Yoga as a Complementary Therapy for Type 2 Diabetes: An Initial Investigation

 描述（由申请人提供）：糖尿病影响近2900万美国人，另有8600万美国成年人为糖尿病前期。2型糖尿病（T2 DM）占成人所有糖尿病病例的90-95%。随着时间的推移，不受控制的糖尿病会对肾脏、眼睛和神经造成严重损害，并增加心脏病和中风的风险。 控制血糖水平是避免这些严重并发症的关键。传统的有氧运动（例如，步行、慢跑、骑自行车）已知可改善T2 DM患者的血糖水平。瑜伽是一种古老的东方实践，与锻炼有许多相同的好处。像有氧运动一样，瑜伽练习可以改善身体健康相关的方面。瑜伽也是一种专注练习，强调放松，冥想和深呼吸，因此可能与T2 DM患者特别相关。瑜伽通过增加正念和副交感神经活动可以缓解压力。对健康和患病参与者的随机试验表明，瑜伽对减轻压力有好处。通过诱导压力恢复力，瑜伽可以防止压力引起的皮质醇上升，从而控制血糖水平的上升。此外，通过减少压力和增加正念，瑜伽还可以改善自我护理行为，包括改善饮食和体育活动。在美国的社会文化背景下，瑜伽作为糖尿病患者的补充疗法的作用需要进一步的研究。当前提案的目的是测试瑜伽干预对成人T2 DM患者的影响，并收集瑜伽与接触控制血糖相比的可行性和可接受性数据。我们将进行一项试点随机对照研究，参与者被随机分配到1）瑜伽干预，或2）团体步行计划（对照）。在干预结束时，将与参与者进行焦点小组讨论，以确定瑜伽练习的促进者和障碍，并检查他们对瑜伽及其与压力和糖尿病管理的关系的看法和信念。我们将探讨瑜伽对压力（生物标志物=唾液皮质醇）的影响，这可能是瑜伽改善血糖控制功效的作用机制。我们还将在基线、治疗结束（12周）、6个月和9个月随访时测量HbA 1c水平、空腹和餐后血糖。将使用受试者招募、出勤率和保留率以及对研究方案的依从性和对项目的总体满意度来评估研究的可行性和可接受性。本研究的结果将为未来更大规模的临床试验提供科学依据。瑜伽，如果被发现提供血糖控制的优势，可能对目前的糖尿病管理实践产生很大的影响。

 DESCRIPTION (provided by applicant): Diabetes affects nearly 29 million Americans and another 86 million adults in the U.S. are prediabetic. Type 2 diabetes (T2DM) accounts for 90-95% of all diabetes cases in adults. Uncontrolled diabetes, over time, can cause serious damage to kidneys, eyes, and nerves and increases the risk of heart disease and stroke. Controlling blood glucose level is crucial to avoid these serious complications. Traditional aerobic exercise (e.g., walking, jogging, cycling) is known to improve blood glucose levels in patients with T2DM. Yoga, an ancient eastern practice, shares many of the same benefits as exercise. Like aerobic exercise, yoga practice can elicit improvements in health related aspects of physical fitness. Yoga is also a mindfulness practice with emphasis on relaxation, meditation, and deep breathing, and therefore may have special relevance to people with T2DM. Yoga by increasing mindfulness and parasympathetic activity can alleviate stress. Randomized trials with healthy and diseased participants have shown the benefit of yoga on stress reduction. By inducing stress resilience, yoga may prevent stress-induced rise in cortisol, thus controlling rise in blood glucose levels. Moreover, by reducing stress, and increasing mindfulness, yoga may also lead to improved self-care behaviors including improved diet and physical activity. The role of yoga as a complementary therapy for diabetics within the socio-cultural context of the U.S. needs additional examination. The purpose of the current proposal is to test a yoga intervention for adults with T2DM and to gather data on the feasibility and acceptability of yoga compared to a contact control for glycemic control. We will conduct a pilot randomized controlled study with participants randomly assigned to 1) Yoga intervention, or 2) Group Walking program (control). Focus groups will be conducted with participants at the end of the intervention to identify facilitators and barriers to yoga practice and to examine their perceptions and beliefs about yoga and its relationship to stress and diabetes management. We will explore the effect of yoga on stress (biomarker = salivary cortisol) that may act as a mechanism of action underlying the efficacy of yoga for improved glycemic control. We will also measure HbA1c levels, fasting and postprandial plasma glucose at baseline, end of treatment (12-weeks), 6- and 9- month follow-ups. Study feasibility and acceptability will be assessed using participant recruitment, attendance and retention rates, and compliance with study protocols and general satisfaction with the program. Results from this study will provide scientific basis for a future larger clinical trial. Yoga, if found to offer advantages for glycemic control, can have potential for high impact on current practices of diabetes management.