Mind-Body Therapies in Diabetes Management

Background and Clinical Problem

Practitioners of meditation have long believed in its ability to treat stress and chronic disease. The physiological basis of this belief has never been fully described, but as current research continues to reveal the intricacies of neuro-endocrine pathways, meditation, yoga, and other mind-body therapies are considered to be promising options in the treatment of diabetes.

The prevalence of diabetes is increasing dramatically worldwide.¹ Negative effects of physiological and emotional stress on blood glucose control have been described in the literature.^2,3 Mind-body therapies, such as meditation, yoga, qi-gong, and other relaxation techniques, have been studied in diabetes as a means of decreasing stress-related hyperglycemia.^4–8 The objective of many mind-body therapies is to facilitate attainment of a physiological state that counteracts the stress response and develops into a permanent set of traits among practitioners.

Physiological and emotional stress activate neuro-endocrine and sympathetic pathways via the hypothalamic-pituitary-adrenal axis and medullary adrenal sympathetic system.^9,10 Circulating catecholamines and glucocorticoids affect the structure and function of a variety of tissues and induce inflammatory cytokines that lead to increased glucagon production and decreased uptake and disposal of glucose in peripheral muscles.¹¹ Cytokines, primarily interleukin 6, have been strongly implicated in oxidative stress and inflammatory processes that lead to insulin resistance and vascular complications.^11–13

The relaxation response promotes regulation of cortisol and other stress hormones.¹⁴ Structured programs of meditation, such as Transcendental Meditation and Mindfulness-Based Stress Reduction (MBSR), train participants in focused attention and diaphragmatic breathing to invoke this response. Other relaxation therapies involve progressive muscle relaxation, biofeedback, and a variety of behavioral stress management techniques, such as guided imagery.

Yoga is a traditional Indian practice that includes diaphragmatic breathing and asanas (body postures that promote physical comfort and mental composure). Yoga …