Abelmoschus Esculentus) on Fasting Blood Sugar and Total Cholesterol Level in Type 2 Diabetes Mellitus

Haryati et al (2019): Effectiveness of Okra fruit on Diabetes Mellitus December 2019 Vol. 22(11)

The Effectiveness of Okra Fruit (Abelmoschus Esculentus) on Fasting Blood Sugar and Total Cholesterol Level in Type 2 Diabetes Mellitus

Haryati1*, Mubarak1, Rahmawati1

1Medical Faculty of Halu Oleo University, Kendari, South East of Sulawesi, Indonesia

Corresponding author: Haryati; email: [email protected]; Telphone: +62-85394750555

ABSTRACT

Background:Diabetes Mellitus is a metabolic disease characterized by hyperglycemia that occurs due to abnormal insulin secretion, insulin action or both. Complex disorders occur in type 2 Diabetes Mellitus, involving various degrees of decreased beta-cell function, peripheral insulin resistance, and abnormal liver glucose metabolism. Okra (Abelmoschus esculentus) is a plant that has an antidiabetic effect because of its efficiency in improving blood sugar control and lipid profile.

Objectives:To evaluate the effectiveness of Okra fruit on fasting blood sugar and total cholesterol levels in type 2 DM patients.

Settings and Design:This study used a quasi-experimental design with a nonequivalent control group approach with pretest and posttest in type 2 DM patients.

Methods and Material: The number of samples was 30 respondents obtained by the consecutive sampling technique. Samples were divided into an intervention group and the control group. The intervention was given an okra fruit immersion water once a day in the morning for two weeks and blood samples were taken early before treatment and end of treatment.

Statistical analysis used: Statistical analysis using T-test with a 95% CI value.

Results:There were differences in the mean of fasting blood sugar levels before and after the intervention (p- value = 0.000; α = 0.05) and the mean of total cholesterol levels before and after the intervention in the intervention group (p-value = 0.004; α = 0.05).

Conclusion:Okra fruit has an effect in reducing fasting blood sugar and total cholesterol levels in patients with type 2 DM.

Keywords: Diabetes mellitus, fasting blood sugar, okra fruit immersion, total cholesterol

How to cite this article: Haryati, Mubarak, Rahmawati (2019):The effectiveness of okra fruit (Abelmoschus Esculentus) on fasting blood sugar and total cholesterol level in type 2 diabetes mellitus, Ann Trop & Public Health; 22(11): S335. DOI: http://doi.org/10.36295/ASRO.2019.221158

Introduction

Diabetes Mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia that occurs due to abnormal insulin secretion, insulin action or both. Abnormalities in the secretion and work of insulin cause abnormalities in carbohydrate, fat, and protein metabolism [1]. World Health Organization (WHO) predicts the number of people with DM in Indonesia will increase from 8.4 million in 2000 to around 21.4 million in 2030. This is shows an increase in the number of people with DM by 2-3 times by 2035. While the International Diabetes Federation (IDF) predicts an increase in the number of people with diabetes in Indonesia from 9.1 million in 2014 to 14.1 million in 2035 [2]. The number of cases of DM in Southeast Sulawesi in 2013 recorded 2,768 cases and settled in 2014. DM was one of the highest non-communicable diseases in Southeast Sulawesi with DM morbidity in second place after Hypertension (Provincial Health Office of Southeast Sulawesi, 2015). While the number of DM patients in Kendari City in 2013 were 2 cases per 1,000 population, in 2014 DM cases were 2 cases per 1,000 population, and in 2015 DM cases increased with a rate of 4 cases per 1,000 population

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(Kendari City Health Office, 2015). Poasia Health Center is one of the health centers in Kendari City which in 2013, the DM case rate were 12 cases per 1,000 population of the Poasia sub-district. In 2014 it was 10 cases per 1,000 population. In 2015 the DM case rate was 16 cases per 1,000 populations and in 2016 cases of DM were recorded with a rate of 12 cases per 1,000 population of the Poasia district. According to data on surveillance of non-communicable diseases in Poasia Health Center, cases of hypertension and cases of DM are still the main concern, where hypertension has 454 cases and DM has 184 cases (Profile of Puskesmas Poasia, 2015). Efforts to prevent various complications that can arise due to uncontrolled blood sugar levels in patients with type 2 diabetes mellitus can be done through pharmacological actions and non-pharmacological actions. By administrating appropriate medication and correction of lifestyle, dyslipidemia and hyperglycemia are manageable[3]. Currently, the main of treatment for diabetes is the use of insulin and hypoglycemic agent[4].However, there is a need to find effective combinations in the treatment or prevention of diabetes with fewer side effects. The herbal-based formulations are commonly used by the community because they are cost- effective and have fewer side effect than synthetic drugs [5]. Okra (Abelmoschus esculentus) is one of the plants that has an antidiabetic effect because of its efficiency in improving blood sugar control and lipid profile. Okra contains a number of vitamins (riboflavin, niacin, ascorbic acid, and carotene and tocopherol), polyphenols (epigallocatechin, procyanidin, catechin and rutin), polysaccharides (hemicellulose, cellulose, gum and pectin) which can reduce glucose absorption and flavonoids (such as quercetin isomers) componentshave potential chemoprotective effects such as antihyperlipidemia,antidiabetic, neuroprotective, radical scavenger and anti- fatigue action. In fact, mixture content of both lipophilic and hydrophilic antioxidant components in this plant enables it to scavenge radicalsin lipid and aqueous phase. Its flavonoids and vitamin Csynergistically, protect the oxidation of Low Density Lipoprotein (LDL) [3]. The Okra plant can be developed as one of the alternative therapies or natural-based complementary therapies in the treatment of Diabetes.Several studies haveconducted to examine the antidiabetic effects of okra on diabetic animals models. In a study conducted by Sabitha et al.on streptozotocin induced diabetic rats, was investigate antihyperlipidemic and antihyperglycemiaproperties of peels and seed extract of Abelmoschus esculentus. The results showed that diabetic rats who received 100 and 200 mg / kg of okra peel and seed extract,compared diabetic control ratsindicated significant alleviation in glucose and HbA1c levels, returned triglycerideand cholesterol level to the normal range[6]. Many studies have been conducted to evaluate the effectiveness of okra on blood sugar and cholesterol levels carried out in rats. Selection of rats as subjects because it is the most popular experimental animal in studies that have anatomical similarities with human. Thus further research in humans is needed by considering the findings in experimental animals.Based on this background, researchers were interested to investigate the effectiveness of Okra (Abelmoschus esculentus)on fasting blood sugar and total cholesterol levels in type 2 Diabetes Mellitus patients. The purpose of this study was to evaluate the effectiveness of Okra (Abelmoschus esculentus) fruit on fasting blood sugar and total cholesterol levels in type 2 DM patients in the Working Area of Poasia Health Center in Kendari City, South east Sulawesi.

Subject andMethods

This study used a quasi-experimental design with a nonequivalent control group approach with pretest and posttest. In this study consisted of one intervention group that given treatment by consuming soaking water of okra fruit once a day in the morning for two weeks and the control group who did not receive intervention of okra fruit soaking.Three pieces of fresh okra fruit were washed clean and sliced into three parts and soaked in 250 ml of drinking water for 8 until 10 hours. After soaking, the water is filtered to separate the solid and mucin parts and then consumed by patients once a day before they take their breakfast.The number of samples was 30 respondents obtained by the cconsecutive sampling technique and the samples were divided into two groups, i.e the intervention group and the control group. Interventions were performed for two consecutive weeks and blood samples were taken early before treatment and end of treatment to analyze fasting blood sugar and total cholesterol levels. Researchers reminded patients to fast at night by telephone, so it can be ascertained that the patient fasted for 8-10 hours before the blood test the next morning. Statistical analysis was performed with a T test with a 95% CI value. The data was analyzed using the SPPS version 20.

Results Characteristics of Respondent

Table 1 showed that age distribution of respondents in the intervention group obtained the number of respondents in the age interval of 51-60 years were more, as many as 8 respondents (53.3%), while in the control group there were more respondents in the 41-50 year age interval, as many as 7 respondents (46.7%). The results of the analysis show that the age group 41-60 years is more likely to suffer from DM than the age group under 40 years and over 60 years. Most (73.3%) respondents were female, both in the intervention group and control ©Annals of Tropical Medicine & Public Health S335

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group. The analysis shows that most DM patients were female. Most (43.3%) respondents had the last high school education, both in the intervention group, as many as 6 respondents (40%) and in the control group as many as 7 respondents (46.7%). The results of the analysis show that there were more respondents who were educated in senior high school, while the least education was elementary school as many as 2 respondents (6.6%). Body mass index (BMI) distribution in the intervention group found a higher number of respondents with normal BMI as many as 7 respondents (46.7%), while in the control group there were more respondents with excessive BMI, namely 8 respondents (53.4%). Most of respondents (60.0%) had long suffered from DM less than five years, both in the intervention group as many as 8 respondents (53.3%) and in the control group as many as 10 respondents (66.7%). The remaining 40.0% of respondents have suffered from diabetes for more than 5 years.

Univariate Analysis a. Fasting Blood Sugar and Cholesterol Total Levels Before Interventionn Table 2 shows that most fasting blood sugar levels before the intervention of okra fruit immersion water were abnormal, both in the intervention group, as many as 12 respondents (80.0%) and in the control group as many as 10 respondents (66.7%). The results of the data analysis found that most of the total cholesterol levels before the intervention ofokra fruit immersion water in the intervention group were normal as many as 8 respondents (53.3%). Whereas in the control group most of the respondents had abnormal cholesterol levels as many as 10 respondents (66.7%). b. Fasting Blood Sugar and Cholesterol Total Levels After Intervention Table 3 shows thatmost fasting blood sugar levels after the intervention of okra fruit immersion water in the intervention group were normal as many as 12 respondents (80.0%). While in the control group most respondents had abnormal fasting blood sugar levels as many as 8 respondents (53.3%). The results of the data analysis showed that most of the total cholesterol levels after the intervention of okra fruit immersion water in the intervention group were normal as many as 13 respondents (86.7%). Whereas in the control group most respondents had abnormal cholesterol levels as many as 9 respondents (60.0%).

Bivariate Analysis a. Homogeneity Test Results on Fasting Blood Sugar and Total Cholesterol Levels Before Okra Fruit Immersion Intervention Based on table 4 showed that the mean offasting blood sugar level before the intervention of the okra fruit immersion in the intervention group was 189.13 mg / dl with a standard deviation of 69.443 mg / dl. Whereas in the control group the mean of fasting blood sugar level was 166.40 mg / dl with a standard deviation of 52.151 mg / dl. The results of statistical tests showed that there was no significant difference between the mean of fasting blood sugar levels before the intervention of okra fruit immersion between the intervention group and the control group (p value = 0.495; α = 0.05). The mean of total cholesterol level before the intervention of the okra fruit immersion in the intervention group was 178.53 mg/ dl with a standard deviation of 45.090 mg/ dl. Whereas in the control group the mean of total cholesterol level was 216.53 mg/ dl with a standard deviation of 35,197 mg/ dl. The results of statistical tests showed that there was no significant difference between the mean of total cholesterol levels before the intervention of okra fruit immersion between the intervention group and the control group (p value = 0.136; α = 0.05). b. Differences in Mean of Fasting Blood Sugar Levels and Total Cholesterol Levels Before and After Interventions in the Intervention and Control Groups

Table 5 showed that the mean of fasting blood sugar level in the intervention group before being given the intervention of okra fruit immersion was 189.13 mg / dl with a standard deviation of 69.443. In the measurement after being given the intervention was found that the mean of fasting blood sugar level was 135.53 with a standard deviation of 47.569. The difference in mean values between the first and second measurements shows a decrease of 53.60 mg/ dl with a standard deviation of 37.889. The results of statistical tests showed that there were significant differences in the mean of fasting blood sugar levels before and after the intervention of okra fruit immersion in the intervention group (value p = 0.000; α = 0.05. Whereas the mean of fasting blood sugar level in the control group before being given the intervention of okra fruit immersion was 166.40 mg/ dl with a standard deviation of 52.151. In the measurement after being given an okra fruit immersion intervention it was found that the mean offasting blood sugar level was 153.47 mg / dl with a standard deviation of 41.350. There were differences in the mean values between the first and second ©Annals of Tropical Medicine & Public Health S335

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measurements which showed a decrease of 12.93 mg/ dl with a standard deviation of 26.988. The results of statistical tests showed no significant difference in the mean fasting blood sugar levels before and after the intervention of okra fruit immersion in the control group (value p = 0.085; α = 0.05). The mean of total cholesterol level in the intervention group before being given the intervention of okra fruit immersion was 178.53 mg/ dl with a standard deviation of 45.090. On measurements after being given an okra fruit immersion intervention, the mean of total cholesterol level was 164.07 mg / dl with a standard deviation of 33.425. The difference in mean values between the first and second measurements shows a decrease of 14.47 mg/ dl with a standard deviation of 16.229. The results of statistical tests showed that there were significant differences in the mean of total cholesterol levels before and after the intervention of okra fruit immersion in the intervention group (value p = 0.004; α = 0.05). The mean of total cholesterol level in the control group before being given the intervention of okra fruit immersion was 216.53 mg/ dl with a standard deviation of 35,197. In the measurement after being given the okra fruit immersion intervention the mean of total cholesterol level was 208.27 mg/ dl with a standard deviation of 33.371. The difference in mean values between the first and second measurements showed a decrease of 8.27 mg/ dl with a standard deviation of 14.825. The results of statistical tests showed that there were significant differences in the mean of total cholesterol levels before and after the intervention of okra fruit immersion in the control group (p value = 0.049; α = 0.05). c. Differences in Mean of Fasting Blood Sugar and Total Cholesterol Levels After Interventions in the Intervention and Control Groups

Table 6 showed that the mean of fasting blood sugar level after the intervention of okra fruit immersion in the intervention group was 135.53 mg/ dl with a standard deviation of 47.569. While in the control group, the mean of fasting blood sugar level was 153.47 mg/ dl with a standard deviation of 41.350. The results of the statistical tests showed that there was no significant difference in the mean of fasting blood sugar levels after the intervention of the okra fruit immersion between the intervention group and the control group (p value = 0.280; α = 0.05). The mean of total cholesterol level after the intervention of okra fruit immersion in the intervention group was 164.07 mg/ dl with a standard deviation of 33.425. While in the control group the mean of total cholesterol level was 208 mg/ dl with a standard deviation of 33.371. The statistical test results showed that there were significant differences in the mean of total cholesterol levels after the intervention of okra fruit immersion between the intervention group and the control group (p = 0.001; α = 0.05).

Discussion

1. Respondent Characteristics

The results of the study on the characteristics of respondents showed that the age group 41-60 years were more likely to suffer from DM compared to the age group under 40 years and over 60 years, ie age 41-50 years as many as 13 people (43.3%) and ages 51 - 60 years 13 people (43.3%). Age is one of the risk factors for diabetes that occurs when physiological changes when age progresses, especially in those who are overweight so that their bodies are not sensitive to insulin. Results of Basic Health Research showed an increase in prevalence with ImpairedGlucose Tolerance (IGT) at the age of 35 years and over and the highest prevalence was found at the age of 75 years or more [7]. According to Flint and Arslanian in his research states that the prevalence of diabetes has increased at the end of young along with the increasing incidence of obesity in the young age group [8]. The results of research based on sex showed that the majority (73.3%) of respondents were female, both in the intervention group and in the control group. Although until now there has not been found a strong reason for differences in the prevalence of diabetes in women and men but various studies show a significant difference in prevalence between men and women. Data Basic Health Researchshows that the incidence of non-communicable diseases with diabetes in women is 51.9% while in men it is 48.1% and factors that affect the high incidence in women are associated with decreased levels of estrogen hormones and body metabolism along with age increase [7]. Another factor that is a risk factor for DM incidence is excessive weight. The results showed that the body mass index (BMI) distribution in the intervention group found a higher number of respondents with normal BMI as many as 7 respondents (46.7%), whereas in the control group there were more respondents with excessive BMI, as much as 8 respondents (53 , 4%). Obesity is a condition that describes the accumulation of fat in the body caused by food intake exceeding the body's need for excessive body weight of at least 20% of the ideal body weight or BMI of more than 25 kg/ m2. AACE states that obesity is a major risk factor for type 2 DM and cardiovascular disease (CVD) and this is supported by research (Chaoyang, Ford, Guixiang, & Mokdad that 34% ©Annals of Tropical Medicine & Public Health S335

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of people in The United States is obese or overweight and is associated with cardiometabolic risk [9] [10]. Respondents in the intervention group who mostly had normal BMI could be associated with a long history of suffering from DM. Most (60.0%) of respondents had long suffered from DM less than five years, both in the intervention group as many as 8 respondents (53.3%) and in the control group as many as 10 respondents (66.7%). The remaining 40.0% of respondents have suffered from diabetes for more than 5 years. In patients with DM, there is a relatively short weight loss and weakness complaints. This is because glucose in the blood cannot enter the cell so the cell lacks fuel to produce energy. For the survival of energy sources must be taken from other reserves, namely fat and protein (gluconeogenesis) so that patients lose fat deposits and proteins that cause weight loss.

2. Effect of Okra Fruit Immersion on Fasting Blood Sugar Levels

The results of this study showed that type 2 DM patients who were given intervention in the form of soaking water consumption of okra fruit for 2 weeks (14 days) with the frequency of drinking once a day in the morning before breakfast showed a significant difference in mean offasting blood sugar levels before and after intervention (there was a decrease in fasting blood sugar levels), with p value = 0.000; α = 0.005. Whereas in type 2 DM patients who were not given soaking water of okra fruit showed a not significant change in fasting blood sugar levels with p value = 0.085; α = 0.005.Based on the results obtained, it can be seen that there was a significant effect of consumption of okra fruit soaking water on fasting blood sugar levels, where the consumption of okra fruit immersion water can reduce fasting blood sugar levels in type 2 DM patients. The decrease in the mean of fasting blood sugar level in the control group can be caused by consumption of oral hypoglycemic drugs namely metformin (biguanid group) and glimepirid (sulfonylurea group). Oral hypoglycemic drugs such as sulfonylurea and glinid are drugs that act as triggers of insulin secretion, while the biguanid group works by increasing sensitivity to insulin, so it can control blood sugar levels. Okra (Abelmoschus esculentus) have an important role in providing a diet of carbohydrates and minerals such as sodium, potassium, and magnesium, calcium, zinc, iron, manganese and nickel, and vitamins such as B6, A, C, and folic acid. Pods of Okra also contains a lot of fibers such as xyloglucan, xylan, pectin, and cellulose. In addition, there are other flavonoids e.g. kaempferol, isoquercetin, quercetin, gossypin which have antihyperlipidemia, antioxidant and anti-diabetic activities [11]. Tomoda et al (1989) reported that okra polysaccharide possesses anticomplementary and hypoglycemic activity in normal mice [12]. Okra contain high fiber which help to stabilize blood sugar by regulating the rate at which sugar is absorbed from the intestinal tract. Okra shows useful for minimizing blood sugar levels because of fiber along with other nutrition contained in it. The fiber likewise helps support blood sugar levels by slowing down sugar assimilation through the intestinal [13]. Water soluble fraction of the fruits of Okra was studied to check the absorption of oral glucose as well as metformin from gastrointestinal tract in the Long Evans rats. It showed significant reduction in absorbtion of glucose as studied in the 24 hours fasting rats [14]. Several studies have reported anti-diabetic effects of Abelmoschus esculentus. Animal and molecular studies investigated hypoglycemic effects of extract fruit Abelmoschus esculentus in diabetic rats (streptozotocin induced).In another animal studyhave shown that the seeds and mucilageofAbelmoschus esculentustreated diabetic ratsmay alsoattenuate inflammation andß-cell dysfunction in the island of Langerhansin histopathological examination, in addition to improvingbiochemical parameters[3].Fan et al (2014) found that treatment with Okra extract, isoquercitrin and quercetin 3-o- gentibioside reduced blood glucose, serum triglycerides, total cholesterol levels and increased serum insulin and glucose tolerance[15].

3. Effect of Okra Fruit Immersion on Total Cholesterol Level

The results of this study indicate that type 2 DM patients who were given intervention in the form of immersion water consumption of okra fruit showed a significant difference in the mean of total cholesterol level before and after the intervention (there was a decrease in total cholesterol levels), with a value of p = 0.004; α = 0.005.Whereas in type 2 DM patients who were not given immersion water of okra fruit also showed differences in the mean of total cholesterol levels before and after intervention (there was a decrease in total cholesterol levels), with a value of p = 0.085; α = 0.005. The decrease in the mean of total cholesterol level in the control group can be caused by consumption of statins drugs that namelysimvastatin which serves to help reduce the amount of Low Density Lipoprotein (LDL) and triglycerides by reducing the amount of cholesterol produced by the liver and increasing High Density Lipoprotein (HDL) in the blood. Okra contains a combination of lipophilic and hydrophilic antioxidant components, allowing Okra to reduce the radical effects in lipids. The content of flavonoids and vitamin C can synergistically protect LDL oxidation [3].A study published in The Journal of the Federation of American Societies for Experimental Biology found that Okra extract can help reduce cholesterol levels. Okra is one type of vegetable that is very low in calories.Every 100 grams of Okra contains only 30 calories. In addition, this plant also does not contain saturated fat or cholesterol. Several recent studiesshowed ©Annals of Tropical Medicine & Public Health S335

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the beneficial impacts of okra seed and mucilage on improving histopathological changes and biochemical parameters in preclinical studies.Thesestudies found the effectivity of okra seed extract in reducting total cholesterol, lipoproteins containing cholesterol, triglyceride and glucose levels and an enhancement of serum insulin level[3]. The mucilage of okra binds cholesterol and bile acid carrying toxins dumped into it by the liver[13].Kahlom, Chapman & Smith (2007) state that Okra polysaccharide lowers the cholesterol level in blood and may pravent cancer by its ability to bind a bile acids [12]. The results of this study are in line with the research conducted by Fauziana on the effect of okra fruit (Abelmoschus esculantus L.) juice on cholesterol levels of mice (Mus musculus L.) BALB-C and their use as leaflets found that the administration of okra fruit juice significantly affected (p = 0,000) to decrease blood cholesterol in rats, where the administration of okra fruit juice at a dose of 0.2 ml / 20 gram body weight of mice is most influential in reducing the total cholesterol level of rats. This is because okra contains pectin which can increase serum cholesterol reduction and reduce the risk of heart disease (Ax, 2009 in Fauziana, 2016). In addition, the flavonoid content in okra pods has the potential to reduce blood cholesterol levels [16]. Thus, it can be concluded that the consumption of okra fruit immersion water is an effective intervention in controllingblood sugarand cholesterol levels in type 2 DM patients.

Acknowledgements

We would like to acknowledgement the Institute for Research and Community Service of the Halu Oleo University who provided research funding and also to the people who participated in this study.

References

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[5]Choudhari VP, Gore KP, Pawar AT. Antidiabetic, antihyperlipidemic activities and herb–drug interaction of a polyherbal formulation in streptozotocin induced diabetic rats. J Ayurveda Integr Med [Internet]. 2017;8(4):218–25. Available from: https://doi.org/10.1016/j.jaim.2016.11.002

[6] Sabitha V, Ramachandran S, Naveen KR, Panneerselvam K. Antidiabetic and antihyperlipidemic potential of Abelmoschus esculentus (L.) Moench. in streptozotocin-induced diabetic rats. Journal of Pharmacy & BioAllied Sciences [Internet]. 2011; 3(3):397-402. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3178946/

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[12] Roy, A., Shrivastava, S. L., & Mandal, S. M. (2014). Functional properties of Okra Abelmoschus esculentus L. (Moench): traditional claims and scientific evidences. Plant Science Today, 1(3), 121–130. https://doi.org/10.14719/pst.2014.1.3.63

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Table 1. Distribution of Respondents by Age, Gender, Last Education, Body Mass Index, and Long Suffering from DM in Type 2 DM Patients

Intervention Control Characteristic Respondents % n % n %

Age Groups 31-40 years 0 0 1 6.7 3.4 41-50 years 6 40.0 7 46.7 43.3 51-60 years 8 53.3 5 33.3 43.3

>60 years 1 6.7 2 23.4 10.0

Total 30 (100)

Gender Male 4 26.7 4 26.7 26.7 Female 11 73.3 11 73.3 73.3 Total 30 (100)

Last Education Elementary School 2 13.3 0 0 6.7 Junior High School 4 26.7 1 6.6 16.7

Senior High School 6 40.0 7 46.7 43.3

College 3 20.0 7 46.7 43.3

Total 30 (100)

Body Mass Index Less 1 6.6 0 0 3.3

Haryati et al (2019): Effectiveness of Okra fruit on Diabetes Mellitus December 2019 Vol. 22(11)

Obesity 4 26.7 2 13.3 20.0

Total 30 (100)

Long Suffering from DM

< 5 years 8 53.3 10 66.7 60.0

≥ 5 years 7 46.7 5 33.3 40.0

Total 30 (100)

Table 2. Distribution of Respondents Based on Fasting Blood Sugar and Total Cholesterol Level Before Intervention in the Intervention and Control Groups Intervention Control Total (%) Variables n % n % Fasting Blood Sugar Level - Normal 3 20.0 5 33.3 26.7 - Abnormal 12 80.0 10 66.7 73.3

Total 30 (100) Total Cholesterol Level - Normal 8 53.3 5 33.3 43.3 - Abnormal 7 46.7 10 66.7 56.7

Total 30 (100)

Table 3. Distribution of Respondents based on Fasting Blood Sugar and Total Cholesterol Level After Intervention in the Intervention and Control Groups Intervention Control Total (%) Variables n % n % Fasting Blood Sugar Level - Normal 12 80.0 7 46.7 63.3 - Abnormal 3 20.0 8 53.3 36.7

Total 30 (100) Total Cholesterol Level - Normal 13 86.7 6 40.0 63.3 - Abnormal 2 13.3 9 60.0 36.7

Total 30 (100)

Table 4. Homogeneity Test Analysis Based on Mean of Fasting Blood Sugar Levels and Total Cholesterol Levels Before Intervention Variabels Group Mean SD SE p-value

Fasting Blood Sugar Level Intervention 189.13 69.443 17.930 0.495 Control 166.40 52.151 13.465 Total Cholesterol Level Intervention 178.53 45.090 11.642 0.136 ©Annals of Tropical Medicine & Public Health S335

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Control 216.53 35.197 9.088

Table 5. Analysis of Differences in the Mean of Fasting Blood Sugar and Total Cholesterol Levels Before and After Interventions in the Intervention and Control Groups Variabels Group Measurement Mean SD p-value

Fasting Blood Sugar Level Intervention Before 189.13 69.443 0.000 After 135.53 47.569 Difference 53.60 37.889 Control Before 166.40 52.151 0.085 After 153.47 41.350 Difference 12.93 26.988 Total Cholesterol Level Intervention Before 178.53 45.090 0.004 After 164.07 33.425 Difference 14.47 16.229 Control Before 216.53 35.197 0.049 After 208.27 33.371 Difference 8.27 14.825

Table 6. Analysis of Differences in Mean of Fasting Blood Sugar and Total Cholesterol Levels After Interventions in the Intervention and Control Groups Variabels Group Mean SD SE p-value

Fasting Blood Sugar Level Intervention 135.53 47.569 12.282 0.280 Control 153.47 41.350 10.667 Total Cholesterol Level Intervention 164.07 33.425 8.630 0.001 Control 208.27 33.371 8.616