First Major Trial Finds Yoga Plus Lifestyle Changes Cut Type 2 Diabetes Risk in Prediabetics More Than Lifestyle Alone

India: A study published in Diabetes and Metabolic Syndrome: Clinical Research and Reviews revealed that incorporating structured yoga intervention with standard lifestyle measures substantially lowers the risk of type 2 diabetes in prediabetics compared to solely following lifestyle measures.

"A structured Yoga intervention consisting of select yoga asanas and Pranayama performed daily for 40 minutes is effective in prevention of type2 diabetes," lead author, Sri V. Madhu from the Centre for Diabetes, Endocrinology, and Metabolism at the University College of Medical Sciences, GTB Hospital, told Medical Dialogues. 

Adding that, "This is the first randomized controlled trial with adequate power to demonstrate the long-term efficacy of yoga over 3 years in close to 1500 individuals with Prediabetes." 

Yoga, a practice with centuries-old roots in India, is widely recognized as a holistic approach to health and wellness. It is effective in the management of several lifestyle-related disorders, including diabetes. The global burden of type 2 diabetes is immense, with India alone accounting for over 77 million individuals with diabetes and an even greater number with prediabetes, who are at significantly higher risk for developing type 2 diabetes. Lifestyle interventions remain the most effective strategy for diabetes prevention.

In the study, Dr. Madhu et. al. aimed to assess the long-term effectiveness of yoga practice in reducing the risk of type 2 diabetes. 

“The major implications both for clinical practice as well as public health and national policy. At a clinical level, it can be a useful approach to manage prediabetes. However, the public health implications are far-reaching and can serve as a game changer for diabetes prevention in the country. If implemented as a national policy for diabetes prevention it can go a long way in controlling the rapidly rising epidemic of type 2 diabetes in our country.” Dr. Madhu said. 

In this study, an open-label randomized controlled trial was conducted at five medical centers. Adults diagnosed with prediabetes via an oral glucose tolerance test were randomly assigned to either a structured yoga intervention group, which included 40 minutes of specific yoga asanas and pranayama in addition to standard lifestyle measures, or a control group that received only standard lifestyle measures.

The primary outcome, the incidence of diabetes, was compared between the two groups after the 3-year intervention period using an intention-to-treat analysis. A total of 974 individuals were randomized (488 to the yoga + lifestyle group-group1 and 486 to the Lifestyle alone group-group2).

The key findings of the study are as follows:

• After 3 years of follow-up, there was a 39.2% reduction in the relative risk of diabetes in the yoga group (11.5%) compared to the lifestyle measures alone group (18.9%).

• The Cox proportional hazard model analysis showed that the lifestyle measures alone group had a significantly higher odds ratio of 1.74 for developing diabetes compared to the yoga group.

• Adherence to yoga was high, with 77% of individuals practicing yoga more than 75% of the time.

Commenting on the effectiveness of yoga for diabetes prevention Dr. Madhu commented “Yoga and standard lifestyle measures showed a 39.2% reduction in the relative risk of incident diabetes over 3 years compared to standard lifestyle measures alone in this study. Yoga fares better when compared to the only 2 available diabetes prevention trials carried out in the country. While the Indian DPP showed a relative risk reduction of approximately 28% with lifestyle measures, the other study using lifestyle and stepwise addition of metformin reported a 32% reduction in the risk of diabetes. Yoga performed better than both.”

“The novelty of the study lies in the fact that this is the first time that yoga, an ancient Indian practice, has been convincingly shown to prevent diabetes in a well-designed long-term trial.”

He concluded that “incorporating yoga with standard lifestyle practices significantly lowers the risk of developing type 2 diabetes compared to relying on lifestyle practices alone.”

“Additionally, the study showed that particular demographics or subgroups within the study population benefited more from yoga in terms of diabetes prevention. Yoga worked better in older individuals and women and in those prediabetic persons who had IGT or HbA1c levels greater than 6%.”

The study has a few limitations. It did not include biomarkers of stress, insulin resistance and inflammation that could have thrown light on the possible mechanisms of the reported benefit. The study was restricted to Indians and needs to be replicated in other populations in the world before it can be taken up as a global strategy.

Reference:

Madhu, S. V., Rao, P. V., Chandalia, H. B., Jothydev, K., & Gupta, A. (2024). Yoga and prevention of type 2 diabetes - The Indian Prevention of Diabetes Study (IPDS). Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 18(7), 103088. https://doi.org/10.1016/j.dsx.2024.103088