Diabetic yoga protocol improves glycemic, anthropometric and lipid levels in high risk individuals for diabetes: a randomized controlled trial from Northern India

Clinical trials landscape in a lower-middle-income country (Pakistan)

In recent times, there have been calls from within the developing nations for increased ownership by governmental research bodies and universities of the priority research setting and research that aligns with national health strategies. This is a review paper of the studies that have been published on clinical trials in developing countries, with a focus mainly on Pakistan. The literature review used online databases such as PubMed, Scopus, and Google Scholar, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov trial registries to search for clinical trials conducted in Pakistan between January 2000 and December 2022 and analyzed. The results revealed that clinical research in Pakistan is hindered by a number of barriers, including a lack of funding, skilled personnel, and regulatory issues. Lack of funding is a common obstacle, and the majority of funding for clinical trials originates from Western countries or pharmaceutical companies established in the West. In conclusion, clinical studies in developing countries, especially in Pakistan, are hindered by a plethora of barriers, and to improve the current state, increasing funding, streamlining ethical approval procedures, simplifying regulatory systems, addressing cultural and religious concerns, and participating in global efforts to bridge the gap in health-based research are crucial.

Effect of Yoga and Walking on Glycemic Control for the Management of Type 2 Diabetes: A Systematic Review and Meta-analysis

Background

A daily habit of yogic practice or walking, along with an oral hypoglycemic agent (OHA) could be beneficial for better control of type 2 diabetes mellitus (T2DM). We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to find out the efficiency of yoga or walking on glycemic control in T2DM.

Methodology

The present systematic review and meta-analysis were completed according to the PRISMA guidelines. The risk of bias in included studies was evaluated, by using the revised Cochrane risk-of-bias tool for randomized trials. Meta-analysis was implemented using RevMan software. Forest plots were used to illustrate the study findings and meta-analysis results.

Results

Sixteen studies were included in this systematic review, where 1820 participants were allocated to one of the following interventions: yoga, walking, and without any regular exercise (control group). Participants were between 17-75 years of age. Compared to the control group, the yoga group had a significant reduction in fasting blood glucose (FBG) by 31.98 mg/dL (95% CI = -47.93 to -16.03), postprandial blood glucose (PPBG) by 25.59 mg/dL (95% CI = -44.00 to -7.18], glycosylated hemoglobin (HbAlc) by 0.73% (95% CI = -1.24 to -0.22), fasting insulin by 7.19 μIU/mL (95% CI = -12.10 to -2.28), and homeostatic model assessment for insulin resistance (HOMA-IR) by 3.87 (95% CI = -8.40 to -0.66). Compared to the control group, the walking group had a significant reduction in FBG by 12.37 mg/dL (95% CI = -20.06 to -4.68) and HbA1c by 0.35% (95% CI = -0.70 to -0.01). Compared to the walking group, the yoga group had a significant reduction in FBG by 12.07 mg/dL (95% CI = -24.34 to - 0.20), HbA1c by 0.20% (95% CI = -0.37 to -0.04), fasting insulin by 10.06 μIU/mL (95% CI = -23.84 to 3.71) and HOMA-IR by 5.97 (95% CI = -16.92 to 4.99).

Conclusions

Yoga or walking with OHA has positive effects on glycemic control. For the management of T2DM, yoga has relatively more significant effects on glycemic control than walking.Review registration number: PROSPERO registration number CRD42022310213.

A Study to Assess and Correlate Metabolic Parameters with Carotid Intima-Media Thickness after Combined Approach of Yoga Therapy among Prediabetics

Background

Prediabetes is an intermediate hyperglycemia in which the fasting blood glucose (FBG) level is greater than normal (100-125 mg/dl) but lower than diabetic levels (more than 125 mg/dl). The aim of the present study was to evaluate and correlate the impact of the combined approach of yoga therapy (CAYT) on carotid intima-media thickness (CIMT) and metabolic parameters including FBG, glycated hemoglobin (HbA1C), and lipid profile-like triglyceride (TG), total cholesterol (TC), and high-density lipoprotein (HDL).

Materials and Methods

Experimental Interventional study was conducted on a total of 250 prediabetics divided into the control (n = 125) and study group (n = 125) at "RUHS College of Medical Sciences and associated hospitals." Assessments were made at baseline and after six months of the CAYT. The study group (n = 125) was engaged in the CAYT, which consists of yoga, dietary modification, counseling, and follow-up. The control group not participated in CAYT.

Result

Mean age of participants was 45.3 ± 5.4 years. Pearson correlation analysis of CIMT and metabolic parameters which were fasting blood sugar, HbA1C, and lipid parameters (TC, TG, and HDL) showed that significant positive correlation with FBG (r =.880), HbA1C (r =.514), TC (r =.523), TG (r =.832), and negative correlation with HDL (r = -0.591) after six months of CAYT.

Conclusion

This study demonstrated that after six months of CAYT metabolic parameters, CIMT were significantly decreased. We have observed a significant correlation exists between CIMT and metabolic parameters. Therefore, regular CIMT measurement might be beneficial for the assessment of cardiovascular disease (CVD) risk and facilitate better use of treatment modalities in prediabetics.

Is Type 2 Diabetes Mellitus a Behavioural Disorder? An Evidence Review for Type 2 Diabetes Mellitus Prevention and Remission through Lifestyle Modification

The prevalence of type 2 diabetes mellitus (T2DM) is steadily rising worldwide due to an increasingly sedentary lifestyle combined with unhealthy food habits. Currently, the burden of diabetes on healthcare systems is unprecedented and rising daily. Several observational studies and randomized controlled trials provide clinical evidence that T2DM remission is possible by adopting dietary interventions and a strict exercise training protocol. Notably, these studies provide ample evidence for remission in patients with T2DM or for prevention in those with risk factors for the disease through various non-pharmacological behavioural interventions. In this article, we present two clinical cases of individuals who showed remission from T2DM/prediabetes via behavioural changes, especially through the adoption of a low-energy diet and exercise. We also discuss the recent advances in T2DM and obesity research, focusing on nutritional interventions and exercise and their benefits for weight loss, improved metabolic profile, enhanced glycaemic control and remission of diabetes.

Effects of weight loss on cognitive function in patients with diabetes: a systematic review and meta-analysis

AIMS

Normalization of body weight is a treatment objective for diabetes. Therefore, anti-diabetic drugs that cause weight loss are widely used in clinics, with the aim of reducing the risk of chronic complications. However, the effect of weight loss on cognition in patients with diabetes is unclear.

METHODS

Embase, the Cochrane Library, PubMed, and the Web of Science were searched systematically, without study type restrictions, from inception to December 18, 2022. Weight loss was defined as a statistically significant decrease in body mass index (BMI) following an observation or intervention. We conducted an analysis of pooled data using a random-effects model.

RESULTS

A total of 619 participants in five studies were included. Weight loss was not associated with cognitive changes in patients with diabetes (standardized mean difference 0.50, 95% confidence interval -0.09 to 1.08). Subgroup analyses showed that this was not significantly affected by the duration of intervention or observation, or the size of the reduction in BMI. However, it was challenging to draw definitive conclusions regarding the effects of interventions and baseline BMI, because only one study was included.

CONCLUSIONS

Weight loss may be neutral to cognitive function in diabetes, but further studies are required to draw more definitive conclusions.

The Effect of Yoga on the Lipid Profile: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Objectives

Yoga is a mind-body stress-relieving exercise that increases mental and physical health, which may have a role in the improvement of metabolic disorders. The present study has reviewed the effect of yoga on lipid profiles as a systematic review and meta-analysis.

Methods

We evaluated the available randomized controlled trials on the effects of yoga-based programs, and lipid profiles by searching PubMed/Medline, Scopus, Web of Science, and the Cochrane central register of control trials up to January 2022. Both fixed and random effect analyses were used to find the relationships. Subgroup analysis was performed based on the continent, duration of the included studies, gender, and health condition of participants to discover the sources of heterogeneity.

Result

Fifty-three studies were included in the current systematic review and meta-analysis with a total sample size of 13,191. There was a striking association between yoga and total cholesterol (−10.31 mg/dl; 95% CI: −14.16, −6.45; I² = 82.5%, P < 0.001), low-density lipoprotein cholesterol (−8.64 mg/dl; 95% CI: −12.03, −5.25; I² = 75.0%, P < 0.001), high-density lipoprotein cholesterol (1.98 mg/dl; 95% CI: 0.81, 3.14; I² = 91.6%, P < 0.001), triglycerides (−13.50 mg/dl; 95% CI: −20.09, −6.92; I² = 90.7%, P < 0.001) and very low-density lipoprotein (−3.94 mg/dl; 95%CI: −6.31, −1.56; I² = 72.2%, P < 0.001).

Conclusion

It seems yoga interventions had a substantial effect on lipid profiles, however, more qualified trials or cohort studies are needed to conclude exactly.