Mindfulness, yoga ‘as strong as drug therapy’ plus lifestyle intervention in type 2 diabetes
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Mind- and body-based practices, including mindfulness-based stress reduction, qigong and yoga, are associated with a reduction in HbA1c for adults with type 2 diabetes, according to findings from a systematic review and meta-analysis.
“Mind- and body-based practices appear to have uniform benefit for people with diabetes regardless of the type of practice,” Richard M. Watanabe, PhD, professor in the department of population and public health sciences, physiology and neuroscience, and associate dean for health and population science programs at the Keck School of Medicine of USC, told Healio. “The beneficial effect appears to be as strong as drug therapy coupled with lifestyle improvement, and the fact that the effect we observed is in addition to standard of care suggests these approaches may reduce risk for future diabetes in at-risk individuals.”
Watanabe and colleagues conducted a systematic review and meta-analysis of studies analyzing whether mind and body practices improve glycemic control in adults with type 2 diabetes. Researchers searched the Ovid MEDLINE, Embase and ClinicalTrials.gov databases through June 10. The primary outcome of interest was mean change in HbA1c from preintervention to postintervention, with fasting blood glucose a secondary outcome of interest.
The findings were published in the Journal of Integrative and Complementary Medicine.
The meta-analysis included 28 studies , of which 18 were randomized controlled trials and 10 were matched preintervention vs. postintervention studies. Yoga was the intervention used in 18 studies, mindfulness-based stress reduction in five studies, qigong in three studies and one study used Buddhist walking meditation. Seven studies examined both HbA1c and FBG, eight reported on HbA1c alone and 13 reported on FBG alone. Participants in all studies were kept on standard care and were not treated with insulin.
Across the studies, intervention participants had a mean HbA1c reduction of 0.84% postintervention compared with preintervention (95% CI, –1.1 to –0.58; P < .0001). Yoga was associated with the largest mean reduction in HbA1c at 1%, followed by qigong at 0.66% and mindfulness-based stress reduction at 0.48%. As with HbA1c, participating in any intervention was associated with a mean reduction in FBG postintervention compared with preintervention (mean reduction, –22.81 mg/dL; 95% CI, –33.07 to –12.55; P < .0001).
“People with diabetes come in all varieties, each with different challenges,” Watanabe said. “This study included populations across the globe and were uniform in terms of effect, so it suggests the benefit should be relatively generalizable. This is important, because some patients may find certain practices more challenging than others, but the general effect suggests they can choose the approach that works best for their specific situation.”
The heterogeneity among the studies was high due to differing lengths in days of yoga practice. In an analysis of all studies with yoga as the intervention, an inverse association was observed between the number of yoga sessions performed per week and HbA1c. For each additional day of yoga per week, participants had a mean HbA1c decline of 0.22% (95% CI, –0.44 to –0.003; P = .046).
Watanabe said future research should explore the mechanisms behind how mind and body practices improve glycemic control, what effect the frequency and durability of practices have on HbA1c and FBG, and whether any practices can reduce the risk for future diabetes.
For more information:
Richard M. Watanabe, PhD, can be reached at rwatanab@usc.edu.
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