Integrative Medicine Case Reports, Volume 3, Issue 1 (January), 2022
Investigating the mitigating role of mind body intervention on glycemic control in prediabetes: A case report
KEY WORDS |
ABSTRACT |
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Glycated haemoglobin
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In the present case study, the case of a high-risk female participant for diabetes was presented. She is a resident of Dhanas colony, Chandigarh, India. The mapping of risk status for diabetes was done through the Indian Diabetes Risk Score (IDRS) in the participant. She was found to be at high risk for diabetes with a risk score of 60. She joined the Yoga camp organized in the Village Dhanas, Chandigarh. The Diabetic Yoga Protocol (DYP), mainly developed for prediabetics, was given to the participant for 12 weeks. The glycated haemoglbin (HbA1c) was considered the guiding criteria for determining the glycemic threshold for prediabetes. The participant’s HbA1c level was 5.8% at baseline, and fasting blood glucose (FBG) was 93 mg/dl. After the 12 weeks of DYP intervention, a significant decline in the HbA1c (5.3%) and FBG (76.9 mg/dl) levels were seen. The present case report supports the efficacy of DYP as an efficient, secure, and cost-effective in reversing prediabetes into normal by ameliorating the glycemic indices. doi: 10.38205/imcr.030112 |
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*Corresponding Author:
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Introduction
Type 2 Diabetes Mellitus (T2DM) cases were escalated worldwide, with India having the second-highest number of cases in the world after China (1). T2DM is not only susceptible in the aging populations, though it was also increasing among adults (2). In the condition of diabetes, there is an incongruous rise in the blood glucose levels, which is owed to the inappropriate insulin secretion from the pancreas (3). The various pharmacological treatments existed for glycemic control in T2DM patients, but that also had side effects (4). Generally, people often ignore the initial cautionary symptoms related to diabetes. There are various contributory risk factors like stress, insomnia, lack of physical activity, family history of diseases, and increasing age and weight, which enhanced the risk for accumulation of diabetes (5,6). Therefore, it is imperative to work upon the preventive aspect of T2DM by the timely screening of the high-risk individuals for diabetes at the prediabetic stage (7,8).
Prediabetes is the stage when a person is on the verge of becoming diabetic (9,10). Prediabetes is the middle phase in which the blood glucose levels are lower than the diabetic glycemic threshold but more than the normal glycemic threshold (11). According to American Diabetes Association (ADA), when the person has the HbA1c level between the 5.7–6.4%, FBG- 100–125 mg/dl, that person is considered prediabetic (12). HbA1c is considered as most reliable method to know the glycemic status of the person (13). In addition, non-invasive methods like the Indian Diabetes Risk Score founded by Mohan et al. (2005) helps to predict the risk status for diabetes based on the two modifiable (age and parental history of diabetes) and two non-modifiable risk factors (waist circumference and level of physical activity) (14).
T2DM is considered a lifestyle-related disorder, and implementing lifestyle changes in the form of diet, exercise, and stress-free life lead to proper prevention and delay in the advancement to diabetes (15,16). Yoga and meditation are well-known integrative practices, which prove to be robust techniques for eradicating elevated glucose levels and other abnormal parameters related to prediabetes (17,18).
Case presentation
The participant is a resident of the Dhanas colony in Chandigarh. She was screened during the house-to-house survey conducted in the community to know the risk status for diabetes based on IDRS. After her screening based on IDRS she was at high risk for diabetes with a risk score of 60, as shown in Table 2. She lived a sedentary lifestyle with a parental diabetes history and had a moderate level of central obesity. All these factors on summation increase her risk for diabetes. After taking the written informed consent, the measurement for FBG and HbA1c were taken at baseline and after three months. The 10 ml blood was drawn for biochemical assessments.
She joined the three-month Yoga camp held at the Sarpanch house in village Dhanas by a well-trained yoga instructor. The AYUSH-approved diabetic Yoga protocol (DYP), specially designed for prediabetics, was implemented for a one hour duration, six days per week for three months in the training regimen. The previously published research work provided a detailed description of DYP with time and duration (19) and its also shown in Table 4. The result of the hbA1c test at baseline is 5.8%, which falls into the category prediabetes according to ADA guidelines, as shown in Table 3. Moreover, the socio-demographic characteristics of the participant were also given in Table 1. After the three months of DYP intervention, promising glycemic control results were seen. The HbA1c (5.3%) and FBG (76.9 mg/dl) show a significant decline after three months of DYP intervention. According to ADA guidelines, the HbA1c value of 5.3% falls into the category of normal HbA1c.
Table 1: Socio demographic characteristics of the study participant
| Socio-demographic characteristics | Values |
|---|---|
| Age (Years) | 32 |
| Previous Yoga Experience | No |
| Marital Status | Married |
| Education | Post-Graduate |
| Occupation | Clerical |
| Socio-economic status | Middle Class |
Table 2: Detailed description of the IDRS Score of the participant
| Indian Diabetes Risk Score | |||
|---|---|---|---|
| Sr. No. | Variables | Values/Response | Score |
| 1. | Age (years) | 32 | 0 |
| 2. | Level of Physical Activity | No | 30 |
| 3. | Parental History | One Parent Diabetic | 10 |
| 4. | Waist Circumference (cm) | 87 | 20 |
| Total IDRS Risk Score = 60
Risk Category = High Risk |
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Table 3: Biochemical characteristics of participant at baseline and after three months of DYP intervention
| Variable | Baseline | After 3 months of DYP Practice |
|---|---|---|
| HbA1c (%) | 5.8 | 5.3 |
| FBG (mg/dl) | 93 | 76.9 |
| ADA Category (HbA1c) |
Prediabetic (5.7–6.4) |
Normal (<5.7) |
HbA1c = Glycated Haemoglobin; FBG = Fasting Blood Glucose; ADA = American Diabetes Association
Table 4: Diabetic yoga protocol
| Sr. No. | Name of Practice | Duration (min) |
|---|---|---|
| 1 | Starting Prayer: Asatoma Sat Gamaya | 2 |
| 2 | Preparatory Sukshma Vyayamas and Shithililarna Practices 1. Urdhavahastashvasan (Hand stretching breathing 3 rounds at 90o, 135o and 180o each) 2. Kati-Shakti Vikasaka (3 rounds) a) Forward and Backward Bending b) Twisting 3. Sarvangapushti (3 rounds clockwise, 3 rounds anticlockwise) |
6 |
| 3 | Surya Namaskara (SN) 10 step fast Surya Namaskara 6 rounds 12 step slow Surya Namaskara 1 round *Modified version Chair SN 7 rounds |
9 |
| 4 | Asanas (1 min per Asana) 1. Standing Position (1 min per Asana) Trikonasana, Parvritta Trikonasana, Prasarita Padhastasana 2. Supine Position Jatara Parivartanasana, Pawanmuktasana, Viparitakarani 3. Prone Position Bhujangasana, Dharuasana followed by Pawanmuktasana 4. Sitting Position Mandukasana, Vakrasana/Ardhamatsayendrasana, Paschimatanasana, Ardha Ushtrasana At the end, relaxation with abdominal breathing in supine position (vishranti), 10–15 rounds (2 minutes) |
15 |
| 5 | Kriya a. Agnisara: 1 minute b. Kapalabhati (@60 breaths per minute for 1 minute followed by rest for 1 minute) |
3 |
| 6 | Pranayama Nadishuddhi (for 6 minutes, with antarkumbhak and jalandhar bandh for 2 seconds) Bhamari 3 minutes |
9 |
| 7 | Meditation (for Stress, for deep relaxation and silencing of mind) Cyclic Meditation |
15 |
| 8 | Closing Prayer: Sarvebhavantu Sukhina………… | 1 |
| Total duration | 60 min |
Discussion
Prediabetes is a stage where through proper lifestyle management through optimum physical activity, healthy diet, time-to-time examining glycemic parameters, weight, and stress management, one can prevent the risk of lifestyle-related disorders, especially diabetes (20). By timely knowing their risk status for diabetes, people with prediabetes can cease and delay the conversion from prediabetes to diabetes. The plethora of literature published in the past advocated the beneficial role of Yoga and meditation as a cost-effective and non-pharmacological way of glycemic control (18,21–23).
In the present case study, the participant religiously and enthusiastically followed the DYP practice. The participant proficiently executed all the practices (e.g., asana, suryanamskar, pranayama, meditation, etc.) included in the training regimen. However, the limitation of the present case study is that no specific dietary changes were suggested to the participant. Although, the participant herself adopts some changes in her dietary pattern, which involves avoiding sweets, rice, fried, packed, and processed foods. A healthy diet pattern can also play a crucial role in managing glucose levels. However, the limitation of the present case study is that no specific dietary changes were suggested to the participant. Although, the participant herself adopts some changes in her dietary pattern, which involves avoiding sweets, rice, fried, packed, and processed foods. A healthy diet pattern can also play a crucial role in managing glucose levels. Additionally, the improvement in general health and reduction in anxiety and stress levels were also observed in the participant (data not shown).
It is pertinent to note that the participant’s age is 32 years, and at a young age, she was found to be prediabetic (blood glucose levels higher than normal) due to her sedentary lifestyle. Then she adopts a healthy lifestyle and includes DYP practice in her daily routine, resulting in a significant decline in biochemical parameters, i.e., FBG and HbA1c. The possible reason is that DYP is specifically designed for diabetics and prediabetics, and it works emphatically upon glucose control. The other reason for the amelioration of glycemic indices in the prediabetic participant is that DYP consists of a variety of asana, pranayama, and suryanamskara, which is likely to elevate insulin sensitivity B-cell functionality, improves the glucose secretion in the muscles (16,24,25). Besides, glucose control Yoga practices also works proficiently on managing weight, (26) stress (27), and wholesome well-being of the individual (28).
Conclusion
DYP practices prove to be promising in reversing the prediabetic glucose threshold into normal glucose threshold. The other modifiable risk factors, according to IDRS, also get improved after DYP Practices. Although, the other factors like age, acclimatization, regularity to a training regimen, and well execution of the training program by the participant also play a prominent role in the overall positive impact on the prediabetic condition.
Acknowledgement
The authors acknowledge MHRD/ICSSR to support for the research. The authors would like to thank the study participant for their involvement in the trial.
Author’s contribution
NK: writing, analysis of data, data collection
KM: Data Collection
RM: Editing, Writing, Co- Conceptualization
SA: Editing of Manuscript
GS: Editing of manuscript
SD: Data Collection
KS: Participant
NM: Conceptualization, study design, Editing.
Ethical statement
Ethical clearance was taken from Institutional Ethics Committee of Panjab University (PUIEC), Chandigarh, India (Approval no: PUIEC210312-III-012, dated 6th April, 2021).
Informed consent
Yes.
Source of funding
This study has been supported by Indian council of Social Science research (MHRD-ICSSR) via Letter no. F.No. P3939/710 IMPRESS/P3939/2018-19/ICSSR.
Conflict of interest
The author declares no conflict of interest.
Received Date: 27-12-21; Revised Date: 03-02-22
Accepted Date: 05-02-22
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