Traditional Indian therapies in type 2 diabetes: strengthening the scientific evidence base
Publication Date
July 17, 2024
Creator
Abstract
Diabetes mellitus is a group of metabolic disorders in which persistent hyperglycaemia is caused by deficient insulin secretion, resistance to the action of insulin, or both.1 Insulin deficiency and insulin resistance lead to the abnormalities of carbohydrates, fat, and protein metabolism that are characteristic of diabetes mellitus.1 Diabetes mellitus is mainly classified into type 1 diabetes mellitus (i.e., an absolute insulin deficiency causes persistent hyperglycaemia, and insulin activity is normal) and type 2 diabetes mellitus (T2DM).1 T2DM is caused by a combination of insulin resistance/insensitivity (where the body is unable to respond to normal levels of insulin) and insulin deficiency (where the pancreas is unable to secrete enough insulin to compensate for this resistance), resulting in persistent hyperglycaemia.1 T2DM is one of the most common chronic diseases, and about 90% of adults currently diagnosed with diabetes mellitus have T2DM.1 T2DM has replaced the terms 'non-insulin-dependent diabetes mellitus (NIDDM)' and 'adult-onset diabetes', as people with T2DM may require insulin, and T2DM can occur in all age groups and is increasingly being diagnosed in children.1 Some of the major risk factors for T2DM are non-modifiable such as age, family history of diabetes, and certain ethnicities and some are modifiable such as unhealthy lifestyle (e.g., lack of physical activity and low-fibre, high glycaemic index diet) and overweight/obesity.1
Many people with T2DM are asymptomatic.1 T2DM is suspected if a person presents with persistent hyperglycaemia that may be accompanied by some of the most common symptoms like polydipsia, polyuria, and polyphagia.1 Some of the well-recognised tests for the diagnosis of T2DM are fasting blood glucose (i.e., ≥126 mg/dL) or glycated haemoglobin (HbA1c; i.e., ≥6.5%).2 People at high risk of T2DM (also known as prediabetes) have higher blood glucose levels than normal, but lower than the established threshold for T2DM (e.g., fasting blood glucose 100 to 125 mg/dL or HbA1c 5.7 to 6.4%).2 T2DM has major health and socioeconomic consequences.3 People living with T2DM are at risk of developing microvascular complications (such as diabetic retinopathy, nephropathy, and neuropathy/foot), macrovascular complications (such as coronary heart disease, stroke, and peripheral arterial disease), leading to an increased need for healthcare services, poor quality of life, and even death.3
Indians are at greater risk of developing T2DM compared to other ethnicities.4,5 They rapidly develop T2DM from the high-risk state, one of the highest rates across many ethnicities.5,6 Currently, India has the world’s second-largest diabetes population and will remain so in 2045.3 In India, the prevalence of diabetes and prediabetes is considerably higher than previously estimated - 21.1% (95% confidence interval (CI) 17.6 to 24.5) and 26·6% (95% CI 22.8–30.4), respectively.7 In other words, it is estimated that 101.3 million (95% CI 90.7 to 111.1) and 136 million (95% CI 123.5 to 147.5) adults in India are living with diabetes and prediabetes, respectively.7 Many cases of diabetes and prediabetes remain undetected in India.3 India has the third highest annual number of deaths from diabetes, at approximately 0.6 million.3 In terms of disability-adjusted life years (DALYs), which combine morbidity and mortality information, diabetes is the 13th leading cause in India and has dramatically increased from the 35th place in 1990 (i.e., from 0.7% in 1990 to 2.2% in 2016).8 In India, the diabetes-related expenditure is US $114.4 per person with diabetes.3
Considering the burden of chronic conditions such as T2DM in India, there is a need to move beyond the one-size-fits-all model. Complex interventions, such as Yoga and Ayurveda, can contribute here to prevent and manage such diseases in India.9 Yoga, a mind-body discipline, incorporates a healthy lifestyle.10 Similarly, Ayurveda incorporates a healthy lifestyle, and Ayurvedic medicines are used for treating diseases.11 People in India prefer these traditional Indian therapies as they align with their health beliefs and culture. Other reasons are satisfaction and perceived benefit, accessibility, and preference for avoiding Western medicines’ side effects, costs, and administration modes like injections. Yoga and Ayurveda share a deep-rooted and interrelated relationship as both originated in ancient India and have been in practice for thousands of years. The exact age of Yoga and Ayurveda is difficult to determine precisely, as these have evolved over thousands of years through oral tradition and written texts. The earliest written references can be found in the Vedas, the foundational scriptures of Hinduism, especially Rigveda (1500-1200 BCE) for Yoga and Atharvaveda (1200–900 BCE) for Ayurveda. Classical Yoga and Ayurveda texts are available, also written in Sanskrit, such as the Yoga Sutras of Patanjali (around 400 BCE) and Charaka Samhita (400–200 BCE), Sushruta Samhita (400–200 BCE), and Astanga Hridaya (around 200 CE) for Ayurveda. Emerging within the broader context of Hindu philosophy and spiritual practices, Yoga and Ayurveda have long been recognised as complementary disciplines. These two systems are based on the principle of holistic health and well-being. They view human beings as a complex interplay of body, mind, and spirit, emphasising the significance of balance and harmony for optimal health and well-being. Traditionally, the primary focus of these two systems is on preventive healthcare, promoting a healthy lifestyle to prevent diseases before they manifest, and for this, complementary practices are used. In modern times, there is a growing trend towards integrating Yoga and Ayurveda into holistic interventions that address the physical, mental, and emotional aspects of health. Ayurvedic interventions often therefore incorporate specific Yogic practices to enhance their effectiveness, while Yoga-based interventions may integrate Ayurvedic principles such as dietary recommendations and lifestyle modifications.
The focus of my written guest editorials and invited book chapters is on strengthening the scientific evidence base of traditional Indian therapies like Ayurveda. These therapies come with both popularity and problems in India, especially issues related to the scientific evidence base. Hence, the emphasis is on how to move forward to strengthen the scientific evidence base by conducting high-quality studies and then using these research findings to bring changes in real practice. In continuation, there is a need to follow a systematic process, starting from the development of interventions based on these traditional therapies, followed by their evaluations, and finally, implementation of evidence-based interventions to promote the health and safety of people and reduce the disease burden on people, their families, the health system, and economy. The work presented in this thesis therefore addresses this important issue and contributes to strengthening the scientific evidence base of traditional Indian therapies, specifically through the development and evaluation of such interventions to prevent and manage T2DM in the four empirical chapters. I have been working in this area for over a decade. I started this work at the London School of Hygiene and Tropical Medicine and was able to fully develop and become a research leader in this area after I joined the University of Nottingham. I secured two highly competitive external research grants as a Principal Investigator, and the projects were funded by the UK’s FCDO, MRC, NIHR, and Wellcome Trust Joint Global Health Trials. All the included publications are the result of work conducted at the University of Nottingham
Item Type
ethesis
Thesis Type
PhD
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Subjects (LC)
Associated Schools / Departments
School of Medicine
eprints ID
77994
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