Yoga, meditation and other mindfulness practices may help people with type 2 diabetes lower their blood sugar — nearly to the degree that standard medications like metformin do, a new analysis suggests.
That does not mean people should swap their medication for meditation. The trials in the analysis all tested body-mind practices as an addition to standard diabetes treatment — not as a replacement for it.
That caveat made, the researchers said mindfulness is worth a try.
"We could use all the tools we can get for [managing] type 2 diabetes," said researcher Fatimata Sanogo, a PhD student at the University of Southern California's Keck School of Medicine, in Los Angeles.
In the United States alone, over 37 million people have diabetes, the vast majority of whom have type 2, according to the U.S. National Institutes of Health. Type 2 diabetes arises when the body loses its ability to properly use insulin, a hormone that shuttles sugars from food into body cells to be used for energy.
As a consequence, sugar builds up in the bloodstream, which over time can damage blood vessels and nerves. Many people with diabetes develop complications like heart disease, kidney failure, nerve damage in the feet and legs, and potentially blinding eye disease.
Controlling blood sugar levels is key to cutting those risks.
But despite the various medications available, only half of people with type 2 diabetes get their blood sugar down to recommended levels, Sanogo said.
So Sanogo, who is also a yoga teacher, wanted to dig into the evidence on mind-body practices: Can they help people with diabetes gain better control over the condition?
For the study, she and her colleagues pulled together 28 published clinical trials that have tested various practices. The majority focused on yoga, which typically combines physical postures, breathing practices and meditation. Ten trials tested either qigong, guided imagery, meditation or mindfulness-based stress reduction — a standardized program that includes meditation and yoga and teaches people how to use mindfulness to deal with daily stressors.
Overall, the researchers found, the practices helped people with type 2 diabetes lower their A1c — a measure of average blood sugar levels over the past three months.
In general, people with diabetes should keep their A1c below 7%. Across these trials, mind-body practices lowered participants' A1c by just over 0.8%, on average. That reduction, the study authors noted, is close to what trials of metformin have shown — where A1c has been cut by about 1%.
"That effects size is pretty big," said senior researcher Richard Watanabe, a professor at Keck. "I don't think we expected to see that magnitude of an effect."
He said the findings also highlight the importance of frequency, at least when it comes to yoga: In those studies, people who practiced more often — as much as every day — saw a greater benefit for their A1c.
Why does mindfulness help? The researchers believe it's related to stress reduction, though the specifics are not fully clear. There could be indirect benefits, with stress relief making daily diabetes management easier. There could also be direct biological effects, where a dip in stress hormones helps quiet systemic inflammation in the body and lower blood sugar.
The findings were published online recently in the Journal of Integrative and Complementary Medicine.
Dr. Eliud Sifonte is an endocrinologist with NYU Langone Medical Associates, in West Palm Beach, Fla. He said it's common for patients to be interested in non-drug ways to improve their blood sugar.
And it's certainly reasonable for people with type 2 diabetes to try mind-body practices, said Sifonte, who was not involved in the study.
"We always recommend lifestyle interventions," he said, noting there is plenty of evidence that people with diabetes can improve their blood sugar control — and overall health — with exercise and diet changes.
Mind-body practices can fit into that, Sifonte said: What's important is that people find healthy lifestyle habits they enjoy, so they will keep them up. With yoga, Sifonte noted, people should be aware there are different styles — ranging from gentle to more vigorous — and choose what's appropriate for them.
Sanogo added that while mind-body practices are low-risk, access can be an obstacle. Not everyone can find a class that is convenient and affordable.
There are, however, plenty of free apps and online sources where people can learn or be guided in meditation and other mind-body practices.
The American Diabetes Association has more on managing type 2 diabetes.
SOURCES: Fatimata Sanogo, PhD student, department of population and public health sciences, Keck School of Medicine of University of Southern California (USC), Los Angeles; Richard M. Watanabe, PhD, professor, population and public health sciences, and physiology and neuroscience, Keck School of Medicine of USC, Los Angeles; Eliud Sifonte, MD, endocrinology, diabetes and metabolism, NYU Langone Medical Associates - West Palm Beach, West Palm Beach, Fla., and clinical assistant professor, NYU Grossman School of Medicine, New York City; Journal of Integrative and Complementary Medicine, Sept. 7, 2022, online