ABE JEROME BLOG

Baseline Characteristics

Records of a total of 146 T2D patients were retrieved. The mean age of the study cohort was 55.61 ± 10.90 years, the majority were female 64.40% (n = 94) , and 76.03% (n = 111) belonged to low socioeconomic status. The recruited study cohort had an average duration of diabetes of ~6 years. According to the ADA criteria, 54.79% (n = 80) of the total study cohort was found to be above recommended A1c targets (≥7.0%, 53 mmol/ml), 81.51% (n = 119) above BP1 targets (≥130/80 mmHg), 47.26% (n = 69), above BP2 targets (≥140/90 mmHg) and 47.94% (n = 70) above lipid targets (LDL ≥ 100 mg/dl)19. Overall, at baseline, 93.83% (n = 137) and 85.62% (n = 125) of the study cohort was found to be above combined ADA composite scores 1 and 2, respectively. The cohort was also observed to have generalized obesity with a mean BMI of 26.69 ± 4.58 Kg/m2. Importantly, 85.62% (n = 125) of the study cohort was found to be overweight/obese according to the Asian cut off for BMI (≥23 kg/m2)20. At baseline, subjects in the yoga group had significantly lower DBP levels than the non-yoga group (yoga, 80.66 ± 9.30 mmHg vs. 84.52 ± 10.12 mmHg; P = 0.032) but were similar to the control group with respect to other parameters (Table 1).

Table 1 Baseline characteristics of theT2DM cohort with and without yoga treatment. Effect of Yoga treatment on the attainment of ADA-laid goals

Yoga treatment was found to have a significant beneficial effect on attainment of the composite ADA goal, reflected by an increase of 2.74% [baseline, 6.85% (n = 5) to follow-up, 9.59% (n = 7)] in the number of subjects meeting the composite score 1, whereas the control group exhibited a pronounced deterioration by 4.11% [baseline (5.48%), n = 4) to follow-up (1.37%, n = 1) (Table 2)]. Similarly, there was an increase of 12.33% [baseline, 15.07% (n = 11) to follow-up, 27.40% (n = 20)] in the number of subjects meeting the composite score 2, whereas the control group exhibited a pronounced deterioration by 8.22% [baseline 13.70%, (n = 10) to follow-up 5.48%, (n = 4) (Table 2)]. When analysed by multiple regression, yoga treatment was found to be 10-fold (OR = 10.20, 95% CI = 0.69–174.19) borderline significant (P = 0.060) and ~8-fold (OR = 8.22, 95% CI = 2.02–33.49), statistically significant (P = 0.003), effective towar ds attaining the favourable composite ADA score 1 and 2, respectively (Table 2).

Table 2 Association of yoga-treatment versus non-yoga treatment with ADA cut-offs and Logistic regression at follow-up.

With respect to the status of A1C goals of ADA (<7%), 46.58% (n = 34) subjects were found to meet criteria for in the yoga group at baseline, however, the percentage increased to 54.79% (n = 40) at follow-up (Table 2). In the non-yoga group, the percentage of subjects with A1c criteria decreased from 43.84% (n = 32) to 36.99% (n = 27) (Table 2). The difference in the distribution between the patients meeting ADA criteria for A1c was statistically significant between yoga and non-yoga treatment groups at the follow-up (P = 0.046). When analysed by multiple logistic regression, modelled by covariates, age, sex, duration of diabetes, socioeconomic status, baseline A1c values, yoga treatment was found to be significantly associated with the ~2-fold (OR = 2.44, 95% CI = 1.19–5.00, P = 0.015) higher chances of attainment of favourable A1c cut off (<7%) as compared to standard of care (Table 2).

The percentage of subjects who met the ADA-criteria with respect to favourable LDL-C, < 100 mg/dl, increased from 52.05% (n = 38) to 54.79% (n = 40) in the yoga group (Table 2). However, in the non-yoga group, there was a decrease from 52.05% (n = 38) to 38.36% (n = 28) in the number of subjects who met the LDL-C criteria (Table 2). The distribution of patients with favourable LDL-C values was not significant between yoga and non-yoga groups at the follow-up (Table 2). However, when analysed by logistic regression, adjusted for covariates and, baseline lipid status, yoga treatment was found to be significantly associated with the ~2-fold (OR = 2.22, 95% CI = 1.06–4.68, P = 0.035) increased chances for the attainment of favourable LDL-C outcome (<100 mg/dl) as compared to standard of care alone (Table 2).

We assessed the BP outcomes with old and revised favourable cut-offs recommended by ADA (Table 3). When analysed with old cut-off (<130/80 mm Hg), we could observe a pronounced increase in the percentage of subjects meeting the favourable BP outcome from 21.92% (n = 16) to 34.25% (n = 25) in the yoga group (Table 2). On the contrary, in the non-yoga group, the number of T2D patients who met BP criteria of <130/80 mm Hg decreased from 15.07% (n = 11) to 8.22% (n = 6) (Table 2). When analysed by logistic regression, yoga treatment was found to be associated with ~6.4-fold (OR = 6.37, 95% CI = 2.24–18.08, P = 0.001) increase the chances of favourable BP cut-offs (<130/80) at follow-up. When analysed with revised new BP cut-off (<140/90 mm Hg), we could observe a pronounced increase in the percentage of subjects meeting the favourable BP outcome from 60.27% (n = 44) to 84.93% (n = 62) in the yoga group (Table 2), yoga treatm ent was also found to be associated with 8.28-fold (95% CI, 3.52–19.48, P < 0.0001) increased chances for the revised favourable BP cut-offs,. In the non-yoga group, the number of T2D patients who met BP criteria decreased from 45.21% (n = 33) to 39.73% (n = 29) (Table 2).

Table 3 Distribution of continuous variables between yoga and non-yoga treatment groups at baseline and follow up.

We also analysed the status of cardiovascular control for the subgroup of study cohort with uncontrolled diabetes (A1c ≥ 8.0%), n = 44. We could observe 63.16% success towards attainment of lipid goal (LDL < 100 mg/dl) and 26.32% for BP targets (130/80 mmHg) 89.47% for BP target (140/90) by 6-months of yoga treatment (data not shown). However, the controls exhibited deterioration with respect to these goals (data not shown).

Effect of yoga treatment as compared to standard of care was demonstrated with respect to the attainment of favourable BMI cut-off (<23 Kg/m2) for Asians (Table 2). When analysed by logistic regression, yoga treatment was found to be associated with 62-fold (OR = 61.73, 95% CI = 3.19–1193) increased chances of attainment of the favourable BMI cut-off over a period of 6 months (Table 2).

Outcomes in continuous measures

Over the study period of around 6-months, the yoga-group exhibited significant within-group beneficial mean changes and percent changes in A1c, −0.50%, (−5.03%); FBS, −11.27 mg/dL (−8.00%); PPBS, −25.51 (−−11.44%); Wt., −2.91 (-4.18%); BMI, −1.14 Kg/m2 (−4.04%); SBP, −5.30 (−3.02%); DBP, −4.57 (−4.60%); TC, −2.94 mg/dl (−1.49%), HDL-c, −0.70 mg/dl (−1.49%) (Table 3). With respect to triglyceride (TG), we could observe an unexpected increase in the mean TG levels in the yoga group, 11.74 ± 3.72 mg/dl (31.94%) (Table 3). We observed pronounced worsening of the metabolic variables in the non-yoga group (Table 3). We could observe a deteriorating trend in the mean difference of these variables from baseline in the non-yoga group (Table 3). Significant within-group differences were also observed in the non-yoga group for FBS, 11.14 mg/dl (18.31%); BMI, 0.76 Kg/m2 (4.06%); HDL-c, −2.51 mg/dl (−4.72%), and TG, 67.70 mg/dl ( 59.01%). Between-study group differences between yoga group and non-yoga group very significant with respect to all the studied parameters (Table 3).