30 million people have diabetes and this is expected to increase to nearly 60 million by 2017 . given india 's limited resources , it is important for health policy makers to choose from the ever - widening list of health conditions that vie for attention , and it is a list to which diabetes must be added as an important public health problem . however , these dilemmas of choice are made even more difficult when policy makers have to prioritize on the basis of disease burden , cost - effectiveness , and equity . in this light , the landmark u.n general assembly in 2011 met to discuss the prevention and control of non - communicable diseases ( ncd ) . it was pointed out that non - communicable diseases are responsible for more deaths than all other causes . while the international community had traditionally focused on communicable diseases , the ncd -cardiovascular disease , diabetes , cancers , and other chronic respiratory diseases emerged , almost unnoticed , in the developing world . with this ever - increasing prevalence of obesity , diabetes , and coronary disease , it is likely that health policy - makers would assign an increasing proportion of funds to chronic diseases in the years to come . thus , the onus might be on optimizing the utilization of these funds for the best possible public health outcome . it is in this light , that we write this commentary on a simple , cost - effective strategy for preventing diabetes  yoga therapy . the management of diabetes poses unique challenges in terms of modification of dietary practices , weight management , exercise , monitoring of body fluids ( blood , urine ) , footcare , use of drugs , and learning new technical skills such as blood glucose monitoring . health care systems need to be redesigned to deliver chronic care that is founded on existing primary care facilities , but supported by good referral systems . inaction will affect millions of lives - often the lives of those who have the least . to deal with the increasing morbidity and mortality , it is important to develop and evaluate low - cost strategies that build on available resources , and especially , interventions that can empower patients . the prevalence of diabetes mellitus in india is projected to increase by 60% and the economic burden by 50% over the same period . these numbers are overwhelming , and it may be pertinent to point out that highly successful , evaluated , prevention program have depended on highly resource - intensive behavior change techniques that would be extremely costly if rolled out universally and would bankrupt the wealthiest of nations . evidence from randomized controlled trials ( rct 's ) have already shown the usefulness , though expensive nature of carrying out lifestyle intervention programs . today , it is necessary to look at alternatives which are not resource - intensive and those which are nearer to the community that people live in . yoga therapy holds promise as a therapeutic intervention and health promotion measure , though studies are not conclusive . a recent randomized controlled study conducted in india also showed a significant improvement in the quality of life but a non - significant trend towards improvement in glycemic control in the intervention group . the advantages of yoga are that , it is a holistic philosophy , in which physical exercises are linked to a wider lifestyle and behavioral change that includes diet , relaxation , and stress management . it is also considered to be a potential therapeutic tool to achieve positive health and cure disease . , 80% of the expenditure on medical care for diabetes is made by the richest countries of the world . a study on determinants of medical outcomes showed that patient - related reasons were more responsible for variability in hba1c when compared with physician - related factors . controlling these patient - related factors hold the key to successful control . according to the american diabetes association guidelines regular , moderate intensity cardiovascular exercise training of at least 150 min / week , alone or in conjunction with resistance exercise training 3 times per week , has been shown to improve glucose control and glucose disposal , improve insulin sensitivity , contribute to weight loss . though regular exercise training is a cornerstone of complementary therapy , it is frequently underutilized as a treatment strategy for the prevention and treatment diabetes . in this context , the importance of yoga is related to the ease of use , safety , and multiple psychological benefits including stress reduction and mental health well being . there have been at least 22 rct studying the risk factors of developing type 2 diabetes with some evidence that the regular practice of yoga over 3 - 6 months can decrease the risk of developing diabetes and improve glucose control in healthy adults . the postulates on the efficacy of yogic practices in controlling diabetes is based on the exercise effect , changes in biochemical and hormonal profile , elimination of stress , and instilling a sense of discipline . if the patient - related reasons like discipline regarding food and exercise can be taken care of and added to this , if there is a positive effect on the biochemical and hormonal profile , it can help to modify the patient - related reasons and result in a better outcome for the patient with diabetes . thus , yoga - based programs may be a low - cost intervention strategy to improve physical as well as psychological well being . yoga provides slow rhythmic movements , which emphasize the stimulation of the organs and glands by easy bending and extension , which do not over - stimulate muscles but concentrate on focused stimulation . the insulin resistance syndrome or metabolic syndrome is a constellation of hyperglycemia , dyslipidemia , hypertension , and central obesity . increased sympathetic activity , enhanced cardiovascular reactivity , and reduced parasympathetic tone have been implicated in the pathogenesis of insulin resistance syndrome . recent research also shows that chronic psychological stress and negative affective states contribute to the pathogenesis and progression of insulin resistance , glucose intolerance , hypertension , and other irs - related conditions . studies have shown that yoga has a positive short - term effect on multiple diabetes - related outcomes , but its long - term effects are not clear . 7.5% had practiced yoga at some point and very interestingly , 90% of this population expressed the belief that yoga was helpful in improving , maintaining health or both . though yoga originated in india , extensive rct - based data are not available for our country . while there are many studies on yoga from india , the studies do have limitations : lack of control groups , reduced power because of a low number of study subjects , possible selection bias or influence of uncontrolled confounding , lack of appropriate statistical analyzes or presentation . additional studies using rigorous methodologies are necessary to examine the effects of yoga therapy on glycemic control , and quality of life of women with type 2 diabetes mellitus . a randomized study done in india found a significant improvement in fasting blood sugar , hba1c , and total cholesterol with yoga therapy . significant improvements in scores of psychological assessment ( satisfaction , impact , and worry ) were also seen . clinically significant reduction in the doses of hypoglycemic agents and insulin were observed after yoga lifestyle intervention . another study ( a more rigorous , inpatient yoga treatment accompanied by visceral cleansing procedures , in addition to asanas and pranayama ) was undergone by 149 patients for 40 days . this study showed that , for type 2 diabetes of less than 10 yrs duration and fasting glucose < 140 mg / dl , hyperglycemia can be controlled by yoga alone . however , patients with very severe hyperglycemia / glucose intolerance would need a combination of yoga and hypoglycemic drugs . , within a short period of study for 10 days was able to show a significant reduction in fasting glucose , total cholesterol , ldl , vldl , total cholesterol / hdl ratio with yoga therapy ; these were more marked in those with hypercholesterolemia and hyperglycemia . in addition to reporting a fall in fasting glucose and post - meal blood glucose , malhotra , et al . also reported a significant fall in waist - hip ratio and changes in insulin levels , suggesting a re - distribution of fat and glucose utilization . another study showed a significant decrease in bmi and anxiety and an increase in general well - being . a randomized trial conducted in uk found a significant improvement in the yoga group for hba1c , fasting glucose , ldl , and total cholesterol . they concluded that traditional i.e. , primarily yoga - based interventions may benefit patients with higher hba1c values . however , there are conflicting reports too- in an exploratory rct in uk , yoga did not show a dramatic benefit . in the intervention group , however , it was also suggested that some other factors like good background control in the targeted population ( mean hba1c-6.9 ) , small sample size , practical and motivational barriers to class attendance , physical and motivational barriers to engaging in exercise could be responsible for the marginal fall in hba1c . in a systematic review , innes , et al . suggested that yoga may be instrumental in improving core indices of the metabolic syndrome including glucose tolerance and insulin sensitivity , lipid profiles , anthropometric characteristics . patients in studies have shown improvement in glycemic control with reduction in dose requirement of oral hypoglycemics . among a small number of elderly , followed up for 7 years , there was good glycemic control and no long - term complications were reported in them . are there studies which have been carried out to ascertain the reasons for the benefit that yoga offers in the setting of type 2 diabetes / metabolic syndrome ? gordon , et al . conducted a prospective randomized study for 6 months on the effects of physical exercise and yoga therapy on oxidative stress indicators . fasting blood glucose decreased significantly , as did markers of oxidative stress ; anti - oxidant molecules showed a significant increase . in a controlled trial conducted in india on oxidative stress indicators like malonyl aldehyde , yoga practitioners achieved significant improvement in bmi , fasting glucose , post - meal glucose , malonyl aldehyde , glutathione , and vitamin c , and no adverse events thus , we suggest that yoga be considered as a candidate for community - based management programs in tackling the burden of type 2 diabetes . yoga is a potential intervention that is not resource - intensive . if studies prove the effectiveness of yoga , the future may see the emergence of a  yoga movement by the people with diabetes  to generate positive health . and finally , yoga , an innovation created in india , could find its way back to pre - eminence in this country , given its potential in the ever - increasing epidemic of diabetes and cardiovascular disease .
the prevalence of diabetes is projected to increase to 80 million by 2030 , placing an immense burden on the health care resources of our country . 
 thus , diabetes poses a challenge to health systems and the individual . 
 hence , it is necessary to look at adjuncts to effective management of diabetes ; adjuncts which are not resource intensive and are nearer to the community that people live in . 
 yoga holds promise as a therapeutic intervention and health promotion measure . 
 this brief communication explores the studies done to date on the beneficial effects of yoga on diabetes .