title: Hypothalamic arousal, insulin resistance and Type 2 diabetes mellitus. A yoga intervention for type 2 diabetes risk reduction: a pilot randomized controlled trial Improving the reporting quality of nonrandomized evaluations of behavioral and public health interventions: the TREND statement. Can lifestyle changes reverse coronary heart disease?: The Lifestyle Heart Trial The Influence of Yoga-Based Programs on Risk Profiles in Adults with Type 2 Diabetes Mellitus: A Systematic Review Yoga Practice for the Management of Type II Diabetes Mellitus in Adults: A systematic review Psychosocial Stress at Work Doubles the Risk of Type 2 Diabetes in Middle-Aged Women CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomized Trials Community based yoga classes for type 2 diabetes: an exploratory randomised controlled trial Effect of community-based yoga intervention on oxidative stress and glycemic parameters in prediabetes: a randomized controlled trial. Effect of exercise therapy on lipid profile and oxidative stress indicators in patients with type 2 diabetes Impact of yoga on blood pressure and quality of life in patients with hypertension – a controlled trial in primary care, matched for systolic blood pressure Utilization of 3-Month Yoga Program for Adults at High Risk for Type 2 Diabetes: A Pilot Study Can the Onset of Type 2 Diabetes Be Delayed by a Group-Based Lifestyle Intervention in Women with Prediabetes following Gestational Diabetes Mellitus (GDM)? Findings from a Randomized Control Mixed Methods Trial Effect of 12 Weeks of Yoga Therapy on Quality of Life and Indian Diabetes Risk Score in Normotensive Indian Young Adult Prediabetics and Diabetics: Randomized Control Trial. Effect of aspirin on renal disease progression in patients with type 2 diabetes: A multicenter, double-blind, placebo-controlled, randomized trial. The renaL disEase progression by aspirin in diabetic pAtients (LEDA) trial. Rationale and study design. Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study. Therapeutic potential of yoga practices in modifying cardiovascular risk profile in middle aged men and women. Effect of psychological stress on glucose control in patients with Type 2 diabetes. Effects of a yoga intervention on lipid profiles of diabetes patients with dyslipidemia. The effectiveness of yoga to prevent diabetes mellitus type 2 The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Completion report: Effect of Comprehensive Yogic Breathing program on type 2 diabetes: A randomized control trial
abstract: AIMS Type 2 diabetes mellitus ( DM ) develops when insulin resistance overcomes the capacity of compensatory insulin secretion . Insulin resistance may be induced via psychoneuroendocrine pathways , a possibility which has received little previous attention . METHODS We have used salivary cortisol measurements to monitor the activity of the hypothalamic-pituitary-adrenal ( HPA ) axis , the major controller of hormones involved in the regulation of peripheral insulin sensitivity under everyday conditions . The influence of external challenges , as well as the sensitivity of feedback regulation , were followed in r and omly selected middle-aged population sample s. RESULTS In health there is a rhythmicity of cortisol secretion , with a high plasticity and efficient feedback control . In contrast , a group of subjects were identified with a flat , rigid day curve and poor feedback control , who showed consistent abnormalities in stress-related cortisol secretion , including inhibited secretions of sex steroids and growth hormone ; insulin resistance ; abdominal obesity ; elevated leptin levels ; hyperglycaemia ; dyslipidaemia and hypertension with elevated heart rate . The endocrine abnormalities are probably responsible for the anthropometric and metabolic abnormalities . The circulatory perturbations seem to be induced by a parallel activation of the central sympathetic nervous system suggesting an ' hypothalamic arousal syndrome ' , gradually developing into an independent risk for disease . An associated cluster of environmental factors , including psychosocial and socio-economic stress , traits of depression and anxiety , alcohol consumption and smoking , all factors known to activate hypothalamic centres , has been identified . A polymorphism of the glucocorticoid receptor gene , with 13.7 % homozygotes in the male Swedish population , parallels receptor dysfunction , and may be responsible for the associated insulin resistance , central obesity and hypertension . CONCLUSIONS This is the first detailed examination of psychoneuroendocrinological processes in the natural environment on a population basis in relation to somatic health . The results suggest that an hypothalamic arousal syndrome , with parallel activation of the HPA axis and the central sympathetic nervous system , is responsible for development of endocrine abnormalities , insulin resistance , central obesity , dyslipidaemia and hypertension , leading to frank disease , including Type 2 DM . We suggest that this syndrome is probably based on environmental pressures in genetically susceptible individuals Background Type 2 diabetes is a major health problem in many countries including India .  Yoga may be an effective type 2 diabetes prevention strategy in India , particularly given its cultural familiarity . Methods This was a parallel , r and omized controlled pilot study to collect feasibility and preliminary efficacy data on yoga for diabetes risk factors among people at high risk of diabetes . Primary outcomes included : changes in BMI , waist circumference , fasting blood glucose , postpr and ial blood glucose , insulin , insulin resistance , blood pressure , and cholesterol . We also looked at measures of psychological well-being including changes in depression , anxiety , positive and negative affect and perceived stress . Forty-one participants with elevated fasting blood glucose in Bangalore , India were r and omized to either  yoga  ( n = 21 ) or a walking control ( n = 20 ) . Participants were asked to either attend yoga classes or complete monitored walking 3–6 days per week for eight weeks . R and omization and allocation was performed using computer-generated r and om numbers and group assignments delivered in sealed , opaque envelopes generated by off-site study staff . Data were analyzed based on intention to treat . Results This study was feasible in terms of recruitment , retention and adherence . In addition , yoga participants had significantly greater reductions in weight , waist circumference and BMI versus control ( weight −0.8 ± 2.1 vs. 1.4 ± 3.6 , p = 0.02 ; waist circumference −4.2 ± 4.8 vs. 0.7 ± 4.2 , p < 0.01 ; BMI −0.2 ± 0.8 vs. 0.6 ± 1.6 , p = 0.05 ) . There were no between group differences in fasting blood glucose , postpr and ial blood glucose , insulin resistance or any other factors related to diabetes risk or psychological well-being . There were significant reductions in systolic and diastolic blood pressure , total cholesterol , anxiety , depression , negative affect and perceived stress in both the yoga intervention and walking control over the course of the study . Conclusion Among Indians with elevated fasting blood glucose , we found that participation in an 8-week yoga intervention was feasible and result ed in greater weight loss and reduction in waist circumference when compared to a walking control . Yoga offers a promising lifestyle intervention for decreasing weight-related type 2 diabetes risk factors and potentially increasing psychological well-being . Trial registration Clinical Trials.gov Identified NCT00090506 Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design In a prospect i ve , r and omised , controlled trial to determine whether comprehensive lifestyle changes affect coronary atherosclerosis after 1 year , 28 patients were assigned to an experimental group ( low-fat vegetarian diet , stopping smoking , stress management training , and moderate exercise ) and 20 to a usual-care control group . 195 coronary artery lesions were analysed by quantitative coronary angiography  . The average percentage diameter stenosis regressed from 40.0 ( SD 16.9)% to 37.8 (16.5)% in the experimental group yet progressed from 42.7 (15.5)% to 46.1 (18.5)% in the control group . When only lesions greater than 50 % stenosed were analysed , the average percentage diameter stenosis regressed from 61.1 (8.8)% to 55.8 (11.0)% in the experimental group and progressed from 61.7 (9.5)% to 64.4 (16.3)% in the control group . Overall , 82 % of experimental-group patients had an average change towards regression .  Comprehensive lifestyle changes may be able to bring about regression of even severe coronary atherosclerosis after only 1 year , without use of lipid-lowering drugs There is growing evidence that yoga may offer a safe and cost-effective intervention for Type 2 Diabetes mellitus ( DM 2 ) . However , systematic review s are lacking . This article critically review s the published literature regarding the effects of yoga-based programs on physiologic and anthropometric risk profiles and related clinical outcomes in adults with DM 2 . We performed a comprehensive literature search using four computerized English and Indian scientific data bases . The search was restricted to original studies ( 1970–2006 ) that evaluated the metabolic and clinical effects of  yoga in adults with DM 2 . Studies targeting clinical population s with cardiovascular disorders that included adults with comorbid DM were also evaluated . Data were extracted regarding study design , setting , target population , intervention , comparison group or condition , outcome assessment , data analysis and presentation , follow-up , and key results , and the quality of each study was evaluated according to specific predetermined criteria . We identified 25 eligible studies , including 15 uncontrolled trials , 6 non-r and omized controlled trials and 4 r and omized controlled trials ( RCTs ) . Overall , these studies suggest beneficial changes in several risk indices , including glucose tolerance and insulin sensitivity , lipid profiles , anthropometric characteristics , blood pressure , oxidative stress , coagulation profiles , sympathetic activation and pulmonary function , as well as improvement in specific clinical outcomes .  Yoga may improve risk profiles in adults with DM 2 , and may have promise for the prevention and management of cardiovascular complications in this population . However , the limitations characterizing most studies preclude drawing firm conclusions . Additional high- quality RCTs are needed to confirm and further eluci date the effects of st and ardized yoga programs in population s with DM 2 The effect of practicing yoga for the management of type II Diabetes  was assessed in this systematic review through search ing related electronic data bases and the grey literature to the end of May 2007 using Ovid . All r and omized controlled clinical trials ( RCTs ) comparing yoga practice with other type of intervention or with regular practice or both , were included regardless of language or type of publication . Each study was assessed for quality by two independent review ers . Mean difference was used for summarizing the effect of each study outcomes with 95 % confidence intervals . Pooling of the studies did not take place due to the wide clinical variation between the studies . Publication bias was assessed by statistical methods . Five trials with 363 participants met the inclusion criteria with medium to high risk of bias and different intervention characteristics . The studies ’ results show improvement in outcomes among patients with diabetes type II .  These improvements were mainly among short term or immediate diabetes outcomes and not all were statistically significant . The results were inconclusive and not significant for the long-term outcomes . No adverse effects were reported in any of the included studies . Short-term benefits for patients with diabetes  may be achieved from practicing yoga . Further research is needed in this area . Factors like quality of the trials and other method ological issues should be improved by large r and omized control trials with allocation concealment to assess the effectiveness of yoga on diabetes type II . A definitive recommendation for physicians to encourage their patients to practice yoga can not be reached at present OBJECTIVE To investigate the effect of psychosocial stress at work on risk of type 2 diabetes , adjusting for conventional risk factors , among a sample of British , white-collar , middle-aged men and women . RESEARCH DESIGN AND METHODS This was a prospect i ve analysis ( 1991–2004 ) from the Whitehall II cohort study . The current sample consists of 5,895 Caucasian middle-aged civil servants free from diabetes at baseline . Type 2 diabetes was ascertained by an oral glucose tolerance test supplemented by self-reports at baseline and four consecutive waves of data collection including two screening phases . The job strain and iso-strain models were used to assess psychosocial work stress .  RESULTS Iso-strain in the workplace was associated with a twofold higher risk of type 2 diabetes in age-adjusted analysis in women but not in men ( hazard ratio 1.94 [ 95 % CI 1.17–3.21 ) . This effect remained robust to adjustment for socioeconomic position and outside work stressors and was only attenuated by 20 % after adjustment for health behaviors , obesity , and other type 2 diabetes risk factors . CONCLUSIONS  Psychosocial work stress  was an independent predictor of type 2 diabetes among women after a 15-year follow-up . This association was not explained by potential confounding and mediating factors . More evidence from prospect i ve studies using the same work stress models is needed to support the current findings and provide further information on sex differences The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement is used worldwide to improve the reporting of r and omized , controlled trials . Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . Background Yoga is a popular therapy for diabetes but its efficacy is contested . The aim of this study was to explore the feasibility of research ing community based yoga classes in Type 2 diabetes with a view to informing the design of a definitive , multi-centre trial Methods The study design was an exploratory r and omised controlled trial with in-depth process evaluation . The setting was two multi-ethnic boroughs in London , UK ; one with average and one with low mean socio-economic deprivation score . Classes were held at a sports centre or GP surgery . Participants were 59 people with Type 2 diabetes not taking insulin , recruited from general practice lists or opportunistically by general practice staff . The intervention group were offered 12 weeks of a twice-weekly 90-minute yoga class ; the control group was a waiting list for the yoga classes . Both groups received advice and leaflets on healthy lifestyle and were encouraged to exercise . Primary outcome measure was HbA1c . Secondary outcome measures included attendance , weight , waist circumference , lipid levels , blood pressure , UKPDS cardiovascular risk score , diabetes-related quality of life ( ADDQoL ) , and self-efficacy . Process measures were attendance at yoga sessions , self-reported frequency of practice between taught sessions , and qualitative data ( interviews with patients and therapists , ethnographic observation of the yoga classes , and analysis of documents including minutes of meetings , correspondence , and exercise plans ) . Results Despite broad inclusion criteria , around two-thirds of the patients on GP diabetic registers proved ineligible , and 90 % of the remainder declined to participate . Mean age of participants was 60 + /- 10 years .  Attendance at yoga classes was around 50 % . Nobody did the exercises regularly at home . Yoga teachers felt that most participants were unsuitable for ' st and ard ' yoga exercises because of limited flexibility , lack of basic fitness , co-morbidity , and lack of confidence . There was a small fall in HbA1c in the yoga group which was not statistically significant and which was not sustained six months later , and no significant change in other outcome measures . Conclusion The benefits of yoga in type 2 diabetes suggested in some previous studies were not confirmed . Possible explanations ( apart from lack of efficacy ) include recruitment challenges ; practical and motivational barriers to class attendance ; physical and motivational barriers to engaging in the exercises ; inadequate intensity and /or duration of yoga intervention ; and insufficient personalisation of exercises to individual needs . All these factors should be considered when design ing future trials . Trial registration National Research Register ( 1410 ) and Current Controlled Trials ( IS RCT N63637211 ) OBJECTIVES To study the effectiveness of yoga intervention on oxidative stress , glycemic status , blood pressure and anthropometry in prediabetes . DESIGN R and omized-controlled trial . PARTICIPANTS Twenty nine prediabetes subjects aged 30 - 75 years . SETTING Yoga was conducted at 4 different community diabetes clinics in Mangalore , India . INTERVENTIONS Participants were r and omized to either 3-month yoga or wait-list control groups . MAIN OUTCOME MEASURES Malondialdehyde , glutathione , vitamin C , vitamin E , superoxide dismutase , plasma glucose , glycated haemoglobin , BMI , waist circumference , waist-to-hip ratio and blood pressure . RESULTS Yoga intervention result ed in a significant decline in malondialdehyde ( p<0.001 ) , relative to the control group . In comparison with the control , there was a significant improvement in BMI , waist circumference , systolic blood pressure and fasting glucose levels at follow-up . No significant improvement in glycated haemoglobin , waist-to-hip ratio or any of the antioxidants was observed . CONCLUSIONS Yoga intervention may be helpful in control of oxidative stress in prediabetes subjects . Yoga can also be beneficial in reduction in BMI , waist circumference , systolic blood pressure and fasting glucose . Effect of yoga on antioxidant parameters was not evident in this study . The findings of this study need to be confirmed in larger trials involving active control groups Background Yoga has been shown to be a simple and economical therapeutic modality that may be considered as a beneficial adjuvant for type 2 diabetes mellitus . This study investigated the impact of Hatha yoga and conventional physical training ( PT ) exercise regimens on biochemical , oxidative stress indicators and oxidant status in patients with type 2 diabetes . Methods This prospect i ve r and omized study consisted of 77 type 2 diabetic patients in the Hatha yoga exercise group that were matched with a similar number of type 2 diabetic patients in the conventional PT exercise and control groups . Biochemical parameters such as fasting blood glucose ( FBG ) , serum total cholesterol ( TC ) , triglycerides , low-density lipoprotein ( LDL ) , very low-density lipoproteins ( VLDL ) and high-density lipoprotein ( HDL ) were determined at baseline and at two consecutive three monthly intervals . The oxidative stress indicators ( malondialdehyde – MDA , protein oxidation – POX , phospholipase A2 – PLA2 activity ) and oxidative status [ superoxide dismutase ( SOD ) and catalase activities ] were measured . Results The concentrations of FBG in the Hatha yoga and conventional PT exercise groups after six months decreased by 29.48 % and 27.43 % respectively ( P < 0.0001 ) and there was a significant reduction in serum TC in both groups ( P < 0.0001 ) . The concentrations of VLDL in the managed groups after six months differed significantly from baseline values ( P = 0.036 ) . Lipid peroxidation as indicated by MDA significantly decreased by 19.9 % and 18.1 % in the Hatha yoga and conventional PT exercise groups respectively ( P < 0.0001 ) ; whilst the activity of SOD significantly increased by 24.08 % and 20.18 % respectively ( P = 0.031 ) . There was no significant difference in the baseline and 6 months activities of PLA2 and catalase after six months although the latter increased by 13.68 % and 13.19 % in the Hatha yoga and conventional PT exercise groups respectively ( P = 0.144 ) . Conclusion The study demonstrate the efficacy of Hatha yoga exercise on fasting blood glucose , lipid profile , oxidative stress markers and antioxidant status in patients with type 2 diabetes and suggest that Hatha yoga exercise and conventional PT exercise may have therapeutic preventative and protective effects on diabetes mellitus by decreasing oxidative stress and improving antioxidant status . Trial Registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) : Background Medical treatment of hypertension is not always sufficient to achieve blood pressure control . Despite this , previous studies on supplementary therapies , such as yoga , are relatively few . We investigated the effects of two yoga interventions on blood pressure and quality of life in patients in primary health care diagnosed with hypertension . Methods Adult patients ( age 20–80 years ) with diagnosed hypertension were identified by an electronic chart search at a primary health care center in southern Sweden . In total , 83 subjects with blood pressure values of 120–179/≤109 mmHg at baseline were enrolled . At baseline , the patients underwent st and ardized blood pressure measurement  at the health care center and they completed a question naire on self-rated quality of life ( WHOQOL-BREF ) . There were three groups : 1 ) yoga class with yoga instructor ( n = 28 ) ; 2 ) yoga at home ( n = 28 ) ; and 3 ) a control group ( n = 27 ) . The participants were matched at the group level for systolic blood pressure . After 12 weeks of intervention , the assessment s were performed again . At baseline a majority of the patients ( 92 % ) were on antihypertensive medication , and the patients were requested not to change their medication during the study . Results The yoga class group showed no improvement in blood pressure or self-rated quality of life , while in the yoga at home group there was a decline in diastolic blood pressure of 4.4 mmHg ( p < 0.05 ) compared to the control group . Moreover , the yoga at home group showed significant improvement in self-rated quality of life compared to the control group ( p < 0.05 ) . Conclusions A short yoga program for the patient to practice at home seems to have an antihypertensive effect , as well as a positive effect on self-rated quality of life compared to controls . This implies that simple yoga exercises may be useful as a supplementary blood pressure therapy in addition to medical treatment when prescribed by primary care physicians . Trial registration Clinical Trials.gov ( NCT01302535 Various modes of physical activity , combined with dieting , have been widely recommended to prevent or delay type 2 diabetes . Among these , yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss , improving glucose levels and reducing blood pressure and lipid levels . This pilot study aim ed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes . Twenty-three adults ( 19 Whites and 4 non-Whites ) were r and omly assigned to the  yoga intervention group or the educational group . The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational material s every 2 weeks . All participants completed question naires and had blood tests at baseline and at the end of 3 months . Effect sizes were reported to summarize the efficacy of the intervention . All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program ( 99.2 % ) . Their yoga session attendance ranged from 58.3 to 100 % . Compared with the education group , the yoga group experienced improvements in weight , blood pressure , insulin , triglycerides and exercise self-efficacy indicated by small to large effect sizes . This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes . In addition , yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group Objective . To evaluate a 12-week group-based lifestyle intervention programme for women with prediabetes following gestational diabetes ( GDM ) . Design . A two-group , mixed methods r and omized controlled trial in which 50 women with a history of GDM and abnormal glucose tolerance postpartum were r and omly assigned to intervention ( n = 24 ) or wait control ( n = 26 ) and postintervention qualitative interviews with participants . Main Outcome Measures . Modifiable biochemical , anthropometric , behavioural , and psychosocial risk factors associated with the development of type 2 diabetes . The primary outcome variable was the change in fasting plasma glucose ( FPG ) from study entry to one-year follow-up . Results . At one-year follow-up , the intervention group showed significant improvements over the wait control group on stress , diet self-efficacy , and quality of life . There was no evidence of an effect of the intervention on measures of biochemistry or anthropometry ; the effect on one health behaviour , diet adherence , was close to significance . Conclusions . Prevention programmes must tackle the barriers to participation faced by this population ; home-based interventions should be investigated . Strategies for promoting long-term health self-management need to be developed and tested Introduction India has become the epicentre for diabetes , a stress-related disorder affecting the working skills and day-to-day lifestyle management of younger population . Most of the studies have reported the effect of yoga on improving Quality of Life ( QoL ) in diabetic patients with other comorbidities . Till date , no r and omized control trial reports are available to show the effect of yoga therapy on QoL and Indian Diabetes Risk Score ( IDRS ) in normotensive prediabetic and diabetic young individuals . Aim To determine the effect of 12 weeks of yoga therapy on QoL and IDRS among normotensive prediabetic and diabetic young Indian adults . Material s and Methods A r and omized control trial was conducted in Endocrinology Outpatient Department ( OPD ) . Normotensive participants ( n=310 ) aged 18 - 45 years were divided into healthy controls ( n=62 ) , prediabetics ( n=124 ) and diabetics ( n=124 ) . Study group subjects were r and omly assigned to Group II ( n=62 , prediabetes-st and ard treatment ) , Group III ( n=62 , prediabetes-st and ard treatment + yoga therapy ) , Group IV ( n=62 , diabetes-st and ard treatment ) and Group V ( n=62 , diabetes-st and ard treatment + yoga therapy ) . Flanagan QoL scale , IDRS question naire , Fasting Plasma Glucose ( FPG ) and insulin were assessed pre and post 12 weeks of intervention . Statistical analysis was done using Student 's paired t-test and one-way ANOVA . Results Pre-post intervention analysis showed significant improvement in QoL scale with p<0.01 in Group II and Group IV ; p<0.001 in Group III and Group V respectively . There was significant reduction in IDRS in Group II ( p<0.05 ) ; p<0.001 in Group III , Group IV and Group V respectively . Significant difference ( p<0.001 ) in QoL scale and IDRS were found when study groups with st and ard treatment along with yoga therapy were compared to st and ard treatment alone . Conclusion Yoga therapy along with st and ard treatment for 12 weeks improved QoL and attenuated the diabetes risk among Indian prediabetics and diabetics compared to st and ard treatment alone Type 2 diabetes mellitus ( T2DM ) is one of the most common causes of chronic kidney disease and kidney failure . It has been estimated that the annual decline of estimated glomerular filtration rate ( eGFR ) among patients with T2DM is approximately 2.0 - 2.5mL min-1 y-1 . Cyclooxygenase-dependent eicosanoids , such as 11-dehydro-thromboxane (Tx)B2 , are increased in T2DM patients and are potentially involved in the regulation of renal blood flow . Animal models showed that cyclooxygenase inhibitors , such as aspirin , are associated with improvements in renal plasma flow and eGFR values . HYPOTHESIS The primary end point of the LEDA trial is to evaluate the 1-year decline of eGFR in T2DM patients treated or not with low-dose aspirin ( 100mg/d ) . Secondary end points will be the rapid decline in renal function , defined as a reduction of eGFR ≥5mL/min , and change of renal function class after 1-year follow-up . Furthermore , urinary excretion 11-dehydro-TxB2 will be related to renal function modifications . STUDY DESIGN A phase 3 no-profit , multicenter , double-blind , r and omized intervention trial of aspirin 100mg/dvs placebo ( Clinical Trials.gov Identifier : NCT02895113 ) . All patients will be monitored at 6 and 12months after r and omization to assess drug adherence and eGFR changes . SUMMARY The LEDA trial is the first double-blind , placebo-controlled , r and omized clinical trial aim ed at examining whether aspirin treatment may beneficially affect kidney function in patients with T2DM by reducing the annual eGFR decline . The trial will also examine whether the potential renoprotective effects of aspirin might be partly due to its inhibition of TxB2 production Incidence rates and risk factors for type 2 diabetes in low-risk population s are not well documented . We investigated these in white individuals who were aged 40 - 79 years and from the population of Bruneck , Italy . Of an age- and sex-stratified r and om sample of 1,000 individuals who were identified in 1990 , 919 underwent an oral glucose tolerance test ( OGTT ) and an assessment of physiological risk factors for diabetes , including insulin resistance ( homeostasis model assessment , HOMA-IR ) , and  postchallenge insulin response  ( Sluiter 's Index ) . Diabetes at baseline by fasting or 2-h OGTT plasma glucose ( World Health Organization criteria , n = 82 ) was excluded , leaving 837 individuals who were followed for 10 years .  Incident cases of diabetes were ascertained by confirmed diabetes treatment or a fasting glucose > or=7.0 mmol/l . At follow-up , 64 individuals had developed diabetes , corresponding to a population -st and ardized incidence rate of 7.6 per 1,000 person-years . Sex- and age-adjusted incidence rates were elevated 11-fold in individuals with impaired fasting glucose at baseline , 4-fold in those with impaired glucose tolerance , 3-fold in overweight individuals , 10-fold in obese individuals , and approximately 2-fold in individuals with dyslipidemia or hypertension . Incidence rates increased with increasing HOMA-IR and decreasing Sluiter 's Index . As compared with normal insulin sensitivity and normal insulin response , individuals with low insulin sensitivity and low insulin response had a sevenfold higher risk of diabetes . Baseline impaired fasting glucose , BMI , HOMA-IR , and Sluiter 's Index were the only independent predictors of incident diabetes in multivariate analyses . We conclude that approximately 1 % of European white individuals aged 40 - 79 years develop type 2 diabetes annually and that " subdiabetic " hyperglycemia , obesity , insulin resistance , and impaired insulin response to glucose are independent predictors of diabetes AIMS OF STUDY To study effect of yoga on the physiological , psychological well being , psychomotor parameter and modifying cardiovascular risk factors in mild to moderate hypertensive patients . METHODS Twenty patients ( 16 males , 4 females ) in the age group of 35 to 55 years with mild to moderate essential hypertension underwent yogic practice s daily for one hour for three months . Biochemical , physiological and psychological parameters were studied prior and following period of three months of yoga practice s , biochemical parameters included , blood glucose , lipid profile , catecholmines , MDA , Vit . C cholinesterase and urinary VMA . Psychological evaluation was done by using personal orientation inventory and subjective well being . RESULTS Results showed decrease in blood pressure and drug score modifying risk factors , i.e. blood glucose , cholesterol and triglycerides decreased overall improvement in subjective well being and quality of life . There was decrease in VMA catecholamine , and decrease MDA level suggestive decrease sympathetic activity and oxidant stress . CONCLUSION Yoga can play an important role in risk modification for cardiovascular diseases in mild to moderate hypertension AIM To investigate the effect of acute psychological stress on glucose concentrations in patients with Type 2 diabetes , in the fasting state as well as in the postpr and ial state . METHODS Thirty patients ( 12 female ) with Type 2 diabetes were included . Mean ± SD age was 60 ± 12 years , BMI 28.8 ± 4.2 kg/m(2 ) , diabetes duration 8.9 ± 6.7 years and HbA(1c ) 51 ± 9 mmol/mol ( 6.8 ± 0.8 % ) . Using a non-r and omized approach , all participants were exposed to moderate psychological stress by means of the Trier Social Stress Test : 10 participants in the fasting state and 20 participants 75 min after intake of a st and ard meal . Blood pressure , heart rate and salivary cortisol  were monitored on the control day and the stress-test  day . Glucose concentrations were assessed using a continuous glucose monitoring system . RESULTS On the stress-test day , blood pressure rose from 117/73 ± 13/12 to 155/92 ± 22/14 mmHg , heart rate from 77 ± 11 to 91 ± 25 b min(-1 ) and salivary cortisol concentrations from 8.5 ± 3.7 to 26.4 ± 12.1 nmol/l ( P < 0.001 ) ; these measurements remained unchanged on the control day . On the stress-test day , when the Trier Social Stress Test was applied 75 min after the intake of a st and ard meal  , the glucose concentrations were significantly higher compared with the control day ( mean difference 1.5 mmol/l , 95 % CI 0.5 - 2.4 , P = 0.003 ) . In the fasting state , glucose concentrations slightly decreased during the control day but remained stable on the stress-test day ( mean difference compared with the control day 0.7 mmol/l , 95 % CI -0.7 to 2.0 , P = 0.31 ) . CONCLUSIONS When stress is experienced in the postpr and ial period , acute psychological stress significantly increases glucose concentrations in patients with Type 2 diabetes OBJECTIVE The present study was conducted to assess the effectiveness of yoga in the management of dyslipidemia in patients of type 2 diabetes mellitus . METHODS This r and omized parallel study was carried out in Medical College Triv and rum , Kerala , India . Hundred type 2 diabetics with dyslipidemia were r and omized into control and yoga groups . The control group was prescribed oral hypoglycemic drugs . The yoga group practice d yoga daily for 1 h duration along with oral hypoglycemic drugs for 3 months . The lipid profiles of both the groups were compared at the start and at the end of 3 months . RESULTS After intervention with yoga for a period of 3 months the study group showed a decrease in total cholesterol , triglycerides and LDL , with an improvement in HDL . CONCLUSION Yoga , being a lifestyle incorporating exercise and stress management training , targets the elevated lipid levels in patients with diabetes through integrated approaches Background : Type 2 diabetes mellitus ( T2DM ) is becoming a leading problem worldwide . Emerging reports reveal alarming evidence of increasing prevalence of T2DM that has reached p and emic levels . Despite the significant incidence , there are limited reliable data re sources and comprehensive systematic review and meta- analysis on the effects of yoga on people who are a prediabetic or high risk for developing T2DM . Objective : The objective of this protocol is to conduct a full-scale systematic review and meta-analyses on the effects of yoga on people who are prediabetes or high risk of developing T2DM . Methods : The articles enrolled in the study will be retrieved from the online data bases between 2002 and the date the search es are executed . The search es will be repeated just before the final analyses and further relevant studies for inclusion . We will conduct a bibliographic search in data bases : Medline / PubMed , Scopus , Cochrane Library , EBSCO , and IndMED using keywords including prediabetes state , high risk for diabetes , metabolic syndrome , and yoga . A defined search strategy will be implemented along with selection criteria to obtain full-text articles of relevant studies . This study protocol was prepared according to the Preferred Reporting Items for Systematic Review s and Meta- Analysis for Protocol s 2015 guidelines . There will be no language restrictions . Ethics and dissemination : The proposed study will be based on published studies and publicly available anonymized data without directly involving human participants and therefore requires neither formal human ethical review nor approval by a human research ethics committee . We published an outline of the protocol in the International Prospect i ve Register of Systematic Review s ( PROSPERO ) in 2018 . We plan to disseminate the findings of this systematic review and meta- analysis through publication in a peer- review ed journal and presentation at relevant conference proceedings . In addition , we believe the results of the systematic review will have implication s for policy and practice . We will prepare policymaker summary using a vali date d format , disseminate through social media and email discussion groups . Review registration number : PROSPERO registration number CRD The prevalence of type 2 diabetes continues to increase in minority and underserved patients , who are also more likely to have poorer control of diabetes and related risk factors for complications . Although the Look AHEAD trial has demonstrated improved risk factor control among overweight or obese diabetes patients who received an intensive lifestyle intervention  , translating such findings into accessible programs is a major public health challenge . The purpose of this paper is to report the design and baseline characteristics of the Lifestyle Interventions for the Treatment of Diabetes study ( LIFT Diabetes ) . The overall goal is to test the impact of a community-based lifestyle weight loss ( LWL ) intervention adapted from Look AHEAD on cardiovascular disease risk at 12-months and 24-months among minority and lower income diabetes patients . Secondary outcomes include body weight , physical activity , medication use , cost , re source utilization , and safety . The primary hypothesis being tested is that the  LWL  will result in 10 % relative reduction in CVD risk compared to the DSM . We have r and omized 260 overweight or obese adults with diabetes one of two 12-month interventions : a LWL condition delivered by community health workers or a diabetes self-management ( DSM ) education condition . The baseline demographic characteristics indicate that our sample is predominantly female , obese , low income , and ethnic minority . Translating evidence -based , lifestyle strategies , and targeting minority and underserved patients , will yield , if successful , a model for addressing the burden of diabetes and may favorably impact health disparities Background : Yoga has been shown to be beneficial in diabetes in many studies , though r and omized control trials are few . The aim of this r and omized control trial was to see the effect of Sudarshan Kriya and related practice s ( comprehensive yogic breathing program ) on quality of life , glycemic control , and cardiac autonomic functions in diabetes . Diabetes mellitus is a risk factor for sudden cardiac death . Cardiac autonomic neuropathy has been implicated in the causation of sudden cardiac death . Therefore , a maneuver to prevent progression of cardiac autonomic neuropathy holds significance . Material s and Methods : A total of 120 patients of diabetes on oral medication and diet and exercise advice were r and omized into two groups : ( 1 ) Continued to receive st and ard treatment for diabetes . ( 2 ) Patients administered comprehensive yogic breathing program and monitored to regularly practice yoga in addition to st and ard treatment of diabetes . At 6 months , quality of life and postpr and ial plasma glucose significantly improved in the group practicing yoga compared to baseline , but there was no significant improvement in the fasting plasma glucose and glycated hemoglobin . Results : On per protocol analysis , sympathetic cardiac autonomic functions significantly improved from baseline in the group practicing comprehensive yogic breathing . Conclusion : This r and omized control trial points towards the beneficial effect of yogic breathing program in preventing progression of cardiac neuropathy . This has important implication s as cardiac autonomic neuropathy has been considered as one of the factors for sudden cardiac deaths
target: This meta- analysis uncovered clinical ly improved effects of yoga intervention on glycemic control , lipid profiles and other parameters of T2DM management in prediabetic population .
  These results suggest that yoga intervention may be considered as a comprehensive and alternative approach to preventing T2DM .
background: A systematic review and meta- analysis was conducted to investigate the effects of yoga on glycemic control , lipid profiles , body composition and blood pressure in people in the pre-diabetic state .