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Adherence to Yoga May Lower Blood Glucose In Type 2 Diabetes

Yoga proven to stimulate the organs to improve metabolic activities leading to efficient chemical transformations within a cell.

Diabetes is one of the most prevalent chronic diseases that cannot be cured completely. However, lifestyle modifications, including physical exercises, such as yoga, may help type 2 diabetes patients to lead a normal life. Yoga has proven to stimulate the organs to improve metabolic activities leading to efficient chemical transformations within a cell. Certain postures stimulate pancreas rejuvenation and its capacity to produce insulin, and studies have shown that yoga practice had led to short-term improvements in fasting glucose and cholesterol levels.

In a single group longitudinal study, conducted at Vivekananda Adarsha Sadhana Kendra (VASK) yoga center in Bangalore, the effect of adherence to yoga on blood glucose parameters was assessed in patients with T2DM. The study included 52 subjects with T2DM aged ≥40 years old who were adherent to yoga for the last 3 months without any major comorbid illnesses. Adherence to yoga was assessed over the 6-month period by daily attendance to the classes. Fasting blood sugar (FBS) and postprandial blood sugar (PPBS) levels were measured using the oral glucose tolerance test (OGTT) at baseline and at the end of  the 1st, 3rd, and 6th month. Also, HbA1c was measured at baseline and at the end of the 3rd and 6th month of the study. A standardized module was scientifically developed consisting of a 60-minute session daily either in the morning, afternoon, or in the evening based on participant convenience. Those with a minimum attendance of 50% adherence to the program were considered “Completers” and <50% were “Dropouts” over six months of the study period.

Qualitative data disclosed that most participants joined and completed the yoga program to help cure their diabetes. It consisted of pre-interview and interviews at the end of the 3rd and 6th months of the study to extract responses from participants regarding their expectations, understanding, reasons, and decisions to attend yoga. It revealed the number of participants that dropped out from the program due to health conditions, traveling plans and increased work at the office, along with extraction of detailed medication history and dietary patterns of the participants.

Quantitative assessments used the Statistical Package for Social Sciences (SPSS) version 10. Paired sample t-tests showed significant decrease in HbA1c at the end of the 3rd month (P = 0.01) compared to baseline and Mann-Whitney U-test showed a trend in lower FBS in completers compared to dropouts (P = 0.08) at the end of the 6th month. Bivariate correlation indicated that increased indulgence (r = 0.26, P = 0.07) and frequency (r = 0.36, P = 0.01) in physical activity correlated with increased adherence to the yoga sessions. Logistic regression predicted adherence based on FBS, HbA1c, stress, diet, and medication intake. FBS or HbA1c levels could not predict adherence, however, there was a trend towards those who dropped out having higher FBS, controlling for medication intake, stress levels and diet pattern (OR = 1.027, P = 0.07).

While the sample size was small and the statistical tests did not provide information about clinical significance, the qualitative results depicted that the majority of the subjects felt subjectively better and healthier after the yoga program. Moreover, over the 6-month period, there were variations in the FBS and PPBS parameters, but there was a clinically significant decline in HbA1c in the “Completers.” Other studies have shown that the participants who indulged in physical activities other than yoga for at least ~40 min once daily continued to have severe diabetes with HbA1c ≥8.0%. This could have been be due to insufficient duration and frequency of physical activities or the type of activities, but yoga as a mind-body intervention, involves fitness at physical, as well as mental level.

In conclusion, although adherence to yoga has an effect on the blood glucose parameters in type 2 diabetes, the effects are small and only observable over a long period of time. Therefore, strategies to motivate adherence to yoga with lifestyle modification including maximizing adherence to yoga should be the focus to experience any beneficial effects of yoga as an adjunct treatment to those on stable medications or as an alternative treatment for those who opt for nondrug treatments.

Practice Pearls:

  • Yoga has an important effect on the blood glucose parameters in diabetes.
  • Adherence to yoga over a long period of time with proper management of diabetes with ‘lifestyle modifications’ may lower HbA1c in type 2 diabetes patients.
  • This study is feasible only in a residential setting and not in a community setting due to multiple variables, including the medication intake, diet, and stress levels along with adherence to yoga.

 

References:

Angadi P, Jagannathan A, Thulasi A, Kumar V, Umamaheshwar K, and Raghuram N. Adherence to yoga and its resultant effects on blood glucose in Type 2 diabetes: A community-based follow-up study. Int J Yoga. 2017 Jan-Apr; 10(1): 29-36.

Sreedevi A, Gopalakrishnan UA, Karimassery Ramaiyer S, and Kamalamma L. A randomized controlled trial of the effect of yoga an dpeer support on glycaemic outcomes in women with type 2 diabetes mellitus: a feasibility study. 2017 Feb 7; 17(1):100.