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LETTER TO EDITOR  
Year : 2015  |  Volume : 8  |  Issue : 2  |  Page : 164-165
Pathways to care in type 2 diabetes mellitus-Where does yoga find a place?


1 Department of Metabolic Disorders, SVYASA Yoga University, Bengaluru, Karnataka, India
2 Division of Yoga and Life Sciences, SVYASA Yoga University, Bengaluru, Karnataka, India

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Date of Web Publication10-Jun-2015
 

How to cite this article:
More P, Jagannathan A. Pathways to care in type 2 diabetes mellitus-Where does yoga find a place?. Int J Yoga 2015;8:164-5

How to cite this URL:
More P, Jagannathan A. Pathways to care in type 2 diabetes mellitus-Where does yoga find a place?. Int J Yoga [serial online] 2015 [cited 2019 Sep 16];8:164-5. Available from: http://www.ijoy.org.in/text.asp?2015/8/2/164/154074
Sir,

Scientific literature shows that type 2 diabetes mellitus (T2DM) patients often use complementary and alternative medicine (CAM) toward prevention and treatment of their disease. [1] The reasons for adopting prescribed medication and/or CAM is usually out of choice and the decision is an outcome of an interplay of frequency of use of different modalities, economic considerations, social networks and information pathways. [1] Yoga, one of the CAM treatments is especially observed to have beneficial effects in the management of blood glucose levels and complications related to diabetes. [2],[3] Western allopathic medication, on the other hand, is known to have significant side-effects and complications; however the number of people who use CAM and/or yoga in India as a primary or secondary treatment for T2DM is less compared with those who use Allopathic medicine. In this context, to propagate the benefits of yoga for T2DM, we first need to look into the different pathways to care adopted by people with T2DM with a focus on whether yoga is considered as one of the pathways toward preventing and managing T2DM in India.

In this endeavor, a pilot study was conducted in Sirsi taluk in Uttara Kannada district of Karnataka state as part of Stop Diabetes Movement, by Swami Vivekananda Yoga Anusandhana Samastahna University, Bangalore. A patient care pathway was defined as the referral pathway from a patient's first consult with a healthcare provider to the time they receive the most appropriate treatment for their condition. [4] A total of 80 participants registered for the camp and were screened for inclusion in the study. Postinformed consent, 29 participants were interviewed using an interview schedule to understand their pathways to care. The quantitative sociodemographic data were analyzed using descriptive statistics, and manual content analysis was conducted to analyze the qualitative data.

The sociodemographic details of the participants are given in [Table 1]. The average duration of T2DM was approximately 7.97 years and participants took approximately 1.48 years to shift from one station of treatment to another. The qualitative data analysis brought out three themes as part of the conceptual framework of pathways to care adopted by T2DM participants in the community in India [Figure 1]: (1) With respect to types and reasons for choosing the treatment, it was observed that participants adopted allopathic, yoga and/or ayurveda to manage diabetes. Allopathic treatment was their primary treatment as almost all of them approached the allopathic physician for their diagnosis and control of diabetes. A few participants, who had attended earlier yoga camps and had been educated about the benefits of yoga, adopted yoga as an alternative treatment for the management of their illness. Participants, who had been practicing yoga even before their diagnosis, stated that they had to adopt allopathic medications due to the severity of their diabetes and the inability to control their blood glucose levels with yoga treatment alone. Others were observed taking ayurvedic medications along with allopathic medications, as suggested by their friends who seemed to have controlled their blood glucose levels with the same. (2) With respect to the length of treatment spent by the participants in each pathway, it was observed that yoga or CAM treatment was only the second line of treatment and the mean (standard deviation) time period to reach to the pathway of yoga was approximately 1.3 (0.48) years. (3) With respect to how yoga works, participants stated that practice of yoga helped calm their mind, reduce their stress and improve their blood sugar (BS) levels. Most participants stated that their BS which were not controlled with medication seemed to improve for the better with an add-on of yoga.
Figure 1: Conceptual framework of pathways to care in type 2 diabetes mellitus DOI: Duration of illness, DOY: Duration of yoga, BS: Blood sugars, T2DM: Type 2 diabetes mellitus, MED: Oral medicine

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Table 1: Sociodemographic data of participants


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One may debate that, as Sirsi taluk is geographically small and has yoga schools in the locality, which propagate yoga and its beneficial effects to the community; this sample of participants who attended the camp could be biased toward yoga as a treatment. This aspect is reiterated in the results of the study, which showed that they indulged only in an average of <2 stops, allopathic medications, and yoga/ayurveda. However, this may not be the case in other taluks where yoga classes are not being conducted or where the community is not aware of the beneficial effects of yoga. The pathways in the latter communities may be entirely different and may need to be assessed. It is also interesting to note that in-spite of there being a bias regarding yoga among participants in this study; it was considered only as a second line of treatment. The decision on the pathways to be chosen was based on knowledge gained from family, friends, or treatment centers and was mostly an unplanned trial and error behavior if the earlier pathway were not helpful in management of the disease. To advocate yoga as a cost-effective and primary treatment for especially participants with mild-moderate T2DM, individual counseling at the participant/family level and awareness programs at the community/district administrative level need to be planned.

 
   References Top

1.
Manderson L, Canaway R, Unantenne N, Oldenburg B, Lin V, Hollingsworth B, et al. Care seeking, use of complementary therapies and self management among people with type 2 diabetes and cardiovascular disease [Online]. Aust J Herbal Med 2012;24:10-8.  Back to cited text no. 1
    
2.
Yang K. A review of yoga programs for four leading risk factors of chronic diseases. Evid Based Complement Alternat Med 2007;4:487-91.  Back to cited text no. 2
    
3.
Bijlani RL, Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma R, et al. A brief but comprehensive lifestyle education program based on yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern Complement Med 2005;11:267-74.  Back to cited text no. 3
    
4.
Lansang EZ, Tang V, Ranade S, Caveney E, Ng NK, Saldanha LM, et al. The patient care pathway for type 2 diabetes mellitus in Asian countries: Implications on target physician group for diabetes clinical trials. J Diabetes Metab 2014;5:331.  Back to cited text no. 4
    

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Correspondence Address:
Pooja More
Research Scholar, Department of Metabolic Disorders, SVYASA Yoga University, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6131.154074

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