YOGA EFFECTS ON INSULIN SENSITIVITY AND RELATED INDICES OF CARDIOVASCULAR RISK

这个子项目是许多研究子项目中的一个 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可以在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 2型糖尿病（DM 2）是一种与胰岛素抵抗综合征（IRS）密切相关的严重的、慢性的、与年龄相关的疾病，是美国死亡和残疾的主要原因，并且在全国和全球范围内迅速达到流行病的比例。 越来越多的证据表明，瑜伽可能为管理DM 2和预防心血管后遗症提供特别的承诺，并可能提供一种安全和具有成本效益的方法来解决这种复杂，破坏性和快速增加的慢性疾病背后的多重相互关联的因素。然而，在西方2型糖尿病人群中的研究是有限的，缺乏关于瑜伽对糖尿病成人生理，人体测量和心理特征影响的严格，系统的研究。 拟议的试点研究将采用随机对照设计，研究8周结构化艾扬格瑜伽计划对2型糖尿病成人胰岛素敏感性和其他相关代谢和心血管疾病风险心理指标的影响。 参与者将是46名年龄在50-75岁之间的患者，他们被确诊为DM 2，并参加了UVA糖尿病教育和管理计划（DEMP）。 合格的参与者将被随机分配到瑜伽组或对照组，并根据性别和种族/民族进行分层。 我们的主要目的是评估艾扬格瑜伽对胰岛素敏感性变化的影响，该变化由QUICKI估计，该措施结合了良好的可靠性和有效性，受试者负担最小。 我们的次要目标是：1）评估瑜伽对胰岛素抵抗其他标志物的影响（空腹血糖、胰岛素、糖化血红蛋白、果糖胺、餐后血糖）和相关CVD风险指数，包括交感神经激活、血脂异常、内皮功能、炎症、凝血病、内脏肥胖、胰岛素样生长因子生物利用度、心理发病率和睡眠障碍的测量;和2）评估和优化总体方案设计，包括招募和保留率、方案依从性以及少数和非少数受试者的仪器负担。 干预将包括8周的结构化艾扬格瑜伽训练，包括每周两次90分钟的课程，以及每天在家进行的瑜伽练习。所有参与者将继续接受常规护理，并参加DEMP计划。 对照组还将在研究完成后获得6个瑜伽课程的优惠券。 在8周治疗期之前和之后，将采集空腹血液样本，并测量胰岛素敏感性的特异性标志物以及与胰岛素抵抗和DM 2相关的其他生理、人体测量和心理指标。 这项研究的结果将1）提供关键的初步和可行性数据，以支持更大的，多种族的随机临床试验，调查瑜伽练习对2型糖尿病老年人胰岛素抵抗和相关代谢和心理指标的影响;和2）产生关于瑜伽在管理DM 2中的潜在效用的重要初步信息。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Type 2 diabetes mellitus (DM 2), a serious, chronic, age-related disorder strongly linked to the insulin resistance syndrome (IRS), is a leading cause of death and disability in the United States and is fast reaching epidemic proportions both nationally and globally. There is growing evidence that yoga may offer particular promise for the management of DM 2 and prevention of cardiovascular sequellae, and may provide a safe and cost-effective means of addressing the multiple, interrelated factors underlying this complex, devastating, and rapidly increasing chronic disorder. However, research in western populations with DM 2 is limited, and rigorous, systematic studies regarding the effects of yoga on physiological, anthropometric, and psychological profiles in diabetic adults are lacking. The proposed pilot study will use a randomized controlled design to investigate the effects of an 8 week structured Iyengar yoga program on insulin sensitivity and other related metabolic and psychological indices of CVD risk in adults with Type 2 diabetes. Participants will be 46 patients aged 50-75 who have an established diagnosis of DM 2 and are enrolled in the UVA Diabetes Education and Management Program (DEMP). Eligible participants will be randomized into yoga or control groups, stratified on gender and race/ethnicity. Our primary aim is to evaluate the effects of Iyengar yoga on change in insulin sensitivity as estimated by the QUICKI, a measure that combines excellent reliability and validity with minimal subject burden. Our secondary aims are: 1) to assess the effects of yoga on other markers of insulin resistance (fasting glucose, insulin, glycated hemoglobin, fructosamine, post-prandial glucose), and related CVD risk indices, including measures of sympathetic activation, dyslipidemia, endothelial function, inflammation, coagulopathy, visceral adiposity, insulin-like growth factor bioavailability, psychological morbidity, and sleep disturbance; and 2) to evaluate and optimize the overall protocol design, including recruitment, and retention rates, protocol adherence, and instrument burden in both minority and non-minority participants. The intervention will comprise 8 weeks of structured Iyengar yoga training, including two 90-minute classes/week in addition to daily directed yoga practice at home. All participants will continue to receive usual care and to participate in the DEMP program. Controls will also receive coupons for 6 yoga classes upon completion of the study. Before and after the 8 week treatment period, fasting blood samples will be collected, and specific markers of insulin sensitivity and other physiological, anthropometric, and psychological indices associated with insulin resistance and DM 2 will be measured. Findings of this study will 1) provide critical preliminary and feasibility data to support larger, multi-ethnic randomized clinical trials investigating the influence of yoga practice on insulin resistance and related metabolic and psychologic indices in older adults with type 2 diabetes; and 2) yield important preliminary information on the potential utility of yoga in managing DM 2.