Efficacy of yoga on type 2 diabetes mellitus patients with glycemia, lipid profile and anthropometric measure: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yong ¹ , WEI Yuanyuan ^2,3 , CHEN Shude ⁴ , TIAN Chen ^5,6 , ZHANG Hongji ¹ , WANG Yiyun ⁵ ,  LI Qiong ⁷ ,  GE Long ^5,6,8

1. The First Clinical Medical College, Lanzhou University, Lanzhou 730000, P. R. China;
2. School of Nursing, Lanzhou University, Lanzhou 730000, P. R. China;
3. Department of Cadre Health Care, First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
4. The Second Clinical Medical College, Lanzhou University, Lanzhou 730000, P. R. China;
5. Institute of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
6. Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, P. R. China;
7. Department of Endocrinology, The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China;
8. Key Laboratory of Evidence-based Medicine and Knowledge Translation of Gansu Province, Lanzhou 730000, P. R. China;

Corresponding author：

LI Qiong, Email: 284686755@qq.com; GE Long, Email: gelong2009@163.com

Keywords：

Yoga; Type 2 diabetes mellitus; Umbrella review; AMSTAR; GRADE

DOI：

10.7507/1672-2531.202309077

Video：

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Objective To overview the systematic reviews/meta-analysis (SR/MA) for the effectiveness of yoga on patients with type 2 diabetes mellitus. Methods The CNKI, WanFang Data, VIP, CBM, PubMed, Cochrane Library, Embase, Web of Science, JBI and CINAHL databases were electronically searched to collect SR/MA on the intervention of yoga in diabetes mellitus from inception to November 6^th, 2023. Two researchers independently screened the literature and extracted data. AMSTAR was used to evaluate the quality of methodology, and GRADE was used to evaluate the certainty of evidence, and the outcome indicators were statistically analyzed. Results A total of 14 SR/MA were included. The evaluation results of AMSTAR showed that 7 articles were of high quality and 7 articles were of moderate quality. The result of GRADE showed that there were 2 items of high-level evidence, 26 items of intermediate evidence, and the remaining 31 items were low-level or very low-level evidence. The results showed that yoga could significantly reduce fasting blood glucose (FBG) (moderate confidence), glycosylated hemoglobin (HA1C) (moderate confidence) and postprandial blood glucose (PPBG) levels (moderate confidence), and was also superior to other interventions in high-density cholesterol (HDL) (moderate confidence), low-density cholesterol (LDL) (moderate confidence), triglyceride (TG) (moderate confidence), total cholesterol (TC) (moderate confidence), systolic blood pressure (SBP) and diastolic blood pressure (DBP) (moderate confidence), muscle strength (high confidence), cardiorespiratory fitness (moderate confidence) and weight (moderate confidence). Conclusion The existing evidence shows that yoga has a good effect on blood glucose control (moderate confidence) and also has a certain effect on lipid parameters (moderate confidence) and anthropometric indicators (moderate confidence), but the quality and confidence of the current research evidence are low. Future researchers should standardize the research design to provide more high-quality evidence for the prognosis and treatment of type 2 diabetes mellitus.

Citation： WANG Yong, WEI Yuanyuan, CHEN Shude, TIAN Chen, ZHANG Hongji, WANG Yiyun, LI Qiong, GE Long. Efficacy of yoga on type 2 diabetes mellitus patients with glycemia, lipid profile and anthropometric measure: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2024, 24(7): 819-826. doi: 10.7507/1672-2531.202309077 Copy

1.	Ahmad E, Lim S, Lamptey R, et al. Type 2 diabetes. Lancet, 2022, 400(10365): 1803-1820.
2.	American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care, 2018, 41(Suppl 1): S13-S27.
3.	Magkos F, Hjorth MF, Astrup A. Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nat Rev Endocrinol, 2020, 16(10): 545-555.
4.	Panjwani U, Dudani S, Wadhwa M. Sleep, cognition, and yoga. Int J Yoga, 2021, 14(2): 100-108.
5.	Raveendran AV, Deshpandae A, Joshi SR. Therapeutic role of yoga in type 2 diabetes. Endocrinol Metab (Seoul), 2018, 33(3): 307-317.
6.	Mishra P, Greenfield SM, Harris T, et al. Yoga program for type 2 diabetes prevention (YOGA-DP) among high-risk people: qualitative study to explore reasons for non-participation in a feasibility randomized controlled trial in India. Front Public Health, 2021, 9: 682203.
7.	Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016, 5(1): 210.
8.	Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
9.	Huang Y, Chen Z, Chen B, et al. Dietary sugar consumption and health: umbrella review. BMJ, 2023, 381: e071609.
10.	Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
11.	The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions version 5.0. 1 Z. 2011.
12.	Borenstein M, Hedges LV, Higgins JPT, et al. Introduction to meta-analysis. Wiley, 2009.
13.	Shim SR, Kim SJ. Intervention meta-analysis: application and practice using R software. Epidemiol Health, 2019, 41: e2019008.
14.	Pérez-Bracchiglione J, Meza N, Bangdiwala SI, et al. Graphical Representation of Overlap for OVErviews: GROOVE tool. Res Synth Methods, 2022, 13(3): 381-388.
15.	Pieper D, Antoine SL, Mathes T, et al. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol, 2014, 67(4): 368-375.
16.	Pollock M, Fernandes RM, Newton AS, et al. The impact of different inclusion decisions on the comprehensiveness and complexity of overviews of reviews of healthcare interventions. Syst Rev, 2019, 8(1): 18.
17.	刘永进, 杜博, 邵江健, 等. 瑜伽锻炼对2型糖尿病血糖疗效的Meta分析. 临床荟萃, 2017, 32(4): 339-343.
18.	Aljasir B, Bryson M, Al-Shehri B. Yoga practice for the management of type II diabetes mellitus in adults: a systematic review. Evid Based Complement Alternat Med, 2010, 7(4): 399-408.
19.	Anuradha None, Rojaria NS, Kaur J, et al. The effects of yoga on cardiovascular risk factors among patients with type 2 diabetes mellitus: systematic review and meta-analysis. Int J Yoga, 2022, 15(1): 3-11.
20.	Chen S, Deng S, Liu Y, et al. Effects of yoga on blood glucose and lipid profile of type 2 diabetes patients without complications: a systematic review and meta-analysis. Front Sports Act Living, 2022, 4: 900815.
21.	Cui J, Yan JH, Yan LM, et al. Effects of yoga in adults with type 2 diabetes mellitus: a meta-analysis. J Diabetes Investig, 2017, 8(2): 201-209.
22.	Dutta D, Bhattacharya S, Sharma M, et al. Effect of yoga on glycemia and lipid parameters in type-2 diabetes: a meta-analysis. J Diabetes Metab Disord, 2021, 20(1): 349-367.
23.	Innes KE, Selfe TK. Yoga for adults with type 2 diabetes: a systematic review of controlled trials. J Diabetes Res, 2016, 2016: 6979370.
24.	Innes KE, Vincent HK. The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review. Evid Based Complement Alternat Med, 2007, 4(4): 469-486.
25.	Jayawardena R, Ranasinghe P, Chathuranga T, et al. The benefits of yoga practice compared to physical exercise in the management of type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr, 2018, 12(5): 795-805.
26.	Kumar V, Jagannathan A, Philip M, et al. Role of yoga for patients with type Ⅱ diabetes mellitus: a systematic review and meta-analysis. Complement Ther Med, 2016, 25: 104-112.
27.	Thind H, Lantini R, Balletto BL, et al. The effects of yoga among adults with type 2 diabetes: a systematic review and meta-analysis. Prev Med, 2017, 105: 116-126.
28.	Venugopal V, Geethanjali S, Poonguzhali S, et al. Effect of yoga on oxidative stress in type 2 diabetes mellitus: a systematic review and meta-analysis. Curr Diabetes Rev, 2022, 18(2): e050421192663.
29.	Vizcaino M, Stover E. The effect of yoga practice on glycemic control and other health parameters in type 2 diabetes mellitus patients: a systematic review and meta-analysis. Complement Ther Med, 2016, 28: 57-66.
30.	Wibowo RA, Nurámalia R, Nurrahma HA, et al. The effect of yoga on health-related fitness among patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Int J Environ Res Public Health, 2022, 19(7): 4199.
31.	熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具AMSTAR. 中国循证医学杂志, 2011, 11(9): 1084-1089.
32.	黄桥, 任相颖, 张蓉, 等. GRADE在我国临床实践指南/专家共识中的应用研究. 中国循证医学杂志, 2021, 21(12): 1457-1462.
33.	吴琼芳, 丁泓帆, 邓围, 等. ROBIS: 评估系统评价偏倚风险的新工具. 中国循证医学杂志, 2015, 15(12): 1454-1457.
34.	Parums DV. Editorial: review articles, systematic reviews, meta-analysis, and the updated preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Med Sci Monit, 2021, 27: e934475.
35.	高亚, 刘明, 杨珂璐, 等. 系统评价报告规范: PRISMA2020与PRISMA2009的对比分析与实例解读. 中国循证医学杂志, 2021, 21(5): 606-616.
36.	Malmivaara A. Methodological considerations of the GRADE method. Ann Med, 2015, 47(1): 1-5.
37.	Cramer H, Lauche R, Klose P, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev, 2017, (1): CD010802.
38.	Cramer H, Krucoff C, Dobos G. Adverse events associated with yoga: a systematic review of published case reports and case series. PLoS One, 2013, 8(10): e75515.
39.	Viswanathan V, Sivakumar S, Sai Prathiba A, et al. Effect of yoga intervention on biochemical, oxidative stress markers, inflammatory markers and sleep quality among subjects with type 2 diabetes in South India: results from the SATYAM project. Diabetes Res Clin Pract, 2021, 172: 108644.
40.	Nagarathna R, Kurian J, Vijayakumar V, et al. 1160-P: does yoga reduce the risk of conversion from prediabetes to diabetes by improving acute phase insulin release. An observation from an RCT. Diabetes, 2021, 70(Suppl 1): 1160.
41.	Nair RG, Vasudev MM, Mavathur R. Role of yoga and its plausible mechanism in the mitigation of DNA damage in type-2 diabetes: a randomized clinical trial. Ann Behav Med, 2022, 56(3): 235-244.
42.	Kurian J, Mohanthy S, Nanjumdaiah RM. Mechanism of action of yoga on prevention and management of type 2 diabetes mellitus: narrative review. J Bodyw Mov Ther, 2022, 29: 134-139.

1. Ahmad E, Lim S, Lamptey R, et al. Type 2 diabetes. Lancet, 2022, 400(10365): 1803-1820.
2. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2018. Diabetes Care, 2018, 41(Suppl 1): S13-S27.
3. Magkos F, Hjorth MF, Astrup A. Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nat Rev Endocrinol, 2020, 16(10): 545-555.
4. Panjwani U, Dudani S, Wadhwa M. Sleep, cognition, and yoga. Int J Yoga, 2021, 14(2): 100-108.
5. Raveendran AV, Deshpandae A, Joshi SR. Therapeutic role of yoga in type 2 diabetes. Endocrinol Metab (Seoul), 2018, 33(3): 307-317.
6. Mishra P, Greenfield SM, Harris T, et al. Yoga program for type 2 diabetes prevention (YOGA-DP) among high-risk people: qualitative study to explore reasons for non-participation in a feasibility randomized controlled trial in India. Front Public Health, 2021, 9: 682203.
7. Ouzzani M, Hammady H, Fedorowicz Z, et al. Rayyan-a web and mobile app for systematic reviews. Syst Rev, 2016, 5(1): 210.
8. Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol, 2007, 7: 10.
9. Huang Y, Chen Z, Chen B, et al. Dietary sugar consumption and health: umbrella review. BMJ, 2023, 381: e071609.
10. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol, 2011, 64(4): 383-394.
11. The Cochrane Collaboration. Cochrane handbook for systematic reviews of interventions version 5.0. 1 Z. 2011.
12. Borenstein M, Hedges LV, Higgins JPT, et al. Introduction to meta-analysis. Wiley, 2009.
13. Shim SR, Kim SJ. Intervention meta-analysis: application and practice using R software. Epidemiol Health, 2019, 41: e2019008.
14. Pérez-Bracchiglione J, Meza N, Bangdiwala SI, et al. Graphical Representation of Overlap for OVErviews: GROOVE tool. Res Synth Methods, 2022, 13(3): 381-388.
15. Pieper D, Antoine SL, Mathes T, et al. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol, 2014, 67(4): 368-375.
16. Pollock M, Fernandes RM, Newton AS, et al. The impact of different inclusion decisions on the comprehensiveness and complexity of overviews of reviews of healthcare interventions. Syst Rev, 2019, 8(1): 18.
17. 刘永进, 杜博, 邵江健, 等. 瑜伽锻炼对2型糖尿病血糖疗效的Meta分析. 临床荟萃, 2017, 32(4): 339-343.
18. Aljasir B, Bryson M, Al-Shehri B. Yoga practice for the management of type II diabetes mellitus in adults: a systematic review. Evid Based Complement Alternat Med, 2010, 7(4): 399-408.
19. Anuradha None, Rojaria NS, Kaur J, et al. The effects of yoga on cardiovascular risk factors among patients with type 2 diabetes mellitus: systematic review and meta-analysis. Int J Yoga, 2022, 15(1): 3-11.
20. Chen S, Deng S, Liu Y, et al. Effects of yoga on blood glucose and lipid profile of type 2 diabetes patients without complications: a systematic review and meta-analysis. Front Sports Act Living, 2022, 4: 900815.
21. Cui J, Yan JH, Yan LM, et al. Effects of yoga in adults with type 2 diabetes mellitus: a meta-analysis. J Diabetes Investig, 2017, 8(2): 201-209.
22. Dutta D, Bhattacharya S, Sharma M, et al. Effect of yoga on glycemia and lipid parameters in type-2 diabetes: a meta-analysis. J Diabetes Metab Disord, 2021, 20(1): 349-367.
23. Innes KE, Selfe TK. Yoga for adults with type 2 diabetes: a systematic review of controlled trials. J Diabetes Res, 2016, 2016: 6979370.
24. Innes KE, Vincent HK. The influence of yoga-based programs on risk profiles in adults with type 2 diabetes mellitus: a systematic review. Evid Based Complement Alternat Med, 2007, 4(4): 469-486.
25. Jayawardena R, Ranasinghe P, Chathuranga T, et al. The benefits of yoga practice compared to physical exercise in the management of type 2 diabetes mellitus: a systematic review and meta-analysis. Diabetes Metab Syndr, 2018, 12(5): 795-805.
26. Kumar V, Jagannathan A, Philip M, et al. Role of yoga for patients with type Ⅱ diabetes mellitus: a systematic review and meta-analysis. Complement Ther Med, 2016, 25: 104-112.
27. Thind H, Lantini R, Balletto BL, et al. The effects of yoga among adults with type 2 diabetes: a systematic review and meta-analysis. Prev Med, 2017, 105: 116-126.
28. Venugopal V, Geethanjali S, Poonguzhali S, et al. Effect of yoga on oxidative stress in type 2 diabetes mellitus: a systematic review and meta-analysis. Curr Diabetes Rev, 2022, 18(2): e050421192663.
29. Vizcaino M, Stover E. The effect of yoga practice on glycemic control and other health parameters in type 2 diabetes mellitus patients: a systematic review and meta-analysis. Complement Ther Med, 2016, 28: 57-66.
30. Wibowo RA, Nurámalia R, Nurrahma HA, et al. The effect of yoga on health-related fitness among patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Int J Environ Res Public Health, 2022, 19(7): 4199.
31. 熊俊, 陈日新. 系统评价/Meta分析方法学质量的评价工具AMSTAR. 中国循证医学杂志, 2011, 11(9): 1084-1089.
32. 黄桥, 任相颖, 张蓉, 等. GRADE在我国临床实践指南/专家共识中的应用研究. 中国循证医学杂志, 2021, 21(12): 1457-1462.
33. 吴琼芳, 丁泓帆, 邓围, 等. ROBIS: 评估系统评价偏倚风险的新工具. 中国循证医学杂志, 2015, 15(12): 1454-1457.
34. Parums DV. Editorial: review articles, systematic reviews, meta-analysis, and the updated preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Med Sci Monit, 2021, 27: e934475.
35. 高亚, 刘明, 杨珂璐, 等. 系统评价报告规范: PRISMA2020与PRISMA2009的对比分析与实例解读. 中国循证医学杂志, 2021, 21(5): 606-616.
36. Malmivaara A. Methodological considerations of the GRADE method. Ann Med, 2015, 47(1): 1-5.
37. Cramer H, Lauche R, Klose P, et al. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database Syst Rev, 2017, (1): CD010802.
38. Cramer H, Krucoff C, Dobos G. Adverse events associated with yoga: a systematic review of published case reports and case series. PLoS One, 2013, 8(10): e75515.
39. Viswanathan V, Sivakumar S, Sai Prathiba A, et al. Effect of yoga intervention on biochemical, oxidative stress markers, inflammatory markers and sleep quality among subjects with type 2 diabetes in South India: results from the SATYAM project. Diabetes Res Clin Pract, 2021, 172: 108644.
40. Nagarathna R, Kurian J, Vijayakumar V, et al. 1160-P: does yoga reduce the risk of conversion from prediabetes to diabetes by improving acute phase insulin release. An observation from an RCT. Diabetes, 2021, 70(Suppl 1): 1160.
41. Nair RG, Vasudev MM, Mavathur R. Role of yoga and its plausible mechanism in the mitigation of DNA damage in type-2 diabetes: a randomized clinical trial. Ann Behav Med, 2022, 56(3): 235-244.
42. Kurian J, Mohanthy S, Nanjumdaiah RM. Mechanism of action of yoga on prevention and management of type 2 diabetes mellitus: narrative review. J Bodyw Mov Ther, 2022, 29: 134-139.

Chinese Journal of Evidence-Based Medicine

Efficacy of yoga on type 2 diabetes mellitus patients with glycemia, lipid profile and anthropometric measure: an overview of systematic reviews

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