Sir,
Exercise plays a significant role in the management of Type 2 diabetes mellitus (T2DM).[1] Increased risk of hypoglycemia remains a major concern while administering exercise in T2DM. The risk factors for exercise include hypoglycemia due to prolonged exercise duration, or intensity.[2] Yoga is considered as a mild-to-moderate intensity physical activity increasingly used in the management of T2DM, with positive influence on blood glucose levels, oxidative stress, and other comorbidities.[3]
We report a unique observation in patients with T2DM who underwent a short 10 days yoga intervention program. In total, 654 individuals diagnosed with T2DM participated in the program from multiple centers. Every session was conducted by a certified yoga therapist under the supervision of a physician. Before commencement, participants were given orientation on various aspects of yoga and diabetes including signs of hypoglycemia. A conventional form of yoga, including asanas, pranayama, and meditation, was taught 1 h every day. Fasting plasma glucose (FPG) levels were measured at baseline and at the end of 10 days. No hypoglycemic episode was reported in any of the participating centers.
We observed a unique pattern during our preliminary data analysis. The reduction in blood glucose levels was directly proportional to the baseline FPG levels, i.e., higher the baseline FPG, higher was the reduction in glucose levels. More interestingly, in patients with normal (70–100 mg/dL) and below normal baseline FPG levels, there was an “increase” rather than further decrease in the plasma glucose levels [Graph 1]. We observed yoga to work more in a bidirectional manner, trying to establish a homeostasis in the blood glucose levels. For instance, the mean reduction in glucose levels were 28.73% (96.85 mg/dL) in patients with baseline glucose levels above 300 mg/dL whereas patients with baseline glucose levels below 70 mg/dL had a mean increase of 19.50% (12.74 mg/dL) [Table 1]. This implies that yoga does not necessarily reduce blood glucose levels at all times and might help increase glucose levels in hypoglycemia through autonomic activation.[4]
Graph 1.
The linear relation between baseline blood glucose levels and percentage (%) difference after yoga intervention
Table 1.
Preglucose range and percentage differences from the baseline glucose levels
| Preglucose range (mg/dL) | Premean (mg/dL) | Postmean (mg/dL) | Difference (mg/dL) | Percentage difference |
|---|---|---|---|---|
| >300 | 337.07 | 240.22 | −96.85 | −28.73 |
| 200-300 | 235.59 | 189.36 | −46.23 | −19.62 |
| 100-200 | 136.71 | 125.76 | −10.95 | −8.01 |
| 70-100 | 86.29 | 89.33 | 3.04 | 3.52 |
| <70 | 65.33 | 78.07 | 12.74 | 19.50 |
| Overall mean | 141.10 | 128.70 | 12.4 | −5.95 |
| SD | 18.97 | |||
| Correlation coefficient (r) | −0.45 |
SD: Standard deviation
Hence, we postulate that, in T2DM, yoga tends to establish a homeostasis in blood glucose levels and has minimal chance to induce hypoglycemia. To the best of our knowledge, this is the first time such a bidirectional nature of yoga in T2DM is being reported. Yoga could thus prove to be a very safe and effective form of physical activity, which could be administered to T2DM patients who are at increased risk of hypoglycemia.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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