Researcher: Dr Jayvant V Bhagattjee

1. The evaluation of the benefit of therapeutic dry cupping as an adjunctive therapy in management of Diabetes Mellitus II. Researcher: Dr Jayvant V Bhagattjee Supervisors: Prof Rashid Bhikha; Dr Yumna Abrahams Date: 24 September 2011

2. Dry cupping in Diabetes Mellitus 2

3. MOTIVATION There is a need for cost effective, non-invasive approach to managing the growing epidemic Diabetes mellitus II

4. ABSTRACT • Diabetes Mellitus Type II is a fast growing epidemic worldwide. According to the Merck Manual (1992), Diabetes Type II occurs most frequently in adults from 30 years onwards. In the recent years, people as young as teens have been diagnosed with Diabetes Mellitus Type II. There is a definite need for more serious education and intervention in the prevention and management of Diabetes Mellitus Type II. The purpose of this study is to evaluate the benefit of therapeutic dry cupping as an adjunctive therapy in the management of diabetes mellitus type II. This experimental, pre-test post-test control group design pilot study employed a quantitative approach. The study population was purposefully sampled to obtain optimum accuracy. The results indicated an overall average drop in blood glucose levels with a dominant Sanguinous temperament. The study indicates the possible benefits of dry cupping in acute cases of hyperglycaemia and alongside an acute Unani medicinal regimen of diabetic management

5. Aims + Objectives Aim • To compare the results of 2hr post-prandial blood glucose readings without cupping intervention to that of readings after intervention with dry cupping therapy Objectives • To determine blood glucose levels 2hr post-prandial and subsequently immediately following 20 minutes of dry cupping therapy (in the experimental group) • To determine blood glucose levels 2hr post-prandial and 20 minutes later (in the control group) with no cupping intervention and with subject in a resting position. • To compare the results of each group to establish if the use of dry cupping is beneficial in the management of Diabetic Mellitus Type 2, according to Unani principles

6. Study design • This experimental, pre-test post-test control group design pilot study employed a quantitative approach

7. Study population and sampling • 30 diabetic males residing in Cape flats region including the Langa, Saartjie Baartman Tibb Centre • Non-probability sampling

8. Sampling procedure • Purposive sampling; although it may not represent the population and limit generalisability of results

9. Inclusion Criteria • Male • Over 40years of age • Pre-diagnosed diabetics (Type II); with no cardiac conditions; no cancer; no blood disorders and not on any blood thinning agents • Currently using only oral hypoglycaemics • Last meal eaten no more than and no less than 2hrs before 1st blood glucose reading

10. Time line • Study duration: 7 months • 30 participants (1 visit per patient)

11. METHODOLOGY • Consultation • Pre-test finger prick glucose reading • Standardised dry cupping procedure • Experimental group: Dry Cupping on points A3, A4 with Hot/Dry oil (5mins light massage) for 20mins • Control group: No activity, no food, cigarettes for 20 mins • Post-test finger prick glucose reading after 20mins for both groups • Patients were advised on management of governing factors

12. Ethical considerations • All participants were provided with an information sheet clearly stating the nature of the study as well as their right to withdraw from the study at any point without being disadvantaged in any way. • Written, voluntary, informed consent was obtained.

13. Fig .1 indicates the distribution with regard to Dominant Temperament

14. Fig 2. Indicates the distribution with regard to Sub-Dominant Temperament

15. Fig 3. Indicates the distribution with regard to Dominant/Sub-Dominant Temperaments

16. Fig 4. is a graph depicting the glucose reading change in:Experimental Group vs Control Group (mmol/l)

17. Fig 5. Comparative changes in Dominant Sanguinous Patients (experimental group)

18. RESULTS • Based on this study, a mean average drop of 2.71mmol/l was noted in the experimental group and -0.15mmol/l in control group.

19. DISCUSSIONFactors affecting results: • Broad age spectrum • Small study sample • Cost of consultation • Limited time within clinics • Temperamental differences • Efficacy of Unani vs Allopathic Medication • Effect of Ramadaan fasting period and drop of glucose readings • Foods eaten (High GI vs Low GI) • Activity levels before pre-testing • Stress levels

20. CONCLUSION • Initial aim: Long term study • Due to lack of resources, time constraints the study was streamlined to one visit per patient. • The possible role of cupping in long term management of Diabetes Mellitus II may be for the reasons that cupping is beneficial for: Improving blood circulation to organs/tissues • Therefore, as a spin-off to this study the researcher is contemplating the role of dry cupping in acute hyperglycaemic cases, alongside the acute Unani oral hypoglycaemic regimen

21. CONCLUSION • This would help stabilize the patient, prevent possible diabetic coma and provide and alternative in the event that emergency medical services is not available taking into consideration the poor status of South African health care services

22. Recommendations • Researchers interested in pursuing this line of research further may delve deeper into factors that may have affected this study • A further study to establish the role of dry cupping in acute hyperglycaemic cases alongside the Unani medicinal regimen for acute conditions. • Points Le 13 may be considered in dry cupping regimen due its metabolic stimulating properties