Effect of self surrender practice on insulin resistance in individuals withtype 2 diabetes mellitus without depression: asingle-blinded randomized controlled trial

https://doi.org/10.19106/JMedSci005201202008

Agus Siswanto(1*), Muhammad Juffrie(2), Bambang Udji Djoko Rianto(3), H.A.H Asdie(4)

(1) Doctoral Programme of Medical Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
(2) Department of Pediatric, Faculty of Medicine, Public Health and Nursing/Dr.Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta
(3) Department of Otorhinolaryngology, Faculty of Medicine, Public Health and Nursing/Dr.Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta
(4) Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing/Dr.Sardjito General Hospital, Universitas Gadjah Mada, Yogyakarta
(*) Corresponding Author

Abstract


Self surrender practice (latihanpasrahdiri/LPD) is a form of relaxation therapy that has been increasingly used, not only in the treatment of psychosomatic diseases, but also of other non-psychosomatic diseases. Previous studies reported thatSSP shows modest improvement on clinical parameters of type 2diabetes mellitus(T2DM) patients,not onlydepression symptoms improvement, but also glycemic control.However, the effect of LPD on insulin resistance has not been investigated. The study aimed to investigate the effect of LPD on insulin resistance in T2DM patients without depression. This was a single-blinded, randomized, controlledtrial conducted in outpatient unit of the Department of Internal Medicine, Dr. Soeradji Tirtonegoro General Hospital, Klaten, Central Java.The subjects of the study were T2DM patients aged over 30 yearsand had no depression.Fourthy-four T2DM patients were randomized into two groups as the controlgroup and the treatment group who underwent SSP group for eight weeks. The data of insulin resistancemeasured by HOMA-IR, perceived stress scale (PSS), fasting plasma glucose (FBG), HbA1c, and two hour plasma glucose (PPG)levels of both groups werecollected and statistically analysed.No significantly different in the patient’scharacteristics of both groups was observed.At the end of the study period, the LPD group showed reduction of HOMA-IR and HbA1c but not statistically significant, (ΔHOMA-IR = -0.39±1.52; p = 0.976; HbA1c=-0.55±0.85%; p = 0.189). The FBG and PPGincreased in the LPD group compared to control but also not statistically significant (ΔFBG=10.16±50.33; p=0.294; PPG=40.74±69.35; p=0.062). We also observed the decrease of stress level in LPD group compared to control groupbut it was no statistical significance (ΔPSS=-5.09±6.47; p=0.655).Self surrender practice (LPD) decreasesHOMA-IR, improves glycemic control (HbA1c) and reduces stress levels in T2DM patients without depressionAlthough the theyarenot statisticallysignificant, however they may be clinically significant.


Keywords


self surrender practice; insulin resistance; type 2 diabetes mellitus; HbA1c; HOMA-IR;

Full Text:

PDF


References

  1. Grundy SM, Brewer HB, Jr, Cleeman JI, Smith SC, Jr, Lenfant C. Definition of metabolic syndrome: Report of the National Heart, Lung, and Blood Institute/American Heart Association conference on scientific issues related to definition. Circulation 2004; 109(3):433-8. https://doi.org/10.1161/01.CIR.0000111245.75752.C6
  2. Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. JCI 1999; 104(6):787-94. https://doi.org/10.1172/JCI7231
  3. Roder ME, Porte D, Jr., Schwartz RS, Kahn SE. Disproportionately elevated proinsulin levels reflect the degree of impaired B cell secretory capacity in patients with noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1998; 83(2):604-8. https://doi.org/10.1210/jcem.83.2.4544
  4. Srinivasan S, Ambler GR, Baur LA, Garnett SP, Tepsa M, Yap F, et al. Randomized, controlled trial of metformin for obesity and insulin resistance in children and adolescents: improvement in body composition and fasting insulin. J Clin Endocrinol Metab 2006; 91(6):2074-80. https://doi.org/10.1210/jc.2006-0241
  5. Svensson E, Baggesen LM, Johnsen SP, Pedersen L, Nørrelund H, Buhl ES, et al. Early glycemic control and magnitude of HbA1c reduction predict cardiovascular events and mortality: population-based cohort study of 24,752 metformin initiators. Diabetes Care 2017; 40(6):800-7. https://doi.org/10.2337/dc16-2271
  6. Yan Y-X, Xiao H-B, Wang S-S, Zhao J, He Y, Wang W, et al. Investigation of the relationship between chronic stress and insulin resistance in a Chinese population. J Epidemiol 2016; 26(7):355-60. https://doi.org/10.2188/jea.JE20150183
  7. McIntyre RS, Soczynska JK, Konarski JZ, Kennedy SH. The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms. Exp Opin Drug Safety 2006; 5(1):157-68. https://doi.org/10.1517/14740338.5.1.157
  8. Levkovitz Y, Ben-Shushan G, Hershkovitz A, Isaac R, Gil-Ad I, Shvartsman D, et al. Antidepressants induce cellular insulin resistance by activation of IRS-1 kinases. Mol Cell Neurosci 2007; 36(3):305-12. https://doi.org/10.1016/j.mcn.2007.05.009
  9. Isaac R, Boura-Halfon S, Gurevitch D, Shainskaya A, Levkovitz Y, Zick Y. Selective serotonin reuptake inhibitors (SSRIs) inhibit insulin secretion and action in pancreatic β cells. JBC 2013; 288(8):5682-93. https://doi.org/10.1074/jbc.M112.408641
  10. Surwit RS, van Tilburg MAL, Zucker N, McCaskill CC, Parekh P, Feinglos MN, et al. Stress management improves long-term glycemic control in type 2 diabetes. Diabetes Care 2002; 25(1):30-4. https://doi.org/10.2337/diacare.25.1.30
  11. Nidhi R, Padmalatha V, Nagarathna R, Ram A. Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. Int J Gynecol Obstet 2012; 118(1):37-41. https://doi.org/10.1016/j.ijgo.2012.01.027
  12. Sahay BK, editor. Yoga and Diabetes. In Proceedings. Novo Nordisk Diabetes Update 94 1994; Bombay: Health Care Communications.
  13. Pastucha D, Filipcikova R, Cajka V, Horakova D, Radova L, Reich P, et al. Effect of yoga exercise on metabolic and homeostatic parameters of insulin resistance. AMM 2012; 35. https://doi.org/10.2478/v10201-011-0031-7
  14. NeeSinha PM, Gandhi A, Mondal S, Jain A, Biswas R, editors. Effect of yoga on HOMA-IR and atherogenic lipid profile parameters of Mets syndrome in early postmenopausal women. Proceedings of The Physiological Society; 2016; Dublin, Ireland: The Physiological Society.
  15. Chen N, Xia X, Qin L, Luo L, Han S, Wang G, et al. Effects of 8-week hatha yoga training on metabolic and inflammatory markers in healthy, female Chinese subjects: a randomized clinical trial. BMRI 2016; 2016:12. https://doi.org/10.1155/2016/5387258
  16. Sun GC, Lovejoy JC, Gillham S, Putiri A, Sasagawa M, Bradley R. Effects of Qigong on glucose control in type 2 diabetes. A randomized controlled pilot study. Diabetes Care 2010; 33(1):e8. https://doi.org/10.2337/dc09-1543
  17. Mishra SB, Rao CV, Ojha SK, Vijayakumar M, Verma A. An Analytical review of plants for anti diabetic activity with their phytoconstituent & mechanism of action. IJPSR 2009; 1(1):29-46.
  18. Li WL, Zheng HC, Bukuru J, De Kimpe N. Natural medicines used in the traditional Chinese medical system for therapy of diabetes mellitus. J Ethnopharmacol 2004; 92(1):1-21. https://doi.org/10.1016/j.jep.2003.12.031
  19. Egede LE, Ye X, Zheng D, Silverstein MD. The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care 2002; 25(2):324-9. https://doi.org/10.2337/diacare.25.2.324
  20. Xue CC, O’Brian KA. Chinese medicine treatment of diabetes. In: Dunning T, editor. Complementary therapies and the management of diabetes and vascular disease. 1sted. Great Britain: John Wiley & Sons Ltd; 2006. p. 24-5.
  21. Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez MX, Gude F, Cadarso-Suarez C, García F, et al. Insulin resistance index (HOMA-IR) levels in a general adult population: Curves percentile by gender and age. The EPIRCE study. Diab Res ClinPract 2011; 94(1):146-55. https://doi.org/10.1016/j.diabres.2011.07.015
  22. Siswanto A, Siregar AK. An Update on the Treatment of depression in diabetic patients: introducing “Latihan Pasrah Diri (LPD)”. 33rd World Congress of Internal Medicine, Nusa Dua, Bali, Indonesia2016.
  23. Wardani DAK, Huriyati E, Mustikaningtyas, Hastuti J. Obesitas, body image, dan perasaan stres pada mahasiswa di Daerah Istimewa Yogyakarta. JGKI 2015; 11(4):161-9. https://doi.org/10.22146/ijcn.22649
  24. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. BRM 2007; 39:175-91. https://doi.org/10.3758/BF03193146
  25. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. BRM 2009; 41:1149-60. https://doi.org/10.3758/BRM.41.4.1149
  26. Ryan TP. Sample Size Determination and Power. Shewhart WA, Wilks SS, editors. Canada: John Wiley & Sons, Inc.; 2013. 378p. https://doi.org/10.1002/9781118439241
  27. Dharma AD. Pengaruh latihan pasrah diri terhadap kontrol gula darah pada penderita diabetes melitus tipe 2 dengan gejala depresi [Thesis]. Yogyakarta: Universitas Gadjah Mada; 2006.
  28. Kurnianingrum NMA. Pengaruh kombinasi Latihan Pasrah Diri dan fluoxetin dibandingkan dengan fluoxetin tunggal terhadap perubahan kadar endothelin-1 : studi pada penderita diabetes melitus tipe 2 dengan simtom depresi [Thesis]. Yogyakarta: Universitas Gadjah Mada; 2015.
  29. Kusbandono S. Pengaruh kombinasi latihan pasrah diri dan fluoxetin dibandingkan dengan fluoxetin tunggal terhadap perubahan kadar high sensitivity c-reactive protein: Studi pada penderita diabetes melitus tipe 2 dengan simtom depresi [Thesis]. Yogyakarta: Universitas Gadjah Mada; 2015.
  30. Sari W. Pengaruh Kombinasi Latihan Pasrah Diri dan fluoxetin dibandingkan dengan fluoxetin tunggal terhadap perubahan kadar oksidanitrit: studi pada penderita diabetes melitus tipe 2 dengan simtom depresi. [Thesis]. Yogyakarta: Universitas Gadjah Mada; 2016.
  31. Arnold LW, Wang Z. The HbA1c and all-cause mortality relationship in patients with type 2 diabetes is J-shaped: a meta-analysis of observational studies. Rev Diabet Stud 2014; 11(2):138-52. https://doi.org/10.1900/RDS.2014.11.138
  32. Ray A, Walford GA, Mannstadt M. Diabetes. In: Sabatine MS, editor. Pocket Medicine: The Massachusetts general hospital handbook of internal medicine. 4th eds. Philadelphia: Lippincot Williams & Wilkins; 2011. p. 7-13.
  33. Mosley M. UKPDS Follow-Up: Early HbA1c reductions linked to a decrease in MI, All-Cause Mortality. Value-Based Care in Cardiometabolic Health 2012; 1(2).
  34. Ketema EB, Kibret KT. Correlation of fasting and postprandial plasma glucose with HbA1c in assessing glycemic control; systematic review and meta-analysis. Arch Publ Health 2015; 73:43. https://doi.org/10.1186/s13690-015-0088-6
  35. Savage DB, Petersen KF, Shulman GI. Mechanisms of insulin resistance in humans and possible links with inflammation. Hypertension (Dallas, Tex : 1979). 2005; 45(5):828-33. https://doi.org/10.1161/01.HYP.0000163475.04421.e4
  36. Hotamisligil GS. Molecular mechanisms of insulin resistance and the role of the adipocyte. J Int Assoc Study Obes 2000; 24 Suppl 4:S23-7. https://doi.org/10.1038/sj.ijo.0801497
  37. Misra A, Khurana L, Vikram NK, Goel A, Wasir JS. Metabolic syndrome in children: current issues and South Asian perspective. Nutrition (Burbank, Los Angeles County, Calif) 2007; 23(11-12):895-910. https://doi.org/10.1016/j.nut.2007.08.018
  38. Gast KB, Tjeerdema N, Stijnen T, Smit JWA, Dekkers OM. Insulin resistance and risk of incident cardiovascular events in adults without diabetes: meta-analysis. PLOS ONE 2012; 7(12):e52036. https://doi.org/10.1371/journal.pone.0052036
  39. Zhang X, Li J, Zheng S, Luo Q, Zhou C, Wang C. Fasting insulin, insulin resistance, and risk of cardiovascular or all-cause mortality in non-diabetic adults: a meta-analysis. Biosci Rep 2017; 37(5). https://doi.org/10.1042/BSR20170947
  40. Kurl S, Zaccardi F, Onaemo VN, Jae SY, Kauhanen J, Ronkainen K, et al. Association between HOMA-IR, fasting insulin and fasting glucose with coronary heart disease mortality in nondiabetic men: a 20-year observational study. Acta diabetologica 2015; 52(1):183-6. https://doi.org/10.1007/s00592-014-0615-x
  41. Facchini FS, Hua N, Abbasi F, Reaven GM. Insulin resistance as a predictor of age-related diseases. JCEM 2001; 86(8):3574-8. https://doi.org/10.1210/jcem.86.8.7763
  42. Rudiansyah M. Pengaruh latihan pasrah diri terhadap kadar C-Reactive Protein pada penderita diabetes mellitus tipe 2 dengan gejala depresi [Thesis]. Yogyakarta: Gadjah Mada University; 2008.
  43. Widodo T. Pengaruh latihan pasrah diri terhadap angka lekosit pada penderita diabetes melitus tipe 2 dengan gejala depresi [Thesis]. Yogyakarta: Gadjah Mada University; 2008.



DOI: https://doi.org/10.19106/JMedSci005201202008

Article Metrics

Abstract views : 1861 | views : 1747


Bookmark and Share


Copyright (c) 2019 Agus Siswanto, Muhammad Juffrie, Bambang Udji Djoko Rianto, H.A.H Asdie

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.