The Effect of Caesalpinia Sappan Linn to Decrease

Blood Glucose Level on Diabetes Type II Patients

Zaqqi Ubaidillah

and Yessy Witantry

Department of Nursing, Faculty of Health Science, University of Muhammadiyah Malang

Jalan Bendungan Sutami No. 188A Malang, East Java, Indonesia 65145

Keywords: Type II Diabetes, Blood Glucose, Caesalpinia Sappan Linn Wood

Abstract: The prevalence of blood glucose control problems is higher in Indonesia. Orally administered

antihyperglycemic agents (OHAs) have various side effects, and it can’t control blood glucose level by single

doses. Diabetes management used complementary therapies as support the administration of OHAs can help

to control blood glucose levels. Caesalpinia Sappan Linn wood has substances high antioxidant and anti-

hyperglycemic that can be used as support therapy in stabilizing blood glucose levels. The aim of this study

was This study used the pretest-posttest control group design. Thirty-two subjects were recruited using a

purposive sampling method. T-Independent test analysis was employed (p <0,05). The result showed the

provision of stew Caesalpiniasappan Linn wood as support of OHAs therapy gave a significant effect of

54.51% compared with control (p = 0,010). Caesalpinia sappan Linn has a brazilin content as a transporter

that helps the pancreas work in insulin secretion. People with diabetes with uncontrolled blood sugar can take

of drinks Caesalpinia Sappan Linn as a supporting the consumption of OHAs.

1 INTRODUCTION

Diabetes mellitus type 2 is a metabolic disorder that

is characterized by hyperglycemia and disturbance of

carbohydrate, fat, and protein metabolism because

inadequate of insulin production, the resistance of

insulin action, or both (Holt et al., 2016)

The

prevalence of DM type 2 accounts for 90% of all of

the diabetes cases worldwide (WHO, 2017). The

largest increases in the prevalence of diabetes in the

world will take place in the regions where economies

are moving from low-income to middle-income

levels, such as Indonesia (IDF, 2015). The prevalence

of diabetes in Indonesia is in sixth place worldwide

and the largest number in Southeast Asia (IDF, 2017).

Lifestyle modification can improve glycemic

control significantly in diabetes type 2 or prediabetes

people (West-Pollak et al., 2014) and treatment with

oral antihyperglycemic or insulin (Yki-Järvinen et al.,

2014; Ishii et al., 2017). Unfortunately, it so many

reports that those regimens had a fatal side effect.

Based on meta-analysis and various studies show that

many oral antihyperglycemics, i.e. metformin,

sulfonylurea, and thiazolidinediones or in

combination with other oral agents could increase

cardiovascular and mortality risk in individual with

diabetes type 2 (Kahler et al., 2007; Rao et al., 2008;

Shimoda and Kaku, 2016) and either insulin could

increase risk of severing hypoglycemia (Ghosh et al.,

2017).

Supporting treatment is needed to improve the

glycemic control of diabetes patients. One of them is

a complementary therapy, for example, traditional

treatment. Based on study by Chinnala, Elsani, and

Nalla (2015) in India found that traditional medicine,

the Caesalpinia Sappan Linn plant used for the

treatment of diabetes mellitus, can reduce the

development of complications and more significantly

reduce blood glucose levels, cholesterol, and total

triglyceride levels and total protein serum levels than

Glibenclamide 10 mg/kg body weight (Chinnala,

Elsani, and Nalla, 2015). This study was conducted to

know the effect of Caesalpinia Sappan L on blood

glucose level on diabetes patients type 2.

2 METHOD

This research used Quasi-Experimental Design and

pretest-postest control group design approach. The

sampling method used a non-probability sampling

technique i.e. purposive sampling. The total of

Ubaidillah, Z. and Witantry, Y.

The Effect of Caesalpinia Sappan Linn to Decrease Blood Glucose Level on Diabetes Type II Patients.

DOI: 10.5220/0009126601810186

In Proceedings of the 2nd Health Science International Conference (HSIC 2019), pages 181-186

ISBN: 978-989-758-462-6

181

subjects were 32 and divided into two groups, 16

intervention group, and 16 control group,

respectively. The intervention group was given

decoction of Caesalpinia Sappan Linn wood

(Caesalpinia Sappan Linn), which has been boiled

with 5 cc/kg BB of water. The boiling process needed

20 minutes with temperature 70

C, whereas the

control group was given standard treatment following

the therapeutic regimen given by the doctor. Dosis of

treatment was once a day for 7 days. Data analysis

used Independent T-test.

3 RESULTS AND DISCUSSION

3.1 Respondents Characteristics

Table 1: Results of Analysis of Body Weight, Age, Genetic

Factors and Diabetes duration in Intervention Group

Intervention Group

Sample Weight

(Kg)

Age

(year)

Duration

(year)

Genetic

1 46 52 3 Yes

2 57 64 3 No

3 60 70 5 Yes

4 76 49 8 No

5 65 47 5 No

6 52 63 7 No

7 61 55 5 No

8 49 60 7 Yes

9 51 70 9 Yes

10 49 70 6 No

11 54 51 5 No

12 53 57 4 No

13 51 63 3 Yes

14 50 60 3 Yes

15 55 57 8 No

16 62 57 2 No

Mean 55,68 59,06 5,18

Table 2: Results of Analysis of Body Weight, Age, Genetic

Factors and Diabetes duration in Control Group

Sample Weight

(Kg)

Age

(year)

Duration

(year)

Genetic

1 51 60 3 No

2 61 59 5 No

3 69 62 8 Yes

4 62 52 8 Yes

5 76 55 3 Yes

6 58 53 3 No

7 60 61 3 No

8 66 60 7 Yes

9 50 55 5 No

10 60 65 5 Yes

11 58 66 4 No

12 85 65 6 No

13 56 56 3 No

14 64 62 5 Yes

15 59 63 3 No

16 62 59 6 No

Mean 62,31 59,56 4,81

Based on Table 1 and 2 shows that the

demographic data in the two groups were no

significant difference. The sample in the intervention

group and the control group had an average age that

was not much different from the average age of 59.06

in the intervention group and 59, 56 in the control

group. The average sample weight data in both groups

also did not show much difference; in group A the

average body weight was 55.68 kg, while in group B,

it was 62.31 kg. Data on the length of time for

diabetes in both groups were also not much different,

which is approximately 5 years with an average of no

genetic offspring who had type II diabetes before.

3.2 Overview of the Effect of

Caesalpinia Sappan Linn Decoction

on Decreasing Blood Glucose

Table 3 shows that the decrease in blood glucose

values was not only in group A (intervention) but also

in group B (control) decreased blood glucose values

with OHO therapy despite fluctuations in each

individual. Samples have decreased blood glucose

values, but each group has a different average value

of decline. The average decrease in blood sugar (GD)

in group A (intervention) for 7 days was 47.13 mg/dl,

and the average decrease in blood sugar (GD) in

group B (control) was 17.94 mg/dl, the difference in

the value of the decrease in blood glucose levels

between intervention group and control group

showed a decrease in blood glucose levels in group A

(intervention) better than group B (control).

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Table 3: Effect of Caesalpinia Sappan Linn Decoction on Decrease in Blood Glucose

Intervention group Control Group

Sample Blood

Glucose at

first day

(mg/dl)

Mean blood

glucose

during 7

day

Mean of

decline

blood

glucose

Sample Blood

Glucose at

first day

(mg/dl)

Mean blood

glucose

during 7

day

Mean of decline

blood glucose

1 244 195 49 1 162 145 17

2 162 116 46 2 159 150 9

3 189 140 49 3 207 192 15

4 155 124 31 4 137 138 1

5 273 180 93 5 187 179 8

6 131 115 16 6 165 165 0

7 196 156 40 7 236 203 33

8 137 120 17 8 193 186 7

9 127 110 17 9 226 201 25

10 224 177 47 10 277 229 48

11 280 191 89 11 165 168 -3

12 238 182 56 12 126 120 6

13 233 188 45 13 130 122 8

14 191 111 80 14 230 204 26

15 155 125 30 15 225 175 50

16 203 154 49 16 206 167 39

Mean 196,12 149,00 47,13 Mean 189,47 171,50 17,94

Graphical in the below showed of changes in blood

glucose from each group:

Figure 1: Changes in Blood Glucose on Intervention Group

Figure 2: Changes in Blood Glucose on Control Group

196.125

182.1875

176.875

154.625

133.375

126.375

122.875

100

150

200

250

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Mean blood glucose

Changes in Blood Glucose on Intervention

Group

189.4375

192 192

184.6875

162.1875

150.875

149.5

100

150

200

250

Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7

Mean blood glucose

Changes in Blood Glucose on Control

Group

The Effect of Caesalpinia Sappan Linn to Decrease Blood Glucose Level on Diabetes Type II Patients

183

Table 4: Respondent’s Life Style

Intervention Group Control Group

Sample Diet Physical Activity Drug Sample Diet Physical Activity Drug

1 Fair Good Good 1 Fair Good Fair

2 Good Good Fair 2 Poor Good Fair

3 Fair Good Good 3 Good Good Fair

4 Good Fair Fair 4 Fair Fair Poor

5 Fair Good Fair 5 Good Poor Good

6 Good Good Poor 6 Poor Fair Good

7 Fair Good Fair 7 Poor Good Good

8 Good Fair Poor 8 Fair Fair Poor

9 Fair Fair Poor 9 Fair Good Fair

10 Fair Good Good 10 Good Good Good

11 Good Good Good 11 Poor Fair Good

12 Fair Good Fair 12 Fair Fair Fair

13 Fair Good Fair 13 Fair Fair Fair

14 Fair Good Good 14 Fair Good Fair

15 Good Fair Fair 15 Good Good Fair

16 Poor Fair Good 16 Fair Good Fair

Analysis of respondents' life habits which are

considered to affect the results of the study so that the

sample is given an observation sheet that will be used

as a process of observing various other factors besides

the administration of Caesalpinia Sappan Linn wood

(Caesalpinia Sappan Linn) which can affect blood

sugar levels. The assessment summary of the

observation sheet is by Gardner & Shoback, 2017.

Table 3 shows that the living habits in both groups

cannot be categorized as good, because there are still

many samples found that do not consume drugs

regularly and correctly, excessive consumption of

food and still consume food or drinks with artificial

sweeteners or added sugar.

Based on the Independent T-Test, a significance

value of 0.010 was obtained. These results indicate

there was a difference significantly on blood glucose

level decline between the intervention group and the

control group. Various factors cause the difference,

those factors are as follows.

3.3 The Active Ingredient in the

Decoction of Caesalpinia Sappan

Linn Wood

Caesalpinia Sappan Linn wood has substances that

help the body to help stabilize blood glucose levels so

that group A has a more stable blood sugar value

compared to group B. Screening results show that

Caesalpinia Sappan Linn wood contains flavonoids,

saponins, and Brazilians. Flavonoids function as

natural biological response modifiers because their

ability to modify the body responds to inflammatory

activity due to oxidative stress in people with diabetes

to stop the chain of cell damage and cell death more

quickly which can worsen the condition of sufferers

(Kusmiati, Dameria, and Priadi, 2014). Saponin is

used as a treatment for patients with

hypercholesterolemia, hyperglycemia, antioxidants,

anticancer, anti-inflammatory and antifungal. The

decoction of Caesalpinia Sappan Linn saponin wood

functions as an antioxidant and anti-hyperglycemic

which can activate an increase in hydrodynamic

activity, which helps to decrease blood glucose levels

quickly (Kusmiati, Dameria, and Priadi, 2014).

Other studies have concluded that the Brazilian

content of Caesalpinia Sappan Linn wood

(Caesalpinia Sappan Linn) is very useful in the

treatment of vascular inflammatory processes or

hyperglycemia through inhibition of oxidative stress

and activation of NF-kB (Nuclear Factor kB). Further

studies on the determination of the Brazilian

mechanism in Indonesia, the transport of glucose

from adipocytes reported that Brazil caused increased

transport of glucose with the help of glucose

transporter (GLUT4) from intracellular to plasma

membrane through activation of phosphatidylinositol

3-kinase (PI3-kinase), not by affecting protein

synthesis, including GLUT4 synthesis (Nirmal et al.,

2015). Various contents in Caesalpinia Sappan Linn

wood, flavonoids, saponins, and brazil are proven to

control glucose levels in the blood of people with

diabetes.

3.4 Age and Genetic

The results of the observation showed that the

administration of Caesalpinia Sappan Linn wood

stew was effective at an average age of approximately

59 years. Age above the vulnerable limit is more than

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45 years (PERKENI, 2015). This result shows that

supporting therapy using wood stew has a success on

the body of a person with an age of approximately 59

years. A decoction of Caesalpinia Sappan Linn wood

as support therapy can still tolerate well with

someone of that age. The results of the observation

showed that the administration of Caesalpinia Sappan

Linn wood was effective at an average bodyweight of

60 kg. According to the Indonesian Endocrinology

Association, a bodyweight of more than 60 kg can

cause a person to have a slower tolerance to drug

therapy, as well as providing supportive therapies

such as herbs and Simplicia (PERKENI, 2015)

3.5 Duration of Diabetes

Respondents who experienced a significant decrease

in blood sugar values were respondents who had

diabetes on average for the last 2-5 years.

Respondents who had diabetes more than 6 years

showed a fairly good response, but have not been able

to show a significant decrease in blood sugar values.

This is in accordance with the theory and survey

according to the Indonesian Endocrinology

Association (2015), the length of time to have

diabetes that is more than 10 years requires more

therapy than drug administration and supporting

therapy. This is because body tolerance is different

compared to people who have long had diabetes

(PERKENI, 2015)

3.6 Life Style

Other results showed that respondents who

experienced a significant decrease in blood glucose

values were respondents with good daily activity

patterns, good sleep rest patterns, and food

consumption patterns were at a fairly good level,

although in terms of pharmacological therapy, require

compliance was still considered poor. This is in line

with the statement of the Indonesian Endocrinology

Association in (2015) stating that food and beverage

consumption factors, daily activities, sleep rest are the

main factors in influencing blood glucose values,

followed by the importance of adherence to taking

medication or therapy that contributes on the stability

of the condition of blood sugar levels of type II

diabetics, and can prevent or delay diabetes

complications continue (PERKENI, 2015)

3.7 Drug Choice

The results of the study found that most of the

samples that experienced a significant decrease in

blood glucose values were the samples that consumed

secretagogue drug class, while the samples taking

combination drugs remained significantly less. This

is due to the content of Brazilian, flavonoid, and

saponin in the decoction of Caesalpinia Sappan Linn

wood in general functions as a substance that helps

the activity of glucose transporters to optimize the

stability of blood glucose levels, which works to

support the function of secretagogue drug class which

functions to help and optimize insulin secretion. This

is supported by research by Chinnala, Elsani, and

Nalla (2015) in India who have tested the use of

glibenclamide along with the administration of

Caesalpinia Sappan Linn wood without being

affected by the number of doses consumed, the results

showed significant effectiveness in various doses

(Chinnala, Elsani, and Nalla, 2015). This shows that

the type of drug consumed can affect the reaction of

the decoction of Caesalpinia Sappan Linn wood, and

the number of doses does not affect the reaction

results of the Caesalpinia Sappan Linn wood stew.

Based on the data and several things that have

been explained, it can be concluded that the pattern of

daily activities, sleep rest patterns, consumption

patterns, types of medication, age factors, genetic

factors, long-term diabetes, and body weight can

influence the results of research and the effect of

Caesalpinia Sappan Linn decoction. Against

decreasing blood glucose levels.

4 CONCLUSIONS

Based on the analysis of research data and discussion,

it can be concluded that the decoction of Caesalpinia

Sappan Linn wood in accordance with the dose of

each respondent in the intervention group was

considered sufficient to have a significant effect on

reducing blood glucose levels in the respondents

during the 7 days of research that was obtained with

sig values (0.010 ) <0.05, whereas in the control

group the results were no better than the intervention

group, by analyzing the data before and after the

administration of Caesalpinia Sappan Linn wood

stew, the intervention group experienced improved

blood sugar levels better than the control group.

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