Dietary compliance is a challenge in Type II diabetes mellitus (T2DM) management majorly due to leptin resistance.1 Insulin and leptin act in a dual hormone feedback loop known as the adipoinsular axis. Even after high doses of medicines, glycemic relapse is observed in approximately 45% T2DM patients within 1 year. Ayurveda based panchakarma therapy is a traditionally used alternative therapy for T2DM patients and thus can be used as a potential add-on therapy for management of T2DM.2
We would like to introduce a study conducted from November 2018 to December 2019 that aimed to record glycemic relapse at 1-year post comprehensive diabetic care (CDC) program (a. 12 week intervention consisting of Panchakarma and low carbohydrate prepacked diet of 800 Kcal/day b. Post 12 weeks, 1 sitting of Panchakarma and low carbohydrate, moderate protein diet as per chart upto 1 year).
Panchakarma therapy involved:
1. Snehana (centripetal oleation) that uses of Azadirachta indica (neem) oil (contains bioactive compounds like azadirachtin, meliacin, nimbidin and other glycoside components) used in massage has hypoglycemic effect activating skeletal muscle for better sugar uptake.
2. Swedana (passive heat therapy) induces sweating leading to reduction in sodium thus aiding DM patients in preventing vascular complications.
3. Basti Kadha that has herbs such as Gymnemasylvestre has shown reduction in plasma glucose levels as well as decrease the HbA1c concentration in various clinical trials. Berberisaristate and Glycyrrhizaglabra have shown anti-hyperglycemic effects in rodent models.
Post the study intervention glycemic control (HbA1c<7) and glucose tolerance test negative status was achieved in 82 (97.6%) patients (mean age of 55.8 years (65 (77.4%) males). The patients showed significant decrease in the weight [t(76)=3.017, p=0.003] post-treatment vs. baseline. At 1-year, 76 (90.5%) patients had maintained glycemic control status while only 8(9.5%) had glycemic relapse. Out of these 76 patients, 36(47.4) followed diet chart for a minimum of 6 days/week for 1-year and 70 (92.1) exercised regularly for a minimum of 25 minutes. While 26 (34.2) had their weight decreased or under control. The percentage consumption of concomitant medication had decreased for most of the patients at 1 year follow up.
This study was able to achieve these results due to dedicated compliance to dietary modification. The 12 week of ‘prepacked’ low carbohydrate diet(800Kcal/day) may have led to appetite regulation due to negative calorie balance that leads to adipolysis, less leptin (satiety hormone) resistance thereby creating satiety signals at limited food in turn causing reduced insulin resistance and controlled glucose levels without the aid of oral hypoglycaemic agents. This reduced insulin resistance further helped to decrease the glycemic relapse rate as observed in this study. Thus, in majority of the patients, the leptin levels may have been regulated even at the end of 1 year thereby reducing the insulin resistance.
One may postulate that setting the hunger axis that regularizes leptin function might prevent the risk of glycemic relapse. However, a blinded trial is warranted to re-impose these findings.
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