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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 161-167

A randomized controlled study to evaluate the effect of meditation, diet, and exercise in type-2 diabetic patients


1 Department of Physiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, India
2 Department of Neurosciences, Dr. GD Pol Foundation, YMT, College of Physiotherapy, Navi Mumbai, Maharashtra, India

Date of Submission10-Mar-2020
Date of Decision22-Apr-2020
Date of Acceptance10-May-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Dalia Biswas
Department of Physiology, Jawaharlal Nehru Medical College, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_278_20

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  Abstract 


Background: Raja-Yoga meditation (RM) is a behavioral intervention which is practiced in India and worldwide. It appears to be the easy, practicable method of meditation, which one can follow on the day-to-day basis. Materials and Methods: Interventional, randomized, pre- and post-study. All diabetic patients in the age group of 30–60 years including both sexes and taking treatment since 5–10 years. Results: Pre- and post-mean difference in blood sugar levels showed a significant mean difference in Group A which was 34.82 ± 50.53. Multiple comparisons of fasting blood sugar in the three groups using Tukey test. The finding between Group A and Group C was found to be significant which means that the effect of Group A is better than Group C. Post meal finding between and within groups using one-way anova test. The F value was 8.24 and P value was 0.001 which is a significant finding. In Group C, the mean difference of hemoglobin A1c (HbA1C) level was 0.86 ± 1.48 and P value was 0.048, which is a significant finding. Conclusion: The effect of RM as a complementary intervention is better than other groups in improving glycemic control. In addition, all the three interventions namely meditation, diet, and exercise favorably affect HbA1C level.

Keywords: Diet and exercise, meditation, type-2 diabetic patients


How to cite this article:
Biswas D, Debnath M. A randomized controlled study to evaluate the effect of meditation, diet, and exercise in type-2 diabetic patients. J Datta Meghe Inst Med Sci Univ 2020;15:161-7

How to cite this URL:
Biswas D, Debnath M. A randomized controlled study to evaluate the effect of meditation, diet, and exercise in type-2 diabetic patients. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 26];15:161-7. Available from: http://www.journaldmims.com/text.asp?2020/15/2/161/304256




  Introduction Top


Diabetes mellitus is a metabolic disorder of multiple etiologies characterized by chronic hyperglycemia with disturbance of carbohydrate, protein, and fat metabolism resulting from defects of insulin secretion, insulin action, or both.[1]

The WHO has also anticipated that number of people with diabetes will be more than double in 2030 as a consequence of population aging and urbanization.[2] In recent years, clinical trials and cohort studies have highlighted the role of meditation, physical activity, and dietary modification in the prevention and management of type 2 diabetes.

Raja-Yoga meditation (RM) is a behavioral intervention which is practiced in India and worldwide. It appears to be the easy, practicable method of meditation, which one can follow on the day-to-day basis.[3] Some studies done on Raja-yoga meditators have shown increased parasympathetic activity in meditators and improvement in the lipid profile of meditators than nonmeditators.[4],[5]

Interventions aimed at increasing exercise combined with diet have been shown to decrease the incidence of type 2 diabetes mellitus (T2DM) in high-risk groups (people with impaired glucose tolerance (IGT) or the metabolic syndrome).[6] However, there are no high-quality data on the efficacy of dietary intervention for the prevention of type 2 diabetes.[7]

Exercise appears to improve glycated hemoglobin at 6 and 12 months in people with type 2 diabetes.[8] Regular physical activity and exercise are important components in the prevention of diabetes. In addition to lowering blood glucose, exercise improves insulin action, contributes to weight loss. The association between increased levels of physical activity and a reduced occurrence of diabetes' long-term complications suggests that regular physical activity has a protective role. This association has been shown in the diabetes prevention program (DPP) in which physical activity in the form of walking for 30 min/day on most days of the week was encouraged.[9] One promising trend is the “lifestyle exercise” approach used in the DPP, in which exercise is broken down into multiple shortbouts of activity (e.g., 10 min of brisk walking).[10]

Our hypothesis is that these three lifestyle interventions namely RM, diet, and exercise can have a role to play in slowing down the progress of diabetes in T2DM. Exercise can have a role to play in slowing down the progress of diabetes in T2DM.

Objectives of the study shall be:

  1. To find out the out the fasting blood sugar (FBS) and post prandial blood sugar in the three groups
  2. To compare the hemoglobin A1c (HbA1C) among the three groups.



  Materials and Methods Top


  • Study design: This was an intervention, randomized, pre- and post-study
  • Study setting: Department of Physiology, Jawaharlal Nehru Medical College, Wardha
  • Period of study: 1½ years
  • Institutional ethical committee clearance: The study was initiated after obtaining institutional ethical committee sanction
  • Study participant: LL diabetic patients in the age group of 30–60 years, including both sexes and taking treatment since 5–10 years
  • Sample size: Fifty
  • Method of randomization: Simple randomization
  • Mechanism used to implement the random allocation sequence: Neither the subject nor the investigator knew the intervention assignment before the subject's decision to enter the study. This was prepared by facilitators of the study
  • Randomization concealment: The sequence of intervention assigned was will know about the investigation group of a participant until a participant is randomly allocated to a group
  • Allocation randomization: Facilitators generated the allocation sequence. Diabetic patients visiting AVBRH Hospital were enrolled as participants for the study by the attending physicians. A attendant of anatomy department assigned participants to their groups
  • Implementation blinding: The outcome evaluators were blinded to the study
  • Period of recruitment: Was for 3 months
  • Efforts to maintain compliance of patients: This was done using log books of diet charts and exercise charts
  • Handling of lost to follow-up patients: This was addressed by recruiting extra 1%, i.e., 6 eligible patients for the study
  • Randomized controlled trial was done based on the CONSORT Statement (http://www.consort-statement.org).


Intervention

By random selection, 60 diabetic patients shall be allocated to the intervention group. The study group shall have three subgroups namely (a) RM only, (b) diet and exercise only, and (c) RM, diet and exercise all three combined. Each subgroup shall have 20 diabetic patients.

In the A group, i.e., RM only, the person shall sit upright and concentrate on a point of white light. There are three stages-

  1. Initiation - In this stage, thoughts in the mind, come in randomly
  2. Concentration - He now, converts all negative thoughts with positive thoughts of peace, happiness, love, bliss, purity, knowledge, and power
  3. Realization - This final stage involves feeling the emotions of these positive thoughts.


Ethical Approval

Ethical approval for this study (DMIMS(DU)/IEC/2015-16/2043) was provided by the Ethical Committee of Datta Meghe Institute of Medical Sciences (Deemed to be University) on 12th April 2016.


  Result Top


RM was practiced daily for 10 min in the morning and 10 min in evening. The participants were reviewed in the department of physiology, every weekend for the first 3 months and after every fortnight for the last 3 months.

RM interventions on the same lines were administered to the C group also.

For the B group, daily food time table was the regular diet of the patients supplemented with additional proteins.[11] A project dietician supported facilitators and gave dietary counseling after the RM orientation class.

The diet regimen planned for this group was as follows:

Compliance was checked by log book and visit by social workers. Eight-five percent adherence to the program was taken as accepted.

Brisk walking for 30 min daily at dawn or dusk for 5 days a week for 6 months was advised.[9] for this group.

The same plan of meditation, diet, and exercise was implemented for the C group [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7] and [Graph 1] and [Graph 2].
Table 1: The diet regimen planned for this group was as follows

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Table 2: Age-wise distribution of patients in three groups

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Table 3: Comparison of fasting blood sugar level in three groups pre- and post-operatively Student's paired t-test

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Table 4: Comparison of fasting blood sugar level in three groups postoperatively descriptive statistics

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Table 5: Comparison of prandial blood sugar level in three groups post operatively descriptive statistics

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Table 6: Comparison of glycated hemoglobin level in three groups pre-and post-operatively Student's paired t-test

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Table 7: Comparison of glycated hemoglobin level in three groups post operatively descriptive statistics

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Outcome measures

Primary follow-up measure was fasting and postmeal blood sugar. Secondary follow-up measure was HBA1C.


  Discussion Top


The prime objective of diabetes therapy – the reduction of hyperglycemia – was shown to be potentially reversible following appropriate lifestyle intervention that incorporates meditation, physical activity, and dietary modifications.

The discussion will be done under the following heads:

1. Pre- and post-mean difference in blood sugar levels showed a significant mean difference in group A which was 34.82 ± 50.53.

Some studies have reported the benefits of yoga as a stand-alone intervention for the management of diabetes and reported improvement in glycemic control.[12] RM is a superior form of meditation in which flow of thoughts is encouraged using the mind in a natural way to relieve stress. Yoga practices can influence outcomes in those with at risk for type 2 diabetes.[13]

In our study, a total of 17 diabetic patients in the age group of 32–60 years were studied. Comparison of FBS pre- and post-intervention yielded significant finding. Raj-yoga as a complementary intervention is effective in improving glycemic control.[14]

Yoga may also increase resilience to stress, a factor that has been linked to improved outcomes in DM2 (Carnethon, 2006). These changes help to buffer the deleterious effects of stress, improve glucose control, enhance mood, sleep, and autonomic function, reduce blood pressure, and promote improvements in other related risk factors of relevance to DM2 management.[15],[16]

2. Multiple comparisons of FBS in the three groups using Tukey test. The finding between Group A and Group C was found to be significant which means that the effect of Group A is better than Group C.

Laatikainen et al. did an intervention study including 237 individuals, 40–75 years of age with moderate or high risk of developing type 2 diabetes. A structured group program with 690 min sessions was delivered during an 8 months' period by trained nurses in Australian primary health care in 2004–2006. Main outcome measures taken at baseline, 3, and 12 months included fasting plasma glucose, plasma glucose 2 h after oral glucose challenge. To test differences between baseline and follow-up, paired t-tests and Wilcoxon rank sum tests were performed. At 12 months, participants mean fasting glucose reduced by 0.14 mmol/l (0.07–0.20), plasma glucose 2 h after oral glucose challenge by 0.58 mmol/l (0.36–0.79), They concluded that type 2 DPP using lifestyle intervention is feasible in primary health-care settings, with reductions in risk factors approaching those observed in clinical trials.[17]

3. Postmeal finding between and within groups using one way anova test. The F value was 8.24 and P value was 0.001 which is a significant finding. Using Tukey test the finding between Group A and Group B was found to be significant. Interpretation is effect of Group A is better than Group B and Group C. Furthermore, effects of Group B and Group C are same. Overall Effect of Group A is better than Group B and Group C.

Thind et al. conducted a meta-analysis was to examine the effects of yoga for glycemic control among adults with T2DM. Twenty-three studies with 2473 participants (mean age = 53 years; 43% women) met eligibility criteria. Compared with controls, yoga participants were successful in improving their FBG (d+ = 0.58, 95% confidence interval [CI] = 0.40, 0.76; k = 20), and PPBG (d+ = 0.40, 95% CI = 0.23, 0.56; k = 14). Overall, studies satisfied an average of 41% of the methodological quality (MQ) criteria; MQ score was not associated with any outcome (P > 0.05). They reported that yoga improved glycemic outcomes and other risk factors for complications in adults with T2DM relative to a control condition. This finding is in line with our study.[18]

Sato studied the mega-trials such as the DPP in the U.S. The study showed that lifestyle intervention programs involving diet and/or exercise reduces the progression of IGT to type-2 diabetes. A significant correlation has been observed between delta Metabolic Clearance Rate (MCR) (insulin sensitivity) and the average number of steps performed in a day. The data suggested that the improved effectiveness of insulin that occurs as a result of physical exercise is attributable, at least in part, to increases in GLUT4 protein, PI3 kinase, and IRS1 protein in skeletal muscle. As a prescription for exercise, aerobic exercise of mild to moderate intensity, including walking and jogging, 10–30 min a day, 3–5 days a week, is recommended. An active lifestyle is essential in the management of diabetes, which is one of the typical lifestyle-related diseases.[19]

4. Findings of HbA1C level in three groups. In group C, the mean difference was 0.86 ± 1.48 and P value was 0.048 which is a significant finding. This implies that HbA1C level are affected by all the three interventions namely meditation, diet, and exercise. Our study shows that regular, low glycemic index diets can have a favorable impact on glycemic control findings as seen through HbA1C.[20]

Thind et al. conducted a meta-analysis to examine the effects of yoga for glycemic control among adults with T2DM. Twenty-three studies with 2473 participants (mean age = 53 years; 43% women) met eligibility criteria. Compared with controls, yoga participants were successful in improving their HbA1c (d + =0.36, 95% CI = 0.16, 0.56; k = 16), FBG (d+ = 0.58, 95% CI = 0.40, 0.76; k = 20), and PPBG (d+ = 0.40, 95% CI = 0.23, 0.56; k = 14).

Exercise interventions were generally found to reduce glycosylated hemoglobin A1c (HbA1c) even though more recently the effects on other parameters, such as carnitine, were investigated.[21]

Some meta-analysis has been particularly useful in summarizing and analyzing prior research. In a meta-analysis, reviewing exercise intervention of at least 8 weeks of supervised exercise in type 2 diabetic patients,[22] regular aerobic exercise was seen to have a statistically and clinically significant effect on HbA1c. This kind of intervention improves glycemic control while having little effect on body weight.

Zanuso et al. reviewed the more relevant evidence on the interrelationships between exercise and metabolic outcomes. They say that the effects of aerobic exercise on HbA1c, the major marker of glycemic control have become well established. However, the most interesting question to be addressed today is not the effect of aerobic exercise itself, but the effect of exercise intensity. They concluded that interventions with more vigorous aerobic exercise programs resulted in greater reductions in HbA1c.[23],[24],[25],[26],[27],[28],[29]


  Conclusion Top


The effect of RM as a complementary intervention is better than other groups in improving glycemic control. In addition, all the three interventions namely meditation, diet and exercise favorably affect HbA1C level.

Acknowledgment

General support by a departmental of medicine especially Dr. Shilpa Gaidhane.

Financial support and sponsorship

This study was supported by Intramural grant, DMIMS (Deemed to be Univ).

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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