Establishing the Efficacy of Homeopathy in the Management of Diabetes Mellitus Type 2 - homeopathy360
Clinical

Establishing the Efficacy of Homeopathy in the Management of Diabetes Mellitus Type 2

Introduction

In 2000 AD, there were 31.7 million Indians having Diabetes. By 2025 AD India would be having the largest number of Diabetics in the world.1 The common symptoms are increase in urination, thirst and appetite with weight loss, weakness and non-healing of wounds. A number of patients remain asymptomatic3,4. Hence, diagnosis is clinched on the basis of the blood glucose levels.5,6 According to American Diabetes Association, a fasting blood glucose level of more than 126 mg percent is the diagnostic criteria for Diabetes.
Individualization is the fundamental principle of homeopathy. Along with this the holistic concept i.e. man as a whole is ill and not any of his parts is the important principle of homeopathic management. Susceptibility is the inherent capacity in all living beings to react to stimuli in the environment and it represents the fundamental quality that distinguishes the living from the non-living.8
An organism (man) in perfect balance represents health. This state of balance, even in the presence of adverse environmental factors, is a resultant of different internal processes which maintain optimum health. Normal susceptibility in a state of good health is characterized by good nutrition and a healthy outlook towards life. Abnormal susceptibility, on the other hand, affects these in the first instance and interferes with the process of adaptation thereby leading to the development of disease. Thus signs and symptoms are the only indications of abnormal susceptibility.9 Logically, an accurate diagnosis of deranged susceptibility of an individual is the key to the understand  the problem of Diabetes10. As mentioned above, the expressions of diabetes varies from case to case. Therefore, it is mandatory to study the state of susceptibility which is responsible for all disease expressions. Our literature shows that both Constitutional as well as Organ medicines are useful in controlling the blood sugar levels.10,11 Which is the most appropriate approach? We need to apply the principles of individualization and totality to determine the answer. This study focuses on this central issue.
In the process of understanding various aspects of susceptibility, we have to understand physical health (patient as a person – general characteristics), mental expressions and the disease expressions
Objectives 
To understand the role of susceptibility in deciding the management of diabetes
To understand the role of Constitutional medicines / Organ remedies in cases of Type 2 Diabetes Mellitus.
Materials and Methods
Randomized single blind clinical trial was conducted during the period 2002 to 2005 at the clinical centres of the Dr M. L. Dhawale Memorial Trust, Mumbai. Ninety patients without microvascular complications were selected from around 314 diabetics. They were divided randomly into three treatment groups – the Constitutional group, the Organ group and the Placebo group. Minimum observation period was of six months. Baseline scores of blood glucose levels and other symptoms were compared with the results obtained at the end of the observation period. Consequently, fifteen randomly selected patients from the Constitutional group and the Placebo group were crossed over. There was a wash-out period of four weeks before the new treatment was started. These cases were observed for a minimum period of three months. Those who were already on Oral Hypoglycemic Agents (OHA) were asked to continue due to ethical considerations. Subsequently, after periodical evaluation by the diabetologist, the doses of OHA of those patients were adjusted on the basis of the blood glucose level and the signs and symptoms and those changes noted in the progress report.  Table 8 gives the details of the status of OHA.
Method
  • Thirty patients in each group, i.e. Constitutional, Organ and Placebo group were enrolled by simple random method.
  • Each selected case was recorded on the Standardized case record with a special attachment for diabetes cases evolved particularly for this study.
  • Diet and exercise – These being the two most important variables, general diet instructions were given to the patients. Approximately 60-70 percent carbohydrates, 15-25 percent proteins and 15-25 percent fats were allowed. They were advised to distribute total calories in three time zones, i.e. 33 percent for breakfast and mid morning, 33 percent for lunch and tea, 33 percent for dinner and before going to bed. They were asked to follow these for thirty days. Baseline assessment was done. Subsequently, they were asked to follow the same diet. Daily diet and exercise schedule was recorded by each patient in a diary.
  • The indicated constitutional remedy and organ remedy was prescribed after forming the totality. Classical Methods of Repertorization, and in some cases, the structuralization method, were used to arrive at the remedy through either of the approaches, viz. Kent, Boenninghausen or Keynote depending on the case.  The repertories of Kent, Boenninghausen, Complete repertory to Homeopathic Materia Medica by E W Berridge second edition and Synthesis 8.1 by Frederik Schroyens were used.
  • Follow-up was taken on a special follow-up sheet which included symptoms of diabetes, symptoms of other diseases, other characteristic symptoms, examination findings e.g.–weight, blood pressure, peripheral pulsations, vibration etc. investigations, diet and exercise record-all of this data helping in the assessment of susceptibility
  • Each case was evaluated by the Homeopathic Physician along with a General Physician (MD – Allopathic), Ophthalmologist, Dietician and Pathologist.
  • Baseline investigations done in each case were – Fasting and Post – Prandial Blood sugar, Glycoslated haemoglobin, Urine sugar, urine ketones, urine albumin, Lipid profile, Complete Blood Count, Serum Creatinine, Serum Uric acid, Microalbuminuria, X-ray chest, Electrocardiogram, USG abdomen and detailed Ophthalmic check up.
  • Subsequently, assessment of response was done through lab test of FBS/ PPBS – monthly, and in some cases weekly during the initial part of the treatment, Glycoslated hemoglobin (3-monthly) and Lipid profile-(6 monthly).
  • Assessment was done at the end of the study on the following basis:
    • Symptomatic level evaluation
    • Changes at the blood glucose levels
    • Status of oral hypoglycemic agent
Assessment Criteria
There is lot of variability in the presentation of diabetes. It is also difficult to correlate the intensity of diabetes on the basis of the severity of symptoms. Hence, they were graded from 0 to 3 according to their severity.
Grading of common symptoms of Diabetes
As mentioned earlier, the intensity of symptoms depends on the individual expression. Common symptoms were graded to gives us more understanding of the deranged susceptibility.
Table 1: Grading of Diabetes Symptoms
Grade Weakness Appetite Thirst Urination
Blood Glucose 
(mg percent)
0
No weakness
Appetite normal Normal thirst Normal frequency for patient
FBS – < 126
PPBS – < 140
1 Weakness after hard work Increased appetite sometimes, but not daily Increased thirst daily and 0-1 at night Every 5-6 hourly Increased than his/ her during day FBS – 127 – 140        PPBS – 141 – 180
2 Weakness after doing daily work Feeling hungry and feels like eating 7-8 times day Thirst increased, every 3-4 hours hourly / two times at night Every 3-4 hourly in day / night two times
FBS –141 – 180
PPBS –  181 -220
3 Persistent Weakness Feeling hungry, eating after food/ lunch Constantly feeling thirsty during day / more than two times at night Every two hourly during day / night > two times
FBS – > 180
PPBS – > 220
Susceptibility assessment
An accurate diagnosis of deranged susceptibility is important for managing a chronic disease like diabetes. Understanding of susceptibility was concluded as low, moderate or high based on the following parameters:11
  1. Predisposition – Family history of diabetes, other illnesses and past history
  2. Disposition – Mental and physical attributes
  3. Precipitating factors – Available: Yes / No. If yes, then Physical / Mental
  4. Onset of the disease – Sudden / Gradual
  5. Character of expressions – Asymptomatic / Symptomatic. If symptomatic, then characteristic / common symptoms
  6. Pace of the disease – Gradual / Rapid
  7. Progress of the disease – Complications: Yes / No
  8. Previous and current medications and its response.
  9. Other diseases present with diabetes.
  10. Qualified Mental Symptoms – Present / Absent
  11. Sensitive to environmental stimuli – Characteristic expression and intensity
  12. General vitality: Examination findings.
High Susceptibility: Capacity of the individual to throw up a good number of characteristics and to limit the extent of changes at the level of tissues to a functional zone.
Moderate susceptibility: Presence of a moderate number of characteristics. The changes at the tissue level are not limited to the functional zone; and yet show capacity to prevent irreversible structural changes.
Low Susceptibility: Poor capacity to throw up characteristics and generally unable to prevent structural changes at the tissue level.
Miasmatic assessment 
Disease is an evolutionary phenomenon. Usually the changes reflecting ill health in an individual start from a functional disturbance and gradually extend to irreversible structural changes. Diseases are also influenced by the predisposing factors in terms of past and family illness.  In order to correctly apply Hahnemannian Pathology to Practice, we need to integrate it fully with the current concepts of Psychology and Pathology – functional and structural. Therefore, the fundamental miasm was derived from the family and the past history of the patient and the dominant miasm from the expressions of diabetes and the concomitant presence of other illnesses.
Outcome assessment 
The outcome was measured as per predetermined criteria.  Therefore the following grading as shown in Table 2 was used for assessing the outcome.
Table 2: Outcome assessment criterion
Improvement
Marked  improvement
Moderate improvement No Improvement
Symptoms Grade 0 Reduced in grade but not grade 0 No change or increased grade
BGL Grade 0 Reduced in grade but not grade 0 No change or increased grade
Associated Complaints Grade 0 Reduced in grade but not grade 0 No change or increased grade
Results and Discussion
Table 3: Susceptibility assessment before treatment 
Susceptibility Constitutional group  Organ group  Placebo group
Low 12 14 13
Moderate 13 10 12
High 05 06 05
Table 4: Miasmatic factors-Fundamental Miasm
Fundamental Miasm   Constitutional Group Organ group  Placebo group  Total 
Psora 02 00 00 02
Sycotic  16 21 24 61
Tubercular 12 09 06 27
Syphilitic  00 00 00 00
Table 5: Miasmatic factors-Dominant Miasm
Dominant Miasm   Constitutional Group Organ group  Placebo Group  Total 
Psora 00 00 00 00
Sycotic 21 16 20 57
Tubercular 09 14 10 33
Syphilitic 00 00 00 00
“The group wise result and conclusions drawn from the project will be published in next issue.”

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