Effect Of Integrated Yoga On Insulin Resistance Biology Essay

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The prevalence of diabetes for all age-groups worldwide was estimated to be 2.8 in 2000 and 4.4 in 2030. The total number of people with diabetes is projected to rise from 171 million in 2000 to 366 million in 2030. The prevalence of diabetes is higher in men than women, but there are more women with diabetes than men. The urban population in developing countries is projected to double between 2000 and 2030. The most important demographic change to diabetes prevalence across the world appears to be the increase in the proportion of people ≥ 65 years of age. [1] 


Insulin resistance can be defined as the inability of insulin to produce its numerous actions, in spite of the unimpaired secretion from the beta cells. [2] 34


Insulin resistance is a common finding in developing countries. Throughout the world hundreds of millions of people and perhaps even >1 billion people are estimated to have insulin resistance. [5] 

Insulin resistance syndrome is found in all races. The degree of clustering of the risk variables of the metabolic syndrome is generally considered to be higher among whites. However, prevalence rates of the various components of the metabolic syndrome tend to be higher among non-white populations. [6] 

Prevalence rates of insulin resistance syndrome reported for white populations ranged from 3-16. A quarter of the world's adults are considered to have the metabolic syndrome. [7] 

The prevalence of insulin resistance and diabetes mellitus is particularly high in adult Asian Indians. [8] 9

Prevalence of insulin resistance in metabolic disorders [10] . These results from a population-based study documented that:

In hypertriglyceridemia and a low HDL cholesterol state, insulin resistance is as common as in NIDDM, whereas it is less frequent in hypercholesterolemia, hyperuricemia, and hypertension.

The vast majority of subjects with multiple metabolic disorders are insulin resistant.

In isolated hypercholesterolemia, hyperuricemia, or hypertension, insulin resistance is not more frequent than can be expected by chance alone.

In the general population, insulin resistance can be found even in the absence of any major metabolic disorders.



Hereditary causes include mutations of insulin receptor, glucose transporter, and signaling proteins, although the common forms are largely unidentified.


Abnormal insulin (mutations)

Anti-insulin antibodies


Decreased number of receptors (mainly, failure to activate tyrosine kinase)

Reduced binding of insulin

Insulin receptor mutations

Insulin receptor - blocking antibodies


Defective signal transduction

Mutations of GLUT4 (In theory, these mutations could cause insulin resistance, but polymorphisms in the GLUT4 gene are rare.)

Combinations of defects - Such combinations are common. Obesity is associated mainly with post-receptor abnormality and is also associated with a decreased number of insulin receptors. Obesity is the most common cause of insulin resistance

Acquired influences

Acquired causes include physical inactivity, diet, medications, hyperglycemia (glucose toxicity), increased free fatty acids, chronic stress and the aging process. [11] 

Physical inactivity:

Diet: excessive energy intake by a high fat diet. [12] 

Medications: These include glucocorticoids (Cushing syndrome), cyclosporine, niacin, and protease inhibitors.

Lifestyle: unhealthy lifestyle and sedentary lifestyle contributes to the pathogenesis. [13] 14

Chronic stress: Increased oxidative stress appears to be a deleterious factor leading to insulin resistance, b-cell dysfunction, impaired glucose tolerance and ultimately type 2diabetes. [15] 16

Aging: This may cause insulin resistance through a decreased production of GLUT-4

IR associated conditions

Association between IR and T2DM

A Preliminary Observation study shows significant genetic association of IR with abnormal cholesterol metabolism and family history of DM. [17] 

Evidence has established that the level of insulin resistance is a pre-diabetic state that can predict incident of T2DM relatively far into the future. [18] 

Some population based studies show that 83.9 of T2DM subjects have insulin resistance and 95.2 in combination of glucose intolerance (IGT or T2DM), dyslipidemia, hyperuricemia, and hypertension are due to IR. [19] 

The metabolic syndrome means the state of glucose intolerance caused by insulin resistance, and develops lipid abnormality and high blood pressure. [20] 



The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Medications that reduce insulin resistance include biguanides and thiazolidinediones, which have insulin-sensitizing and antihyperglycemic effects. Large quantities of insulin are also used in overcoming insulin resistance.


Biguanides are insulin sensitizers useful in type 2 diabetes and related insulin resistance. They reduce hepatic glucose output and peripheral resistance to insulin action and lower plasma insulin levels. Metformin (Glucophage) is an example for Biguanides it reduces hepatic glucose output, decreases intestinal absorption of glucose, and increases glucose uptake in the peripheral tissues (muscle and adipocytes). Major drug used in obese patients who have type 2 diabetes. Enhances weight reduction and improves lipid profile and vascular integrity. Individualize treatment with monotherapy or administer in combination with insulin or sulfonylureas.


These agents are insulin-sensitizing drugs that increase the disposal of glucose in peripheral tissues and act by activating a specific nuclear receptor, the peroxisome proliferator-activated receptor gamma (PPAR-gamma). Thiazolidinediones have a major effect in the stimulation of glucose uptake, skeletal muscle, and adipose tissue. They lower plasma insulin levels and are used to treat type 2 diabetes associated with insulin resistance for example Pioglitazone (Actos) can be used in monotherapy and in combination with metformin, insulin, or sulfonylureas. Improves target cell response to insulin without increasing insulin secretion from pancreas. Decreases hepatic glucose output and increases insulin-dependent glucose use in skeletal muscle and, possibly, in liver and adipose tissue.

Rosiglitazone (Avandia)

Insulin sensitizer with major effect in stimulation of glucose uptake in skeletal muscle and adipose tissue. Lowers plasma insulin levels. Used for treatment of type 2 diabetes associated with insulin resistance.


These agents are immunosuppressants used for the treatment of immune insulin resistance due to anti-insulin antibodies.

Prednisone (Sterapred)

Immunosuppressant for the treatment of autoimmune disorders. May decrease inflammation by suppressing key steps of the immune reaction process.

Antidiabetic agent, insulin

This is used to overcome insulin resistance, but large quantities are often required.For example Insulin (Humulin, Novolin, Humalog) these stimulates proper utilization of glucose by the cells and reduces blood sugar levels. Various preparations are available.

Lipase inhibitors

These agents inhibit nutrient absorption for example Orlistat (Xenical) Gastrointestinal lipase inhibitor that induces weight loss by inhibiting nutrient absorption. Effectiveness in producing weight loss does not depend on systemic absorption. May reduce absorption of some fat-soluble vitamins (A, D, E, and K) and beta carotene. Administer multivitamin supplement containing fat-soluble vitamins PO qd 2 h ac or 1 h pc.


These agents reduce appetite and may increase metabolism. Sibutramine (Meridia) is an example for Anorexant it inhibits central reuptake of neurotransmitters (eg, dopamine, norepinephrine, and serotonin). The pharmacologic action - inhibiting serotonin reuptake may produce enhanced satiety, while the action-inhibiting norepinephrine reuptake raises the metabolic rate.

Ayurvedic management of T-2DM

There is a considerable amount of data from both animal and human trials suggesting efficacy of Ayurvedic interventions in managing diabetes. Some of them are as follows:

Tinospora cordifolia

Aegle marmelos

Salacia reticulata

Bitter melon

Syzygium cumini

Lagenaria siceraria

Embelia ribes

Terminalia chebula Retz

Auriculata against

Coscinium fenestratum

Momordica charantia

Picrorhiza Kurrooa


Momordica charantia

Pterocarpus marsupium

Trigonella foenum greacum

M. charantia

Eugenia jambolana

Mucuna pruriens

T. cordifolia

T. foenum graecum

O. sanctum

P. marsupium

Murraya koeingii

Brassica juncea.

Trigonella foenum-graecum Linn

Syzygium cumini Linn

Swertia chirayita

Pterocarpus marsupium Roxb

Ocimum sanctum

Momordica charantia

Momordica charantia

Ficus bengalensis

Coccinia grandis

Cinnamomum tamala

Azadirachta indica

Annona squamosa

Aloe vera

Allium sativum

Allium cepa

Aegle marmelos Linn.

However, the reported human trials generally fall short of contemporary methodological standards. More research is needed in the area of Ayurvedic treatment of diabetes, assessing both whole practice and individual modalities.

Yoga and T-2DM

There is growing evidence that yoga practices may aid in the prevention and management of T-2DM, by attenuating the symptoms and signs of those with clinical T-2DM, with improved glycemic control, improve lipid profile and reduce insulin resistance and thus improve its prognosis. [21] 22232425Additional high quality RCTs are needed to confirm. [26] 


Healthy lifestyle composed of sufficient daily physical activity and a balanced diet for the prevention and management of type 2 diabetes (T2D) and cardiovascular disease risk. In particular, it is recommended that adults accumulate 30 min of moderate-intensity aerobic physical activity on most days of the week. [27] 

Diet in IR

Low fat/high carbohydrate diet is traditionally thought to aid weight loss and improve metabolic and reproductive dysfunction; there has been increased community interest in a high protein/low carbohydrate diet. [28] This may aid in increased weight loss [29] due to the increased satiating power of protein compared with carbohydrate or fat [30] and may improve insulin sensitivity through maintenance of lean body mass with weight loss. [31] 

Recent studies have shown that a low-carbohydrate, ketogenic diet can lead to weight loss and improvements in insulin resistance. [32] 

Exercise and IR

As skeletal muscle is responsible for over 80 of the peripheral glucose uptake, chronic oxidative stress in this tissue can result in particularly devastating effects on peripheral insulin sensitivity. Exercise is beneficial to patients with metabolic syndrome, and can markedly increase glycemic control [33] 34. Exercise stimulates glucose uptake and increases insulin sensitivity in the muscle and other peripheral tissues. [35] 

Exercise, which acutely increases oxidative stress in the muscle, improves insulin sensitivity and glucose tolerance in patients with Type 2 diabetes. [36] 

Need for present study



To study the effect of integrated Yoga on IR in T2DM patients after 2 weeks of residential program.


To study the effect of integrated effect of Yoga.







Sample size

A sample size of 60 was divided in to two groups.

Inclusion Criteria

Type two Diabetics of more than 5 years

Age: 40 -70 yrs

Gender: both

Exclusion criteria

Those with complications (like CAD, renal disease, proliferative retinopathy, severe peripheral vascular disease).

Those who are doing yoga regularly and or on Ayurveda treatment in the past three months.

Type 1DM, GDM or secondary diabetes

Baseline assessment

Baseline demography,

To confirm diagnosis and absence of spontaneous remission.

IGT-FBS followed by 75 grams glucose drink -check glucose after two hour

To rule out renal disease -micoralbunurea, serum urea and creatinine,

To rule out CAD- ECG

To rule out proliferative retinopathy-fundoscopy

Source of subjects

People willing to come for the 2week residential training program at Prashanti Kutiram.

Participants were recruited by voluntary participation through advertisement among hospital staff and personnel. The sample selection was performed using a random sampling method. After clinical screening (medical history, physical examination, and laboratory tests), only healthy subjects with inclusion criteria were into the study.


Informed Consent

The signed informed consent of subjects will be taken before the pre data recording.

Design: A prospective control study.

The 60 subjects recruited will be divided into two groups.


The pre and post assessments will be carried out by persons who are not involved in teaching or counseling the subjects to nullify the confounding investigator bias variable.


The researcher will record the pre and post data and monitor the sessions.

Practices for Yoga group

Intensive residential yoga therapy for 2 weeks. Trained yoga instructors will teach the yoga under the guidance of experts. Two modules of integrated approach of yoga therapy practice are formed with following basic structure.

Wait list control

Each subject would be provided appropriate written information on DM and on a balanced weight-reducing diet.


Primary outcome measures

Changes in the endocrine parameters, insulin sensitivity and lipid profile.

Changes in body composition

Secondary outcome measures

Change in anthropometric measurements;

Anthropometric measurements

Weight (kg)

Height (cm)

Body Mass Index (kg/m2)

Waist circumference (cm)

Hip circumference (cm)

Waist: hip ratio

Systolic Blood Pressure

Diastolic Blood pressure

Endocrine parameters and lipid profiles

Fasting glucose (m mol/l)

PPBS(m mol/l)

Fasting insulin (p mol/l)

Insulin resistance (IR) by HOMA method

Triglycerides (m mol/l)

Body composition

Body fat in and Kg

Lean in and kg

Water in and Lit


Data entry will be completed by the research staff, under the guidance of the study statistician.


Data is analyzed by using Statistical Package for Social Sciences (SPSS) version 16.0 with appropriate tests.