Department of Population and Public Health Sciences, Keck School of Medicine of USC, Los Angeles, CA, USA.
USC Diabetes and Obesity Research Institute, Keck School of Medicine of USC, Los Angeles, CA, USA.
J Integr Complement Med. 2023 Feb;29(2):69-79. doi: 10.1089/jicm.2022.0586. Epub 2022 Sep 7.
Only 51% of patients with type 2 diabetes achieve the hemoglobin A1c (HbA1c) <7% target. Mind and body practices have been increasingly used to improve glycemic control among patients with type 2 diabetes, but studies show inconsistent efficacy. The authors conducted a systematic review and meta-analysis to assess the association between mind and body practices, and mean change in HbA1c and fasting blood glucose (FBG) in patients with type 2 diabetes. The authors conducted a literature search of Ovid MEDLINE, Embase, and ClinicalTrials.gov seeking through June 10, 2022, published articles on mind and body practices and type 2 diabetes. Two reviewers independently appraised full text of articles. Only intervention studies were included. Reviewers extracted data for meta-analysis. Restricted maximum likelihood random-effects modeling was used to calculate the mean differences and summary effect sizes. The authors assessed heterogeneity using Cochran's and statistics. Funnel plots were generated for each outcome to gauge publication bias. Weighted linear models were used to conduct study-level meta-regression analyses of practice frequency. The authors identified 587 articles with 28 meeting the inclusion criteria. A statistically significant and clinically relevant mean reduction in HbA1c of -0.84% (95% confidence interval [CI]: -1.10% to -0.58%; < 0.0001) was estimated. Reduction was observed in all intervention subgroups: mindfulness-based stress reduction: -0.48% (95% CI: -0.72% to -0.23%; = 0.03), : -0.66% (95% CI: -1.18% to -0.14%; = 0.01), and yoga: -1.00% (95% CI: -1.38% to -0.63%; < 0.0001). Meta-regression revealed that for every additional day of yoga practice per week, the raw mean HbA1c differed by -0.22% (95% CI: -0.44% to -0.003%; = 0.046) over the study period. FBG significantly improved following mind and body practices, with overall mean difference of -22.81 mg/dL (95% CI: -33.07 to -12.55 mg/dL; < 0.0001). However, no significant association was found between the frequency of weekly yoga practice and change in FBG over the study period. Mind and body practices are strongly associated with improvement in glycemic control in patients with type 2 diabetes. The overall mean reduction in HbA1c and FBG was clinically significant, suggesting that mind and body practices may be an effective, complementary nonpharmacological intervention for type 2 diabetes. Additional analyses revealed that the mean decrease in HbA1c was greater in studies requiring larger number of yoga practice sessions each week.
仅有 51%的 2 型糖尿病患者达到了血红蛋白 A1c（HbA1c）<7%的目标。越来越多的身心实践被用于改善 2 型糖尿病患者的血糖控制，但研究结果显示疗效不一致。作者进行了一项系统评价和荟萃分析，以评估身心实践与 2 型糖尿病患者的 HbA1c 和空腹血糖（FBG）平均变化之间的关联。作者对 Ovid MEDLINE、Embase 和 ClinicalTrials.gov 进行了文献检索，截至 2022 年 6 月 10 日，检索了关于身心实践和 2 型糖尿病的已发表文章。两位审查员独立评估了文章的全文。仅纳入干预研究。审查员提取了荟萃分析的数据。使用受限最大似然随机效应模型计算平均差异和汇总效应大小。作者使用 Cochrane's 和 统计量评估异质性。为每个结局生成漏斗图以评估发表偏倚。使用加权线性模型对每周练习频率进行研究水平的荟萃回归分析。作者确定了 587 篇文章，其中 28 篇符合纳入标准。估计 HbA1c 平均降低 -0.84%（95%置信区间[CI]：-1.10%至-0.58%；<0.0001）具有统计学意义和临床相关性。所有干预亚组均观察到降低：基于正念的压力减轻：-0.48%（95%CI：-0.72%至-0.23%；=0.03），-0.66%（95%CI：-1.18%至-0.14%；=0.01）和瑜伽：-1.00%（95%CI：-1.38%至-0.63%；<0.0001）。荟萃回归显示，每周瑜伽练习天数每增加一天，HbA1c 的原始平均水平在研究期间差异为 -0.22%（95%CI：-0.44%至-0.003%；=0.046）。身心实践后 FBG 显著改善，总体平均差异为-22.81mg/dL（95%CI：-33.07 至-12.55mg/dL；<0.0001）。然而，在研究期间，每周瑜伽练习频率与 FBG 变化之间未发现显著关联。身心实践与 2 型糖尿病患者血糖控制的改善密切相关。HbA1c 和 FBG 的总体平均降低具有临床意义，表明身心实践可能是 2 型糖尿病的一种有效、互补的非药物干预措施。进一步的分析显示，每周需要更多瑜伽练习次数的研究中，HbA1c 的平均下降幅度更大。
