Oct. 14, 2022 -- Patients with type 2 diabetes achieve much better control of their blood sugar if they participate in mind-and-body-practices such as yoga, a new study shows.
While past research has been done specifically for yoga, this study, published online recently in the Journal of Integrative and Complementary Medicine, also looked at the benefits of other mind-and-body practices for these patients, including qi gong and meditation.
The study is "the first to show that there is a very consistent effect [on hemoglobin A1c, a marker of diabetes] regardless of which modality you use,” says one of the researchers, Richard Watanabe, PhD.
“So I think one of the important messages ... is that any sort of mind-body intervention seems to be helpful, which makes this a much more flexible tool than telling a patient that they should [just] do yoga,” says Watanabe, who is a professor of population and public health sciences at the University of Southern California's Keck School of Medicine in Los Angeles.
There are other options available, “and if you are a busy person and getting to yoga is not doable, you can learn about meditation and do it anywhere. So again, it [is] ... a flexible tool to help their patients with blood sugar control,” he says.
“The most surprising finding was the magnitude of the benefit these practices provide,” says the lead author, Fatimata Sanogo, from the University of Southern California, Los Angeles, in a statement. “We expected there to be a benefit but never anticipated it would be this large.”
But how do mind-body practices reduce A1c? It's not totally clear, Watanabe says, noting that more research needs to be done to figure this out.
“But I think everyone’s hypotheses is that these methods reduce stress, so the idea is that they reduce stress hormones and since these hormones do have an effect on glucose metabolism, reducing them using these modalities reduces A1c and blood sugar levels,” he explains.
Alternatively, mind-body practices might improve insulin sensitivity. “You basically allow insulin to be more efficient at increasing glucose uptake by insulin-sensitive tissues,” Watanabe says.
So should doctors prescribe any one of the mind-body practices looked at in the study? Maybe, Watanabe says.
“Our results suggest that the effect you are going to see with the mind-body intervention is going to be on top of whatever standard of care patients are getting, so it definitely cannot hurt,” he says. He also notes that for patients with diabetes, constantly having to monitor their blood sugar levels and watch what they eat is very stressful.
“That just contributes to the difficulty in controlling blood sugar,” he says. "So I think physicians need to evaluate their patients and help them pick the thing that fits best with their lifestyle and personality, so it’s really up to the physician to work with patients and help them find something that works for them."
A Study of Studies
The researchers conducted what is known as a meta-analysis, where they identified 28 studies, published between 1993 and 2022, looking at the use of mindfulness practices in patients with type 2 diabetes.
All studies excluded patients who needed insulin to control their diabetes as well as those with medical complications such as heart disease or kidney complications. The types of mind-body practices analyzed included meditation, breathing techniques, yoga, and an ancient Chinese practice known as qi gong, a type of slow-moving martial arts that's similar to tai chi.
Using hemoglobin A1c (HbA1c) as a test that tells patients what their average blood sugar levels have been for the last 3 months, the results showed that the overall reduction in average A1c was 0.84 percentage points.
And reductions in A1c were seen with all types of mind-body practices. In patients who practiced mindfulness-based stress reduction, A1c was reduced by a mean of 0.48 percentage points. This practice involves focusing on one’s breath and on a particular thought, object, or activity to engender a stable emotional state and be fully present and aware of one’s surroundings.
The practice of qi gong also reduced A1c by a larger degree of 0.66 percentage points.
But the reduction in A1c was largest among those who practiced yoga, at 1.0 percentage points -- about the same degree of reduction in A1c that's seen with metformin, a drug widely used to treat type 2 diabetes around the world.
In fact, for every additional day of yoga practiced each week, the mean A1c differed by -0.22 percentage points over the study period.
Fasting blood sugar also improved significantly with mind-body practices.
Overall, the average reduction in A1c and fasting blood sugar “was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes,” the study authors said.