Proposed Yoga Protocol Based on Glycemic Control, Insulin Resistance and Anthropometry-specified Parameters: A Retrospective Study on Clinically Euthyroid Type II Diabetics
Manoharan Mangalagowri, Rajendran Jayanthi, Abu R Srinivasan, Ananda B Bhavanani, Ramanathan Meena
Asian Indian, Euthyroid, Insulin resistance, T2DM, WHO, Yoga,Anthropometry
Citation Information :
Mangalagowri M, Jayanthi R, Srinivasan AR, Bhavanani AB, Meena R. Proposed Yoga Protocol Based on Glycemic Control, Insulin Resistance and Anthropometry-specified Parameters: A Retrospective Study on Clinically Euthyroid Type II Diabetics. 2020; 3 (3):107-114.
Background and objectives: Inclusion of yoga in the daily routine would favorably moderate glycemic control, alleviate insulin resistance (IR), besides reducing the risk of complications in people with long-standing diabetes and comorbidity. The body mass index (BMI) cut-off criteria are different as per the Asian Indian and WHO standards. Accordingly, overweight range of 23–24.9 in the Asian Indian category will fall under the nonobese category. Obese range of ≥25 BMI in the Asian Indian group will come under the overweight category as per the WHO standards. To devise a unique yoga protocol based on anthropometry and biochemical assessment, has been proposed with reference to specific parameters in insulin-resistant, clinically euthyroid type II diabetics with special reference to Asian Indian and WHO standards.
Materials and methods: A retrospective study was conducted in the Department of Biochemistry with inputs from the diabetic clinic of a tertiary care teaching hospital as well as a designated center for yoga therapy, following acceptance from the research advisory committee. The study subjects were clinically euthyroid type II diabetics (both genders) in the age group 35–70 years who were on diabetic diet and oral hypoglycemic agents (OHAs). Data from clinically euthyroid type II diabetics (n = 101) (adult males and females in the age group 35–70) were utilized for the study. The Pearson correlation coefficient and multivariate analysis were enabled and p < 0.05 was considered significant.
Results: Statistically significant associations were observed between IR (dependent variable) and other independent variables, namely HbA1c, TAG/HDL (surrogate marker of small dense LDL), and thyroid hormones. With reference to BMI, based on Asian Indian standards, TAG/HDL depicted association with homeostasis model assessment-Insulin resistance (HOMA-IR) (p = 0.011) and TSH was negatively associated with HbA1c (p = 0.027) in overweight; HbA1c and TSH exhibited positive association with p = 0.001 and 0.04, respectively, in obese as per the Asian Indian criteria for BMI. Keeping BMI as per the WHO, TAG/HDL (p = 0.008) in nonobese and in overweight HbA1c with p = 0.001 were associated with HOMA-IR. Significant association was not found in the obese subjects, as per the WHO standards.
Conclusion: There is a need for a unique yoga protocol to address clinically euthyroid type II diabetics. Hitherto, such a protocol has not been developed, especially with reference to BMI, as per the Asian Indian and WHO standards. Practicing this proposed yoga protocol on the basis of anthropometry might prove beneficial in glycemic control, alleviating IR, besides reducing complications of type II diabetics in euthyroid population who may later be candidates for frank thyroid comorbidity.
The IDF Diabetes Atlas. Diabetes facts & figures. 9th ed. International Diabetes Federation. 2019.
World Health Organization (WHO). Management of substance abuse unit. Global status report on alcohol and health 2014;1(1).
Gupta R, Misra A. Type 2 diabetes in India: regional disparities. Br J Diabetes Vasc Dis 2007;7:12–16.
Joshi SR, Das AK, Vijay VJ, Mohan V. Challenges in diabetes care in India: sheer numbers, lack of awareness and inadequate control. J Assoc Physicians India 2008;56:443–450.
Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes 2012;3(6):110–117. DOI: 10.4239/wjd.v3.i6.110.
Fishman L, Saltonstall E. Yoga in pain management. Integrative Pain Medicine 2008. 259–284.
Chappie CK. Modern yoga. Relig Stud Rev 2008;34(2):71–76. DOI: 10.1111/j.1748-0922.2008.00256.x.
Raub JA. Psychophysiologic effects of hatha yoga on musculoskeletal and cardiopulmonary function: a literature review. J Altern Complement Med 2002;8(6):797–812. DOI: 10.1089/10755530260511810.
Jeter PE, Slutsky J, Singh N, Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies from 1967 to 2013. J Altern Complement Med 2015;21(10):586–592. DOI: 10.1089/acm.2015.0057.
Sigh S, Malhotra V, Singh KP, Madhu SV, Tandon OP. Role of yoga in modifying certain cardiovascular functions in type 2 diabetic patients. J Assoc Physicians India 2004;52:203–206.
Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini L, Wdowczyc-Szulc J, et al. Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study. BMJ 2001;323(7327):1446–1449. DOI: 10.1136/bmj.323.7327.1446.
Carlson LE, Speca M, Faris P, Patel KD. One year pre-post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain Behav Immun 2007;21(8): 1038–1049. DOI: 10.1016/j.bbi.2007.04.002.
Raup JA. Psycho-physiologic effect of hatha yoga on musculoskeletal and cardiopulmonary function; a literature review. AlternTher Health Med 2000;6:55–63.
Gordon LA, Morrison EY, McGrowder DA, Young R, Fraser YTP, 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(1):21. DOI: 10.1186/1472-6882-8-21.
Innes KE, Selfe TK. Yoga for adult with type 2 diabetes: a systematic review of controlled trials. J Diab Res 2016;2016:6979370. DOI: 10.1155/2016/6979370.
Mitra A, Dewanjee D, Dey B. Mechanistic studies of lifestyle intervention in type 2 diabetes. World J Diabetes 2012;3(12):201–207. DOI: 10.4239/wjd.v3.i12.201.
Shanthakumari N, Sequeira S, Eldeep R. Effect of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. Ind Heart J 2013;65(2):127–131. DOI: 10.1016/j.ihj.2013.02.010.
Rosmond R, Bjorntorp P. The hypothalamic-pituitary-adrenal axis activity as a predictor of cardiovascular disease, type 2 diabetes and stroke. J Intern Med 2000;247(2):188–197. DOI: 10.1046/j.1365-2796.2000.00603.x.
Larsen JJ, Dela F, Kjaer M, Galbo H. The effect of moderate exercise on postprandial glucose homeostasis in NIDDM patients. Diabetologia 1997;40(4):447–453. DOI: 10.1007/s001250050699.
Mohan V, Premalatha G, Viswanathan M, Hitman GA. Genetics of NIDDM in South Indians. in: novo nordisk diabetes update 1994 proceedings. Health Care Commun 1994. 76–77.
Sahay BK, Sadasivodo B, Yogi, Raju PS. Biochemical parameters in normal volunteers before and after yogic practices. Ind J Med Res 1982;76:144–148.
Park K. Park's textbook of preventive and social med. 18th ed., Jabalpur: Banarsidas Bhanot Publishers; 2005. pp. 311–315.
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(4):469–486. DOI: 10.1093/ecam/nel103.
Kiecolt-Glaser JK, Christian LM, Andridge R, Hwang BS, Malarkey WB, Belury MA, et al. Adiponectin, leptin, and yoga practice. Physiol Behav 2012;107(5):809–813. DOI: 10.1016/j.physbeh.2012.01.016.
Hegde SV, Adhikari P, Kotian S, Pinto VJ, Dsouza S, Dsouza V. Effect of 3-month yoga on oxidative stress in type 2 diabetes with or without complications: a controlled clinical trial. Diab Care 2011;34(10):2208–2210. DOI: 10.2337/dc10-2430.
Yang L, Brozovic S, Xu J, Long Y, Kralik PM, Waigel S, et al. Inflammatory gene expression in OVE26 diabetic kidney during the development of nephropathy. Nephron 2011;119(1):8–20. DOI: 10.1159/000324407.
Amita S, Prabhakar S, Manoj I, Harminder S, Pavan T. Effect of yoga-nidra on blood glucose level in diabetic patients. Ind J Physiol Pharmacol 2009;53(1):97–101.
Singh S, Malhotra V, Singh KP, Sharma SB, Madhu SV, Tandon OP. A preliminary report on the role of yogasanas on oxidative stress in non-insulin dependent diabetes mellitus. Ind J Clin Biochem 2001;16(2):216–220. DOI: 10.1007/BF02864866.
Rawal SB, Singh MV, Tyagi AK, Selvamurthy W, Chaudhuri BN. Effect of yogic exercises on thyroid function in subjects resident at sea level upon exposure to high altitude. Ind J Biometeorol 1994;38(1):44–47. DOI: 10.1007/BF01241804.
Dacosta D, Dritsa M, Ring A, Fitzcharles MA. Mental health status and leisure-time physical activity contribute to fatigue intensity in patients with spondylarthropathy. Arthritis Rheum 2004;51(15): 1004–1008. DOI: 10.1002/art.20841.
Malhotra V, Singh S, Singh KP. Effects off yogasana and pranayama in non–insulin dependent diabetes mellitus. Ind J Traditional Knowledge 2004;32(2):162–167.
Wilson T, Kelly KL, Baker SE. Review: can yoga breathing exercises improve glycemic response and insulin sensitivity? A clinical commentary. J Yoga Phys Ther 2017;7(02):270. DOI: 10.4172/2157-7595.1000270.
Dang KK, Sahay BK. Yoga and meditation. Medicine Update 1999;9:502–512.
Sahay BK, Murthy KJR. Long-term follow up studies on effect of yoga in diabetes. Diab Res Clin Pract 1988. 5.
Sahay BK, Kapur A. Yoga and diabetes. In: Proceedings of novo nordisk diabetes update. Bombay: Health Care Communication; 1994. pp. 159–167.
Netam R, Yadav RK, Khadgawat R, Sarvottam K, Yadav R. Interleukin-6, vitamin D & diabetes risk factors modified by a short-term yoga-based lifestyle intervention in overweight/obese individuals. Ind J Med Res 2015;141(6):775–782. DOI: 10.4103/0971-5916.160698.
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(1):212. DOI: 10.1186/1472-6882-14-212.
Azam S. The effect of eight weeks yoga program on the thyroid function in middle-aged women. J Phy Activ Hormo 2018;2(4): 8015–8074.
Chatterjee S, Mondel S. Effect of combined yoga programme on blood levels of thyroid hormones: a quasi-experimental study. Ind J of Tradit Knowledge 2017;16:9–16.
Jayanthi R, Srinivasan AR, Hanifah M, Maran AL. Association among insulin resistance, triacylglycerol/high density lipoprotein (TAG/HDL ratio) and thyroid hormone levels – a study on type 2 diabetes mellitus in obese and overweight subjects. Diab Metab Syn: Clin Res Rev 2017;11:121–126. DOI: 10.1016/j.dsx.2016.12.020.
Jayanthi R, Srinivasan AR, Niranjan G. Thyroid status in premenopausal and postmenopausal women – a biochemical study on insulin resistance in non obese, overweight and obese type 2 diabetics. Diab Metab Syn: Clin Res Rev 2018;12(6):859–862. DOI: 10.1016/j.dsx.2018.05.001.
Jayanthi R, Srinivasan AR. Sex hormone independent associations between insulin resistance and thyroid status –a gender based biochemical study on clinically euthyroid non-obese, overweight and obese type 2 diabetics. Diab Metab Syn: Clin Res Rev 2019;13(3): 2286–2291. DOI: 10.1016/j.dsx.2019.05.017.
Khatri D, Mathur KC, Gahlot S, Jain S, Agrawal RP. Effects of yoga and meditation on clinical and biochemical parameters of metabolic syndrome. Diab Res Clin Pract 2007;78(3):9–10. DOI: 10.1016/j.diabres.2007.05.002.
Seo DY, Lee S, Figueroa A, Kim HK, Baek YH, Kwak YS, et al. Yoga training improves metabolic parameters in obese boys. Korean J Phy Pharmac 2012;16(3):175–180. DOI: 10.4196/kjpp.2012.16. 3.175.
Dukhabandhu N, Nihal T. Yoga- a potential solution for diabetes & metabolic syndrome. Ind J Med Res 2015;141(6):753–756. DOI: 10.4103/0971-5916.160689.
Sohl SJ, Wallston KA, Watkins K, Birdee GS. Yoga for risk reduction of metabolic syndrome: patient-reported outcomes from a randomized controlled pilot study. Evid Based Complem Alter Med 2016. 1–9. DOI: 10.1155/2016/3094589.
Teixeira Henriques ACP, Costa Carvalho FH, Feitosa HN, Garcia de Alencar JC, Miranda Pinto LR. LucenaFeitosaFE. metabolic syndrome after preeclampsia: a cohort study with a mean follow up of 14 years. J Metabolic Synd 2014;3:152.
Comhaire F. Nutriceutical approach to the metabolic syndrome. Endocrinol Metab Syndr 2014;3(3):1–4. DOI: 10.4172/2161-1017.1000134.
Tadesse FG, Worku Y, Feleke Y, El-Metwally TH. Metabolic syndrome biomarkers in type ii diabetic Ethiopian patients. J Metabolic Synd 2014;3(02):139. DOI: 10.4172/2167-0943.1000139.
Kanagasabai T, Nie JX, Masaon C, Ardern CI. Metabolic syndrome and prevalent any-site, prostate, breast and colon cancers in the U.S. adult population: NHANES 1999-2010. J Metabolic Synd 2014;3(01):135. DOI: 10.4172/2167-0943.1000135.
Gruppen EG, Dallinga-Thie GM, Bakker SJL, Dullaart RPF. Plasma apoE is elevated in metabolic syndrome: Importance of large very low density and low density lipoprotein particles. J Mol Biomark Diagn 2015;6:210.
Dayanidy G, Bhavanani AB. Yoga practical notes. Pondicherry: center for yoga therapy education and research (CYTER). 2016;3–83.
Ortega C, Arredondo S, Daniel A. Sick euthyroid syndrome. Acta Medica Grupo Angeles 2019;17:131–136.