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Effect of yoga on glycemia and lipid parameters in type-2 diabetes: a meta-analysis

Abstract

Purpose

Prior systematic reviews on yoga and diabetes have given conflicting results. They have been limited by inclusion of uncontrolled unblinded single group observational studies. No reviews are available which have used the Cochrane methodology and GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. This meta-analysis evaluated the efficacy of yoga on glycaemia and lipids in T2DM using the Cochrane methodology and GRADE approach.

Methods

Major repositories were searched to pick randomized controlled trials involving T2DM patients receiving yoga. Primary outcome was to evaluate changes in fasting plasma glucose (FPG) and glycated haemoglobin (HbA1c). Secondary outcomes were to evaluate changes in post-prandial plasma glucose (PPG), total cholesterol (TC), triglycerides, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Sub-group analysis involving people undergoing structured exercise regimen (SER) versus those undergoing standard diabetes care in controls was done.

Results

Data from 13 studies involving 1440 patients were analysed. Compared to controls, individuals doing yoga had significantly lower FPG [mean difference (MD) -17.22 mg/dl (95% CI: −26.19 – −8.26 mg/dl); p < 0.01; considerable heterogeneity (CH); low certainty of evidence (LCE)], PPG [MD -27.77 mg/dl (95% CI: −35.73 – −19.81 mg/dl); p < 0.01; low heterogeneity; moderate certainty of evidence (MCE)], TC [MD -19.48 mg/dl (95% CI: −31.97 – −6.99 mg/dl); p < 0.01; CH; LCE], triglycerides [MD -12.99 mg/dl (95% CI: −23.74 – −2.25 mg/dl); p < 0.01; CH; LCE], LDL-C [MD -11.71 mg/dl (95% CI: −17.49 – −5.93 mg/dl); p < 0.01; I2 = 69% CH; LCE] and significantly higher HDL-C [MD 4.58 mg/dl (95% CI: 3.98–5.18 mg/dl); p < 0.01; low heterogeneity; MCE]. On sub-group analysis, where yoga was compared to SER, FPG was significantly lower in yoga group.

Conclusion

Yoga improves glycaemia and lipid parameters in T2DM with additional benefits seen both in people doing/not doing structured exercise.

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References

  1. Dutta D, Ghosh S. Young-onset diabetes: an Indian perspective. Indian J Med Res. 2019;149:441–2.

    Article  Google Scholar 

  2. Dutta D, Mukhopadhyay S. Intervening at prediabetes stage is critical to controlling the diabetes epidemic among Asian Indians. Indian J Med Res. 2016;143:401–4.

    CAS  Article  Google Scholar 

  3. Gupta L, Khandelwal D, Lal PR, Gupta Y, Kalra S, Dutta D. Factors determining the success of therapeutic lifestyle interventions in diabetes - role of partner and family support. Eur Endocrinol. 2019;15:18–24.

    Article  Google Scholar 

  4. Raveendran AV, Deshpandae A, Joshi SR. Therapeutic role of yoga in type 2 diabetes. Endocrinol Metab (Seoul). 2018;33:307–17.

    Article  Google Scholar 

  5. Kiecolt-Glaser JK, Christian LM, Andridge R, Hwang BS, Malarkey WB, Belury MA, et al. Adiponectin, leptin, and yoga practice. Physiol Behav. 2012;107:809–13.

    CAS  Article  Google Scholar 

  6. Hagins M, States R, Selfe T, Innes K. Effectiveness of yoga for hypertension: systematic review and meta-analysis. Evid Based Complement Alternat Med. 2013;2013:1–13.7.

    Google Scholar 

  7. Raub JA. Psychophysiologic effects of hatha yoga on musculoskeletal andcardiopulmonary function: a literature review. J Alternat Complement Med. 2002;8:797–812.8.

    Article  Google Scholar 

  8. Campbell DE, Moore KA. Yoga as a preventative and treatment for depression,anxiety, and stress. Int J Yoga Ther. 2004;14:53–58.12 Yoga as a Preventative and Treatment for Depression, Anxiety, and Stress.

    Article  Google Scholar 

  9. Sharma M. Yoga as an alternative and complementary approach for stressmanagement: a systematic review. J Evid Based Complement Alternat Med. 2014;19:59–67.14.

    Article  Google Scholar 

  10. Higgins JP, Altman DG, Gotzsche PC, et al. Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  Google Scholar 

  11. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.

    Article  Google Scholar 

  12. Popli U, Subbe CP, Sunil K. Research letter-the role of yoga as a lifestyle modification in treatment of diabetes mellitus: results of a pilot study. Altern Ther Health Med. 2014;20:24–6.

    PubMed  Google Scholar 

  13. Hegde SV, Adhikari P, Kotian SM, Shastry R. Effects of Yoga Versus Sham Yoga on Oxidative Stress, Glycemic Status, and Anthropometry in Type 2 Diabetes Mellitus: A Single-Blinded Randomized Pilot Study. Int J Yoga Therap. 2019. https://doi.org/10.17761/D-18-2020-00018.

  14. Skoro-Kondza L, Tai SS, Gadelrab R, Drincevic D, Greenhalgh T. Community based yoga classes for type 2 diabetes: an exploratory randomised controlled trial. BMC Health Serv Res. 2009;9:33. https://doi.org/10.1186/1472-6963-9-33.

    Article  PubMed  Google Scholar 

  15. Jyotsna VP, Dhawan A, Sreenivas V, Deepak KK, Singla R. Completion report: effect of comprehensive yogic breathing program on type 2 diabetes: a randomized control trial. Indian J Endocr Metab. 2014;18:582–4.

    CAS  Article  Google Scholar 

  16. Jyotsna VP, Ambekar S, Singla R, Joshi A, Dhawan A, Kumar N, et al. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program. Indian J Endocr Metab. 2013;17:480–5.

    Article  Google Scholar 

  17. Jyotsna VP, Joshi A, Ambekar S, Kumar N, Dhawan A, Sreenivas V. Comprehensive yogic breathing program improves quality of life in patients with diabetes. Indian J Endocr Metab. 2012;16:423–8.

    Article  Google Scholar 

  18. Gordon LA, Morrison EY, McGrowder DA, Young R, Fraser YT, Zamora EM, et al. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes. BMC Complement Altern Med. 2008;8:21.

    Article  Google Scholar 

  19. Datey P, Hankey A, Nagendra HR. Combined Ayurveda and yoga practices for newly diagnosed type 2 diabetes mellitus: a controlled trial. Complement Med Res. 2018;25:16–23.

    Article  Google Scholar 

  20. Bock BC, Thind H, Fava JL, Dunsiger S, Guthrie KM, Stroud L, et al. Feasibility of yoga as a complementary therapy for patients with type 2 diabetes: The Healthy Active and in Control (HA1C) study. Complement Ther Med. 2019;42:125–31.

    CAS  Article  Google Scholar 

  21. Sreedevi A, Gopalakrishnan UA, Karimassery Ramaiyer S, Kamalamma L. A randomized controlled trial of the effect of yoga and peer support on glycaemic outcomes in women with type 2 diabetes mellitus: a feasibility study. BMC Complement Altern Med. 2017;17:100.

    Article  Google Scholar 

  22. Bairy S, Rao MR, Edla SR, Manthena SR, Tatavarti NVGD. Effect of an integrated naturopathy and yoga program on long-term glycemic control in type 2 diabetes mellitus patients: a prospective cohort study. Int J Yoga. 2020;13:42–9.

    Article  Google Scholar 

  23. Vaishali K, Vijaya Kumar K, Adhikari P, UnniKrishnan B. Effects of yoga-based program on glycosylated hemoglobin level serum lipid profile in community dwelling elderly subjects with chronic type 2 diabetes mellitus–a randomized controlled trial. Phys Occup Ther Geriatrics. 2012;30:22–30.

    Article  Google Scholar 

  24. McDermott KA, Rao MR, Nagarathna R, Murphy EJ, Burke A, Nagendra RH, et al. A yoga intervention for type 2 diabetes risk reduction: a pilot randomized controlled trial. BMC Complement Altern Med. 2014;14:212.

    Article  Google Scholar 

  25. Shantakumari N, Sequeira S. El deeb R. Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Indian Heart J. 2013;65:127–31.

    Article  Google Scholar 

  26. Ebrahimi M, Guilan-Nejad TN, Pordanjani AF. Effect of yoga and aerobics exercise on sleep quality in women with type 2 diabetes: a randomized controlled trial. Sleep Sci. 2017;10:68–72.

    Article  Google Scholar 

  27. Sharma R, Shahi VK, Khanduri S, Goyal A, Chaudhary S, Rana RK, et al. Effect of Ayurveda intervention, lifestyle modification and Yoga in prediabetic and type 2 diabetes under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS)–AYUSH integration project. AYU. 2019;40:8–15.

    Article  Google Scholar 

  28. Sreedevi A, Unnikrishnan AG, Karimassery SR, Deepak KS. The effect of yoga and peer support interventions on the quality of life of women with diabetes: results of a randomized controlled trial. Indian J Endocr Metab. 2017;21:524–30.

    Article  Google Scholar 

  29. Nagarathna R, Tyagi R, Kaur G, Vendan V, Acharya IN, Anand A, Singh A, Nagendra HR. Efficacy of a Validated Yoga Protocol on Dyslipidemia in Diabetes Patients: NMB-2017 India Trial. Medicines (Basel). 2019 6(4). E100. doi: https://doi.org/10.3390/medicines6040100.

  30. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.

    Article  Google Scholar 

  31. Keerthi GS, Pal P, Pal GK, Sahoo JP, Sridhar MG, Balachander J. Effect of 12 weeks of yoga therapy on quality of life and Indian diabetes risk score in normotensive Indian Young adult Prediabetics and diabetics: randomized control trial. J Clin Diagn Res. 2017;11:CC10–4.

    PubMed  PubMed Central  Google Scholar 

  32. Ramamoorthi R, Gahreman D, Skinner T, Moss S. The effect of yoga practice on glycemic control and other health parameters in the prediabetic state: a systematic review and meta-analysis. PLoS One. 2019;14(10):e0221067.

    CAS  Article  Google Scholar 

  33. Innes KE, Vincent HK. The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review. Evid Based Complement Alternat Med. 2007;4:469–86. https://doi.org/10.1093/ecam/nel103.

    Article  PubMed  Google Scholar 

  34. Aljasir B, Bryson M, Al-Shehri B. Yoga practice for the Management of Type II diabetes mellitus in adults: a systematic review. Evid Based Complement Alternat Med. 2010;7(4):399–408.

    Article  Google Scholar 

  35. Cui J, Yan JH, Yan LM, Pan L, Le JJ, Guo YZ. Effects of yoga in adults with type 2 diabetes mellitus: a meta-analysis. J Diabetes Investig. 2017;8:201–9.

    CAS  Article  Google Scholar 

  36. Innes KE, Selfe TK. Yoga for adults with type 2 diabetes: a systematic review of controlled trials. J Diabetes Res. 2016;2016:6979370.

    Article  Google Scholar 

  37. Kumar V, Jagannathan A, Philip M, Thulasi A, Angadi P, Raghuram N. Role of yoga for patients with type II diabetes mellitus: a systematic review and meta-analysis. Complement Ther Med. 2016;25:104–12.

    Article  Google Scholar 

  38. Vizcaino M, Stover E. The effect of yoga practice on glycemic control and other health parameters in type 2 diabetes mellitus patients: a systematic review and meta-analysis. Complement Ther Med. 2016;28:57–66.

    Article  Google Scholar 

  39. Thind H, Lantini R, Balletto BL, Donahue ML, Salmoirago-Blotcher E, Bock BC, et al. The effects of yoga among adults with type 2 diabetes: A systematic review and meta-analysis. Prev Med. 2017;105:116–26.

    Article  Google Scholar 

  40. Jayawardena R, Ranasinghe P, Chathuranga T, Atapattu PM, Misra A. The benefits of yoga practice compared to physical exercise in the management of type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr. 2018;12(5):795–805.

    Article  Google Scholar 

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Correspondence to Deep Dutta.

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DD, SB, MS, DK, VS and SK have no conflict of interests with regard to this research work and have nothing to declare.

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Supplementary Information

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(DOC 64 kb)

Supplementary Table-1: Risk of Bias assessment table for the meta-analysis (DOCX 24 kb)

Supplementary Figure-1: Forest plot evaluating the impact of yoga on (a): fasting blood glucose with subgroup analysis; (b): glycated haemoglobin (Hba1c) with subgroup analysis; (c): post-prandial blood glucose with subgroup analysis; (d): total cholesterol with subgroup analysis

The sizes of the boxes are proportional to the weight of each individual study in the analyses. The summary effect size is represented by a diamond; Active exercise regimen controls represent the structured exercise regimen (SER) sub-group; Passive control group represent the standard diabetes care (SDC) sub-group (JPG 743 kb)

Supplementary Figure-2: Forest plot evaluating the impact of yoga on (a): triglycerides with subgroup analysis; (b): LDL-cholesterol with subgroup analysis; (c): HDL-cholesterol with subgroup analysis.

The sizes of the boxes are proportional to the weight of each individual study in the analyses. The summary effect size is represented by a diamond; Active exercise regimen controls represent the structured exercise regimen (SER) sub-group; Passive control group represent the standard diabetes care (SDC) sub-group (JPG 380 kb)

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Dutta, D., Bhattacharya, S., Sharma, M. et al. Effect of yoga on glycemia and lipid parameters in type-2 diabetes: a meta-analysis. J Diabetes Metab Disord 20, 349–367 (2021). https://doi.org/10.1007/s40200-021-00751-0

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Keywords

  • Yoga
  • Diabetes
  • Exercise
  • Meta-analysis