Diabetes is a group of diseases characterized by increased levels of glucose in the blood resulting from defects in insulin secretion, insulin action, or both. Normally, a certain amount of glucose circulates in the blood. The major sources of this glucose are absorption of ingested food in the gastrointestinal tract and formation of glucose by the liver from food substances. Insulin, a hormone produced by the pancreas, controls the level of glucose in the blood by regulating the production and storage of glucose. In diabetes, the cells may stop responding to insulin or the pancreas may stop producing insulin entirely. This may leads to hyperglycaemia, which may result in acute metabolic complications. Long term effects of hyperglycaemia contribute to macro vascular complications. India leads the world with largest number of diabetic subjects earning the dubious distinction of being termed the "diabetes capital of the world". India is now the country with the most diabetic people, and Indian migrants in many parts of the world have a higher frequency of diabetes than the indigenous population has. There has been a progressive rise in the prevalence of diabetes in India since the 1970, with increase from about 2% to 12% in urban populations. Diabetes is an "Iceberg" disease. Although there is increase in both prevalence and incidence of non-insulin dependent diabetes globally, it have been especially dramatic in newly industrialized countries and in developing countries. The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8% in 2000 and 4.4% in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people above 65 years of age. The prevention and control of the diabetes pandemic and its complications is a major public challenge, but there is hope for the future. The progress of research in all fields of diabetes therapeutics from diabetes treatment to continuous glucose monitoring systems to novel insulin delivery system has been spectacular. Recently There are different modalities of treatment for Diabetes Mellitus. Among them, in India alternative medicine plays an important role, e.g.: Ayurveda, Homeopathy, Siddha, yoga, naturopathy etc. In Ayurveda herbal extracts from plant roots, leaves ,flowers etc are commonly used as a mode of treatment. The role of Ayurveda in control of diabetes is under exploration. Some studies reveals the effectiveness of curry leaves in reducing blood sugar. Pharmacological properties Murraya koenigii has been mentioned in the traditional medicinal system Ayurveda (Sathyavati et al., 2011), Bark, root, leaves, fruits and fruit pulp of Murraya koenigii (Curry leaves) are widely used in the treatment of diabetes. The aqueous extract of these leaves may be prescribed as adjunct to dietary and drug treatment for controlling diabetes mellitus. This findings create an inspiration for the investigator to conduct this study in urban community area where she found more diabetic clients. This curry leaves can easily available and affordable by the community people .

MATERIAL AND METHODS:

Research approach was used a quantitative research. Research design The study designed chosen for the study is Experimental Pre-test, Post-test research design. It is represented as: O1: Pretest assessment of Blood Glucose Level. X: Intervention on Curry leaves (10gms of curry leaves powder along with their routine treatment) NO2: Post-test assessment of Blood Glucose level.

In this study the independent variables refers to the curry leaves powder. Dependent variable is the variable that the researcher is interested in understanding, explaining or predicting. In this study the dependent variable refers to the level of blood glucose The population of the present study consists of type ii diabetes mellitus patients who will be willing to participate. In this study the sample are type ii diabetes mellitus patients in a selected area Punjab. The sample size of the study consists of 60 type ii diabetes mellitus patients in which 30 patients were selected in experimental and 30 were selected in the control group and the random sampling technique was used. Conducted at selected areas in Haryana.

RESULTS:

Frequency and percentage distribution of demographic variables of Type II Diabetic patients in experimental and control group

Table-1 Distribution of demographic variables of type II diabetic clients. N-60

Table -2 Clinical variables of Type II Diabetic clients

*Significant---p≤0.05

**Highly Significant--p≤0.001

***Very Highly Significant--p≤0.0001

The above table shows about the medical related information of the study participants Majority of the Type II Diabetic Patients 73.3% (22) in experimental and 56.7% (17) in control group have no family history of Type II Diabetic mellitus. Those with family history of Type II Diabetes mellitus 16.7% (5) in experimental and 23.3% (7) in control group, Fathers have Type II Diabetic mellitus.

On the basis of duration of illness equal percentage of the clients 50.0% (15), were with in 2-3 years and 4-5 years in experimental group. Half of them 50% (15) were between 2-3 years and 46.7% (14) were between 4-5 years and in control group. 100% in experimental and 90% in control group study participants were on regular treatment. All of the study participants in both groups were following (100%) Allopathy treatment. Majority of the participants in both groups are taking Tab. Glipizide (36.7%). Around 53.3% in experimental and 56.7% in control group clients are having palpitation symptom on hypoglycemic state. When assessing the knowledge on awareness about complication of diabetes mellitus 100.0% (30) of the patients both in experimental and control group were aware of the complications. According to them 43.3% in experimental and 46.7% in control group assumes that DM will cause eye complications. About 40% in experimental and 53.3% in control group assumes that DM will cause foot ulcers.

Table: 2 Comparison of The level of blood sugar among Type II Diabetic clients before and after the intervention in experimental group

*Significant---p≤0.05

**Highly Significant--p≤0.001

***Very Highly Significant--p≤0.0001

The above table reveals that the blood sugar level in post assessment is reduced when comparing with the pre assessment of blood sugar level among Type II Diabetic client in experimental group. The mean score of pre assessment is 204.90 and post assessment is 183.50. this shows the hypothesis of the study was proved. the t value is 3.437 with df=29 and p=0.002. is statistically significant.

Table 3. Comparison Of The Level Of Blood Sugar Among Type II Diabetic Clients Before And After The Intervention In Control Group.

*Significant---p≤0.05

**Highly Significant--p≤0.001

***Very Highly Significant--p≤0.0001

The above table shows the blood sugar level in post assessment is not reduced when comparing with the pre assessment of blood sugar level among Type II Diabetic client in control group. The mean score of pre assessment is 169.53 and post assessment is 170.83. the p=0.4 and it is statistically not significant.

Table 4. Comparison Of The Level Of Blood Sugar in both Experimental and Control Group

*Significant---p≤0.05

**Highly Significant--p≤0.001

***Very Highly Significant--p≤0.0001

The above table shows the blood sugar level between experimental and control group. The post assessment of blood sugar reveals that there is a mark reduction in the mean value of blood sugar level in experimental group and the p= 0.04 is statistically significant (t= 1.13).

Table 4. Comparison of pretest & post-test blood sugar level among Experimental and Control group

The above table reveals the mean and SD between the experimental and control group blood sugar level. In Experimental group the value in pretest is 204.90 ± 91.20 and in posttest it is 183.50 ± 66.31. In Control group the value in pretest is 170.83 ± 12.54 and in posttest it is 169.53 ± 14.366. The p=0.002 (t=3.44) in experimental shows the result was statistically significant.

Table 5. Score of post-test blood sugar level among Type II Diabetic clients in both experimental and control group

*Significant---p≤0.05

**Highly Significant--p≤0.001

***Very Highly Significant--p≤0.0001

Table above table shows the decrease level of blood sugar levels in both experimental and control group. Among this there is about 66.7 % in control group comes under no decrease blood sugar level. About 23.3% of study participant's blood sugar level reduced above 20mg in experimental group. About 33.3% of participant's blood sugar level reduced between 10-19 mg in experimental group. The analysis was done with Chi square test and the value is Chi- 30.1 (P=0.001) and it is <0.05 it is statistically significant.

Table 6. Mean difference of effectiveness of curry leaves

*Significant---p≤0.05

**Highly Significant--p≤0.001

***Very Highly Significant--p≤0.0001

The above table shows that there is mean difference of 21.40 when comparing the pre and post assessment of blood sugar level in experimental group and the mean difference is only 1.3 in control group blood sugar level reduction. Thus, the hypothesis of this study was proved.

Table 7. Effectiveness of the study in % (with 95% confidence interval)

The above table shows the effectiveness of the study in 95% CI; it reveals that the effectiveness of curry leaves in reducing blood sugar level is high among the experimental group than the control group. The mean difference is 21.4 and it is 10.44% In 95 % CI.

The association between the clinical variables and the reduction of blood sugar level in experimental group. Less duration of illness and less duration of treatment for Diabetes mellitus are having more reduction in blood sugar level.

It reveals that in the duration of illness 2-3years (X2=4.19, P=0.005) and according to the duration of treatment to the illness less than five years (X2=12.38, P=0.015) are reduced more post prandial blood sugar level than others. This study analysis revealed that there is a significant effect of curry leaves powder on reduction of blood sugar level among Type II Diabetic clients.

DISCUSSION

Major Findings: Frequency and percentage distribution of demographic variables of Type II Diabetic Patients in experimental and control group were as follows: Majority of the Type II Diabetic Patients 66.70% (20) were females and 33.3% (10) were males in the experimental group and 56.7% (17) were females and 43.3%(13) were males in the control group. Majority of the diabetic patients 83.3%(25) were Hindus,13.3% (4)were Christians in the experimental group and 76.7% (23) were Hindus 20%(6) were Christians in the control group. Majority of the Type II Diabetic Patients 73.3% (22) in experimental and 56.7% (17) in control group have no family history of Type II Diabetic mellitus. Those with family history of Type II Diabetes mellitus 16.7% (5) in experimental and 23.3%(7) in control group, Fathers have Type 2 Diabetic mellitus. On the basis of duration of illness equal percentage of the clients 50.0%(15), were within 2-3 years and 4-5 years in experimental group. Half of them 50%(15) were between 2-3 years and 46.7%(14) were between 4-5 tears and in control group. Majority of the participants in both group are taking Tab. Glipizide (36.7%). When assessing the knowledge on awareness of complication of diabetes mellitus 100.0% (30) of the patients both in experimental and control group were aware of the complications. According to them 43.3% in experimental and 46.7% in control group assumes that DM will cause eye complications. About 40% in experimental and 53.3% in control group assumes that DM will cause foot ulcer.

The first objective of the study is to identify the blood sugar level in type II Diabetic clients by routine blood sugar examination. In this study, the analysis reveals the pretest level of blood glucose among Type II Diabetic patients in experimental and control group. In experiment group blood glucose level in pretest is 204.90 and in control it is 170.83. Statistical calculation was assessed using student independent t-test. In experiment group post prandial blood glucose level is 183.50 and in control it is 169.53. Statistical calculation was done using student independent t-test.

The second objective of the study is to evaluate the effectiveness of curry leaves on blood sugar level among the clients in the experimental group. On comparing the pre and posttest blood glucose level in relation to curry leaves powder among Type II Diabetic Patients in experimental group. The obtained “t” value of blood glucose level reduction was 3.12 from the base line which is significant at p<0.003 levels and the difference between pretest and post test score was analyzed using mean difference with 95% confidence interval. The findings implies that there was a significant difference in blood glucose level before and after intervention. The mean score of postprandial blood glucose level was 204.90, 183.50 and 170.83, 169.53 respectively from pre intervention to post intervention, depicts the effectiveness of the interventions, as the mean score decreased.

The third objective of the study is to compare the effectiveness of curry leaves in control of blood sugar levels in post test result between control and experimental group. On comparing the pre and post blood glucose level in relation to curry leaves among Type II Diabetic patients in experimental group and control group, the obtained mean difference is 10.44% and 0.76% respectively. The finding implies that there is a significant difference between post- prandial blood glucose level in experimental and control group.

The fourth objective is to associate certain demographic and clinical variables with the reduction of blood sugar level in experimental group. Less duration of illness and less duration of treatment for Diabetes mellitus are having more reduction in blood sugar level. It reveals that in the duration of illness 2-3years (X2=4.19, P=0.005) and according to the duration of treatment to the illness less than five years (X2=12.38, P=0.015) are reduced more post prandial blood sugar level than others. This study analysis revealed that there is a significant effect of curry leaves powder on reduction of blood sugar level among Type II Diabetic clients. The overall finding of the study showed that the curry leaves was effective in reducing blood glucose level among Type II Diabetic clients in experimental group. Thus, as a community health nurse the researcher has educated the community people about the benefits of curry leaves in daily diet at the end of the study. The assumption of the study was curry leaves may have some effect on blood glucose level is hereby accepted because the present study results also have proved that overall, 10.44% of Type II Diabetic patients with high blood glucose levels in experimental group have improvement in reduction of blood glucose after the intervention of curry leaves for 14 days.

Conflict of interest: The authors have no conflict of interest to declare.

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