Diabetes Quality Of Life Research Articles

Development and validation of the Asian Diabetes Quality of Life (AsianDQOL) Questionnaire

AimTo construct a type-2 diabetes specific quality of life (QOL) tool for Asian populations that is valid and reliable across different ethnicities, languages, and socio-economic backgrounds. MethodsA focus group determined the domains affecting QOL in consultation with an expert group. A pilot study was conducted to validate the Asian Diabetes QOL (AsianDQOL) in English, Malay and Chinese–Mandarin. The World Health Organization Brief Quality of Life Questionnaire (WHOQOL-BREF) was used for comparison. Exploratory factor analysis (EFA), reliability analysis (RA) using Cronbach's alpha, test–retest reliability, and confirmatory factor analysis (CFA) using structural equation modeling (SEM) was undertaken using the statistical software IBM SPSS Statistics version 20. ResultsEFA with eigenvalues (>1) and factor loadings ≥0.3 for English and Malay language demonstrated 21 items (5 components). CFA (English version) confirmed the model (CMIN 201.08, p-value 0.071, GFI 0.88, RMSEA 0.036, CFI 0.978). CFA (Malay version) confirmed the 5-factor model (CMIN 189.39, p-value 0.085, GFI 0.937, RMSEA 0.025, CFI 0.987). The Cronbach's alpha scores (English version) were 0.917, 0.818, 0.816, 0.749 and 0.719, respectively. The Malay version scored 0.833, 0.819, 0.816, 0.775, 0.673, respectively, whilst the Chinese/Mandarin version scored 0.890, 0.719, 0.826, 0.862 and 0.759, respectively. Test–retest reliability showed Pearson correlation of 0.600 (English version), 0.700 (Malay version) and 0.500 (Chinese–Mandarin version). A scoring system was generated based on the 25th, 50th and 75th centiles for all the three languages. ConclusionThe AsianDQOL is a valid, reliable and stable tool for assessing QOL in multi-ethnic and multi-lingual T2DM Asian populations.

Recent advances in nanotechnology for diabetes treatment.

Nanotechnology in diabetes research has facilitated the development of novel glucose measurement and insulin delivery modalities which hold the potential to dramatically improve quality of life for diabetics. Recent progress in the field of diabetes research at its interface with nanotechnology is our focus. In particular, we examine glucose sensors with nanoscale components including metal nanoparticles and carbon nanostructures. The addition of nanoscale components commonly increases glucose sensor sensitivity, temporal response, and can lead to sensors which facilitate continuous in vivo glucose monitoring. Additionally, we survey nanoscale approaches to 'closed-loop' insulin delivery strategies which automatically release insulin in response to fluctuating blood glucose levels (BGLs). 'Closing the loop' between BGL measurements and insulin administration by removing the requirement of patient action holds the potential to dramatically improve the health and quality of life of diabetics. Advantages and limitations of current strategies, as well as future opportunities and challenges are also discussed.

Assessment of satisfaction, impact and emotional stress in elderly diabetics without satisfactory control of disease

Materials and methods We performed a historical case-control study of diabetic patients in the Endocrinology Department of a Brazilian tertiary hospital who were treated between June and December 2014. We include patients over 60 yrs. of age, of both sexes, with HbA1c ≥ 8.5% using oral hypoglycemic agents and insulin. Patients were submitted to BPAID (Problems Ares in Diabetes – Brazil) and DQOL (Diabetes Quality of Life) questionnaires, both validated in Portuguese. The first evaluates emotional stress related to DM in 20 questions. On the second, we use the variables “impact” and “satisfaction” to evaluate quality of life. There were 33 issues. We divided the patients into two groups, according the mean of score BPAID (39.45). There are no pre-defined cutoff point for this BPAID questionnaire. The higher the final score, the greater the stress related to DM. Results Forty-five patients were included. There were no differences between the groups for age, gender, education, race, religion, smoking and alcohol. There was no difference in HbA1c (10.75% vs. 9.98%, p=0.09) in the moment of interview. However, the HbA1c levels was greater in the year preceding study in patients with the worst stress scores (10.87% vs. 9.31%, p=0.023). Number of medicines used, dose of Insulin UI/kg, number of daily insulin injections or use of Regular insulin, weight, presence of hypoglycemia, blood pressure levels, or presence of chronic complications associated were not different. Patients with higher levels of stress presented greater negative impact of diabetes on quality of life compared to patients with lower levels of stress (p<0.001). Results were similar with respect to the degree of satisfaction (p<0.001).

Health Related Quality of Life in Rheumatoid Arthritis, Osteoarthritis, Diabetes Mellitus, End Stage Renal Disease and Geriatric Subjects. Experience From a General Hospital in Mexico

IntroductionChronic diseases have a great impact on the morbidity and mortality and on the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. ObjectivesThe aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, and end-stage renal disease, in geriatric subjects and in a control group. Patients and methodsWe conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met the classification criteria for RA, OA, diabetes mellitus, and end-stage renal disease; the geriatric subjects group was aged ≥65 years and the control group ≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analog scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea. ResultsWe evaluated 290 subjects (control group: 100; geriatric subjects: 30 and the rest of groups: 160). Differences were detected in baseline characteristics (P<.0001). The SF-36 scores were different between the control group and other groups (P=.007). The worst HRQoL was observed in the end-stage renal disease group (SD: 48.06±18.84x/SD). General health was the principal affected area in RA. Pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±.76 vs .82±.82, respectively; P=.001). Forty-five percent of all subjects had depression. ConclusionsThe HRQoL in RA patients is poor and comparable to that of other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered as high impact diseases and therefore should receive more attention.

Psychosocial Burden and Glycemic Control During the First 6 Years of Diabetes: Results From the SEARCH for Diabetes in Youth Study

PurposeTo evaluate the psychosocial burden of adolescents with diabetes, determine the trajectory of psychosocial burden, and examine the interdependent relationships between psychosocial burden and glycemic control across the first 6 years of diabetes. MethodsData from SEARCH for Diabetes in Youth, an observational study of U.S. children diagnosed with diabetes before the age of 20, were collected during study visits conducted at baseline and then at 12, 24, and 60 months after baseline. Blood was drawn, clinical and demographic information was collected, and psychosocial burden was evaluated using standardized depression and generic and diabetes-specific health-related quality of life (QOL) surveys. ResultsAmong the 1,307 adolescents (mean age, 14.1±2.5 years) with baseline data, 1,026 had type 1 diabetes and 281 had type 2 diabetes. For those with a 60-month follow-up visit, glycated hemoglobin (A1c) values rose 1.5% from baseline (type 1, 7.7%–9.3% and type 2, 7.3%–8.8%). Adolescents with type 2 diabetes reported more depression and poorer QOL than adolescents with type 1 diabetes. For each diabetes type, there were similar baseline risk factors for higher A1c values: longer diabetes duration, ethnic minority status, and declining diabetes QOL (p < .05). However, youth with type 2 diabetes had higher A1c values with increasing generic QOL, an unexpected finding. Younger adolescents with type 1 diabetes had higher A1c values at the end of the study. ConclusionsSignificant deterioration in glycemic control marks the first 6 years of diabetes for adolescents. Psychosocial burden, particularly poor diabetes-specific QOL, is a contributor to suboptimal glycemic outcomes.

Calidad de vida relacionada con la salud en artritis reumatoide, osteoartritis, diabetes mellitus, insuficiencia renal terminal y población geriátrica. Experiencia de un Hospital General en México

IntroductionChronic diseases have a great impact in the morbidity and mortality and in the health-related quality of life (HRQoL) of patients around the world. The impact of rheumatic diseases has not been fully recognized. We conducted a comparative study to evaluate the HRQoL in different chronic diseases. ObjectivesThe aim of the present study was to assess the HRQoL and identify specific areas affected in patients with rheumatoid arthritis (RA), osteoarthritis (OA), diabetes mellitus, end-stage renal disease, geriatric subjects and a control group. Patients and methodsWe conducted a cross-sectional study, in a General Hospital in Morelia, Mexico. All patients met classification criteria for RA, OA, diabetes mellitus, end-stage renal disease; the geriatric subjects group was≥65 years, and the control group≥30 years. Demographic characteristics were recorded, different instruments were applied: SF-36, visual analogue scale for pain, patient's and physician's global assessments, Beck Depression Inventory and specific instruments (DAS-28, HAQ-Di, WOMAC, Diabetes Quality of Life [DQOL] and Kidney Disease Questionnaire of Life [KDQOL]). Biochemical measures: erythrocyte sedimentation rate, blood count, glucose, HbA1C, serum creatinine and urea. ResultsWe evaluated 290 subjects (control group: 100; geriatric subjects: 30 and 160 for the rest of groups). Differences were detected in baseline characteristics (P<.0001). The SF-36 scores were different between control group and others groups (P=0.007). The worst HRQoL was in end-stage renal disease group (±SD: 48.06±18.84 x/SD). The general health was the principal affected area in RA. The pain was higher in rheumatic diseases: OA (5.2±2.4) and RA (5.1±3). HAQ was higher in OA compared to RA (1.12±0.76 vs 0.82±0.82, respectively; P=.001). Forty five percent of all subjects had depression. ConclusionsThe HRQoL in RA patients is poor and comparable to other chronic diseases (end-stage renal disease and diabetes mellitus). Rheumatic diseases should be considered high impact diseases and therefore should receive more attention.

Bacterial Profile of Diabetic Foot Ulcers of Patients Visiting a Specialist Diabetic Clinic at Komfo Anokye Teaching Hospital, Kumasi, Ghana

Aims: Diabetic foot ulcers (DFU’s) pose socio-economic challenges and are a major cause of hospital admissions and morbidity often causing suffering and poor quality of life for diabetics especially in developing world. The aim of this study was to determine the bacterial profile and antibiotic susceptibility and resistance pattern of foot ulcers of diabetics at Komfo Anokye Teaching Hospital (KATH). Study Design: Descriptive cross-sectional. Twenty seven (27) diabetics with foot ulcers comprising 15 males and 12 females attending the diabetic clinic at KATH were recruited

Health related quality of life in type-2 diabetic patients in Western India using World Health Organization Quality of Life – BREF and appraisal of diabetes scale

Diabetes mellitus is a chronic disorder that affects quality of life (QOL) of patients. Measurement of QOL is an important outcome for disease management. We determined QOL in type-2 diabetics receiving drug therapy using World Health Organization Quality Of Life – BREF (WHOQOL-BREF) and Appraisal of Diabetes Scale (ADS) and compared QOL between controlled and uncontrolled diabetics. Study was carried out in medicine outpatient department of tertiary care hospital for 8 weeks. All patients diagnosed with type-2 diabetes and on drug therapy for at least 1 month were included. Patients’ socio-demographic and clinical data including drug therapy were noted and then interviewed for QOL using two questionnaires - WHOQOL-BREF and ADS. Total 114 patients were enrolled with mean (±SD) age and duration of diabetes of 56.8 ± 10.5 and 8.3 ± 9.4 years respectively. Mean ADS and total WHOQOL-BREF scores for uncontrolled and controlled diabetics were significantly different (P < 0.001 and 0.042 for ADS and WHOQOL-BREF respectively). Age, duration of diabetes, number of symptoms, number of co-morbidities and number of non-pharmacological measures were significantly correlated with Health Related QOL (HRQOL) scores (P < 0.05). Total scores of both the scales were significantly correlated (P < 0.01). QOL was significantly more impaired in patients with uncontrolled diabetics than controlled diabetics. Age, duration of diabetes, number of symptoms, number of co-morbid illness, blood glucose level and number of non-pharmacological measures may be predictors of QOL for type-2 diabetics.

Quality of life in monogenic diabetes (a case report)

Monogenic diabetes in children mostly results from mutations in genes that regulate beta-cell function. It may be dominantly or recessively inherited or may be a de novo mutation and hence a spontaneous case. Quality of life is important in management of patient with monogenic diabetes. Objective is to analyze quality of life in a patient with monogenic diabetes. A-19year old, girl, 29.5 kg, sufferred from polyuria, polydipsia, and polyphagia. Family history of diabetes was positive. Physical examination revealed non obese, with colateral vein, and hepatosplenomegaly. Laboratory examination revealed fasting blood glucose 275 mg/dL, hemoglobin A1C/A1C 10.3%, C-peptide 4.2ng/mL (normal:0.9-7.1ng/mL), ALT:110 U/L, AST:115 U/L; HDL:70 µg/dL, LDL:57mg/dL, total cholesterol:319mg/dL, and triglyceride:2030 mg/dL. Liver biopsy revealed hepatosteatosis. She was diagnosed with monogenic diabetes and Nonalcoholic Steatohepatitis (NASH). Patient was given glibenclamide 5 mg twice daily; insulin detemir 14 IU; metformin 500 mg twice daily, with uncooked corn starch. After three months of treatment random blood glucose became 132 mg/dL and A1C became 7.7%; insulin was stopped. Seven months later random blood glucose increased to 287.5 mg/dL, ALT: 204 U/L, and AST: 257 U/L. Insulin was readminestered and glibenclamide were increased to three times daily. A1C evaluation revealed 5.7%. Diabetic nephropathy (DN) occurred, but after a month of captopril, proteinuria was improved from 2.8 g/24 hrs to 1.5 g/24 hrs. Diet for DN was put to therapy. No retinopathy was found. Measurement of quality of life using Diabetes Quality of life (DQOL) revealed satisfaction with life 65.8%, impact of diabetes 55%, worries about diabetes 50.9%, and overall her health was poor. Conclusion is hyperglycemia, nonalcoholic steatohepatitis, hypertriglycemia, and diabetic nephropathy reported as clinical course of monogenic diabetes. The quality of life revealed satisfaction.

Impact of Reinforcement of Diabetes Self-Care on Poorly Controlled Diabetes

The purpose of the study was to assess the value of reinforcing diabetes self-management for improving glycemia and self-care among adults with type 2 diabetes who had at least 3 hours of prior diabetes education. In this randomized controlled trial, 134 participants (75% white, 51% female, 59 ± 9 years old, 13 ± 8 years with diabetes, A1C = 8.4% ± 1.2%) were randomized to either a group map-based program (intervention) or group education on cholesterol and blood pressure (control). Participants were assessed for A1C levels, diabetes self-care behaviors (3-day pedometer readings, 6-minute walk test, blood glucose checks, frequency of self-care), and psychosocial factors (distress, frustration, quality of life) at baseline, 3, 6, and 12 months post intervention and health literacy at baseline. Groups did not differ on baseline characteristics including A1C levels, health literacy, or self-care; however, the intervention group had more years of education than controls. Intervention arm participants modestly improved A1C levels at 3 months post intervention but did not maintain that improvement at 6 and 12 months while control patients did not improve A1C levels at any time during follow-up. Importantly, frequency of self-reported self-care, diabetes quality of life, diabetes-related distress, and frustration with diabetes self-care improved in both groups over time. Reinforcing self-care with diabetes education for patients who have not met glycemic targets helps improve A1C and could be considered a necessary component of ongoing diabetes care. The best method to accomplish reinforcement needs to be established.

PHS67 - Health-related quality of life in diabetes

PHS67 - Health-related quality of life in diabetes

Testing the efficacy of culturally adapted coping skills training for Chinese American immigrants with type 2 diabetes using community‐based participatory research

Chinese Americans demonstrate greater prevalence of diabetes than non-Hispanic whites and find standard diabetes care disregards their cultural health beliefs. Academic researchers and Chinatown agencies collaborated to culturally adapt and test an efficacious cognitive-behavioral intervention using community-based participatory research. Using a delayed-treatment repeated-measures design, 145 adult Chinese immigrants with Type 2 diabetes completed treatment. Immediate benefits of treatment were evident in the improvement (p < .05) in diabetes self-efficacy, diabetes knowledge, bicultural efficacy, family emotional and instrumental support, diabetes quality of life, and diabetes distress. Prolonged benefits were evident in all changed variables 2 months post-intervention. The CBPR approach enabled the development of a culturally acceptable, efficacious behavioral intervention, and provides a model for working with communities that demonstrate health disparities.

Diabetes-specific variables associated with quality of life changes in young diabetic people: The type 1 diabetes Registry of Turin (Italy)

Background and aimsType 1 diabetes (T1DM) affects young people during the most active years of their life. Our aim was to assess quality of life (QoL) and associated variables in a large cohort of adults with childhood-onset and adult-onset T1DM. MethodsA cohort of adult patients (18 years and older) from the T1DM Registry of Turin, Italy, was recruited. Clinical characteristics and Diabetes QoL (DQOL) questionnaire were assessed by standardized procedures. Results310 adults completed the questionnaire. Age and diabetes duration at assessment (mean ± SD) were 32.8 ± 7.3 years and 17.3 ± 6.3 years, respectively. DQOL and its subscores were in the lower quartiles of their distributions, indicating a good level of QoL. However, scores were significantly higher in females than in males, particularly for the subscale of diabetes-related worries. In multivariate analysis, lower QoL was independently associated with female sex (β = 1.07, 95% CI 1.03–1.11, p = 0.003), higher age at onset (β = 1.03, 1.00–1.05, p = 0.009), lower schooling (β = 1.05, 1.00–1.09, p = 0.02), higher fasting plasma glucose (β = 1.03, 1.01–1.05, p = 0.008), daily SMBG >4 (β = 1.06, 1.01–1.10, p = 0.01), severe hypoglycemia over the last year (β = 1.06, 1.01–1.11, p = 0.02), lower numbers of diabetologic visits (β = 1.07, 1.01–1.13, p = 0.02) and hypertension (β = 1.06, 1.02–1.10, p = 0.005). Autonomic neuropathy was associated with diabetes impact. Female sex (β = 4.36, 2.43–7.83) and daily SMBG >4 (β = 3.77, 1.72–8.30) were independently associated with worst level and CSII with better level (β = 0.22, 0.07–0.68) of diabetes-related worries. ConclusionsThe impact of T1DM on QoL may depend on demographic, metabolic control-related variables, presence of complications and insulin delivery modality.

Associations between Psychosocial and Physiological Factors and Diabetes Health Indicators in Asian and Pacific Islander Adults with Type 2 Diabetes

The associations between psychosocial and physiological factors and diabetes' health indicators have not been widely investigated among Asians and Pacific Islanders. We hypothesize that health behaviour and depression are directly or indirectly associated with diabetes' health indicators such as BMI, glycemic control, general health, and diabetes quality of life. Our hypothesis was tested through a structural equation modelling (SEM) approach. Questionnaires that assessed health behaviour, depression, general health, diabetes quality of life, and haemoglobin A1c (HbA1c), along with patients' demographic information, were obtained from 207 Asian and Pacific Islander adults with type 2 diabetes. IBM SPSS Amos 20 was used for the SEM analysis at 5% level of significance, and the goodness fit of the SEM model was also evaluated. The final SEM model showed that diet and exercise and foot care had positive associations, while depression had a negative association with diabetes' health indicators. The results highlighted the importance of exercise and depression in diabetes patients' BMI, glycemic control, general health, and quality of life, which provide evidence for the need to alleviate patients' depression besides education and training in diet and exercise in future intervention studies among Asians and Pacific Islanders with type 2 diabetes.

Sleep Quality as a Potential Mediator Between Psychological Distress and Diabetes Quality of Life in Veterans With Type 2 Diabetes

The goal of this study was to explore sleep quality as a potential mediator between depression symptoms and diabetes quality of life (DQOL), and anxiety symptoms and DQOL. Participants were 83 male and 3 female veterans with type 2 diabetes (Mage = 62.4). Self-report measures were completed during the baseline assessment of a larger intervention study conducted at the VA Boston Healthcare System. Depression symptoms, anxiety symptoms, and sleep quality were all associated with DQOL. Additionally, sleep quality had a partial indirect effect on the relationships between depression symptoms and DQOL, and between anxiety symptoms and DQOL. These findings suggest that sleep quality may have an important role in the way that psychological distress affects diabetes quality of life.

PDB75 The Validation of the Diabetes Health Profile (DHP-18) and the Development of a Brief Measure of Health Related Quality of Life in Diabetes (DHP-12)

PDB75 The Validation of the Diabetes Health Profile (DHP-18) and the Development of a Brief Measure of Health Related Quality of Life in Diabetes (DHP-12)

Translation and validation of an Iranian version of the Diabetes Quality of Life measure.

Aims/Introduction: The objective of this study was to translate and validate an Iranian version of the Diabetes Quality of Life (DQOL) questionnaire in an Iranian population of males and females with a diagnosis of type 2 diabetes. A total of 503 patients with type 2 diabetes were recruited from nine diabetes clinics across several Iranian cities. A standard backward and forward translation procedure was used to convert the English version of the DQOL into the Iranian language (Persian). Internal consistency, convergent validity, known group comparison, confirmatory factor analysis (CFA) and factorial invariance were applied for the assessment of psychometric properties of the translated version. The translated version of the DQOL showed adequate internal consistency reliabilities for all subscales (Cronbach's α >0.70). CFA confirmed the underlying domain structure to be the same as for the original English version, therefore supporting the factorial validity of the translated questionnaire. In addition, questionnaire responsiveness showed good sensitivity to interventions. In conclusion, the translated Iranian version of DQOL has shown high internal reliability and good construct validity, and can potentially be applied as an assessment tool for health-related quality of life in patients with diabetes. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2012.00217.x, 2012).

A flexible diet using an insulin to carbohydrate ratio for adolescents with type 1 diabetes – A pilot study

There is significant interest in the utility of flexible meal plans for individuals with type 1 diabetes. However, there is a paucity of data examining this approach in adolescents. The aim of this study was to assess glycemic control, weight status and quality of life over 12 months in adolescents with type 1 diabetes, who were commenced on a flexible meal plan using an insulin to carbohydrate ratio. 38 adolescents with type 1 diabetes were recruited and 28 completed the study. Glyceamic control, weight status and quality of life were measured using haemoglobin A1c, BMI and the Diabetes Quality of Life -Youth questionnaire. Nine months after the adolescents were transitioned to a flexible meal and insulin plan, mean BMI SDS decreased (by 0.15 ± 0.20; P < 0.001) and haemoglobin A1c increased (by 0.7 ± 0.83%; P = 0.001). Adolescents reported no change in the impact or concerns about diabetes. However, mean life satisfaction scores increased (5.5 ± 9.5; P = 0.008). On a flexible meal and insulin plan glycemic control deteriorated although weight status and life satisfaction, two outcomes which may be important to the adolescents, improved. A flexible meal and insulin plan warrants further investigation as a management option.

Clinical Requirements for Closed-Loop Control Systems

Closed-loop (CL) therapy systems should be safe, efficacious, and easily manageable for type 1 diabetes mellitus patient use. For the first two clinical requirements, noninferiority and superiority criteria must be determined based on current conventional and intensive therapy outcomes. Current frequencies of hypoglycemia and diabetic ketoacidosis are reviewed and safety expectations for CL therapy systems are proposed. Glycosylated hemoglobin levels lower than current American Diabetes Association recommendations for different age groups are proposed as superiority criteria. Measures of glycemic variability are described and the recording of blood glucose levels as percentages within, above, and below a target range are suggested as reasonable alternatives to sophisticated statistical analyses. It is also suggested that Diabetes Quality of Life and Fear of Hypoglycemia surveys should be used to track psychobehavioral outcomes. Manageability requirements for safe and effective clinical management of CL systems are worth being underscored. The weakest part of the infusion system remains the catheter, which is exposed to variable and under-delivery incidents. Detection methods are needed to warn both the system and the patient about altered insulin delivery, including internal pressure and flow alarms. Glucose monitor sensor accuracy is another requirement; it includes the definition of conditions that lead to capillary glucose measurement, eventually followed by sensor recalibration or replacement. The crucial clinical requirement will be a thorough definition of the situations when the patient needs to move from CL to manual management of insulin delivery, or inversely can switch back to CL after a requested interruption. Instructions about these actions will constitute a major part of the education process of the patients before using CL systems and contribute to the manageability of these systems.

Prospective randomized controlled intervention trial: Comprehensive Yogic Breathing Improves Cardiac autonomic functions and Quality of life in Diabetes

Aims and Objectives: To assess the effect of Comprehensive Yogic Breathing Program on glycemic control, quality of life, and cardiac autonomic functions in diabetes. Material and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 120 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes (n = 56) and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program (n = 64). Standard therapy included advice on diet, walk, and oral antidiabetic drugs. Comprehensive yogic breathing program was an interactive session in which Sudarshan kriya yoga, a rhythmic cyclical breathing, preceded by Pranayam was taught under guidance of a certified teacher. Change in fasting, post prandial blood sugars, glycated hemoglobin, and quality of life were assessed. Cardiac autonomic function tests were done before and six months after intervention. Results: There was significant improvement in psychological (P = 0.006) and social domains (P = 0.04) and total quality of life (P = 0.02) in the group practicing comprehensive yogic breathing program as compared to the group following standard therapy alone. In the group following breathing program, the improvement in sympathetic cardiac autonomic functions was statistically significant (P = 0.01), while the change in the standard group was not significant (P = 0.17). When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P = 0.07). In the standard therapy group, no change in cardiac autonomic functions was noted (P = 0.76). The parameters of glycemic control were comparable in both groups. Conclusion: There was significant improvement in quality of life and cardiac autonomic functions in the diabetes patients practicing comprehensive yogic breathing program compared to those following standard treatment alone.