RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESKARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address (in block letters)

PRASHANT V. PARANDEI YEAR M. Sc. NURSINGDR. M. V. SHETTY COLLEGE OF NURSINGVIDYANAGARMANGALORE – 575013.

2. Name of the Institution DR. M. V. SHETTY COLLEGE OF NURSINGVIDYANAGARMANGALORE – 575013.

3. Course of Study and Subject M. Sc. NURSINGCOMMUNITY HEALTH NURSING

4. Date of Admission to the Course 21.06.2011

5. Title of the study

A STUDY TO ASSESS THE EFFECTIVENESS OF FENUGREEK

SEED POWDER ON MAINTAINING THE BLOOD GLUCOSE

LEVEL AMONG DIABETIC CLIENTS IN A SELECTED RURAL

AREA MANGALORE, DAKSHINA KANNADA.

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6. Brief resume of the intended work

6.1 Need for the study

“Mantolsaham athisthoolam Athisnigdham mahasanam Mrithyuprameha roopena Kskhipra Madhya gaehati”

This Sanskrit slogan of Charka gives the overall concept of diabetes mellitus. This

means diabetes mellitus comes in the form of death to those who are obese, live without

exercise and eat more, especially sweet items. The term diabetes mellitus is derived from the

Greek word “diabetes” meaning “to go through” or a siphon and the word “mellitus” is

derived from the Latin word “mel” meaning honey describing the sweet odour of urine.

Diabetes mellitus is a disease known during period of 1500 BC and it was described by

Ebers Papyrus of ancient Egypt. In 1000 BC by Sushrutha, the father of medicine, in 400 BC

by Charka and in 200 AD by Aratentus Cappadocia the same concept was described.1

Currently the number of diabetic cases worldwide is estimated to be around 150

million. In 2000, India topped the list with 31 million diabetics; China had 21 million and

America had 17 million. India will have 79 million diabetics by 2030 and America 30

million. But it was an understatement. Facts falsified these estimates. As revealed by facts

about diabetes, in 2007, the number of diabetics in the US was 23.6 million. The figure

predicted was just 30 million by 2030. With only seven years gone, it has reached 23.6 and

gone up by 39%. It is ironical that in spite of spending trillions of dollars in allopathic

medical research on diabetes, American healthcare systems have not been able to control

diabetes; on the contrary incidence of diabetes has increased. If this trend continues until

2030, America will reach 33 million by 2014 and by 2030, it will be around 70 million.

These facts about diabetes confirm that USA has beaten the WHO estimates by 133%. If the

same trend continues in India, this country will have 184 million diabetics in 2030 whereas

WHO estimated it as 79 million. The true facts about diabetes are staggering indeed.2

In a 2005 press release, the Centres for Disease Control (CDC) stated that diabetes

affects nearly 21 million Americans or 7% of the population. As bad as these numbers are,

they are not the worst part of this terrible statistic. More than a third of these are

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unaware that they have the disease. In addition, a further 41 million people are estimated to

have pre-diabetes, a condition that increases the risk of developing Type 2 diabetes as well

as heart disease and stroke. Diabetes is the sixth leading cause of death in the United States

and the risk of contracting it increases with age. About 21% of Americans 60 years or older

have the disease as compared to approximately two percent for people aged 20-39 and about

10% for those between the ages of 40-59 years of age. The United States spends

approximately $132 billion dollars each year on this disease; $92 billion in direct medical

costs and another $40 billion in indirect costs due to losses in productivity.3

The World Health Organisation (WHO) had projected that the global prevalence of

type 2 diabetes mellitus will be more than double 135 million in 1995 to 300 million by the

year 2025. It has been reported by International Diabetes Federation and WHO that in the

year 2002, at least 177 million people were having diabetes mellitus worldwide. Unless

effective methods are implemented to curb this enormous increase, the number is predicted

to double by prevalence rate of about 5.4% with the greater number expected in China and

India (WHO, 2002). One hundred and seventy-one million people were affected by type 2

diabetes mellitus around the world in 2000.4 There will be an increase from 45% to 200% in

developing countries. Nearly 63% of total diabetic patients are residing in the developing

countries. Around 20% of the diabetic population resides in the south East Asia region: the

number is expected to increase by the year 2025 from the present 30 million to 80 million. In

India, the type 2 non-insulin dependent diabetes mellitus is a silent, chronic unidentified

killer among population. The prevalence of disease in adults is 2.4% in rural and 4.0 to

11.6% in urban dwellers. Recent studies have reported India with a current figure of 50.8

million, China with 43.2 million, USA with 26.8 million, Russia with 9.6 million, Brazil

with 7.6 million, Germany with 7.5 million, Pakistan with 7.1 million, Japan with 7.1

million, Indonesia with 7 million and Mexico with 6.8 million.5

India, the world’s second most populous country, has now more people with type-2

diabetes (more than 50 million) than any other nation and is being called as the “Diabetic

capital” of the world. In 2010, the average age-adjusted prevalence of diabetes in India was

8%, higher than that in most European countries1. By contrast, surveys in 1938 and 1959, in

large Indian cities that are today diabetes strongholds, yielded prevalence of just 1% or less.

Only in the 1980s did those numbers start to rise, first slowly and now explosively.6

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In India, a wide range of outcomes for different groups is buried within the average

diabetes prevalence of 8%. Prevalence is only 0.7% for non-obese, physically active, rural

Indians. It reaches 11% for obese, sedentary, urban Indians; and it peaks at 20% in the

Ernakulum district of Kerala, one of India’s most urbanised states. Among lifestyle factors

predicting the incidence of diabetes in India, some are familiar from the west, whereas others

turn expectations upside down. As in the West, diabetes in India is associated with obesity,

high blood pressure, and sedentariness. But prevalence of the disease is higher among

affluent, educated, urban Indians than among poor, uneducated, rural people. Exactly

opposite trends are observed in the West, and similar situation is among developing

countries. For instance, Indians with diabetes are more likely to have undergone higher

education, and less likely to be illiterate, than their healthy compatriots. In 2004, the

prevalence of diabetes averaged 16% in urban India and is only three percentage in rural

India.6

Although Indians who are poor are currently at lower risk than affluent Indians, the

rapid spread of fast food exposes even urban Indian slum dwellers to the risk of diabetes.

The researcher of the Madras Diabetes Research Foundation, summarised the situation as

follows “diabetes [in India] is no longer a disease of the affluent or a rich man’s disease. It is

becoming a problem even among the middle income and poorer sections of the society.

Studies have shown that poor diabetic subjects are more prone to complications as they have

less access to quality healthcare. This presents an alarming picture.”6 Studies from 1989 to

1995 reported the prevalence of diabetes in Chennai increased by 39.8 percent (8.3 to

11.6%), from 1995 to 2000 by 16.3 percent (11.6 to 13.5%); and from 2000 to 2004 by 6.0

percent (13.5 to 14.3%). Thus within a span of 14 years, the prevalence of diabetes increased

significantly by 72.3%7. In the recent National Urban Diabetes Survey (NUDS) the

prevalence of diabetes was found to be 13.5% among Chennai residents, in Bangalore

12.4%, Hyderabad 16.6%, Kolkata 11.7%, New Delhi 11.6%, and Mumbai 9.3%. The

survey also concluded that there is a large pool of individuals with impaired glucose

tolerance test (GTT) at risk of conversion of diabetes especially among the younger age

group below 40 years.8

Alternate treatment reported is the use of Fenugreek. Fenugreek is a plant, which is

grown in Egypt, India and Middle East. It has been used since ancient times in the Indian

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medicine to heal various body conditions and diseases. The part of fenugreek that is used for

medical purposes is its seeds. Indians dry its seeds and prepare several dishes. Sometimes

they also prepare tea.

Fenugreek (Trigonella foenum-graecum in Latin), also known as Greek hay or

fenugreek, was used to treat a whole slew of ailments in ancient Egypt, Greece and Rome,

everything from bronchial problems to low libido. Indian Ayurvedic and traditional Chinese

medicine recommend fenugreek to treat arthritis and bronchitis, induce labour, improve

digestion, and maintain healthy metabolism. Fenugreek also has a long history of use for

treatment of reproductive disorders in women. Fenugreek seeds contain alkaloids, including

triglgonelline, gentianine and carpaine compounds. The seeds also contain fibre, 4-

hydroxyisoleucine and fenugreekine, a component that may have hypoglycaemic activity.

The mechanism is thought to delay gastric emptying, slow carbohydrate absorption, and

inhibit glucose transport. Fenugreek may also increase the number of insulin receptors in red

blood cells and improve glucose utilisation in peripheral tissues, thus demonstrating

potential anti-diabetes effects both in the pancreas and other sites. The amino acid 4-

hydroxyisoleucine, contained in the seeds, may also directly stimulate insulin.9

The true benefits of lie in its long history of medical uses for centuries spanning

Ayurvedic traditional medicine; fenugreek has been used all over the world. Fenugreek has

so many usages almost too numerous to count, however scientists have been able to narrow

down fenugreek to two functions. Fenugreek has the ability to reduce blood sugar and

cholesterol. With its ability to lower blood sugar, fenugreek may hold a special interest by

people who suffer from diabetes. Due to the high content of soluble fibre, it has long been

assumed that the benefit of fenugreek seeds for diabetes lies with its ability to modulate

plasma glucose levels by delaying gastric emptying and by direct interference with glucose

absorption. This study indicates that fenugreek seed powder significantly increased molar

insulin-binding receptor sites of erythrocytes. Peripheral glucose utilisation improved. This

adds even greater rationale for including fenugreek seed powder in the supplement regime of

non-insulin dependent diabetics. In 2003, Alternative Medicine Review published some

research showing how fenugreek supplementation in type 2 diabetes lowered total

cholesterol and lowered triglycerides or blood fat as well as easy the symptoms of diabetes.

In 1991, phototherapy research published showing similar research on non diabetics.10

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Fenugreek seeds may help lower blood sugar and reduce the need for insulin. It may

also improve glucose tolerance and excretion. Some research has shown that the benefits of

fenugreek may inhibit the absorption of cholesterol as well as decrease the amount of

cholesterol manufactured by the liver.11

Fenugreek helps in maintaining good metabolism and prevents constipation. It

purifies blood and helps in flushing out the harmful toxins. It helps in dissolving excess

mucus, thereby making the digestive organs refreshed and clean. Also fenugreek seeds are

useful in improving memory power. This natural herb has very potent seeds, which help treat

balding, thinning of hair ,and hair fall. The benefits of fenugreek in breastfeeding stem from

the diosgenin in its seeds, a compound similar to oestrogen. As such it increases milk

production and stimulates breast tissue growth. This herb is very effective in losing weight.

With the assistance of proper diet and exercise, fenugreek can work wonders on human

body. The fibre in fenugreek fills the stomach, even when consumed in a little amount. Soak

a few fenugreek seeds in water and chew them in the morning, on an empty stomach.12

An experimental study on ‘Effects of fenugreek (Trigonella foenum-graecum linn) on

serum lipid profile in hypercholesteremic type 2 diabetic patients’ was conducted in

Bangladesh. The sample selected was 30. Provision of fenugreek seed powder of 25 gm

orally twice daily for 3 weeks and 6 weeks produced significant (P<0.001) reduction of

serum total cholesterol, triacylglyceride and LDL-cholesterol in hypercholesteremic group

but the change of serum HDL-cholesterol was not significant. On other hand, changes of

lipid profile in hypercholesteremic type 2 diabetic patients without fenugreek were not

significant (P<0.001). The study suggested that fenugreek seed powder would be considered

an effective agent for lipid lowering purposes. The research result showed that the use of

fenugreek seed powder significantly reduced serum total cholesterol, serum triacylglyceride

level and serum LDL-cholesterol level in hyperlipidemic type 2 diabetic patients.13

The investigator’s experience with family members and information collected on

home remedy for diabetes mellitus showed that blood sugar level can be maintained using

fenugreek seed power. While in community field posting, the investigator came across many

lifestyle diseases in the people of the surveyed area, and among them diabetes mellitus was

the most common condition. Based on the literature survey discussed, the investigator was

motivated to conduct an evaluatory study to observe the effectiveness of fenugreek seed

powder in maintaining the blood glucose level.

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6.2 Review of literature

An experimental study on “complimentary study and alternative medicine for

patients with type two diabetes” was conducted in Tamil Nadu. The sample selected was 50.

In one trial, 25 patients consumed 1 g of seed extract or placebo for 2 months with no

change in fasting blood glucose levels. In a small crossover study, 10 patients added 25 g of

defatted seed powder to one meal or ate the meal without the powder for 15 days. Several

measures of glucose metabolism were unchanged. A third trial, which used a higher dose

(100 g) of defatted seed powder in 15 patients for 10 days, did report improvements in

fasting blood glucose values. The research result showed improvement in fasting blood

glucose values. The researcher concluded that there was a significant improvement in the

blood glucose level of the patient with type 2 diabetes mellitus due to fenugreek treatment.14

An experimental study on the effect of fenugreek seeds in reducing fasting and

postprandial (after a meal) blood glucose levels in diabetic patients was conducted at

National Institute of Nutrition, Indian Council of Medical Research, Jamia-Osmania,

Hyderabad. The sample selected was 10. Diets, with or without 25 grams of fenugreek seed

powder, were given randomly to 10 non-insulin dependent patients, each for 15 days, in a

cross-over design. An intravenous glucose tolerance test (GTT) at the end of each study

period indicated that fenugreek powder significantly reduced the area under the plasma

glucose curve and increased the metabolic clearance rate. In addition, it increased

erythrocyte insulin receptors. The results suggested fenugreek can improve peripheral

glucose utilisation which contributes to improvement in glucose tolerance. Fenugreek

appears to exert its hypoglycaemic effect by acting at the insulin receptor as well as the

gastrointestinal level. The research result showed that fenugreek can improve peripheral

glucose utilisation which contributes to improvement in glucose tolerance. The researcher

concluded that there was significant improvement in the blood glucose level of the patients

with type 2 diabetes mellitus due to fenugreek treatment.15

An experimental study on “the effects of ethanol extract of Trigonella foenum-

graecum (fenugreek) seeds on the blood glucose levels in alloxan-induced diabetic rats at

different doses (2g/kg, 1g/kg, 0.5g/kg and 0.1g/kg) was conducted in Bangladesh Council

for Scientific and Industrial Research (BCSIR), Chittagong, Bangladesh. The sample

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selected was 16 rats. Sixteen Wistar Albino rats were randomly divided into four

experimental groups (Gr-A, Gr-B, Gr-C, and Gr-D), where four rats were taken in each

group. Diabetes was induced in three of the groups and one was control. Induction of

diabetes was performed by intraperitoneal (i.p) injection of alloxan monohydrate (axn,

Sigma-Aldrich, Germany, 4 mg/kg body weight) dissolved in 0.9% NaCl saline solution

immediate before use to 2.5-3.5 months old rats fasted for 18 hrs. After 18 hrs of fasting,

normal control (nondiabetic rat), diabetic control (axn induced diabetic rat) and positive

control (axn induced diabetic rat treated by antidiabetic drug) of each of the groups was

treated by distilled water (1ml), distilled water (1 ml), and standard antidiabetic drug

glimepiride (4 mg/kg), respectively. The fourth rat of each of the group was treated by T.

foenum-graecum extract 2g/kg, 1g/kg, 0.5 gm/kg, and 0.1g/kg body weight to Gr-A, Gr-B,

Gr-C, and Gr-D, respectively. The effect of different dose level of T. foenum-graecum on

alloxan induced diabetic rats showed that 1 gm/kg of extract has highest activity (39.32 %)

which decreased gradually for 2 gm/kg (33.92 %), 0.5 gm/kg (12.40 %), and 0.1 gm/kg

(8.72 %), respectively. The researcher concluded that there was a significant effect of

fenugreek in reducing the blood glucose level as compared to other anti diabetic drugs.16

An experimental study on “the effect of a high fibre diet, fenugreek and other herbal

agents in the management of diabetes mellitus” was conducted in Department of

Endocrinology at the Institute of Medical Sciences, Srinagar. The sample selected was 42

patients who attended the outpatient clinic at the hospital based upon certain definite criteria.

They were then divided into 3 groups. Group I comprised 14 patients who were fed 10 gm of

the powdered fenugreek seeds per day. Group II comprised 14 patients who were fed 20 gm

of the powdered fenugreek seeds per day. Group III comprised 14 patients who were not fed

with any powdered fenugreek seeds but were continued on the diet and drug regimen already

prescribed. Patients were assessed for 6 weeks fortnightly. HbAIc was estimated initially and

then at the end of 6 weeks by HPLC method. Blood glucose was periodically estimated

along with clinical assessment, dietary survey, and laboratory studies. The blood sugar levels

in Group II showed a significant drop in fasting sugar levels but the decrease was

insignificant in Group I and III. The difference in HbAIc levels was statistically

insignificant.17

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6.3 Statement of the problem

“A study to assess the effectiveness of fenugreek seed powder on maintaining the

blood glucose level among diabetic clients in a selected rural area Mangalore, Dakshina

Kannada.”

6.4 Objectives of the study

The objectives of the study are to:

determine the mean blood glucose level of subjects from experimental and control

group before intervention.

find out the effectiveness of fenugreek seed powder on maintaining blood glucose

level among subjects of experimental group comparing with control group.

find the association between fenugreek seed on controlling the blood glucose level

with selected demographic variables.

6.5 Operational definitions

1. Assess: In this study, it refers to the effectiveness of fenugreek seed powder on

lowering the blood glucose level among diabetic clients.

2. Effectiveness: In this study, it refers to the extent to which the fenugreek seed

powder to maintain the blood glucose level among diabetic clients has achieved the

desired effect as evidenced by the post test with the help of glucometer. Effectiveness

is determined by the significant difference between pre-test and post-test scores.

3. Fenugreek seed powder: In this study, fenugreek seed refers to roasted and

powdered fenugreek seeds which contains alkaloids, including trigonelline,

gentianine and carpaine compounds. The seeds also contain fibre, 4-

hydroxyisoleucine, and fenugreekine, a component that may have hypoglycaemic

activity. The mechanism is thought to delay gastric emptying, slow carbohydrate

absorption and inhibit glucose transport.

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4. Maintain: In this study, maintain refers to measure that help to alleviate or reduce

blood glucose level of diabetic clients.

5. Blood glucose level: Presence of glucose level in the blood. In this study, it refers to

the blood glucose level maintaining by the diabetic clients

6. Diabetic clients: Refers to those clients who were diagnosed to suffer from non-

insulin dependent diabetes mellitus whose blood sugar level between 120-140 mg/dl.

7. Rural area: In this study, it refers to a small geographical area allotted to rural field

for the institution which is coming under the Surathkal PHC. The rural area is easily

reachable and is about 24 km from college.

6.6 Assumptions

1. All diabetic clients may follow dietary regimen as per physician’s advice.

2. Diabetic clients may be using some of the home remedies for the control of diabetes.

3. Fenugreek seed powder 25 gm/day may have an effect on controlling the blood

glucose level.

4. Clients with diabetes mellitus will accept the fenugreek seed powder as an alternative

modality to maintain the blood glucose level.

6.7 Hypotheses

Hypothesis will be tested at 0.05 level of statistical significance.

H1: There will be a significant difference between the pre-intervention and post-

intervention blood glucose level of clients with diabetes mellitus in experiment

group.

H2: There will be a significant difference in the post-intervention blood glucose levels of

experimental group in comparison to control group.

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H3: There will be a significant association between pre-intervention blood glucose levels

and selected baseline variables of the experimental and control group.

6.8 Delimitations

The study is delimited to:

Only 60 non insulin dependent diabetic clients in a selected rural area at Mangalore.

A time period of 15 days.

The selected rural area at Mangalore.

7. Material and methods

7.1 Source of data

Data will be collected from the diabetic clients in the age group of 40-60 who fulfil

the inclusion criteria.

7.1.1 Research design

The research design for the study will be quasi experimental design with

experimental and control group

7.1.2 Setting

The study will be conducted in a selected rural area at Mangalore, Dakshina

Kannada, Karnataka. Mangalore taluk has 22 primary health centre (PHCs), 4 community

health centres (CHCs), and 6 sub centres (SCs). This study will be conducted in a selected

village, under Surathkal PHC. The investigator selected this area because the batches of this

institution are allotted for community field visit in this rural area and it is well connected

with the transport facilities. Here the total population is 63,600 in which the rural population

consists of 8,354. Rural area is easily reachable and is 24 km from the college.

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7.1.3 Population

The population consists of both male and female diabetic patients who are staying in

the rural area at Mangalore.

7.2 Method of data collection

7.2.1 Sampling technique

Purposive sampling technique and random allotment of sample equally to

experimental and control group.

7.2.2 Sample size

30 experimental group and 30 control group subjects, both male and female, in the

age group of 40-60 years, will be selected from rural area at Mangalore.

7.2.3 Inclusion criteria for sampling

Clients who are:

diagnosed as non insulin dependent diabetic mellitus

willing to take part in the study.

clients with regular pharmacological treatment.

random blood sugar level between 120-140 mg/dl.

aged between 40-60 years.

both male and female patients.

who can understand Kannada.

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7.2.4 Exclusion criteria for samplings

Clients:

who are insulin dependent diabetic patients

having any complications of diabetic mellitus.

with uncontrolled diabetes.

7.2.5 Instruments intended to be used

An interview schedule will be used to collect data.

Glucometer to check the blood glucose levels.

7.2.6 Data collection method

The researcher will obtain prior permission from the concerned authority.

The purpose of the study will be explained to all the clients and informed consent

will be obtained from them.

Subjects will be selected using purposive sampling technique and allotted randomly

to both the groups, that is, 30 patients in experimental and 30 patients in control

group.

Pre-test of random blood sugar level will be checked in both experimental and

control group using glucometer.

In the experimental group 24 gms/day of roasted fenugreek seed is given for 15 days.

Half dose is given before breakfast and remaining half dose before dinner.

The regularity of the intake of roasted fenugreek seed powder will be checked by the

by the investigator personally.

Investigator visits the subjects twice a week.

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Post-test will be conducted on the 16th day for experimental and control groups.

7.2.7 Plan for data analysis

Collected data will be analysed by using descriptive and inferential statistics.

7.3 Does the study require any investigations or interventions to be conducted on patients, or other animals? If so please describe briefly.

Yes, blood glucose level will be measured using standard device, Glucometer and

roasted fenugreek seed powder will also be given.

7.4. Has ethical consideration been obtained from the institution in case of the above?

Yes, ethical clearance has been obtained from the ethical committee of the

institution. Consent form will be taken by subjects at the time of data collection.

8. References

1. Prasad GP, Babu G, Swamy GK. A contemporary scientific support on role of

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Ancient ayurvedic diet and concepts in Diabetes mellitus (madhumeha) I

commentary by Kasinadha Sastry. Varanasi: Chowkhamba Sanskrit Series; 1969.

2. Sathiamurthi M. National diabetes statistics, American Diabetes Association.

Geneva: World Health Organization Reports; 2000.

3. Dorfman M. Mar 8, 2007. Diabetes Statistics Alarming

4. WHO. The World Health Report 2002—Reducing Risks, Promoting Healthy Life.

Geneva: WHO; 2002.

5. IDF. [online]. Available from: URL:http://www.articlesbase.com/diseases-and-

conditions-articles/india-the-diabetic-capital-of-the-world-3835106.html

6. Diamond J, 2011 Medicine: Diabetes in India Nature 469, Pg. No. 478–479

7. Deb L, Sampathkumar KP, Bhowmik D. Traditional Indian herbs cinnamon

zeylanicum and its health benefits. Int J Chem Res 2011;1(2):11-20.

8. Mohan V, Sandeep S, Deepa R, Shah B, Varghese C. Epidemiology of type 2

diabetes: Indian scenario. Indian Journal of Medicine 2007 Mar;219.

9. Herbs: Fenugreek. [online]. Available from:

URL:http://www.vitaminstuff.com/herbs-fenugreek.html

10. Lower cholesterol and blood sugar with fenugreek seed. [online]. Available from:

URL:http://www.thehealthyvillage.com/diseases-and-conditions/diabetes/lower-

cholesterol-and-blood-sugar-with-fenugreek-seed.html.

11. Herbal supplements guide. [online]. Available from: URL:http://www.herbal-

supplements-guide.com

12. http://www.healthmad.com

13. Saleh AM, Uddin M. Hypolipidemic effects of fenugreek seed powder. Bangladesh J

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Pharmacol 2006;2.

14. Nahas R. Complementary and alternative medicine for the treatment of type 2

diabetes. Can Fam Physician Journal 2009;55(6):591–6.

15. Raghuram TC, Sharma RD. Effect of fenugreek seeds on intravenous glucose

disposition in non-insulin dependent diabetic patients. Research Phytotherapy

1994;8.

16. Mowla A, Alauddin M. Effect of Trigonella Foenum-Graecum (Fenugreek) Seed

Extract in Alloxan-Induced Diabetic Rats and Its Use in Diabetes Mellitus. Afr J

Traditional, Complementary and Alternative Medicines 2009;3-4.

17. Zargar AH, Nehru A. Effect of consumption of powdered fenugreek seeds on blood

sugar and HbAIc levels in patients with type ii diabetes mellitus. Intl J Diab Dev

Countries 1992;1.

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9. Signature of the candidate

10. Remarks of the guide

11. Name and designation of (in block letters)

11.2 Guide PROF. (MRS.) VIMALA PRASADVICE PRINCIPAL & H. O. DCOMMUNITY HEALTH NURSING,DR. M. V. SHETTY COLLEGE OF NURSING, KAVOOR, VIDYANAGARMANGALORE -575 013.

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

12 12.1 Head of the department PROF. (MRS.) VIMALA PRASADH.O.D, COMMUNITY HEALTH NURSING,DR. M. V. SHETTY COLLEGE OF NURSING, KAVOOR, VIDYANAGARMANGALORE -575 013.

12.2 Signature

13. 13.1 Remarks of the Chairman and Principal

13.2 Signature

17