. Serum fructosamine concentration reflects the degree of blood glucose control in diabetic patients. This study was aimed to investigate the antidiabetic, hypolipidemic and hepatoprotective effects of supplementation of Boswellia serrata in type2 diabetic patients.
Methods
60 type 2 diabetic patients from both sexes (30 males and 30 females) were dedicated to the control and intervention groups (30 subjects per group). Boswellia serrata gum resin in amount of 900 mg daily for 6 weeks were orally administered (as three 300 mg doses) in intervention group and the control group did not receive anything. Blood samples were taken at the beginning of the study and after 6 weeks. Blood levels of fructosamine, lipid profiles as well as hepatic enzyme in type 2 diabetic patients were measured.
Results
Treatment of diabetic patient with Boswellia serrata was caused to significant increase in blood HDL levels as well as a remarkable decrease in cholesterol, LDL, fructosamine (p < 0.05) SGPT and SGOT levels after 6 weeks (p < 0.01). In spite of reduction of serum triglyceride, VLDL levels in intervention group, we did not detect a significant difference after 6 weeks.
Conclusion
This study showed that Boswellia serrata supplementation can be beneficial in controlling blood parameters in patients with type 2 diabetes. Therefore, its use can be useful in patients with medicines.
doi:10.1186/2251-6581-13-29
PMCID: PMC3929136  PMID: 24495344
Boswellia serrata; Fructosamine; Lipid profiles; Diabetes
18.  Standardization of a Traditional Polyherbo-Mineral Formulation-Brahmi Vati 
The present study deals with standardization of an in-house standard preparation and three marketed samples of Brahmi vati, which is a traditional medicine known to be effective in mental disorders, convulsions, weak memory, high fever and hysteria. Preparation and standardization have been done by following modern scientific quality control procedures for raw material and the finished products. The scanning electron microscopic (SEM) analysis showed the reduction of metals and minerals (particle size range 2–5 µm) which indicates the proper preparation of bhasmas, the important ingredient of Brahmi vati. Findings of EDX analysis of all samples of Brahmi vati suggested the absence of Gold, an important constituent of Brahmi vati in two marketed samples. All the samples of Brahmi vati were subjected to quantitative estimation of Bacoside A (marker compound) by HPTLC technique. Extraction of the samples was done in methanol and the chromatograms were developed in Butanol: Glacial acetic acid: water (4.5:0.5:5 v/v) and detected at 225nm. The regression analysis of calibration plots of Bacoside A exhibited linear relationship in the concentration range of 50–300 ng, while the % recovery was found to be 96.06% w/w, thus proving the accuracy and precision of the analysis. The Bacoside A content in the in-house preparation was found to be higher than that of the commercial samples. The proposed HPTLC method was found to be rapid, simple and accurate for quantitative estimation of Bacoside A in different formulations. The results of this study could be used as a model data in the standardization of Brahmi vati.
PMCID: PMC3777576  PMID: 24146464
Brahmi vati(BV); Standardization; EDX; HPTLC; Bacoside-A
19.  Hypolipidemic Activities of Ficus Racemosa Linn. Bark in Alloxan Induced Diabetic Rats 
Ficus racemosa (Moraceae family) is used in traditional system of medicine for the treatment of several disorders including diabetes mellitus. The aim of the study was to investigate the antihyperglycemic and hypolipidemic activities of ethanolic extract of Ficus racemosa bark (FrEBet) in alloxan-induced diabetic rats. A total number of 30 animals were divided into 5 groups of six each. Diabetes mellitus was induced by single intraperitoneal injection of freshly prepared solution of alloxan monohydrate (150 mg/kg bw) dissolved in physiological saline in overnight fasted wistar rats. Dose dependent studies for FrEBet (100–500mg/kg bw) was carried out to find out the effective pharmacological dose (antidiabetic and hypolipidemic) to alloxan-induced diabetic rats. Blood glucose, plasma insulin, total cholesterol, phospholipids, triglycerides, free fatty acids, HDL cholesterol and LDL cholesterol levels in plasma, erythrocyte membranes, liver and kidney were determined by specific colorimetric methods. An increase in blood glucose was accompanied by an increase in total cholesterol, phospholipids, triglycerides, FFA and decrease in HDL choleterol in diabetic rats. Oral administration of FrEBet (300mg/kg bw) to diabetic rats restrored the status of blood glucose, lipids and lipoproteins to near normal range. Our investigation thus shows that FrEBet has potent antidiabetic and hypolipidemic effects in alloxan-induced diabetic rats and these effects were much comparable to that of the standard reference drug, glibenclamide.
PMCID: PMC2816482  PMID: 20161890
Diabetes mellitus; Alloxan; Lipids; Lipoproteins
20.  Muscle-Strengthening and Conditioning Activities and Risk of Type 2 Diabetes: A Prospective Study in Two Cohorts of US Women 
PLoS Medicine  2014;11(1):e1001587.
Anders Grøntved and colleagues examined whether women who perform muscle-strengthening and conditioning activities have an associated reduced risk of type 2 diabetes mellitus.
Please see later in the article for the Editors' Summary
Background
It is well established that aerobic physical activity can lower the risk of type 2 diabetes (T2D), but whether muscle-strengthening activities are beneficial for the prevention of T2D is unclear. This study examined the association of muscle-strengthening activities with the risk of T2D in women.
Methods and Findings
We prospectively followed up 99,316 middle-aged and older women for 8 years from the Nurses' Health Study ([NHS] aged 53–81 years, 2000–2008) and Nurses' Health Study II ([NHSII] aged 36–55 years, 2001–2009), who were free of diabetes, cancer, and cardiovascular diseases at baseline. Participants reported weekly time spent on resistance exercise, lower intensity muscular conditioning exercises (yoga, stretching, toning), and aerobic moderate and vigorous physical activity (MVPA) at baseline and in 2004/2005. Cox regression with adjustment for major determinants for T2D was carried out to examine the influence of these types of activities on T2D risk. During 705,869 person years of follow-up, 3,491 incident T2D cases were documented. In multivariable adjusted models including aerobic MVPA, the pooled relative risk (RR) for T2D for women performing 1–29, 30–59, 60–150, and >150 min/week of total muscle-strengthening and conditioning activities was 0.83, 0.93, 0.75, and 0.60 compared to women reporting no muscle-strengthening and conditioning activities (p<0.001 for trend). Furthermore, resistance exercise and lower intensity muscular conditioning exercises were each independently associated with lower risk of T2D in pooled analyses. Women who engaged in at least 150 min/week of aerobic MVPA and at least 60 min/week of muscle-strengthening activities had substantial risk reduction compared with inactive women (pooled RR = 0.33 [95% CI 0.29–0.38]). Limitations to the study include that muscle-strengthening and conditioning activity and other types of physical activity were assessed by a self-administered questionnaire and that the study population consisted of registered nurses with mostly European ancestry.
Conclusions
Our study suggests that engagement in muscle-strengthening and conditioning activities (resistance exercise, yoga, stretching, toning) is associated with a lower risk of T2D. Engagement in both aerobic MVPA and muscle-strengthening type activity is associated with a substantial reduction in the risk of T2D in middle-aged and older women.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Worldwide, more than 370 million people have diabetes mellitus, a disorder characterized by poor glycemic control—dangerously high amounts of glucose (sugar) in the blood. Blood sugar levels are normally controlled by insulin, a hormone released by the pancreas. In people with type 2 diabetes (the commonest form of diabetes), blood sugar control fails because the fat and muscle cells that normally respond to insulin by removing excess sugar from the blood become less responsive to insulin. Type 2 diabetes, which was previously known as adult-onset diabetes, can often initially be controlled with diet and exercise, and with antidiabetic drugs such as metformin and sulfonylureas. However, as the disease progresses, the pancreatic beta cells, which make insulin, become impaired and patients may eventually need insulin injections. Long-term complications of diabetes, which include an increased risk of cardiovascular problems such as heart disease and stroke, reduce the life expectancy of people with diabetes by about 10 years compared to people without diabetes.
Why Was This Study Done?
Type 2 diabetes is becoming increasingly common worldwide so better preventative strategies are essential. It is well-established that regular aerobic exercise—physical activity in which the breathing and heart rate increase noticeably such as jogging, brisk walking, and swimming—lowers the risk of type 2 diabetes. The World Health Organization currently recommends that adults should do at least 150 min/week of moderate-to-vigorous aerobic physical activity to reduce the risk of diabetes and other non-communicable diseases. It also recommends that adults should undertake muscle-strengthening and conditioning activities such as weight training and yoga on two or more days a week. However, although studies have shown that muscle-strengthening activity improves glycemic control in people who already have diabetes, it is unclear whether this form of exercise prevents diabetes. In this prospective cohort study (a study in which disease development is followed up over time in a group of people whose characteristics are recorded at baseline), the researchers investigated the association of muscle-strengthening activities with the risk of type 2 diabetes in women.
What Did the Researchers Do and Find?
The researchers followed up nearly 100,000 women enrolled in the Nurses' Health Study (NHS) and the Nurses' Health Study II (NHSII), two prospective US investigations into risk factors for chronic diseases in women, for 8 years. The women provided information on weekly participation in muscle-strengthening exercise (for example, weight training), lower intensity muscle-conditioning exercises (for example, yoga and toning), and aerobic moderate and vigorous physical activity (aerobic MVPA) at baseline and 4 years later. During the study 3,491 women developed diabetes. After allowing for major risk factors for type 2 diabetes (for example, diet and a family history of diabetes) and for aerobic MVPA, compared to women who did no muscle-strengthening or conditioning exercise, the risk of developing type 2 diabetes among women declined with increasing participation in muscle-strengthening and conditioning activity. Notably, women who did more than 150 min/week of these types of exercise had 40% lower risk of developing diabetes as women who did not exercise in this way at all. Muscle-strengthening and muscle-conditioning exercise were both independently associated with reduced diabetes risk, and women who engaged in at least 150 min/week of aerobic MVPA and at least 60 min/week of muscle-strengthening exercise were a third as likely to develop diabetes as inactive women.
What Do These Findings Mean?
These findings show that, among the women enrolled in NHS and NHSII, engagement in muscle-strengthening and conditioning activities lowered the risk of type 2 diabetes independent of aerobic MVPA. That is, non-aerobic exercise provided protection against diabetes in women who did no aerobic exercise. Importantly, they also show that doing both aerobic exercise and muscle-strengthening exercise substantially reduced the risk of type 2 diabetes. Because nearly all the participants in NHS and NHSII were of European ancestry, these results may not be generalizable to women of other ethnic backgrounds. Moreover, the accuracy of these findings may be limited by the use of self-administered questionnaires to determine how much exercise the women undertook. Nevertheless, these findings support the inclusion of muscle-strengthening and conditioning exercises in strategies designed to prevent type 2 diabetes in women, a conclusion that is consistent with current guidelines for physical activity among adults.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001587.
The US National Diabetes Information Clearinghouse provides information about diabetes for patients, health-care professionals and the general public, including information on diabetes prevention (in English and Spanish)
The UK National Health Service Choices website provides information for patients and carers about type 2 diabetes and explains the benefits of regular physical activity
The World Health Organization provides information about diabetes and about physical activity and health (in several languages); its 2010 Global Recommendations on Physical Activity for Health are available in several languages
The US Centers for Disease Control and Prevention provides information on physical activity for different age groups; its Physical Activity for Everyone web pages include guidelines, instructional videos and personal success stories
More information about the Nurses Health Study and the Nurses Health Study II is available
The UK charity Healthtalkonline has interviews with people about their experiences of diabetes
MedlinePlus provides links to further resources and advice about diabetes and about physical exercise and fitness (in English and Spanish)
doi:10.1371/journal.pmed.1001587
PMCID: PMC3891575  PMID: 24453948
21.  GC-MS analysis and screening of antidiabetic, antioxidant and hypolipidemic potential of Cinnamomum tamala oil in streptozotocin induced diabetes mellitus in rats 
Aim of the study
This study was made to investigate the antidiabetic, antioxidant and hypolipidemic potential of Cinnamomum tamala, (Buch.-Ham.) Nees & Eberm (Tejpat) oil (CTO) in streptozotocin (STZ) induced diabetes in rats along with evaluation of chemical constituents.
Materials and methods
The GC-MS (Gas chromatography–mass spectrometry) analysis of the oil showed 31 constituents of which cinnamaldehyde was found the major component (44.898%). CTO and cinnamaldehyde was orally administered to diabetic rats to study its effect in both acute and chronic antihyperglycemic models. The body weight, oral glucose tolerance test and biochemical parameters viz. glucose level, insulin level, liver glycogen content, glycosylated hemoglobin, total plasma cholesterol, triglyceride and antioxidant parameters were estimated for all treated groups and compared against diabetic control group.
Results
CTO (100 mg/kg and 200 mg/kg), cinnamaldehyde (20 mg/kg) and glibenclamide (0.6 mg/kg) in respective groups of diabetic animals administered for 28 days reduced the blood glucose level in streptozotocin induced diabetic rats. There was significant increase in body weight, liver glycogen content, plasma insulin level and decrease in the blood glucose, glycosylated hemoglobin and total plasma cholesterol in test groups as compared to control group. The results of CTO and cinnamaldehyde were found comparable with standard drug glibenclamide. In vitro antioxidant studies on CTO using various models showed significant antioxidant activity. In vivo antioxidant studies on STZ induced diabetic rats revealed decreased malondialdehyde (MDA) and increased reduced glutathione (GSH).
Conclusion
Thus the investigation results that CTO has significant antidiabetic, antioxidant and hypolipidemic activity.
doi:10.1186/1475-2840-11-95
PMCID: PMC3461457  PMID: 22882757
Cinnamomum tamala; Cinnamaldehyde; Glibenclamide; Hyperglycaemia; Streptozotocin
22.  Ayurvedic treatments for diabetes mellitus 
Background
Patients with diabetes frequently use complimentary and alternative medications including Ayurvedic medications and hence it is important to determine their efficacy and safety.
Objectives
To assess the effects of Ayurvedic treatments for diabetes mellitus.
Search methods
We searched The Cochrane Library (issue 10, 2011), MEDLINE (until 31 August 2011), EMBASE (until 31 August 2011), AMED (until 14 October 2011), the database of randomised trials from South Asia (until 14 October 2011), the database of the grey literature (OpenSigle, until 14 October 2011) and databases of ongoing trials (until 14 October 2011). In addition we performed hand searches of several journals and reference lists of potentially relevant trials.
Selection criteria
We included randomized trials of at least two months duration of Ayurvedic interventions for diabetes mellitus. Participants of both genders, all ages and any type of diabetes were included irrespective of duration of diabetes, antidiabetic treatment, comorbidity or diabetes related complications.
Data collection and analysis
Two authors independently extracted data. Risk of bias of trials was evaluated as indicated in the Cochrane Handbook for Systematic Reviews of Intervention.
Main results
Results of only a limited number of studies could be combined, in view of different types of interventions and variable quality of data. We found six trials of proprietary herbal mixtures and one of whole system Ayurvedic treatment. These studies enrolled 354 participants ( 172 on treatment, 158 on controls, 24 allocation unknown). The treatment duration ranged from 3 to 6 months. All these studies included adults with type 2 diabetes mellitus.
With regard to our primary outcomes, significant reductions in glycosylated haemoglobin A1c (HbA1c), fasting blood sugar (FBS) or both were observed with Diabecon, Inolter and Cogent DB compared to placebo or no additional treatment, while no significant hypoglycaemic response was found with Pancreas tonic and Hyponidd treatment. The study of whole system Ayurvedic treatment did not provide data on HbA1c and FBS values. One study of Pancreas tonic treatment did not detect a significant change in health-related quality of life. The main adverse effects reported were drug hypersensitivity (one study, one patient in the treatment arm); hypoglycaemic episodes (one study, one participant in the treatment arm; none had severe hypoglycaemia) and gastrointestinal side effects in one study (1 of 20 in the intervention group and 0 of 20 participants in the control group). None of the included studies reported any deaths, renal, hematological or liver toxicity.
With regard to our secondary outcomes, post prandial blood sugar (PPBS) was lower among participants treated with Diabecon, was unchanged with Hyponidd and was higher in patients treated with Cogent DB. Treatment with Pancreas tonic and Hyponidd did not affect lipid profile significantly, while patients treated with Inolter had significantly higher HDL- and lower LDL-cholesterol as well as lower triglycerides. Cogent DB treated participants also had lower total cholesterol and triglycerides.
Studies of treatment with Diabecon reported increased fasting insulin levels; one study of treatment with Diabecon reported higher stimulated insulin levels and fasting C-peptide levels in the treatment group. There was no significant difference in fasting and stimulated C-peptide and insulin levels with Hyponidd, Cogent DB and Pancreas tonic treatment. The study of Inolter did not assess these outcomes.
No study reported on or was designed to investigate diabetic complications, death from any cause and economic data.
Authors’ conclusions
Although there were significant glucose-lowering effects with the use of some herbal mixtures, due to methodological deficiencies and small sample sizes we are unable to draw any definite conclusions regarding their efficacy. Though no significant adverse events were reported, there is insufficient evidence at present to recommend the use of these interventions in routine clinical practice and further studies are needed.
doi:10.1002/14651858.CD008288.pub2
PMCID: PMC3718571  PMID: 22161426
23.  RNA Viral Metagenome of Whiteflies Leads to the Discovery and Characterization of a Whitefly-Transmitted Carlavirus in North America 
PLoS ONE  2014;9(1):e86748.
Whiteflies from the Bemisia tabaci species complex have the ability to transmit a large number of plant viruses and are some of the most detrimental pests in agriculture. Although whiteflies are known to transmit both DNA and RNA viruses, most of the diversity has been recorded for the former, specifically for the Begomovirus genus. This study investigated the total diversity of DNA and RNA viruses found in whiteflies collected from a single site in Florida to evaluate if there are additional, previously undetected viral types within the B. tabaci vector. Metagenomic analysis of viral DNA extracted from the whiteflies only resulted in the detection of begomoviruses. In contrast, whiteflies contained sequences similar to RNA viruses from divergent groups, with a diversity that extends beyond currently described viruses. The metagenomic analysis of whiteflies also led to the first report of a whitefly-transmitted RNA virus similar to Cowpea mild mottle virus (CpMMV Florida) (genus Carlavirus) in North America. Further investigation resulted in the detection of CpMMV Florida in native and cultivated plants growing near the original field site of whitefly collection and determination of its experimental host range. Analysis of complete CpMMV Florida genomes recovered from whiteflies and plants suggests that the current classification criteria for carlaviruses need to be reevaluated. Overall, metagenomic analysis supports that DNA plant viruses carried by B. tabaci are dominated by begomoviruses, whereas significantly less is known about RNA viruses present in this damaging insect vector.
doi:10.1371/journal.pone.0086748
PMCID: PMC3897770  PMID: 24466220
24.  PA01.17. A clinical study to evaluate the effect of extract based herbal formulation on hypertension- a single blinded standard controlled randomized study 
Ancient Science of Life  2012;32(Suppl 1):S66-S67.
Purpose:
In Ayurveda although there is no such terminology like hypertension but still this work is an approach to establish relationship between Hypertension & vitiated functioning of three governing forces of our body i.e. Tridosha and to treat Hypertension on Ayurvedic principles. The logic behind such correlation is based on the fact that, like other physiological processes, B.P. too is normal phenomenon of our body which is governed by Tridosha. After going through modern pathogenesis of primary hypertension and its symptomology, in present study it has been correlated with Vata Kaphaja Vikara with Rasavaha, Raktavaha and Manovahi Srotas as the seat of disease. Looking at its pathogenesis, the term Uccha Vyan Bala (exaggerated physiological functioning of Vyan Vayu leading to increase contractility of heart & blood vessels) can be coined for hypertension.
Method:
Subjective criteria Headache, Palpitation, Vertigo, Dyspnoea on walks and Fatigue. Objective criteria BP value recorded by sphygmomanometer in supine position. Final assessment of results; Subjective assessment 75 to 100% disappearance of symptoms effectively cured. 50 to 74% disappearance of symptoms well cured. 25 to 49% disappearance of symptoms fairly cured. 0 to 24% disappearance of symptoms poorly cured. Objective assessment Patient showing reduction in BP by 10mmHg Poorly cured; Patient showing reduction in BP between 11 to 20mmHg Fairly cured; Patient showing reduction in BP between 21 to 30 mmHg Well cured; Patient showing reduction in BP by more than 30 mmHg Effectively cured. Research methodology Type of study-Single blinded comparative study. Study site IPD and OPD department of Shubhdeep ayurved medical college, Indore (MP). Sample size 50 patients divided randomly into two equal groups. Group A given trial drug whereas Group B given control drug. Drug dosage and vehicle 1 capsule twice daily with lukewarm water after meals. Duration of treatment one month (examined at weekly intervals.) Dietary advice to strictly restrict the daily intake of Amla, Lavana, Guru & Vidahi diet.
Result:
70% Patients found to be hypertensive were above 40 years of age. 60% Patients were fond of salty & spicy diet. Out of 50 patients 30 patients (60%) belongs to service class. Out of 50 patients 35 patients (70%) were male. Regarding prevalence of symptoms, Dyspnoea on routine work was found in 82%, Headache & palpitation in 80%, Vertigo in 78% & Fatigue in 66% patients.
Conclusion:
As per classical texts, Vata predominant diseases are caused due to vitiation of Vata due to emaciation (Dhatu Kshaya) & obstruction (Marg avarodha). Hypertension seems to be Vata predominant disease due to obstruction. Reason being that, Lavana is Vata Shamak, & should therefore decrease Blood pressure but on contrary it increases B.P. Similarly increase in weight leads to greater chances of High Blood pressure. Above discussion favours that Hypertension can be considered Vata predominant disease due to Marg avarodha by Kapha Dosha and Pitta Dosha in Anubandh. Finally it can be concluded that the drug under study has shown enthusiastic results in reducing the overall value of blood pressure. 64% patients got effectively cured, 24% got well cured and 12% got fairly cured. Regarding symptomatic relief, out of 25 patients 8 showed more than 75% relief, 9 showed more than 50% relief, 7 showed more than 25% relief and only 1 patient showed less than 25% relief in overall symptoms. No significant side effects have been reported in any subject.
PMCID: PMC3800947
25.  OA01.05. Role of prabhakara vati and lekhana basti treatment in the management of coronary artery disease (Hridroga) 
Ancient Science of Life  2012;32(Suppl 1):S5.
Purpose:
The present study was conducted on 30 clinically diagnosed and confirmed patients of Coronary Artery Disease (C.A.D.). Patients having C.A.D. with specific conditions were not registered. The study was conducted with an objective of evaluating the role of Prabhakara Vati and Lekhana Basti in the management of C.A.D. on various scientific parameters.
Method:
30 patients were randomly divided into three groups. It was a randomised, comparative, open ended, pre and post design, clinical trial. Out of the three groups, 10 patients were administered Tab. Dilzem 30 mg TDS for one month, 10 patients of second group were administered Prabhakara Vati 500 mg (two tablets) bd for one month and 10 patients were administered Lekhana Basti (for 15 days) along with Prabhakara Vati 500 mg (two tablets) bd for one month.
Result:
During present trial it was observed that there was significant improvement in clinical manifestations of stable angina after the therapy with Prabhakara Vati and Lekhana Basti. The level of S. Cholesterol, L.D.L., V.L.D.L. and Serum Triglycerides decreased and the level of H.D.L. increased considerably after the therapy.
Conclusion:
Prabhakara Vati and Lekhana Basti possesses potent antianginal and cardio protective activities and it can be used effectively in the management/to slow down the progress of pathogenesis of atherosclerosis leading to various Hridrogas (C.A.D.) specially stable angina.
PMCID: PMC3800929

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