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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 2  |  Page : 64-67

Effect of Lagerstroemia Speciosa (L.) Pers. (Jarula) leaves powder as a hypoglycemic agent in the management of Type 2 diabetes mellitus: An interventional study


Department of Kayachikitsa, North Eastern Institute of Ayurveda and Homoeopathy, Ministry of AYUSH, Government of India, Shillong, Meghalaya, India

Date of Submission06-Jan-2022
Date of Decision20-Jan-2022
Date of Acceptance21-Jan-2022
Date of Web Publication29-Jun-2022

Correspondence Address:
Bishnu Choudhury
Department of Kayachikitsa, North Eastern Institute of Ayurveda and Homoeopathy, Ministry of AYUSH, Government of India, Mawdiangdiang, Shillong - 793 018, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_4_22

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  Abstract 


Background: Perusal of history revels the earliest description of Madhumeha (diabetes mellitus [DM]) is found in Vedic literature of India. The hypoglycemic effect of Lagerstroemia speciosa (L.) Pers. has been date back from the old writing of Ayurveda (Bhavaprakash Nighantu). Objective: The objective is to assess the efficacy of L. speciosa (L.) Pers as an oral hypoglycemic agent. Materials and Methods: The present study is a single group, open label, clinical trial with pre-post follow-up test design on 100 subjects of type 2 DM. Subjects were intervened with L. speciosa (L.) Pers. leaves powder in the dose of 12 g daily in two divided dose ½ h before breakfast and dinner with warm water for 90 days along with advice for standard control of diet and lifestyle modification. The result of the study was determined by the changes in fasting and postprandial blood sugar and glycosylated hemoglobin (HbA1C) level before and after completion of study. Statistical analysis was done using all values which are expressed as mean ± standard deviation and “Z” test. The results were assessed through “P” value. Results: After 90 days of intervention, mean laboratory measured fasting and postprandial blood glucose showed a decrease from 168 and 202 mg/dl to 135 and 166 mg/dl respectively. Reduction in mean HbA1C was also observed from 7.3% to 6.5%. The rate of shift of grade was observed statistically significant (P < 0.01) in all parameters. Conclusion: Leaf's powder of L. speciosa (L.) Pers. showed significant hypoglycemic effect.

Keywords: Diabetes mellitus, hypoglycemic effect, Lagerstroemia speciosa, Madhumeha


How to cite this article:
Choudhury B. Effect of Lagerstroemia Speciosa (L.) Pers. (Jarula) leaves powder as a hypoglycemic agent in the management of Type 2 diabetes mellitus: An interventional study. AYUHOM 2021;8:64-7

How to cite this URL:
Choudhury B. Effect of Lagerstroemia Speciosa (L.) Pers. (Jarula) leaves powder as a hypoglycemic agent in the management of Type 2 diabetes mellitus: An interventional study. AYUHOM [serial online] 2021 [cited 2022 Aug 17];8:64-7. Available from: http://www.ayuhom.com/text.asp?2021/8/2/64/348859




  Introduction Top


Diabetes represents a spectrum of metabolic disorders, which has become a major health challenge worldwide. It has emerged as a global health hazard having a tremendous socioeconomic impact on the individual as well as society as a whole. The rapid urbanization in Asian countries, particularly in India has led to a shift in health problems like diabetes mellitus (DM). This disease is characterized by elevated levels of blood glucose, which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves. In spite of tremendous advances in modern medical sciences, diabetes remains the most common noncommunicable diseases.[1] About 422 million people worldwide have diabetes, the majority living in low- and middle-income countries, and 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.[2]

A perusal of history reveals the earliest description of Madhumeha (DM) is found in Vedic literature of India. In Bhavaprakash Nighantu (Ayurvedic classic of 16 century) mentioned Lagerstroemia speciosa (L.) Pers. as hypoglycemic drugs.[3] L. speciosa (L.) Pers. (Tinisha), being named as Tinisha and in vernacular name Jarula in Hindi, Azar in Assamease, etc., and is traditionally used by the people of Philippines, India, and Malaysia for curing DM.[4],[5] It is a deciduous, tropical, flowering tree of Lythraceae family. The leaves are arranged opposite, or almost opposite, to one another. They are simple, elliptical, and oblong with entire (not lobed) margins. The leaf blade is 5-10 cm long, and has prominent veins, especially on the dorsal side. Mature leaves are leathery in texture. Flowers are showy, pink to purple colors are borne in large, erect terminal clusters from late April to June.[5] This plant contains Corosolic Acid and lagerostromin which are having hypoglycemic and antihyperlipidemic action.[5],[6]

Unfortunately, even today, diabetes is one of the most common chronic diseases in the country and worldwide. In the US, it remains as the seventh leading cause of death.[7] In spite of tremendous development in the modern medical science diabetes till remains a challenge to healthcare workers. Although different oral hypoglycemic agents are available most of them develop resistance after a period. Moreover, none of these drugs are capable to control the late-stage complications of the disease. Researches and surveys showed that it is not possible to combat the disease only with the modern medical science and an alternative therapy is highly essential, preferably herbal medicine. Hence, keeping the above view in mind, the present clinical study was planned to assess the efficacy of L. speciosa (L.) Pers. as an oral hypoglycemic agent in the management of type 2 DM.

Objective of the study

The objective was to assess the efficacy of L. speciosa (L.) Pers. as an oral hypoglycemic agent in the management of type 2 DM.


  Materials and Methods Top


Plant material

L. speciosa (L.) Pers. leaves were collected from Kamrup District of Assam, India. Authentication of the plant was confirmed by an expert taxonomist at the Gauhati University, Guwahati, Assam.

Preparation Lagerstroemia speciosa leaves powder

After washing properly with clean water, the mature and fresh leaves of L. speciosa (L.) Pers. were dried in shed and fine powder was made. The powder is packed in an air tight container. No preservative or coloring agents are used during the preparation of the trial drug.

Ethical clearance

Ethical clearance was obtained from Institutional Ethics Committee of Gauhati Medical College and Hospital, Guwahati, Assam; Vide Ref. No. MC/190/2007/pt-1/70, dated July 19, 2010. Written informed consent was taken from patients as per the Helsinki declaration after offering sufficient explanations about the study and its aims. A detailed research pro forma was prepared incorporating all the points of history taking, physical examination.

Study design

The source of data was selected from the Govt. Ayurvedic College and Hospital, Guwahati and North Eastern India Ayurveda Research Institute, Guwahati, Assam based on inclusion and exclusion criteria irrespective of sex, religion, occupation between years of July 2010 and January 2012. Most of the patients were already known cases of DM, but few were diagnosed for the first time when they came hospital with some other complaints. Single group, open label, clinical trial with pre-post and follow-up test design. A total of 112 subjects were registered, there were 12 dropouts. The study was completed in 100 subjects and data of 100 subjects were collected.

Interventions

The L. speciosa (L.) Pers. leaves powder was given in the dose of 12 g daily in two divided doses ½ h before breakfast and dinner with warm water for 90 days along with advice for standard control of diet and lifestyle modification for type 2 DM.

Assessment

Data were collected on 0th, 30th, 60th, and on 90th day.

Duration of the study 90 days.

Preassessment on 0th day.

Postassessment on 90th day.

Assessment parameter

The findings were subjected to analysis before and after treatment on the following parameters - Fasting blood sugar (FBS), postprandial blood sugar (PPBS), and glycosylated hemoglobin (HbA1C) level. Testing was done in each follow-up (at an interval of 30 days) till completion of study (90 days).

Statistical methods

Statistical analysis was done using all values which are expressed as mean ± standard deviation and “Z” test. The results were assessed through “P” value.

Inclusion criteria

  1. Age not bellow 30 and not above 70 years
  2. FBS ≥126 mg/dl
  3. PPBS ≥140 mg/dl
  4. HbA1C ≥6.5%


Exclusion criteria

  1. GDM and lactating women
  2. FBS 250 mg/dl, PPBS <350 mg/dl and HbA1C <10%
  3. Subjects having any medical or surgical condition that would require immediate medical or surgical intervention at the time of screening
  4. Subjects having any chronic disease like chronic kidney disease, cardiac disease and diseases with immune compromised status like HIV-AIDS, hepatitis, tuberculosis, cancer etc.
  5. Subjects taking insulin, steroid treatment and or any kind of immune-suppressive therapy
  6. Subjects having a past history of allergy to any medicine that is part of the Ayurvedic intervention.


Observation on demographic data

A total of 112 patients of type 2 DM were registered for the present study of which 100 patients completed the full course of treatment, and 12 patients dropped out as they did not timely report for the follow-up. In the study, 48% males and 52% females were participated. Regarding the age incidence maximum of patient was reported 41% in between 41 and 50 years, 40% in between 51 and 60 years and 13% in between 61 and 70 years. Nearly, 72% of the patients were from urban area and 38% found to have positive family history of DM whereas 60% subjects were overweight and obese.


  Results Top


The observations made in this study are displayed in [Table 1],[Table 2],[Table 3].
Table 1: Effect of intervention on fasting blood sugar

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Table 2: Effect of intervention on postprandial blood sugar

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Table 3: Effect of intervention on glycosylated hemoglobin

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  Discussion Top


After 90 days of intervention, mean laboratory-measured fasting and postprandial blood glucose showed a decrease from 168 and 202 mg/dl to 135 and 166 mg/dl, respectively. Reduction in mean HbA1c was also observed from 7.3% to 6.5% in 90 days. The rate of shift of grade was observed statistically significant (P < 0.01) in all parameters.

The decrease of FBS is perhaps due to some inhibiting factors which stop the process of glycogenolysis and gluconeogenesis.[8] The decrease of PPBS by decreasing the glucose absorption from GIT and by activating the transport of glucose across the cell membrane (peripheral utilization of Glucose) and by inhibiting alpha-amylase and alpha-glycosidase.[9] It works as insulin receptor activator by increasing tyrosine-phosphorylation of the sub-unit of insulin receptor and hence maintained the insulin concentration of blood. The active principles of the L. speciosa (L.) Pers. leaves are corosolic acid, lagerostromin and lagertannins. Corosolic acid activates the transport of glucose across the cell membrane, resulting blood sugar reduction. It has inhibitory effects on postprandal hyperglycemia by inhibiting alpha-amylase and alpha-glycosidase. Lagerstroemin is an ellagitannin works as insulin receptor activator by increasing tyrosine- phosphorylation of the sub-unit of insulin receptor. Lagertannins stimulates glucose transport and adipocyte differentiation inhibitory activity in 3T3 – L1 which helps in reducing weight.[10]

The major cause leading to type 2 DM as per Ayurveda is aggravated Kapha dosha, which could be due to a sedentary lifestyle and poor eating habits. However, on the basis of predominance and derangement of doshas there are three main types of Prameha (DM) which is further subdivided in twenty types, i.e., 10 - Kaphaja, 6 - Pittaja, and 4 – Vataja.[11]

Kaphaja, in which Kapha affects lipid metabolism, muscle tissue development and fluids in the urinary bladder. Excessive consumption of high carbohydrate or heavy and oily foods or sweet foods along with less of physical exercise, oversleep increase Kapha and Meda (fat) that build up “ama” (endo-toxins which causes metabolic disturbances) and thereby cause Prameha.[11]

L. speciosa leaves powder has Kasaya and Katu rasa (taste) and Laghu and Ruksha guna (properties), which is useful for decreasing of Kapha dosa and Meda dhatu (fats),[3] Due to the above properties, this drug has been found effective in controlling blood sugar in type 2 DM subjects.


  Conclusion Top


The results of the present study on L. speciosa (L.) Pers. leaves powder shows potent hypoglycemic effects as it significantly reduces the levels of FBS, PPBS, and HbA1c in Type 2 DM patients. Clinically, no adverse effect was reported during the study period. Further, well-designed studies are needed to evaluate the potential benefits and tolerability or safety of L. speciosa (L.) Pers. leaves powder in diabetic patients.

Acknowledgment

I would like to express my special gratitude and regards to my Guide Prof. (Dr.) B.P. Sarma, Former Head, Department of Kayachikitsa, Government Ayurvedic College, Guwahati, Assam for his Guidance and support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Mehta SR, Kashyap AS, Das S. Diabetes mellitus in India: The modern scourge. Med J Armed Forces India 2009;65:50-4.  Back to cited text no. 1
    
2.
Available from: https://www.who.int/health-topics/diabetes#tab= tab_1. [Last accessed on 2021 Jun 28].  Back to cited text no. 2
    
3.
Brahmasankara M, Rupalalaji V. Bhavaprakasha Nighantu of Sri Bhava Mishra. 1st Part. Varanasi: Published by Chaukhamba Sanskrit Bhawan; 2018. p. 706.  Back to cited text no. 3
    
4.
Nanda GC. Analytical screening of certain mehaghna and pramehaghna plants of charak samhita with special reference to anti-diabetic studies. Int J Ayurveda Pharma Res 2016;4:1-4.  Back to cited text no. 4
    
5.
Patel A. A systematic review on banaba. IJRAR Int J Res Anal Rev 2020;7:608-16.  Back to cited text no. 5
    
6.
Stohs SJ, Miller H, Kaats GR. A review of the efficacy and safety of banaba (Lagerstroemia speciosa L.) and corosolic acid. Phytother Res 2012;26:317-24.  Back to cited text no. 6
    
7.
Sapra A, Bhandari P. Diabetes mellitus. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021.  Back to cited text no. 7
    
8.
Miura T, Takagi S, Ishida T. Management of diabetes and its complications with Banaba (Lagerstroemia speciosa L.) and corosolic acid. Evid Based Complement Alternat Med 2012;2012:871495.  Back to cited text no. 8
    
9.
Hou W, Li Y, Zhang Q, Wei X, Peng A, Chen L, et al. Triterpene acids isolated from Lagerstroemia speciosa leaves as alpha-glucosidase inhibitors. Phytother Res 2009;23:614-8.  Back to cited text no. 9
    
10.
Liu F, Kim J, Li Y, Liu X, Li J, Chen X. An extract of Lagerstroemia speciosa L. has insulin-like glucose uptake-stimulatory and adipocyte differentiation-inhibitory activities in 3T3-L1 cells. J Nutr 2001;131:2242-7.  Back to cited text no. 10
    
11.
Choudhury B. Diabetes mellitus: A comparative study as per ayurvedic and modern classics. Int J Res Ayurveda Pharm 2016;1:30-2.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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