|Year : 2017 | Volume
| Issue : 1 | Page : 9-12
The influence of yoga therapy in adults with type 2 diabetes mellitus: A single-center study
Mallikarjun V Jali1, Rajendra B Deginal2, Shridhar C Ghagane3, Sujata M Jali4, Ambika A Shitole5
1 Chief of Diabetes Centre & Alternative Medicine, Medical Director & CEO, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre; Professor of Diabetology (Medicine), KLE Academy of Higher Education and Research (KLE UNIVERSITY); President of National Diabetes Foundation, Belagavi (Regd NGO), National Diabetes Foundation Society, Belagavi, Karnataka, India
2 Chief of Yoga, Naturopathy and Guided Meditation Centre, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, Karnataka, India
3 Research Associate, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, Karnataka, India
4 Pediatric Diabetes-in-charge, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre; Professor & Head Pediatrics, KLE Academy of Higher Education and Research (KLE UNIVERSITY), Belagavi, Karnataka, India
5 Consultant in Yoga & Ayurveda, KLES Dr. Prabhakar Kore Hospital & Medical Research Centre, Belagavi, Karnataka, India
|Date of Web Publication||16-Jun-2017|
Mallikarjun V Jali
Medical Director & CEO, Chief Diabetologist & Professor of Diabetology, KLES Dr Prabhakar Kore Hospital & Medical Research Centre, KLE Academy of Higher Education and Research, (KLE University), Belagavi - 590 010, Karnataka
Aims: The aim of this study is to investigate the effect of yoga therapy and its influence on blood glucose parameters in patients with type 2 diabetes mellitus.
Materials and Method: This was a prospective study conducted at Diabetes Centre, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, India, from January 2016 to December 2016. A total of 1000 type 2 diabetic patients were enrolled in the study with informed consent. We assessed the patients for pre- and post-assessment blood parameters after a period of 12 months for fasting blood sugar (FBS), postprandial blood sugar (PPBS) levels, glycosylated hemoglobin (HbA1c), cholesterol, and triglycerides. A qualitative in-depth interview of the participants and therapist was conducted at baseline, end of 6 months, and end of 12 months.
Statistical Analysis: The observations were recorded and analyzed for significance using SPSS version 20.0 statistical tool.
Results: During pre-assessment, the results revealed an increase in the level of FBS (181.75 ± 71.47), PPBS (262.04 ± 97.23), HbA1c (10.30 ± 5.3), cholesterol (180.13 ± 47.1), and triglycerides (159.77 ± 110.39). However, the participants who completed the yoga therapy had significantly lower FBS (133.01 ± 46.98) (p < 0.0001), PPBS (187.67 ± 68.61) (p < 0.0001), and HbA1c (7.89 ± 1.6) (p < 0.0001) at the end of the 12th month. There was statistically significant positive correlation observed in yoga group as compared to the control group during postassessment blood parameters.
Conclusions: The results of the present study demonstrated that yoga is effective in reducing the blood glucose levels in patients with type 2 diabetes mellitus. Our study also showed positive benefits of yoga in the management of diabetes with real impact on glycemic control and lipid profile.
Keywords: Glycosylated hemoglobin, type 2 diabetes mellitus, yoga
|How to cite this article:|
Jali MV, Deginal RB, Ghagane SC, Jali SM, Shitole AA. The influence of yoga therapy in adults with type 2 diabetes mellitus: A single-center study. Yoga Mimamsa 2017;49:9-12
|How to cite this URL:|
Jali MV, Deginal RB, Ghagane SC, Jali SM, Shitole AA. The influence of yoga therapy in adults with type 2 diabetes mellitus: A single-center study. Yoga Mimamsa [serial online] 2017 [cited 2017 Dec 10];49:9-12. Available from: http://www.ym-kdham.in/text.asp?2017/49/1/9/208280
| Introduction|| |
Diabetes is a serious ailment affecting humankind, it was first recognized by the Egyptians in the manuscripts of Ebers papyrus dating from 1550 BC, was found in a grave in Thebes region south of Egypt in 1862, and named after the Egyptologist Geary Ebers. Its pathogenesis has been known by physicians for nearly 3500 years in Ancient Egypt (Ebbell, 1937). Diabetes is a chronic metabolic disease that occurs either when pancreas does not produce enough insulin, or when the body cannot effectively use the insulin it produces (Shaw, Sicree, & Zimmet, 2010). More than 400 million people live with diabetes having increased blood glucose level which may lead to severe damage to the heart, blood vessels, eyes, kidneys, and nerves (Joint WHO, FAO Expert Consultation, 2003). Type 2 diabetes is most common in adults and usually occurs when the body develops resistance to insulin or fails to produce sufficient insulin. In the past three decades, the prevalence of type 2 diabetes has increased dramatically in countries of all income levels (WHO, 2017). Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself. For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025 (American Diabetes Association, 2010).
Yoga is primarily a philosophical science, born out of human's need to fathom the meaning of existence. The origins of yoga are a matter of debate as there is no consensus on its chronology or precise background other than that yoga developed in Ancient India (Samuel, 2008). Suggested sources are the Indus Valley Civilization (3300–1900 BCE) and pre-Vedic Eastern states of India, the Vedic period (1500–500 BCE), and the Sramana movement (Georg, 2001). Yoga has been studied and is increasingly recommended to promote relaxation and reduce stress and some medical conditions such as premenstrual syndrome, stress reduction, and improving the diseases caused due to sedentary lifestyle (Douglas & Rebecca, 2006; Ospina et al., 2008).
Yoga is an ancient science and rich heritage of our culture (Melkote, 1975). Several studies have been conducted in our country to evaluate the management of diabetes in the patients practicing yoga on a regular basis (Divakar, Bhatt, & Mulla, 1978). Most of these studies were done on a small number of patients, over short periods of time and just relied on blood sugar estimations to assess the results (Shambekar & Kate, 1980). These studies also included combined Pranayama and several other yogic practices making it difficult to interpret their individual contributions (Sahay, 2007). Hence, we have made an attempt to carry out an extensive well-designed study to assess the effect of yoga in the treatment of diabetes exclusively.
| Materials and Method|| |
The study was conducted at the KLES Diabetes Centre of Dr. Prabhakar Kore Hospital and Medical Research Centre, India, from January 2016 to December 2016. The study involved 1000 type 2 diabetic patients and written informed consent was obtained at the outset. The participants of experimental group were given yoga therapy along with regular walking. Out of 1000 diabetic patients, 771 patients were enrolled for yoga and walking whereas 74 patients were assigned to control group (no yoga or walking). Sociodemographic data, i.e., age, occupation, residential address, and socioeconomic status, were recorded. Basic clinical characteristics of the study participants were measured at the baseline and after a period of 12 months of yoga therapy. Biochemical variables, i.e., fasting blood glucose, postprandial blood glucose, glycosylated hemoglobin (HbA1C), cholesterol, and triglycerides were included in the study. A comprehensive qualitative counseling of the study participants and therapists were conducted at baseline, 6 months, and 12 months.
Data were analyzed using SPSS version 20.0, IBM SPSS Statistics software Inc., (Armonk, NY: IBM Corp.). Mean of each of these parameters and standard deviation (SD) along with a change in these parameters were calculated for each group at baseline and 6 months. All the data were expressed till two decimal places and presented as ± SD unless stated otherwise. Unpaired t-test was conducted to check the level of significance of p-value between individual parameters. The significance level of 5% has considered for reporting the results.
| Results|| |
The present study involved 1000 type 2 diabetic patients; 645 (64.5%) patients were males and 355 (35.5%) were females. Most of the patients (male - 59.53%) and (female - 40.46%) were 51–60 years of age. The age-specific rate of male and female type 2 diabetics is presented in [Table 1]. Preassessment blood parameters analysis revealed that fasting blood glucose was 181.75 ± 71.47 mg/dl, postprandial glucose 262.04 ± 97.23 mg/dl, body mass index (BMI) 28.44 ± 77.86 kg/m 2, HbA1C 10.30 ± 5.3%, cholesterol 180.13 ± 47.1 mg/dl, and triglycerides 159.77 ± 110.39 mg/dl. There was a significant association between the blood glucose parameters of pre- and post-assessment patients receiving yoga therapy (p< 0.0001). However, no statistical significance was observed in BMI and high-density lipoproteins examined in both pre- and post-assessment patients [Table 2].
|Table 2: Comparison of mean±standard deviation values of blood parameters of yoga type 2 diabetes mellitus group|
Click here to view
51.1% (511) patients including both male and female had family history of type 2 diabetes. Addiction to tobacco, smoking, and alcohol habits was not analyzed from the clinical point of view [Table 3]. Sociodemographic features of patients are presented in [Table 4], which includes occupational status such as service people, business, farmers, homemakers, retired, and others. [Table 5] illustrates location of patients whereas socioeconomic status is presented in [Table 6]. During the preassessment, 96.2% (962) patients did not perform regular yoga, and 47.3 % (473) of the patients did not exercise regularly. The postassessment results showed that 77.1% (771) patients performed yoga regularly and 74.8% did daily walks [Table 7].
|Table 7: Allocation of patients on yoga therapy pre- and post-assessment|
Click here to view
| Discussion|| |
The present study validates the favorable role of yoga that assumes relevance today more than ever (Melkote, 1975). Yogic movements can either be of high or low intensity, depending on the clinical condition of patients (Bhavanani, 2011). Practiced in its entirety, it improves one's physical health, enhances intelligence and mental endurance, and creates a sense of well-being (Sahay, 2007). Yoga comprises asanas, pranayama, and meditation. Yoga therapy aids in improving blood glucose parameters, cholesterol, physical and psychological aspects and quality of life in patients with diabetes (Pandey, Arya, Kumar, & Yadav, 2017). A young active individual can be made to practice very intense asanas in a dynamic manner, which will increase the cellular activity of the muscle (Melkote, 1975). Yoga asanas are beneficial in the treatment of diabetes because of the different postures performed in the course of asanas; which leads to a gradual increase in the supply of blood and oxygen resulting in improved efficiency and functioning of the body (Pandey et al., 2017). However, stretching of various glands during asanas results in greater efficiency of the endocrine system because asanas have a direct influence on pancreatic secretion by rejuvenating pancreatic cell (Angadi et al., 2017).
Yoga leads to enhancement of sensitivity to insulin and results in a reduction of insulin resistance. Resistance to insulin is the core abnormality in type 2 diabetes and heads the progress of overt diabetes by several years. The decrease in free fatty acid levels also reduces the lipotoxicity, which has now been shown to have a significant effect on beta cell function (Angadi et al., 2017). Therefore, it is rational to assume that the beneficial effect of yogic asanas on the insulin kinetics and the lipid metabolism prevents the beta-cell exhaustion and the burgeoning of a beta-cell secretory defect, thereby preventing type 2 diabetes (Sahay, 1994).
Our study reveals the importance of practicing yoga on a scientific basis and observations made during the survey period. Fasting and postprandial blood glucose levels came down significantly in diabetic patients group on the practice of yoga and exercise regularly, which is in concordance with the previous studies (Sahay, 2007). Good glycemic status can be maintained for prolonged periods. There was a downfall observed in free fatty acids suggesting an enhanced insulin sensitivity and decrease in insulin resistance, with a possible protective effect on beta-cell function (Fadnis, Malhosia, Pandey, & Singh, 2009). There are beneficial outcomes on the comorbid conditions such as cholesterol, hypertension, and dyslipidemia. Practicing yoga is recommended for all age groups and can be performed in all seasons.
| Conclusion|| |
The findings of our study presented suggest that yogic practices may promote significant improvements in several indices of primary importance in the management of type 2 diabetes, including glycemic control, lipid levels, and body composition. However, additional high-quality investigations are required to confirm and further elucidate the potential therapeutic benefits of standardized yoga programs in populations with type 2 diabetes in this part of the country.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Diabetes Association. (2010). Diagnosis and classification of diabetes mellitus. Diabetes Care
(Suppl 1), S62-S69.
Angadi, P., Jagannathan, A., Thulasi, A., Kumar, V., Umamaheshwar, K., & Raghuram, N. (2017). Adherence to yoga and its resultant effects on blood glucose in type 2 diabetes: A community-based follow-up study. International Journal of Yoga
Bhavanani, A. B. (2011). Understanding the science of yoga. International Yoga Scientific Journal SENSE
Divekar, M., M. Bhat, and A. Mulla. “Effect of yoga therapy in diabetes and obesity.” J Diab Assoc Ind 17 (1978): 75-8.
Ebbell, B. (1937). The Papyrus Ebers
(pp. 115). Copenhagen, Oxford: Oxford University Press.
Fadnis, M., Malhosia, A., Pandey, S. C., & Singh, S. M. (2009). Impact of oral hypoglycemic drugs and yoga on the non-insulin dependent diabetes mellitus patients. Journal of Environmental Research and Development, 3
Georg, F. (2001). The Yoga Tradition: Its History, Literature, Philosophy and Practice.
Arizona, USA: Hohm Press. [p. Kindle Locations 7299-7300].
Joint WHO, FAO Expert Consultation. (2003). Diet, nutrition and the prevention of chronic diseases. World Health Organization Technical Report Series
Melkote, G. S. (1975). The Science of Yoga versus Modern Medicine in Seminars on Yoga (pp. 190-202). New Delhi: CURI MHE.
Ospina, M. B., Bond, K., Karkhaneh, M., Buscemi, N., Dryden, D. M., & Barnes, V., … Shannahoff-Khalsa, D. (2008). Clinical trials of meditation practices in health care: Characteristics and quality. The Journal of Alternative and Complementary Medicine
Pandey, R. K., Arya, T. V., Kumar, A., & Yadav, A. (2017). Effects of 6 months yoga program on renal functions and quality of life in patients suffering from chronic kidney disease. International Journal of Yoga
Sahay, B. K. (1994). The Role of Yogic Practices in the Prevention of NIDDM in Abstracts of the 15th
International Diabetes Federation Congress at Kobe. (pp. 95). (159 – 167) Ed. Anil Kapur, Publ. Health Centre Care Communications, Bombay.
Sahay, B. K. (2007). Role of yoga in diabetes. The Journal of the Association of Physicians of India
Samuel, G. (2008). The Origins of Yoga and Tantra: Indic Religions to the Thirteenth Century
. New York: Cambridge University Press.
Shambekar, A. G., & Kate, S. K. (1980). Yogic exercise in the management of diabetes mellitus. Journal of the Diabetic Association of India
Shaw, J. E., Sicree, R. A., & Zimmet, P. Z. (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]