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利用 资源由NIH/NCRR资助的中心拨款提供。子项目和 调查员(PI)可能从NIH的另一个来源获得了主要资金， 并因此可以在其他清晰的条目中表示。列出的机构是 该中心不一定是调查人员的机构。 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、慢性、与年龄相关的疾病，在美国是导致死亡和残疾的主要原因，并在全国和全球迅速蔓延。越来越多的证据表明，瑜伽可能为2型糖尿病的治疗和心血管后遗症的预防提供了特别的希望，并可能提供一种安全和经济有效的手段来解决这种复杂、破坏性和快速增长的慢性疾病背后的多种相互关联的因素。然而，西方人群中患有2型糖尿病的研究有限，缺乏关于瑜伽对成年糖尿病患者的生理、人体测量和心理特征影响的严谨、系统的研究。拟议的试点研究将使用随机对照设计来调查为期8周的结构化艾扬格瑜伽计划对成年2型糖尿病患者的胰岛素敏感性和其他相关的心血管疾病风险的代谢和心理指标的影响。参与者将是46名年龄在50-75岁之间的患者，他们被确诊为2型糖尿病，并参加了UVA糖尿病教育和管理计划(DEMP)。符合条件的参与者将被随机分为瑜伽组或对照组，按性别和种族/民族分层。我们的主要目标是评估艾扬格瑜伽对Quicki评估的胰岛素敏感性变化的影响，Quicki是一种将出色的可靠性和有效性与最小的受试者负担相结合的衡量标准。我们的次要目标是：1)评估瑜伽对其他胰岛素抵抗标记物(空腹血糖、胰岛素、糖化血红蛋白、果糖胺、餐后血糖)和相关心血管风险指数的影响，包括交感神经激活、血脂异常、内皮功能、炎症、凝血功能、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；以及2)评估和优化总体方案设计，包括少数和非少数参与者的招募、保留率、方案遵从性和器械负担。这项干预将包括8周的结构化艾扬格瑜伽训练，除了每天在家中进行指导瑜伽练习外，还包括每周两节90分钟的课程。所有参与者将继续接受通常的照顾，并参加Demp计划。研究结束后，控制组还将收到6节瑜伽课的优惠券。在8周的治疗前后，采集空腹血样，检测胰岛素敏感性的特异性标志物以及与胰岛素抵抗和2型糖尿病相关的其他生理、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，以支持更大规模的多种族随机临床试验，调查瑜伽练习对患有2型糖尿病的老年患者的胰岛素抵抗及相关代谢和心理指标的影响；以及2)就瑜伽在管理2型糖尿病方面的潜在效用提供重要的初步信息。

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. Research in western populations with DM 2 is limited, however 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.