Available online on 15.06.2026 at http://jddtonline.info
Journal of Drug Delivery and Therapeutics
Open Access to Pharmaceutical and Medical Research
Copyright © 2026 The Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited
Open Access Full Text Article Research Article
A Study on Expenditure of Health Care Incurred by Diabetes Patients Attending a Diabetes Centre
Champak Kumar Singh 1, Sanjeev Kumar 2, Rama Devi Pahari Gyawali 3, Shirjana Shrestha 3, Dr. Ram Bahadur Shrestha 4, Hemank KC 5 *
1 PhD (Scholar), Department of Public Health, Noida International University, Noida, India
2 Project Coordinator (SMNHS) in Mandwi-One Heart Worldwide, Nepal
3 Assistant professor, National Academy for Medical Science, Nepal
4 Associate Professor, National Academy for Medical Science, Nepal
5 MSC Student, School of Nursing and Healthcare, BPP University, West London
Article Info:
_______________________________________________ Article History:
Received 13 March 2026
Reviewed 29 April 2026
Accepted 31 May 2026
Published 15 June 2026
_______________________________________________
Cite this article as:
Singh CK, Kumar S, Gyawali RDP, Shrestha RB, Shrestha S, Hemank KC, A Study on Expenditure of Health Care Incurred by Diabetes Patients Attending a Diabetes Centre, Journal of Drug Delivery and Therapeutics. 2026; 16(6):99-106 DOI: https://doi.org/10.22270/jddt.v16i6.7784 _______________________________________________
For Correspondence:
Champak Kumar Singh, PhD (Scholar), Department of Public Health, Noida International University, Noida, India
Email; drckrbj@gmail.com
Abstract
_______________________________________________________________________________________________________________
Many socio-economic factors and health care delivery-related issues impact the outcome of diabetes and consequently the costs and vice versa. Those with higher education, higher income and actively working people are diagnosed earlier because of better awareness, affordability and the need to remain fit to earn a livelihood for the family. The objective of this study was to assess the average annual expenditure for management of diabetes and its complications. According to the study objectives, various variables, including dependent and independent variables, as well as medical and non-medical care expenses, were considered. A descriptive cross-sectional research design was followed in this study and primary data was collected through questionnaire and interview methods. The data was collected from diabetic patients attending a diabetes centre in a hospital. The sample size was limited to 200 respondents. The majority of respondents belonged to the age group of 50–59 years. Among the respondents, 44.5 percent were male and 55.5 percent were female. In terms of religion, 59.5 percent were Hindus, 28 percent were Christians and 12.5 percent were Muslims. About 30.5 percent of the respondents were housewives. The present study shows that a patient with or without complications had spent an average of Rs. 4390 per year within a range of Rs. 720 to Rs. 55946 per annum. Out of the total respondents, 25 percent of the patients had spent up to Rs. 2440 while another 25 percent spent over Rs. 17435 annually. There were wide variations in the expenditure pattern. The major portion of expenditure was on diet followed by treatment of complications. Patients with complications spent more compared to those without complications. The study highlights that the annual expenses on diabetic treatment increase with medical and non-medical costs such as consultation charges, medical expenses, blood examination charges and hospitalization expenses. Regular check-ups and medication are therefore essential for reducing complications and minimizing the economic burden of diabetes.
Keywords: expenditure for management of diabetes, consultation charges, medical expenses, blood examination charges and hospitalisation expenses
INTRODUCTION
Diabetes mellitus is one of the most common metabolic disorders affecting populations worldwide. It is a chronic, non-communicable disease that has become a major public health concern as the prevalence of infectious diseases and malnutrition-related conditions has declined. Along with other chronic multifactorial diseases such as hypertension and cardiovascular diseases, diabetes mellitus contributes significantly to morbidity and mortality across both developed and developing countries.¹
Diabetes mellitus refers to a group of metabolic disorders characterized primarily by hyperglycemia resulting from defects in insulin secretion, impaired insulin action, or both. The condition is often associated with symptoms such as glycosuria, polyuria, polyphagia, polydipsia, and hyperlipidemia. Historically, diabetes was recognized as a disease associated with “sweet urine,” since elevated blood glucose levels lead to the excretion of glucose in urine.² If left untreated or poorly managed, diabetes can lead to serious long-term complications affecting the heart, kidneys, eyes, nerves, and blood vessels.
Diabetes mellitus is broadly classified into two main types: Type 1 diabetes mellitus and Type 2 diabetes mellitus. Type 1 diabetes results from an absolute deficiency of insulin due to the destruction of pancreatic beta cells, whereas Type 2 diabetes occurs mainly due to insulin resistance combined with relative insulin deficiency. Among individuals diagnosed with diabetes, approximately 5 percent suffer from Type 1 diabetes, while nearly 95 percent have Type 2 diabetes.3 The rapid increase in the prevalence of Type 2 diabetes has become a major global health challenge.
The economic burden of diabetes is substantial and affects individuals, families, healthcare systems, and national economies. The costs associated with diabetes can be broadly categorized into three types: direct healthcare costs, indirect healthcare costs, and productivity costs. Direct healthcare costs include expenses related to medications, medical devices, consultations with healthcare professionals, and hospitalization for diabetes and its complications. Indirect healthcare costs include long-term care services such as nursing home care and informal care provided by family members or caregivers. Productivity costs arise from reduced work capacity, absenteeism, disability, and premature mortality associated with diabetes and its complications.4
Globally, diabetes is a major and growing health problem. It was estimated that approximately 285 million adults were living with diabetes in 2010, and this number is expected to rise due to factors such as population aging, urbanization, sedentary lifestyles, and increasing rates of obesity. Individuals with diabetes generally require more frequent medical care, including outpatient visits, medications, and hospitalizations, which significantly increases healthcare expenditures.3 Understanding the economic burden of diabetes is essential for policymakers and healthcare planners in order to allocate resources effectively and develop strategies for prevention and management.
In developing countries like India, the rising prevalence of Type 2 diabetes poses a significant clinical and economic challenge. Healthcare systems in many developing countries lack comprehensive documentation of medical costs, making it difficult to accurately estimate the total expenditure associated with diabetes care. Both public and private healthcare systems operate in India, with government hospitals providing free or subsidized treatment for economically disadvantaged populations.5
Previous studies in India have shown that the financial burden of diabetes care can be considerable for families, particularly those with low income. In some cases, individuals from lower-income groups spend up to 25 percent of their annual income on diabetes treatment. Furthermore, studies have reported a steady increase in the prevalence of diabetes in India over recent decades. A national survey conducted in six major cities in 2000 reported that the prevalence of diabetes among urban adults was 12.1 percent, while impaired glucose tolerance was observed in 14 percent of the population.¹⁰
Considering the increasing prevalence of diabetes and its significant economic burden, there is a strong need to assess the cost of diabetic care. Therefore, the present study aims to contribute to a better understanding of the economic impact of diabetes and to provide useful information for improving healthcare planning and management.
METHODS
Study Area
The study was conducted at ST.MARTHA’S HOSPITAL, NO.5, NRUPATHUNGA ROAD, BANGALORE, which was established in 1886. St. Martha's Hospital is one of the oldest and most highly regarded hospitals in Bangalore. Despite its age this hospital has kept up with the times and secured its place in the world of medicine and health care. It is run by the sisters of the Good Shepherd and therefore there is an emphasis on providing care for the weak and vulnerable, women and children and for HIV/AIDS patients including DIABETES patients. There is a 24 hour emergency, ambulance, blood bank and laboratory. Services are available in all the departments of medicine, including surgery.
Study Design
A Descriptive cross sectional research design was followed in this study and primary data was collected to study the expenditure of health care incurred by diabetic subjects through structured pre tested questionnaire by interview method. The data was collected from diabetes patients attending a diabetes centre in the hosp[ital.
The patients attending the diabetes centre were interviewed for the study purpose on a systemic random sample basis. The sample size was limited to 200.
Variables Considered
1. Independent variables:
• Age
• Sex
• Religion
• Occupation
• Education
• Family income
• Family size
• Awareness on Diabetes Mellitus
2. Dependent variable:
A. Medical care
• Consultation
• Investigation
• Treating Complication
• Hospitalization
• Medication
B. Non Medical care
• Transportation
● Dietary expenses
Conceptual Framework:
Figure 1: Conceptual Framework
Sampling Population and Procedure
The sample size was limited because of time factor and economic factor. Only 200 respondents were taken from the selected diabetes centre of hospital.
Inclusion and Exclusion criteria
Inclusion criteria: Known diabetic patient attending Clinic were included in this study.
Exclusion criteria: Among known cases of diabetic patients those who were recently diagnosed within a month were not included for the study.
Source of Data
Primary data was collected by personal interview of the respondent and also by giving questionnaire to them to fill up. Personal details were collected by interview and expenditure details were collected by questionnaire.
Data Collection Tools and Techniques
The data collection methods or techniques that were used for this study was Semi- structured Interview and the pretested questionnaire. Each respondent had been fully oriented about the interview and also with the questionnaire and technique to fill it up. The data was collected when the patient came for diabetes check-up.
Interview Methods
Respondents who were diagnosed as a Diabetic patient attending the Clinic were interviewed after taking their informed consent. During the interview the researcher or research assistant had explained the objectives of the study to the respondents and request them to give the required information according to the questionnaire.
Tools
Structured and semi structured questionnaire were used.
Questionnaire Design
The questionnaire was designed by the researcher with the help of the supervisor and the subject experts. Various literatures were reviewed for the purpose of questionnaire design.
Pre Test and Administration
The questionnaire was designed and pre tested among some of the respondents coming for check-up in Padmashree Dianostic who were suffering from Diabetes more than a year. The questionnaire was again discussed with the supervisor. Necessary feedback was taken from the discussions. Other concerned persons were requested to read the questionnaire and give necessary feedback regarding the questionnaire.
Data Processing
First of all the collected data were checked thoroughly and necessary editing were done first. Then the data were coded into numerical values as required. The data were then entered in the computer for processing. Then, analysis was carried out with the software SPSS in the computer to get the necessary results or outcomes of the research conducted.
Method of Analysis and Interpretation:
In this study, quantitative methods was used and maintained while analyzing the data. Data were analyzed by using the SPSS software. Finally, the interpretation was carried out based on the generated tables.
Editing
The raw data were edited to detect errors, omission and correct them early. The purpose of editing was to make sure that the data was accurately filled, consistent, uniformly entered, completed and well arranged to facilitate coding and tabulation.
Data analysis
The expenditure analysis has been carried out on major expenses on direct expenditure like consultation, medicines, hospitalization, treatment of complications, transport and diet.
Median and quartile values of expenditure have been calculated along with minimum and maximum expenditures on each item. The comparison of total expenditure between income groups and duration of disease groups have been done using Mann- Whitney test.
Data analysis was also done in terms of frequency on different socio-demographics characteristics by using SPSS 16 program.
Reliability and Validity
Reliability of research instrument is defined as the extent to which the instrument yields the same results on repeated measures. It is then concerned with consistency, accuracy, precision, stability, equivalence and homogeneity. The structured interview schedule was tested for reliability. 10 respondents were interviewed using structured interview schedule.
Validity and reliability were maintained by pre-test and necessary modifications if required.
1. Consultation was done with the supervisor/guide.
2. Concerned persons were requested to read the questionnaire and give some necessary feedback.
3. Data were gathered promptly after collecting the data from the Hospital.
4. Scientific tools were applied to analyze the data.
5. Collected data were rechecked and verified on the same day.
Ethical Considerations
1. Data was collected after taking written consent only.
2. All the information belonging to the respondent were kept confidential.
3. The results were used only for the study purpose.
4. No information were published which will break the autonomy of the respondent.
5. Ethical approval was obtained from Padmashree School of Public Health.
6. Consent was taken from the Medical superintendant of the hospital.
RESULTS
This chapter deals with the analysis and results of the data collected from 200 respondents to assess the expenditure of health care incurred by diabetic patients who were taken through structured and pre tested questionnaire by interview method visiting the hospital.
The general objective of the study is to assess the average monthly expenditure for management of Diabetes and its complication attending the diabetic Clinic.
Section 4.1 Socio-demographic characteristics of Respondents Section 4.2 Average monthly expenditure on Diabetes management
4.1 Socio-Demographic Characteristics of Respondents
Table 1: Age of respondents
Age group N %
30-39 17 8.5
40-49 44 22.0
50-59 73 36.5
60-69 42 21.0
70-79 16 8.0
≥ 80 8 4.0
Total 200 100
8.5 percent were in the age group 30-39 years, 22.0 percent were in age group of 40- 49 years, 36.5 percent were in age group of 50-59 years, 21.0 percent were in the age group of 60-69 years, 8.0 percent were in the age group of 70-79 years and similarly
4.0 percent were in the age group of 80 years and above. The majority of the respondents fall under the age group of 50-59 years.
Table 2: Sex of respondents
Sex N %
Male 89 44.5
Female 111 55.5
Total 200 100
Out of the total respondents, 44.5 percent were male and 55.5 percent were female among the total respondents.
Table 3: Religion of respondents
Religion N %
Hindu 119 59.5
Christian 56 28.0
Muslim 25 12.5
Total 200 100
Majority of respondent i.e. 59.5 percent were Hindus, 28.0 percent were Christians and only 12.5percent respondents were Muslims.
Table 4: Occupation of respondents
Occupation N %
Government employment 30 15.0
Private employment 38 19.0
Business 40 20.0
Agriculture 9 4.5
Daily wages 11 5.5
Housewife 61 30.5
Retired 11 5.5
Total 200 100
30.5 percent of total respondent’s main occupation was housework i.e. they were housewife, 20.0 percent respondents were involved in business, 19.0 percent in private employ,15.0 percent were government employ, 5.5 percent were in daily wages and retired, and similarly the minimum respondents were involved in agriculture.
Table 5: Respondent’s Income
Income interval N %
≤ 10000 52 37.7
10001 to 20000 61 44.2
20001 to 30000 15 10.9
30001 to 40000 5 3.6
40001 to 50000 3 2.2
≥ 50001 2 1.4
Total 138 100
Among the total respondents 44.2 percent respondents income were between 10001 to 20000. 37.7 percent respondents income were less than and equal to 10000. 10.9 percent respondents income were between 20001 to 30000, 3.6 percent respondents income were 30001 to 40000, 2.2 percent respondents income were between 40001 to 50000, whereas only 1.4 percent respondents incomes were equal to and greater than 50001.
Table 6: Family income of respondents
Income Interval N %
≤10000 58 29.0
10001 to 20000 58 29.0
20001 to 30000 38 19.0
30001 to 40000 14 7.0
40001 to 50000 11 5.5
50001 and above 21 10.5
Total 200 100
29.0 percent respondent’s family incomes were less than 10000 and from 10001 to 20000, 19.0 percent of the their family income were between 20001 to 30000, 7.0 percent of their family income were between 30001 to 40000, 5.5 percent respondents family incomes were between 40001 to 50000, similarly 10.5 percent respondents family income were 50001 and above.
4.2 Average annual major expenditure on Diabetes management
There were wide variations in the expenditure pattern and as such Median values are taken as Average expenditure per case.
Table 7: Expenditure reported by all patients (Rs.)
Item of expenditure N Median Minimum Maximum Quartile 1 Quartile 3
Consultation 191 720 60 3000 360 720
Routine Medicine expenses 188 1000 300 4500 800 1500
Treatment for complications 60 12000 250 550000 2500 20000
Hospitalization 91 2300 300 14000 1000 4000
Lab. Invest. 197 840 100 3840 720 1440
Transport 150 480 30 2400 216 720
Special Diet 35 15600 1800 33600 12000 21600
Total 200 4390 720 559460 2440 17435
On an average a patient with or without complications had spent Rs. 4390 per year with a range of Rs. 720 to 559460 per annum. 25% of the patients had spent up to Rs.2440 while another 25% over Rs.17435. There were wide variations in the expenditure pattern. The major portion of the expenditure was on Diet followed by treatment of complications.
Table 8: Expenditure reported by patients without complications (Rs)
Item of expenditure N Median Minimum Maximum Quartile 1 Quartile 3
Consultation 117 720 60 2400 360 720
Routine Medicine expenses 108 1000 300 2000 625 1000
Hospitalization 33 1800 300 7000 600 4000
Lab. Invest. 120 720 100 3360 600 1200
Transport 77 360 50 2400 200 720
Special Diet 8 16800 9600 25200 13500 19800
Total 120 2940 720 28360 1928 4890
On an average a patient without complications had spent Rs. 2940 per year with a range of Rs. 720 to 28360 per annum. 25% of the patients had spent up to Rs.1928 while another 25% over Rs.4960. There were wide variations in the expenditure pattern. Major portion of the expenditure was on Diet followed by treatment of complications
Table 9: Expenditure reported by patients with complications (Rs)
Item of expenditure N Median Minimum Maximum Quartile 1 Quartile 3
Consultation 74 720 100 3000 360 720
Routine Medicine expenses 80 1350 400 4500 1000 2500
Treatment for complications 60 12000 250 550000 2500 20000
Hospitalization 58 2500 600 14000 1400 4500
Lab. Invest. 77 1440 120 3840 840 1920
Transport 73 480 30 2000 270 720
Special Diet 27 14400 1800 33600 12000 24000
Total 80 19380 1040 559460 5540 35740
There were 80 (40%) of cases who had complications in the sample. On an average a patient with complications had spent Rs.19380 per year with a range of Rs.1040 to Rs. 559460 per annum. 25% of the patients had spent up to Rs.5540 while another 25% over Rs.35740. There were wide variations in the expenditure pattern. Major portion of the expenditure was on special Diet followed by hospitalization.
Table 10: Median total expenditure according to family annual income (Rs)
Income up to Rs 20000 N= 113 4100 Z =2.092
P= 0.036
Income above Rs 20000 N= 25 17320
Patients in lower income group had spent Rs.4100 as compared to Rs.17320 in higher income group who constituted about 12.5 % of the patients.
Table 11: Median total expenditure according to duration of disease (Rs)
Duration up to 10 years N=147 3920.00 Z = 4.811
P= 0.000
Duration above 10 years N= 53 3230.0
Patients with less than 10 years duration of disease had spent Rs. 3920 as compared to Rs. 3230 by patients with over 10 years of duration of disease who constituted about 27% of cases.
DISCUSSION
The present study was conducted to assess expenditure on health care incurred by diabetes patients attending a diabetes centre. A Descriptive cross sectional research design was followed in this study and primary data was collected from diabetic subjects through structured pre tested questionnaire by interview method from respected hospital.The expenditure elicited in the present sample is on patients attending a diabetic care hospital and not from the community. The study has elicited only the direct cost and not on indirect costs like loss of wages of self and attendants, cost on sociological and psychological implications etc. The information elicited may have recall lapses as past one year information was gathered. However it is bound to through sufficient light on the expenditure pattern of diabetic cases.The present study shows that, patients with or without complications had spent on an average Rs.4390 in a year. This expenditure is mostly contributed towards treatment for complications and associated diet modifications. However 25% of the patients spend only up to Rs 2440 in a year.On comparison of the expenditure incurred by patients with complications and without complications, patients with complications spend Rs 19380 as compared to Rs.2940 without complications. This indicates that complications increase the expenditure by nearly 6 times. Major portion of this extra expenditure is towards treatment of complications through hospitalizations and diet management. As such it is imperative to advice the patients on various aspects of controlling complications. Studies at Chennai have also indicated that total median expenditure on health care of diabetic patients was Rs 10,000 in urban and Rs 6,260 in rural subjects. Treatment costs increased with duration of diabetes, presence of complications, hospitalization, surgery, insulin therapy, and urban setting. Money spent on DM Investigations, Physicians fees and Medicine Expenditure on Hospitalization constitute around Rs.11675 for inpatient care and Rs.3050 for outpatient care.6In another study conducted by Ramachandran had shown that, on an average diabetic patients spend Rs.4,500 for each patient per year. A recent analysis has shown a further increase in the expenditure to an average of Rs.10,000/- per annum in the urban areas and Rs.6,260/- per annum in the rural areas. The average annual expenditure of those who attend the specialty centre is quite high averaging from Rs.3,310 to Rs.13,880 in patients who require surgical care. The expenditure increases if the patients are hospitalized and further rise will be incurred if they need any surgery as indicated by the results of this study.5 A study conducted by Bjork et al reported that, on an average diabetic patient spend Rs.7189 per annum, out of which cost of drug treatment and disease monitoring tests and checkups was 4724 rupees and hospitalisation cost was Rs. 2435 for diabetes patients.7A study of the Direct costs incurred by Type-2 Diabetes Mellitus, patients for their treatment at a large tertiary care hospital in Karnataka shows that the median annual direct medical costs for patients with type 2 diabetes mellitus without complication, was Rs. 14,507 per patients. Analysis of the expenditure incurred by 150 patients in the study population showed that 49 percent of their annual expenditure was on drugs and about 21 percent on Hospitalization. The average length of stay in hospital was 10 days and the average expense incurred by the patient, while admitted was Rs. 871.85 per day. 75 percent of the patients in this study group were on oral anti-diabetic drugs. Only 23 percent required hospitalization during the study period, while 63 percent of those being treated with Insulin required hospitalization.8 All the expenditure incurred for the direct cost was met out-of-pocket by the patients. Diabetes being a life-long disorder is an expensive ailment for a very large proportion of subjects in developing societies. The money spent is either from the family’s financial resources or in the Indian context the financial burden is often shared by relatives of the patients. As such a high expenditure is big a financial burden for the diabetic patients and is big loss to the National exchequer. The present study’s result on expenditure of patient treating with complication was more than other, and this was because they were treating their complication which has been grown to chronic stages and for long time of hospitalization. This study has produced some important key findings related to the economics of diabetes that may contribute to better healthcare planning. It indicates how much family is spending on diabetes care, which can then be weighed against the cost of implementing prevention programs. Once the diabetes develops then it needs to be controlled to avert the co-morbidities and complications, which can again cause significant cost. Secondly, this study has recognized the cost of diabetes care in relation to different socio-demographic and clinical characteristics. The overwhelming cost of diabetes threatens to stunt economic growth and undermine the standard of living. Thirdly, it identified the diverse components of cost and the magnitude of the contribution of each component. In some items costs (consultation and laboratory investigations) were subsidized, hence a level of subsidy was calculated using approximate average for consultation and laboratory investigations services.The total cost in this study cannot be compared with previous studies done in developed countries because of the methodological differences and vast differences in economic/social set ups between developing and developed countries. On the other hand, studies from developing countries are limited and varied widely in the methodology used to estimate.
CONCLUSION
The present study suggest strategies that could improve access to regular diabetes care, in terms of expenditure related Diabetes and its complication. Firstly, this study showed that it is an expensive illness to treat, although the pattern of costs was quite different from that of developed ones. There is a need to increase awareness of these facts among all health professionals as well as diabetes patients involved in the care of diabetes in developing countries, as well as health policy makers. This work also makes it clearly evident that the largest share of costs was being borne by patients and their families. Any efforts at cost reduction should, therefore, have the family as its focus, and relieving the family of this financial burden needs to be prioritized. Diabetes is a life-long disorder is an expensive ailment for a very large proportion of subjects in developing countries as well as developed countries. The money spent for diabetic treatment is from the family’s financial resources in the Indian context. The financial burden is often shared by relatives of the patients. As such a high expenditure is big a financial burden for the diabetic patients and is big loss to the National exchequer.
Despite the limitations of the present study it may be concluded that a majority of the diabetes patients spend a significant proportion of their family income on diabetes related expenditure. The cost is higher for subjects with longer duration since diagnosis, those with higher income, and those with complication of diabetes.
Conflict of Interest: The authors declare that there is no conflict of interest regarding the publication of this study.
Funding Statement: No external funding was received for this study.
Acknowledgements: The authors would like to express sincere gratitude to the management and staff of St. Martha’s Hospital for their support during the study. The authors are also thankful to all diabetic patients who participated in the research.
Author Contributions: Champak Kumar Singh conceptualized the study and supervised the research process. Sanjeev Kumar contributed to data collection and coordination. Rama Devi Pahari Gyawali, Dr. Ram Bahadur Shrestha, and Shirjana Shrestha contributed to methodology development and manuscript review. Hemank KC assisted in data analysis, manuscript preparation, and final editing. All authors reviewed and approved the final manuscript.
REFERENCES
1. Kumar Sampath K.P, Bhowmik Debjit, Srivastava Shweta, Paswan Shravan, Dutta Amit sankar, Diabetes Epidemic in India-- A Comprehensive Review of Clinical Features, Management and Remedies, 2012.Vol. 1 No. 2,17
2. El-Hazm Mohsen A.F. A Study of Diabetes Mellitus in Saudis Project No. AT- MW-2010.
3. Shaw,R.A. Sicree, P.Z. Zimment, Global estimates of the prevalence of diabetes for 2110 and 2030, diabetes Res. Clin.Pract.87(1)(2010) 4-14. https://doi.org/10.1016/j.diabres.2009.10.007 PMid:19896746
4. Economist Intelligence Unit,The silent epidemic, An economic study of diabetes in developed and developing countries, June 2007
5. Mohan V, Shantirani S, Deepa R, Premalatha G, Sastry NG, Saroja R. Intra-urban differences in the prevalence of the metabolic syndrome in southern India - the Chennai Urban Population Study. Diabetic Medicine 2001; 18:280-287. PMid:11437858 https://doi.org/10.1046/j.1464-5491.2001.00421.x
6. Ramachandran A, Snehalatha C, Kapur A,Vijay V, Mohan V, Das AK, Rao PV, Yajnik CS, Prasanna Kumar KM, Jyotsna D, the Diabetes Epidemiology Study Group in India (DESI): Hig
Available online on 15.06.2026 at http://jddtonline.info
Journal of Drug Delivery and Therapeutics
Open Access to Pharmaceutical and Medical Research
Copyright © 2026 The Author(s): This is an open-access article distributed under the terms of the CC BY-NC 4.0 which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original author and source are credited
Open Access Full Text Article Research Article
Qualitative phytochemical screening and in vitro anti-inflammatory activities of Raphionacme brownii Scott-Elliot (Apocynaceae)
Ngounbe Rilengar Léon 1, Guedeungbe Zoufane 1, Ambera Halsouakar 1 Brahim Boy Otchom 2
1 Faculty of Human Health Sciences, Laboratory of Research, Diagnostics and Scientific Expertise, Unit of Toxicology and Pharmacology. University of N'Djamena.
2 Toumaï University, N'Djamena.
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Article Info: _______________________________________________ Article History: Received 22 March 2026 Reviewed 27 April 2026 Accepted 23 May 2026 Published 15 June 2026 _______________________________________________ Cite this article as: For Correspondence: |
Abstract _______________________________________________________________________________________________________________ Our study involved a qualitative phytochemical analysis and an evaluation of the anti-inflammatory activities of Raphionacme brownii tubers . To achieve these objectives, we employed several methods. Secondary metabolites were analyzed qualitatively. Anti-inflammatory activities were tested by inhibition of albumin denaturation, an antihemolytic assay, and inhibition of proteinase and lipoxygenase enzymes. Our results showed that the qualitative analysis revealed the presence of polyphenols, flavonoids, saponins, tannins, alkaloids, terpenoids, and sugars. The strongest capacity of the plant to inhibit albumin denaturation was observed in the aqueous extract (78.24 ± 0.17 µg/ml). The aqueous extract (3.16 ± 0.02 µg/ml) also exhibited rapid inhibition of proteinase. The aqueous extract (2.44 ± 0.016 µg/ml) inhibited lipoxygenase more rapidly than diclofenac. The capacity of R. brownii tubers to inhibit heat-induced hemolysis was higher in the methanol extract (3.35 ± 0.005 µg/ml). However, the different extracts showed rapid but weak anti-inflammatory activity compared to diclofenac. The richness in bioactive compounds and the anti-inflammatory activity could justify the traditional use of Raphionacme brownii against cardiovascular diseases. Keywords: Raphionacme brownii , phytochemical screening, anti-inflammatory. |
INTRODUCTION
Traditional medicine based on the use of medicinal plants to treat numerous diseases, especially metabolic diseases, has been steadily increasing in recent years. Traditional medicine practices vary greatly from country to country and region to region. They are influenced by well-known factors: culture, history, and personal philosophies. 1
According to the WHO, nearly 80% of the population in developing countries in the African region uses traditional medicine. The sustainable use of natural resources is a growing concern in many countries. Therefore, since its General Assembly, the WHO has recommended evaluating the safety and efficacy of herbal medicines with a view to standardizing their use and integrating them into conventional healthcare systems. 2
In Chad, a law was developed and adopted to promote the practice of traditional medicine while encouraging scientific research to highlight the therapeutic effects of medicinal plants.
Epidemiological studies have demonstrated that dietary habits based on high fruit and vegetable consumption have been associated with a longer life expectancy and a significant decrease in the incidence and prevalence of several chronic inflammatory diseases, such as cardiovascular diseases. This beneficial activity has been linked to polyphenols.
It is with this in mind that we focused on evaluating the anti-inflammatory activities of the tubers of Raphionacme brownii (Apocynaceae) Scott-Elliot. Raphionacme brownii is a perennial herbaceous plant that grows from a tuberous rhizome to a height of 30 cm or more.4 It is an African genus widely distributed across the continent, with the highest concentration of species in Southern Africa, except for the single species Raphionacme arabia, which is found on the Arabian Peninsula. Raphionacme brownii is a medicinal plant used as a diuretic by the Malinke people of Senegal.5 The tubers of Raphionacme brownii (Apocyaceae) Scott-Elliot are used in traditional medicine in Benin to treat cardiovascular diseases through maceration.6
However, studies on the anti-inflammatory activities of Raphionacme brownii tubers are not carried out in Chad, nor are the solvents that can allow good extraction of secondary metabolites.
MATERIALS AND METHODS
Study framework
This work was carried out at the Laboratory of Biochemistry and Biological Chemistry of the Faculty of Sciences at the University of Maroua in Cameroon.
Plant material
The tubers of Raphionacme brownii (Apocynaceae) Scott constituted the plant material for this work. The plant was harvested in May 2024 in Doba, the capital of the Pende Department, in the Logone Oriental Province of southern Chad.
Figure 1: Geographical location of the Logone Oriental region. Local Development Plan (PDL) of the Doba Rural Canton 7.
The plant was identified at the IRED (Institute for Livestock Research and Development). The tubers were washed, peeled, cut into small pieces, and dried for 14 days at room temperature in the shade. They were then ground using a VICTORIA brand manual mill, and the resulting powder was used for the extraction.
Extraction
The method described by Dellaoui (2021) was used for extraction 8. Specifically, 100 g of Raphionacme brownii tuber powder was placed in a glass flask containing two liters of hot distilled water (100°C). The mixture was cooled for 4 hours. It was then filtered using Wattman No. 3 filter paper. The resulting filtrates were freeze-dried in a Binder oven at 45°C for 48 hours. The extract was weighed and stored for testing. The yield was calculated using the following formula:
Yield (%) = (amount of plant extract) / (amount of dry matter) * 100
Phytochemical studies
For qualitative phytochemical screening, we used several methods to highlight alkaloids, free quinones and tannins 9, flavonoids 10 , glycosides and saponins 11 , terpenoids 12 and phenols 13 .
Evaluation of anti-inflammatory activity in vitro
The method described by Ruiz-Ruiz et al. (2017), with slight modifications, was used to determine the in vitro anti-inflammatory activity of different extracts from the tubers of Raphionacme brownii . The methods used were albumin denaturation inhibition, proteinase inhibition, heat-induced hemolysis inhibition, and lipoxygenase inhibition. The extract of each tuber solvent was diluted in dimethyl sulfoxide (DMSO 500 mg/ml) as a negative control and diclofenac (500 mg/mL, Sigma-Aldrich, Singapore), an anti-inflammatory agent, as a positive control.
Statistical analyses
The results presented represent the mean ± ESM. Means were calculated using Microsoft Office Excel. Means were compared using the Student's t-test and one-way ANOVA test in Origin Graph Pad Prism software (Version 8.0.1.244). A p-value < 0.05 was considered statistically significant.
RESULTS
PHYTOCHEMICAL SCREENING
Yield
Table I: Yield of different extracts of R. brownii
Metabolites Powder Mass (mg ) Extract Mass (mg) Yield %
EMeOH 2000 894 4.47
EAcEt 2000 412 2.06
Eaq 2000 1450 7.25
Ehex 2000 392 1.96
EMeOH: Methanolic Extract, EAcEt: Ethyl Acetate Extract, Eaq: Aqueous Extract, Ehex: Hexane Extract
Table I shows the gross yield of 2000 mg of Raphionacme brownii Scott-Elliot tubers in the different extracts. This result indicates that the aqueous extract had the highest yield (7.25%) compared to the other extracts, followed by the methanolic extract (4.47%). The hexane extract had the lowest yield (1.96%), after the ethane acetate extract (2.06%).
Qualitative phytochemical screening
Table II presents the qualitative screening of Raphionacme brownii Scott-Elliot tubers in different solvents. This result reveals an abundance of total polyphenols in the methanolic extract, with moderate presence in the other extracts. Flavonoids, tannins, saponins, alkaloids, terpenoids, and sugars are also present. Quinones are observed in all solvents. However, sugars are absent in the hexane extract.
Table II : Phytochemical constituents of R. brownii Scott-Elliot tubers
Metabolites: alkaloids, phenols, quinone, flavonoids, tannins, terpenoids, sugars
EMeOH ++ +++ + ++ ++ ++ ++
EAcEt ++ + + + ++ + +
Aeacus + ++ + + + ++ ++
Ehex + ++ + + + ++ -
-: negative reaction, +: positive, ++: moderate presence, +++: abundance
EMeOH: Methanolic Extract, EAcEt: Ethyl Acetate Extract, Eaq: Aqueous Extract, Ehex: Hexane Extract
Anti-Inflammatory Activity
Albumin denaturation test
Figure 1 shows the inhibitory activity of R. brownii extracts against serum protein denaturation. The results reveal that the plant exhibited the strongest capacity to inhibit albumin denaturation in the aqueous extract (78.24 ± 0.17 µg/ml), followed by the methanolic extract (75.88 ± 0.50 µg/ml) and the hexane extract (75.18 ± 0.1 µg/ml). The ethyl acetate extract (73.29 ± 0.50 µg/ml) showed lower inhibitory activity than the other extracts.
Figure 1 : Graph of the test for albumin denaturation by R. brownii tubers.
EMeOH: Methanolic Extract, EAcEt: Ethyl Acetate Extract, Eaq: Aqueous Extract, Ehex: Hexane Extract
Proteinase inhibition
Regarding the inhibition of plasma enzymes involved in the degradation of membrane macromolecules and lipid peroxidation generating free radicals, the results are shown in Figure 2. These results indicate that diclofenac (3.34 ± 0.10 µg/ml) inhibited proteinase activity more than the other extracts. However, the aqueous extract (3.16 ± 0.02 µg/ml) showed a significantly greater inhibition of proteinase than the other extracts at 30 minutes of the test.
Figure 2 : Graph of the protease inhibition test by R. brownii tubers.
EMeOH: Methanolic Extract, EAcEt: Ethyl Acetate Extract, Eaq: Aqueous Extract, Ehex: Hexane Extract.
Antilipoxygenase Test
The inhibition of lipoxygenase by extracts of R. brownii tubers is shown in Figure 3. This demonstrates that diclofenac (the reference drug) conferred superior inhibitory activity (2.50 ± 0.011 µg/ml) to the different extracts at 40 minutes of the test. However, at 20 minutes of the test, the aqueous extract significantly inhibited lipoxygenase (2.44 ± 0.016 µg/ml).
Figure 3 : Graph of the lipoxygenase inhibition test by R. brownii tubers.
EMeOH: Methanolic Extract, EAcEt: Ethyl Acetate Extract, Eaq: Aqueous Extract, Ehex: Hexane Extract.
Anti-hemolysis test
Figure 4 shows that the ability of R. brownii tubers to inhibit heat-induced hemolysis is higher in the methanol extract (3.35±0.005 µg/ml) compared to Diclofenac (3.27±0.005 µg/ml), followed by the aqueous extract (2.67±0.015 µg/ml) at 20 minutes time.
Figure 4 : Graph of the anti-hemolysis activity test by R. brownii tubers .
EMeOH: Methanolic Extract, EAcEt: Ethyl Acetate Extract, Eaq: Aqueous Extract, Ehex: Hexane Extract
Table III: Variation of anti-inflammatory activity in vitro.
Extracts Anti-denaturation Anti-hemolysis Anti-proteinase Antilipoxygenase
albumin
Water 78.24±0. 17 2.67±0.01 5 3.16±0.02 2.44±0.016
EMeOH 75.88±0.50 3.35±0.005 2.49±0.10 2.32±0.016
EAcEt 73.29±0.50 1.99±0.01 3.11±0.12 2.052±0.011
Ehex 75.18±0.1 2.08±0.006 3.03±0.03 2.08±0.016
The values are the means ± standard deviation of 2 replications per species. Means are significant at the P < 0.05 level.
DISCUSSION
The determination of the yield of R. brownii tubers in the different extracts showed that the use of water as a solvent resulted in a higher extraction percentage (7.25%) than the other solvents, followed by the methanol extract (4.47%) and the ethanol extract (2.06%). This result confirms that water, methanol, and ethanol provide the best yield for medicinal plants .15The combined use of water and an organic solvent, particularly methanol and
pure ethanol, are the best solvents to use for the extraction of secondary metabolites to obtain a better yield, thus facilitating the extraction of chemicals soluble in water and/or the organic solvent .16 The low yield observed in the different extracts could be explained by the fact that the drying time strongly influences the yield percentage .17 Given that R. brownii is a tuber with a high water content 18, it took a long time to dry it. Also, the solvent volume-to-ground mass ratio, the ethanol percentage of the hydro-ethanolic solvent, the particle size of the ground material, and the maceration time are factors that influence the yield 19 .
Qualitative phytochemical screening of R. brownii tubers revealed the presence of total polyphenols, flavonoids, tannins, saponins, alkaloids, terpenoids, and sugars. These results are similar to studies conducted on Raphionacme vignei in Senegal, which found the same secondary metabolites.20 The presence of these chemical compounds in R. brownii tubers could explain their antioxidant, anti-inflammatory,21 and diuretic18 activities . Plants with antioxidant and anti-inflammatory activity play a crucial role in preventing atherosclerosis.22 The presence of sugars in the three extracts would explain the consumption of this tuber during periods of famine in southern Chad.
Regarding anti-inflammatory activity, four methods were used to test the anti-inflammatory effect of R. brownii tubers . Indeed, the different extracts of R. brownii tubers exhibited lower albumin denaturation inhibition activity than diclofenac, a reference non-steroidal anti-inflammatory drug. However, the aqueous extract (78.24 ± 0.17) inhibited albumin denaturation better than the other extracts. This result is higher than that of Kakesse et al., who found an inhibition of 65.32 ± 1.02 with the aqueous extract.23 This inhibition of albumin denaturation is thought to be due to the alkaloid content, which has activity in immune responses related to the essential type 1 interferon pathway and to canonical pathways and key mediators of inflammation .24 The aqueous extract significantly inhibited lipoxygenase (2.44 ± 0.016 µg/ml) at 20 minutes of the test, better than diclofenac. Since lipoxygenases are widespread enzymes that catalyze the oxidation of polyunsaturated fatty acids, they play an important role in stimulating inflammatory responses.25 The presence of polyphenols in the tubers is thought to be responsible for the inhibition of lipoxygenase-dependent linoleic acid peroxidation.26 The inhibitory activity of lipoxygenase may also be due to the difference in monoterpene content between the different extracts.27 The inhibition of hemolysis is thought to be due to the presence of polyphenols, tannins, and flavonoids in the tubers of R. brownii .28 The antihemolytic effect of R. brownii tubers may also be due to the inhibition of lipid peroxidation by the insertion of flavonoids into the erythrocyte cell membrane.29 This result does not corroborate the work of Kakesse et al. (2022), who found proteinase inhibition in the aqueous extract at 62.32 ± 1.02 µg/ml versus 31.56 ± 0.02 µg/ml .23 The proteinase inhibition is thought to be due to the presence of glucosides in R. brownii tubers.30
Conflicts of Interest: The authors declare that there is no conflict of interest for this work.
Contributions from the Authors: NRL searched for and collected the sample in the field, assisted with laboratory handling, and drafted the initial manuscript. GZ handled the laboratory handling techniques. AH contributed to data processing. BBO coordinated the entire project.
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