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2010-08-24, 10:21 PM
بحكم عملى كطبيب وجدت هذه الدراسة حببت أن أنوه عنها
Effect of Camel Milk on Glycemic Control, Risk Factors and Diabetes Quality of Life in Type-1 Diabetes: A Randomised Prospective Controlled Study
منشورة فى الدورية العالمية للعلاج مرضى السكر فى الدول النامية
http://www.ijddc.com
ملخص البحث
Demographic characteristics are summarized in [Table - 1] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_1.jpg). The group 1 (control group) and group 2 (camel milk group) were similar in age (20.3 ± 5.0 vs. 19.5 ± 8.2 years), sex (10M, 2F in both groups), body mass index (18.43 ± 3.59 vs. 20.21 ± 2.97), fasting blood glucose (117.2 ± 17.7 vs. 115.7 ± 7.2), plasma insulin (16.37 ± 7.57 vs. 16.39 ± 6.57) and C-peptide levels (1.24 ± 0.6 vs. 1.26 ± 0.61). Plasma lipids along with different clinical, demographical and biochemical variables were also comparable.
After three months of treatment there was statistically significant increase in body mass index (20.21 ± 2.97 to 21.3 ± 2.95 Kg/m2, p <0.05), and improvement in fasting blood glucose (115.7 ± 7.2 to 100 ± 16.2, p<0.002) and in HbA1C (9.54 ± 2.1 to 9.08 ± 1.77%, p<0.002), in the camel milk group. These parameters were either unchanged or there was a slight increase in group 1 patients [Table - 2] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_2.jpg). Fasting plasma insulin and C-peptide levels did not reveal a significant change in either group and so were the levels of lipid profile, after three months of treatment. The diabetes quality of life questionnaire score changed significantly in favor of camel milk (i.e. satisfaction score 26.08 ± 4.11 to 22.5 ± 3.96, p <0.05, impact score 32.5 ± 2.71 to 28.08 ± 5.26, p <0.05 and worry score 14.66 ± 1.15 to 11.9 ± 1.24, p<0.05). There was a significant reduction in the mean doses of insulin (41.16 ± 10.32 to 30 ± 12.6u, p<0.002) in patients receiving camel milk. [Table - 3] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_3.jpg), [Figure - 1] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_4.jpg) The acceptability of camel milk was very good and only one patient complained of mild flatulence for 3-4 days. Mild diarrhea (2-3 semisolid stools) was reported by two patients, which also subsided spontaneously.
ملخص للنتيجة
بعد ثلاث أشهر من التجربة وجدوا فرقا أحصائيا واضحا فى معدل وزن الجسم وتحسن فى مستوى السكر الصائم وتم تقليل جرعة الأنسولين المطلوبة فى المجموعة التى تعتمد على الأنسولين
Discussion http://www.ijddc.com/images/arrow_top.gif (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#top)
The present study was performed to observe the role of camel milk in achieving glycemic control in type-1 diabetic patients. We observed a significant improvement in mean BMI (20.21 ± 2.97 to 21.3 ± 2.95, p<0.002) after three months of camel milk treatment. The positive effects in weight gain may be because of good nutritional value of camel milk. There was no change in lipid profile and it may be due to lower fat ####### of camel milk. (i.e. 2.49-3.1 gm% vs. cow milk 3.79 gm%).
We also observed significant reduction in insulin doses to obtain glycemic control along with significant improvement in HbA1C level at the end of three months. No other studies are available for comparison. Improvement in microalbuminuria may be due to good glycemic control or it may be due to direct effect of camel milk. There was marked improvement in diabetes quality of life score after 3 month of camel milk treatment. It may be because of good glycemic control or anabolic effect of camel milk. El Agamy (1992)[11] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref11) found good amount of lysozyme, lactoferrin, lactoperoxidase, immunoglobulin G and secretory immunoglobulin A in camel milk.
Requirement of mean doses of insulin/day before treatment in patients of group-2 was 41.2 ± 10.32. It came down very fast initially and then gradually to a mean level of 30±12.06, (p<0.05). Only one patient out of 12 patients required the same doses of insulin and the other 11 patients had lower requirement to maintain euglycemic blood level. Camel milk was found to contain about 52 units/liter insulin (Raghvendra Singh, Senior Scientist, NRCC, Bikaner, Personal Communication) and it may be the reason for lesser requirement of insulin in camel milk group. Oral insulin has been known since many years but the important drawback is its coagulum formation in acidic media in stomach thereby neutralizing its potency. The lack of coagulum formation of camel milk may act as an effective vehicle to take the insulin present in it in an unchanged form to the intestine and from there it can be absorbed, even if some amount is destroyed in the passage. Beg (1986)[12] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref12) has found that the amino acid sequence of some of the camel milk protein is rich in half cystine, which has superficial similarity with insulin family of peptides.
The data of this study shows a significant hypoglycemic effect of camel milk when given as an adjunctive therapy. The action is presumed to be due to presence of insulin/insulin like protein in it. Its therapeutic efficacy may be due to lack of coagulum formation of camel milk in acidic media. There is no doubt that the discovery and development of oral insulin for therapeutic use is a Himalayan task. It has been observed that oral administration of insulin initiated at clinical onset of type 1 diabetes did not prevent the deterioration of beta cell function[13] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref13). P. Pozzilli et al in IMDIAB VII study indicates that addition of 5mg of oral insulin does not modify the course of the disease in the first year after diagnosis and probably does not statistically effect the humoral immune response against insulin[14] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref14). It is important to note that a certain level of scientific testing on camel milk has been already attempted and documented, particularly, insulin levels in camel milk and this scientific wisdom can be a remarkable achievement for diabetic patients.
وجد تأثير جيد للبن الأبل فى خفض جرعة الأنسولين المطلوبة وتقليل نسبة السكر الصائم فى الدم
Effect of Camel Milk on Glycemic Control, Risk Factors and Diabetes Quality of Life in Type-1 Diabetes: A Randomised Prospective Controlled Study
منشورة فى الدورية العالمية للعلاج مرضى السكر فى الدول النامية
http://www.ijddc.com
ملخص البحث
Demographic characteristics are summarized in [Table - 1] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_1.jpg). The group 1 (control group) and group 2 (camel milk group) were similar in age (20.3 ± 5.0 vs. 19.5 ± 8.2 years), sex (10M, 2F in both groups), body mass index (18.43 ± 3.59 vs. 20.21 ± 2.97), fasting blood glucose (117.2 ± 17.7 vs. 115.7 ± 7.2), plasma insulin (16.37 ± 7.57 vs. 16.39 ± 6.57) and C-peptide levels (1.24 ± 0.6 vs. 1.26 ± 0.61). Plasma lipids along with different clinical, demographical and biochemical variables were also comparable.
After three months of treatment there was statistically significant increase in body mass index (20.21 ± 2.97 to 21.3 ± 2.95 Kg/m2, p <0.05), and improvement in fasting blood glucose (115.7 ± 7.2 to 100 ± 16.2, p<0.002) and in HbA1C (9.54 ± 2.1 to 9.08 ± 1.77%, p<0.002), in the camel milk group. These parameters were either unchanged or there was a slight increase in group 1 patients [Table - 2] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_2.jpg). Fasting plasma insulin and C-peptide levels did not reveal a significant change in either group and so were the levels of lipid profile, after three months of treatment. The diabetes quality of life questionnaire score changed significantly in favor of camel milk (i.e. satisfaction score 26.08 ± 4.11 to 22.5 ± 3.96, p <0.05, impact score 32.5 ± 2.71 to 28.08 ± 5.26, p <0.05 and worry score 14.66 ± 1.15 to 11.9 ± 1.24, p<0.05). There was a significant reduction in the mean doses of insulin (41.16 ± 10.32 to 30 ± 12.6u, p<0.002) in patients receiving camel milk. [Table - 3] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_3.jpg), [Figure - 1] (http://www.ijddc.com/viewimage.asp?img=IntJDiabDevCtries_2002_22_2_70_2 6821_4.jpg) The acceptability of camel milk was very good and only one patient complained of mild flatulence for 3-4 days. Mild diarrhea (2-3 semisolid stools) was reported by two patients, which also subsided spontaneously.
ملخص للنتيجة
بعد ثلاث أشهر من التجربة وجدوا فرقا أحصائيا واضحا فى معدل وزن الجسم وتحسن فى مستوى السكر الصائم وتم تقليل جرعة الأنسولين المطلوبة فى المجموعة التى تعتمد على الأنسولين
Discussion http://www.ijddc.com/images/arrow_top.gif (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#top)
The present study was performed to observe the role of camel milk in achieving glycemic control in type-1 diabetic patients. We observed a significant improvement in mean BMI (20.21 ± 2.97 to 21.3 ± 2.95, p<0.002) after three months of camel milk treatment. The positive effects in weight gain may be because of good nutritional value of camel milk. There was no change in lipid profile and it may be due to lower fat ####### of camel milk. (i.e. 2.49-3.1 gm% vs. cow milk 3.79 gm%).
We also observed significant reduction in insulin doses to obtain glycemic control along with significant improvement in HbA1C level at the end of three months. No other studies are available for comparison. Improvement in microalbuminuria may be due to good glycemic control or it may be due to direct effect of camel milk. There was marked improvement in diabetes quality of life score after 3 month of camel milk treatment. It may be because of good glycemic control or anabolic effect of camel milk. El Agamy (1992)[11] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref11) found good amount of lysozyme, lactoferrin, lactoperoxidase, immunoglobulin G and secretory immunoglobulin A in camel milk.
Requirement of mean doses of insulin/day before treatment in patients of group-2 was 41.2 ± 10.32. It came down very fast initially and then gradually to a mean level of 30±12.06, (p<0.05). Only one patient out of 12 patients required the same doses of insulin and the other 11 patients had lower requirement to maintain euglycemic blood level. Camel milk was found to contain about 52 units/liter insulin (Raghvendra Singh, Senior Scientist, NRCC, Bikaner, Personal Communication) and it may be the reason for lesser requirement of insulin in camel milk group. Oral insulin has been known since many years but the important drawback is its coagulum formation in acidic media in stomach thereby neutralizing its potency. The lack of coagulum formation of camel milk may act as an effective vehicle to take the insulin present in it in an unchanged form to the intestine and from there it can be absorbed, even if some amount is destroyed in the passage. Beg (1986)[12] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref12) has found that the amino acid sequence of some of the camel milk protein is rich in half cystine, which has superficial similarity with insulin family of peptides.
The data of this study shows a significant hypoglycemic effect of camel milk when given as an adjunctive therapy. The action is presumed to be due to presence of insulin/insulin like protein in it. Its therapeutic efficacy may be due to lack of coagulum formation of camel milk in acidic media. There is no doubt that the discovery and development of oral insulin for therapeutic use is a Himalayan task. It has been observed that oral administration of insulin initiated at clinical onset of type 1 diabetes did not prevent the deterioration of beta cell function[13] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref13). P. Pozzilli et al in IMDIAB VII study indicates that addition of 5mg of oral insulin does not modify the course of the disease in the first year after diagnosis and probably does not statistically effect the humoral immune response against insulin[14] (http://www.ijddc.com/article.asp?issn=0973-3930;year=2002;volume=22;issue=2;spage=70;epage=74 ;aulast=#ref14). It is important to note that a certain level of scientific testing on camel milk has been already attempted and documented, particularly, insulin levels in camel milk and this scientific wisdom can be a remarkable achievement for diabetic patients.
وجد تأثير جيد للبن الأبل فى خفض جرعة الأنسولين المطلوبة وتقليل نسبة السكر الصائم فى الدم