Role of yoga in diabetes.

The science of yoga is an ancient one. It is a rich heritage of our culture. Several older books make a mention of the usefulness of yoga in the treatment of certain diseases and preservation of health in normal individuals. The effect of yogic practices on the management of diabetes has not been investigated well. We carried out well designed studies in normal individuals and those with diabetes to assess the role of yogic practices on glycaemic control, insulin kinetics, body composition exercise tolerance and various co-morbidities like hypertension and dyslipidemia. These studies were both short term and long-term. These studies have confirmed the useful role of yoga in the control of diabetes mellitus. Fasting and postprandial blood glucose levels came down significantly. Good glycaemic status can be maintained for long periods of time. There was a lowering of drug requirement and the incidence of acute complications like infection and ketosis was significantly reduced. There were significant changes in the insulin kinetics and those of counter-regulatory hormones like cortisol. There was a decrease in free fatty acids. There was an increase in lean body mass and decrease in body fat percentage. The number of insulin receptors was also increased. There was an improvement in insulin sensitivity and decline in insulin resistance. All these suggest that yogic practices have a role even in the prevention of diabetes. There is a beneficial effect on the co-morbid conditions like hypertension and dyslipidemia.

Hypertension in diabetes.

Diabetes mellitus and hypertension are both major public health problems in our country, which co-exist frequently resulting in significant morbidity and mortality. The reported prevalence of hypertension in diabetes varies widely but is probably 1.5-2 times higher than that reported in the general population. In type 2 diabetics many are hypertensives at the time of diagnosis, while in type 1 diabetes, hypertension is predominantly associated with the development of nephropathy. Hypertension in diabetes is due to several pathophysiological mechanisms which include increased volume expansion, altered sodium homeostasis, increased peripheral vascular resistance, hyperinsulinaemia, insulin resistance, etc. The presence of hypertension in diabetic patients increases the mortality 4-5 folds, largely through coronary artery disease and stroke. It may also be an aetiological factor in the development of nephropathy and retinopathy. Treatment of hypertension in a diabetic has considerable therapeutic advantages and should be carried out vigorously. Lifestyle modifications have a useful role in the treatment of mild hypertension and have a beneficial effect on other cardiovascular risk factors. The choice of antihypertensive agents should be based on their potential impact on the metabolic abnormalities observed in diabetics. Amongst the currently available antihypertensive agents, ACE inhibitors and calcium channel blockers are the favoured agents.

Lifestyle modification in management of diabetes mellitus.

India has the largest diabetic population in the world. Change in eating habits, increasing weight and decreased physical activity are major factors leading to increased incidence of type 2 diabetes. Obesity is the most important modifiable risk factor. Smoking is an independent risk factor for type 2 diabetes mellitus. Diet and exercise are primary therapeutic options for its management. Dietary management should not only aim to achieve glycaemic control but to normalise dyslipidaemia. Smoking cessation reduces the risk of morbidity and mortality in CAD. Exercise improves the condition of a diabetic patient. Exercise includes yoga practices which have a role to play in the prevention of type 2 diabetes.

DiabCare Asia--India Study: diabetes care in India--current status.

AIM: To investigate the relationship between diabetes control, management and late complications in a subset of urban Indian diabetes population treated at tertiary diabetes care centres and measure the quality of management to set benchmarks for future improvement. METHODOLOGY: The study population consisted of 100 consecutive review patients treated for more than one year at each of the 26 participating centres. HbA1c was estimated centrally by Bio-Rad Variant method. The methods used to diagnose diabetic complications varied among centres, depending on the doctor's standard clinical examination. A more detailed methodology was eschewed for reason of brevity of the data collection form, and lack of standardisation of methods. Similarly, the assessment of renal function was performed via a variety of methods, namely dipstick proteinuria, a 24 hour urinary excretion assay, presence of microalbuminuria and serum creatiine concentration; retinopathy was detected using fundoscopy. Data was collected in a standardized data collection form, entered into an SAS database, validated and descriptive analysis performed. RESULTS: A total of 2,269 subjects with valid relevant data formed the study population. Subjects had a mean age of 53.3 +/- 13 years. The mean age at onset of diabetes was 43.6 +/- 12.2 years, with a mean diabetes duration of 10.0 +/- 6.9 years. Type 2 diabetics constituted 90.6% of the patients. Approximately half the patients had poor control (HbA1c > 2% points above upper limit of normal and FBG > 139 mg/dl). Mean HbA1c (central laboratory) was 8.9 +/- 2.1% and FBG 150 +/- 59 mg/dl. Over 54% patients had severe late complications, apart from a high frequency of associated hyperlipidemia. Mean HbA1c level and frequency of complications was higher in patients with longer diabetes duration. Frequency of self-monitoring was low. Only 4% of patients were on diet therapy, 53.9% were receiving oral hypoglycemic agents (OHAs), 22% were receiving insulin and 19.8% a combination of insulin and OHAs. Frequency of insulin usage was higher amongst patients with longer diabetes duration. CONCLUSIONS: This large multi-centre collaborative observational study shows that type 2 diabetes begins at an early age amongst Indians. With increasing duration of diabetes, glycemic control deteriorates leading to late complications. Diabetes care in India leaves much to be desired. Concerted efforts to increase awareness amongst health professionals to improve diabetes care are urgently needed. The study by increasing awareness about the current status of diabetes care provides a useful benchmark to plan future improvements.

Neurological emergencies--diabetes management.

Diabetes can affect the nervous system in several ways. Of all the neurological complications of diabetes, peripheral neuropathy is by far the commonest and has been extensively studied. The involvement of central nervous system can be in several forms. The underlying damage may be due to involvement of the large and small cerebral blood vessels as also due to metabolic derangement caused by prolonged hypoglycemia, anoxia or ketoacidosis. The neurological emergencies that occur in diabetes can be: 1) atherothrombotic and lacunar strokes; 2) convulsive disorder in the setting of both hypo and hyperglycemia; 3) coma; 4) cranial neuropathies; and 5) acute proximal muscle weakness. In patients with diabetes, atherothrombotic stroke is associated with poor outcome. Hyperglycemia at the time of stroke is an important risk factor for an adverse outcome than chronic stable diabetic state. Proper management of diabetes in these acute situations is crucial for a better outcome of the underlying disease process.

Comparison of effects of yoga & physical exercise in athletes.

The effect of pranayama a controlled breathing practice, on exercise tests was studied in athletes in two phases; sub-maximal and maximal exercise tests. At the end of phase I (one year) both the groups (control and experimental) achieved significantly higher work rate and reduction in oxygen consumption per unit work. There was a significant reduction in blood lactate and an increase in P/L ratio in the experimental group, at rest. At the end of phase II (two years), the oxygen consumption per unit work was found to be significantly reduced and the work rate significantly increased in the experimental group. Blood lactate decreased significantly at rest in the experimental group only. Pyruvate and pyruvate-lactate ratio increased significantly in both the groups after exercise and at rest in the experimental group. The results in both phases showed that the subjects who practised pranayama could achieve higher work rates with reduced oxygen consumption per unit work and without increase in blood lactate levels. The blood lactate levels were significantly low at rest.

Specific immune responses in typhoid fever & after TAB vaccination.

The specific immune responses to Salmonella typhi were investigated in 131 patients suffering from typhoid fever and 34 healthy individuals after TAB vaccination. A proportion of individuals failed to develop either specific humoral or cell mediated immune responses. About 5 per cent of the patients with natural infection and nearly 9 per cent of the vaccine recipients failed to develop both the responses. Frequent reinfection and carrier state, and lack of absolute protection following TAB vaccination could be due to the inability of a proportion of naturally infected and TAB vaccinated individuals to mount sufficient specific immune responses, due to the same mechanism.