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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
NAME OF THE
CANDIDATE AND
ADDRESS
Mr. SOMASHEKARA K. C.
1st YEAR M Sc. NURSING STUDENT
NISARGA COLLEGE OF NURSING
# 18, KIADB, B. KATIHALLY INDUSTRIAL
AREA HASSAN, KARNATAKA.
2NAME OF THE
INSTITUTIONNISARGA COLLEGE OF NURSINGHASSAN, KARNATAKA.
3COURSE OF STUDY
AND SUBJECTMASTER OF SCIENCE IN NURSING
MEDICAL SURGICAL NURSING SPECIALITY
4DATE OF ADMISSION
TO THE COURSE 01/07/2011
5 TITLE OF THE TOPIC
EFFECTIVENESS OF VIDEO ASSISTED TEACHING (VAT) PROGRAMME ON THE KNOWLEDGE REGARDING YOGA AS A COMPLEMENTARY THERAPY IN THE MANAGEMENT OF DIABETES MELLITUS AMONG DIABETIC PATIENTS.
5.1STATEMENT OF THE
PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED TEACHING (VAT) PROGRAMME ON THE KNOWLEDGE REGARDING YOGA AS A COMPLEMENTARY THERAPY IN THE MANAGEMENT OF DIABETES MELLITUS AMONG DIABETIC PATIENTS IN S.D.M AYURVEDIC MEDICAL COLLEGE HOSPITAL, HASSAN, KARNATAKA.”
1
6. BRIEF RESUME OF THE INTENDED WORK:-
6.1. INTRODUCTION:-
“Life is not over because you have diabetes. Make the most of what you have, be
grateful.”
Dale Evans
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus of
American Diabetes Association defined diabetes mellitus as a group of metabolic diseases
characterized by elevated levels of glucose in the blood resulting from defects in insulin
secretion, insulin action, or both. The primary goals of treatment for patients with diabetes
include controlling blood glucose levels and preventing acute and long-term complications.
Thus, the nurse who cares for diabetic patients must assist them to develop self-care
management skills.1
Exercise is extremely important in managing diabetes because of its effects on
lowering blood glucose and reducing cardiovascular risk factors. Exercise lowers the blood
glucose level by increasing the uptake of glucose by body muscles and by improving
insulin utilization. It also improves circulation and muscle tone. These effects are useful in
diabetes in relation to losing weight, easing stress, and maintaining a feeling of well-being.
Exercise also alters blood lipid levels, increasing levels of high-density lipoproteins and
decreasing total cholesterol and triglyceride levels.1
The science of yoga is an ancient one. It is a rich heritage of our culture. Several
ancient books make a mention of the usefulness of yoga in the treatment of certain diseases
and preservation of health in normal individuals. Many recent scientific studies have
confirmed the useful role of yoga in the control of diabetes mellitus. 2
According to World Health Organization, 80% of type 2 diabetes is preventable by
changing diet, increasing physical activity and improving the living environment. Yet,
2
without effective prevention and control programmes, the incidence of diabetes is likely to
continue rising globally.3
Diabetes mellitus not only cause excess healthcare expenditure but it also imposes
large economic burdens in the form of lost productivity and foregone economic growth.
The largest economic burden is the monetary value associated with disability and loss of
life as a result of the disease itself and its related complications.3
Yoga has been utilized as a therapeutic tool to achieve positive health and control
and cure diseases. Interest has been shown in this direction by many workers and studies
on the effect of Yoga on some ailments like bronchial asthma, hypertension, diabetes
mellitus and obesity have been carried out. It has been observed that plasma levels of
cortisol increase in bronchial asthma and decrease in diabetes mellitus after practice of
pranayama. It is possible that yogic exercises bring about normalization of the
pathological state by control of counter-regulatory hormones or by increased receptor sites.
There is increasing evidence suggesting that even the short-term practice of Yoga can
decrease both psychological and physiological risk factors for Cardio Vascular Disorders
and may reduce signs, complications and improve the prognosis of those with clinical or
underlying disease. 4
6.2. NEED FOR THE STUDY
World health organization expressed its concern that the prevalence of diabetes has
reached epidemic proportions. It predicts that developing countries will bear the brunt of
this epidemic in the 21st century. Currently, more than 70% of people with diabetes live in
low- and middle income countries. An estimated 285 million people, corresponding to
6.4% of the world's adult population, will live with diabetes in 2010. The number is
expected to grow to 438 million by 2030, corresponding to 7.8% of the adult population.
According to World health organization, India has the world's largest diabetes population
with an estimated 50.8 million people living with diabetes, followed by China with 43.2
million.3
3
Diabetes is one of the major causes of premature illness and death worldwide. Non-
communicable diseases including diabetes account for 60% of all deaths worldwide. The
number of deaths attributable to diabetes in 2010 shows a 5.5% increase over the estimates
for the year 2007. Type 2 diabetes is responsible for 85-95% of all diabetes in high-income
countries and may account for an even higher percentage in low- and middle-income
countries.3
A study by Internal Diabetes Federation (IDF) revealed that a diabetic in India
spends Rs 25,931 annually on diagnosis and treatment of the ailment, and its attendant
complications. It includes costs for routine lab investigations, physicians, ambulances,
inpatient or outpatient care, medication and transport. The patient also spends nearly Rs
5,000 as indirect cost annually in the form of lost man days while making rounds to
hospitals for treatment. Extrapolating the figures, the study claims that India will spend a
whopping $31.9 billion this year on diabetes care.5
Yoga is an original and ancient holistic art of living that includes physical, mental,
moral and spiritual spheres. The Sanskrit word Yoga means “to join or union” and the
practice of Yoga brings this union to all levels of one's self. The popular usage of the term
focuses primarily on postures beneficial for physical health and many people have
witnessed the same. Yoga has increasingly become an accepted practice.6
Asana is a Sanskrit word used to describe a position of the body. It is defined as a
steady and comfortable posture. Traditionally, many Asanas are practiced in Hatha Yoga
primarily to achieve, better physical and mental health. There are plenty Asanas, each one
has a special name, special form and a distinct way of performing. Asanas have an
extraordinary capacity to overhaul, rejuvenate and bring the entire body into a state of
balance. 7
Pranayama is a Sanskrit word meaning “restraint of the prana or breath”, which is
often translated as breath control. Several researchers have reported that pranayama
techniques are beneficial in treating a wide range of stress disorders. Practitioners report
that the practice of pranayama develops a steady mind, strong willpower and sound
4
judgment. Pranayama strengthens the lungs, improves their function and enhances the
lung power. It improves the defense mechanism of the body, slows down mental chatter
and infuses positive thinking and thus helps in the reduction of morbidity and mortality
due to diabetes mellitus. 4
Several studies which assessed the effectiveness of yoga as a complimentary
therapy on diabetic status have shown that fasting and postprandial blood glucose levels
came down significantly after yoga therapy. Maintenance of good glycaemic status for
long periods of time, significant lowering of drug requirement and the incidence of acute
complications like infection and ketosis, significant beneficial changes in the insulin
kinetics and those of counter-regulatory hormones like cortisol, significant decrease in free
fatty acids, significant increase in lean body mass and decrease in body fat percentage, etc.
were observed in many yoga interventional studies. There was an improvement in insulin
sensitivity and decline in insulin resistance. All these suggest that yogic practices have a
role even in the prevention of diabetes. There is a beneficial effect even on the co-morbid
conditions like hypertension and dyslipidemia.4
Diabetic patients must become knowledgeable about nutrition, medication effects
and side effects, exercise, disease progression, prevention strategies, blood glucose
monitoring techniques etc. For some patients exposure to diabetes education during
hospitalization may be the only opportunity for learning self-management skills and
preventing complications. Many hospitals employ nurses who specialize in diabetes
education and management and they play a vital role in identifying diabetic patients,
assessing self-care skills, providing basic education, reinforcing the teaching provided by
the specialist, and referring patients for follow-up care after discharge. 8
The patient with Diabetes Mellitus should receive education about nutrition,
exercise, care of diabetes during illness, and medications to lower the plasma glucose.
Along with improved compliance, patient education allows individuals with Diabetes
Mellitus to assume greater responsibility for their care. Patient education should be viewed
as a continuing process with regular visits for reinforcement. It should not be a process that
is completed after one or two visits to a nurse educator or nutritionist. 9
5
Maintaining flexibility in teaching approaches is important. Various tools can be
used to complement teaching. Many of the companies that manufacture products for
diabetes self-care also provide booklets and videotapes to assist in patient teaching. It is
important to use a variety of written handouts that match the patient’s learning needs
(including different languages, low literacy information, large print). Patients can continue
learning about diabetes care by participating in activities sponsored by local hospitals and
diabetes organizations. 10
After extensive review of literature, after obtaining suggestions from several
experts, and based on the long working experience regarding the management of diabetic
patients in a well-known ayurvedic hospital, the student investigator realized that there is a
great need of increasing the awareness among diabetic patients regarding the benefits of
incorporating complimentary therapies in the reduction of morbidity and mortality of
diabetes. Therefore the investigator decided to develop a Video Assisted Teaching (VAT)
Programme regarding yoga as a complementary therapy in the management of diabetes
mellitus and to evaluate its effectiveness on the knowledge of diabetic patients attending in
SDM Ayurvedic Medical College Hospital, Hassan.
6.3. STATEMENT OF THE PROBLEM:-
“A STUDY TO ASSESS THE EFFECTIVENESS OF VIDEO ASSISTED
TEACHING (VAT) PROGRAMME ON THE KNOWLEDGE REGARDING
YOGA AS A COMPLEMENTARY THERAPY IN THE MANAGEMENT OF
DIABETES MELLITUS AMONG DIABETIC PATIENTS SELECTED IN SDM
AYURVEDIC COLLEGE AND HOSPITAL, HASSAN, KARNATAKA.”
6.4. OBJECTIVES OF THE STUDY:-
1. To assess the existing knowledge of diabetic patients regarding Yoga as a
complementary therapy in the management of diabetes mellitus through pre test.
6
1. To develop and conduct video assisted teaching programme regarding
Yoga as a complementary therapy in the management of diabetes mellitus.
2. To assess the obtained knowledge of diabetic patients regarding Yoga as a
complementary therapy in the management of diabetes mellitus through post
test.
3. To evaluate the effectiveness of video assisted teaching by comparing
mean pretest and post test knowledge score.
4. To find the association between posttest knowledge scores of diabetic
patients with their selected demographic variables
6.5. HYPOTHESIS:-
H1: There will be a significant difference between mean pretest knowledge score
and mean posttest knowledge score.
H2: There will be a significant association between post test knowledge scores of
diabetic patients and with their selected demographic variables.
6.6. ASSUMPTIONS:-
1) Structured knowledge questionnaire is an appropriate tool to measure the
knowledge of diabetic patients regarding Yoga as a complementary therapy in the
management of diabetes mellitus.
2) Diabetic patients are willing to express and also to improve their knowledge
regarding Yoga as a complementary therapy in the management of diabetes
mellitus.
3) Increased level of knowledge of diabetic patients regarding Yoga as a
complementary therapy in the management of diabetes mellitus lead better
management of their diabetic status.
6.7. OPERATIONAL DEFINITIONS:-
1. Effectiveness: Effectiveness is a measure of the ability of video assisted teaching
programme regarding Yoga as a complementary therapy in the management of
7
diabetes mellitus to produce a specific desired effect or result that can be
qualitatively measured.
2. Knowledge: Knowledge refers to the ability of respondents give correct responses
to the questions in the knowledge questionnaire.
3. Diabetic patients: Diabetic patients refer to the adult patients belong to the age
group of 35-50 years, diagnosed to have diabetic mellitus, who are presented at
SDM Ayurvedic Medical College Hospital, Hassan.
4. Video-assisted teaching programme: It refers to a planned video programme in
Kannada language for 30 minutes regarding yoga as a complementary therapy in
the management of diabetes mellitus. It includes basic information about yoga,
general benefits of yoga, specific benefits of yoga in diabetes, and most commonly
used yogasanas to treat yoga.
5. Yoga; It refers to a series of postures and breathing exercises practiced to achieve
control of the body and mind, tranquility, etc.
6. Out Patient Department; It refers to the clinical area of SDM Ayurvedic Medical
College Hospital, Hassan, where out-patients are assessed, diagnosed, and treated.
6.8. CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA:-
The sample include
1. The patients who are of the age group 35-50 years.
2. The patients who are present at the time of data collection.
3. The patients who are willing to participate in the study.
4. The patients who are able to read and write Kannada.
EXCLUSION CRITERIA:-
The sample exclude
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1. Patients who have other serious illnesses.
2. Patients who have altered level of consciousness.
3. Patients who are not willing to participate in the study.
4. Patients who are absent at the time of data collection.
6.9. LIMITATIONS OF THE STUDY:-
1. Study is limited to the diabetic patients attending SDM Ayurvedic Medical College
Hospital, Hassan. Karnataka.
2. Study is limited to the diabetic patients who are available during study period.
6.10. SIGNIFICANCE OF THE STUDY:-
This study may: -
1) Promote knowledge regarding Yoga as a complementary therapy in the
management of diabetes mellitus.
2) Help to control of the diabetic mellitus.
6.11. CONCEPTUAL FRAME WORK:-
This study is based on General system Model.
6.12. REVIEW OF LITERATURE:-
Reviews are classified into sub division:-
1) Reviews related to incidence and prevalence of Diabetes mellitus.
2) Reviews related to complications and others health related problems due to
Diabetes mellitus.
3) Reviews related to effectiveness of yoga as a complimentary therapy in diabetes
mellitus management.
1) REVIEWS RELATED TO INCIDENCE AND PREVALENCE OF
DIABETES MELLITUS:-
9
An observational study was conducted in Gujarat, India to describe the profile of
subjects with type 2 diabetes mellitus. The sample of newly-diagnosed 622 type 2 diabetic
subjects was performed. 62% (384) of the subjects were male. The majority (68%) of the
Type 2Diabetis Mellitus subjects was obese, and 67% had a positive family history of
diabetes. Renal dysfunctions and vision impairment were, respectively, found in 10%) and
9% subjects. The results revealed that many factors, such as obesity, family history of
diabetes, dyslipidaemia, uncontrolled glycaemic status, sedentary lifestyles, and
hypertension were prevalent among the Type 2Diabetis Mellitus subjects. This study
concludes that the characterization of this risk profile will contribute to designing more
effective and specific strategies for screening and controlling T2DM in Gujarat, India.11
A pooled cross-sectional analysis was conducted in different parts of Asia to
evaluate the association between baseline body mass index (BMI, measured as weight in
kg divided by the square of height in m) and self-reported diabetes status in over 900,000
individuals recruited in 18 cohorts. The sample has been obtained from Bangladesh, China,
India, Japan, Korea, Singapore and Taiwan. The sex- and age-adjusted prevalence of
diabetes was 4.3% in the overall population, ranging from 0.5% to 8.2% across
participating cohorts. The results revealed that positive association between BMI and
diabetes prevalence was present in all cohorts and in all subgroups of the study population,
although the association was stronger in individuals below age 50 at baseline (p-value of
interaction<0.001), in cohorts from India and Bangladesh (p<0.001), in individuals with
low education (p-value 0.02), and in smokers (p-value 0.03). This study concludes the
shape and the strength of the association between BMI and prevalence of diabetes in Asian
populations and identified patterns of the association by age, country, and other risk factors
for diabetes. 12
A study was conducted in India to assess the potential impact of diabetes as a risk
factor for incident pulmonary tuberculosis. An epidemiological model was used to collect
data on tuberculosis incidence, diabetes prevalence, population structure, and relative risk
of tuberculosis associated with diabetes and the contribution made by diabetes to both
tuberculosis incidence, and to the difference between tuberculosis incidence in urban and
rural areas was evaluated. Results revealed that diabetes accounts for 14.8% of pulmonary
tuberculosis and 20.2% of smear-positive (i.e. infectious) tuberculosis. It is estimated that
10
the increased diabetes prevalence in urban areas is associated with a 15.2% greater smear-
positive tuberculosis incidence in urban than rural areas - over a fifth of the estimated total
difference. This study concludes that Diabetes makes a substantial contribution to the
burden of incident tuberculosis in India, and the association is particularly strong for the
infectious form of tuberculosis. 13
A study was conducted in North India to find out the social class and all-cause
mortality in an urban population. Death records from 2222 (1385 men and 837 women)
victims, aged 25-64 years, out of 3034 death records during 1999-2001 at the Municipal
Corporation, Moradabad were randomly selected. Results revealed that 2.2% of deaths
occurred directly due to diabetes mellitus (n = 49) while complications of diabetes such as
infectious diseases (41.1%, n = 915) and circulatory diseases (29.1%, n = 646) top the list.
Heart attacks, strokes, hypertension, diabetes and obesity were statistically significantly
more common among higher social classes. This study indicates that circulatory diseases,
injury and malignant diseases have become the major causes of death in India, after
infections. 14
2) REVIEWS RELATED TO COMPLICATIONS AND OTHERS HEALTH
RELATED PROBLEMS DUE TO DIABETES MELLITUS:-
A study was conducted in New Delhi, India to estimate the prevalence of non-
alcoholic fatty liver disease (NAFLD) by ultrasonography, and to correlate NAFLD with
coronary artery disease (CAD) and coronary risk factors in a group of Indian type 2
diabetics. The study group was divided into a NAFLD group (n=71) and a non-NAFLD
group (n=53). The results revealed that the prevalence of NAFLD was 57.2%. CAD was
more prevalent in the NAFLD subgroup (60.5%) compared to the non-NAFLD subgroup
(45.2%). The NAFLD subgroup had higher prevalence of hypertension, smoking, obesity
(measured by BMI), central obesity (measured by waist circumference and waist hip ratio),
higher HbAlc, higher triglyceride levels and lower HDL levels. It was found that
hypertension (p=0.013), LDL cholesterol (p=0.049), microalbuminuria (p=0.034) and
NAFLD (p=0.016) were significantly correlated with CAD. 15
11
A study was conducted in Jhansi, India study the incidence of nephropathy in
newly diagnosed type 2 diabetics and to study the relationship of development of
nephropathy with various risk factors associated with DM, like age, sex, blood pressure,
blood sugar, body mass index (BMI). A total number 300 newly diagnosed type 2 diabetics
(diagnosed within 6 months), between Jan 2008 to August 2009. Presence of urinary
microalbuminuria in two samples in a period of six months was taken as criteria for
detecting nephropathy. Results revealed that incidence of 17.34% (52/300) nephropathy in
newly diagnosed type 2 diabetics. It increased significantly with increase in age and was
30% in age group >60 years. This study concludes Incidence of nephropathy in newly
diagnosed type 2 diabetics is as high as 17.34%. Hypertension is the most important
associated factor contributing to development of nephropathy in these patients. Poor
glycemic control (high HbA1C), high BMI, dyslipidemia, age, male sex also play
significant role. Family history of DM seems to have little effect.16
A study was conducted in India to assess the pattern and causes of amputations in
diabetic patients across various parts of India. A total of 1985 (M:F 1249:736) type 2
diabetic subjects were selected from 31 centers across India. A total of 1295 (850:445)
patients had undergone amputations among study participants. Results revealed that the
major cause for the occurrence of amputations among the patients was infection (90%).
Among the subjects who underwent major amputations, more than 50% accounts for below
knee amputations and 11.9% above knee amputations. Prevalence of neuropathy (82%)
was high and 35% had peripheral vascular disease. In conclusion, infection was found to
be the major cause of amputation in India. Below knee, toes and rays amputations were the
most common type of amputations. Diabetic patients should be educated on foot care and
importance of proper foot wear.17
A study was conducted in Srinagar, India to investigate the nitrate level, which is
very essential for the healthy functioning of blood vessels, in patients having diabetes and
hypertension and to determine the relationship of nitrate turn over with the disease. The
first group consisted of 74 hypertensive patients, the second group consisted of 72 diabetic
patients and the third group consisted of 60 healthy controls. Nitrate synthesis activity was
evaluated by automated Nitric Oxide detector. Results revealed that the plasma
concentration of nitrate was found to be significantly lower in both essential hypertensive
12
patients and diabetic patients without complications as compared to the healthy controls (P
< 0.05). This data concludes that different factors like hyperglycemia and blood pressure
are seen to have immense influence on NO production.18
3) REVIEWS RELATED TO EFFECTIVENESS OF YOGA AS A
COMPLIMENTARY THERAPY IN DIABETES MELLITUS
MANAGEMENT:-
A study was conducted in New Delhi, India to determine the effectiveness of yoga
asanas in assessment of pulmonary function in NIDDM patients. A total number of 24
NIDDM patients who are on anti-hyperglycemic and dietary regimen to investigate the
metabolic and clinical evidence of improvement in glycaemic control and pulmonary
functions. The expert gave these patients training in yoga asanas for 30-40 min/day for 40
days. After 40 days of yoga asanas regimen, which consisted of 13 well known postures,
The results indicate that there was significant decrease in fasting blood glucose levels
(basal 190.08 +/- 90.8 in mg/dl to 141.5 +/- 79.8 in mg/dl). The postprandial blood glucose
levels also decreased (276.54 +/- 101.0 in mg/dl to 201.75 +/- 104.1 in mg/dl),
glycosylated hemoglobin showed a decrease (9.03 +/- 1.4% to 7.83 +/- 2.6%). These
findings conclude that better glycaemic control and pulmonary functions can be obtained
in NIDDM cases with yoga asanas and pranayama. The exact mechanism as to how these
postures and controlled breathing interact with somato-neuro-endocrine mechanism
affecting metabolic and pulmonary functions remains to be worked out. 19
A prospective randomized study was conducted in Kingston, Jamaica to investigate
the impact of Hatha yoga and conventional physical training (PT) exercise regimens on
biochemical, oxidative stress indicators and oxidant status in patients with type 2 diabetes.
It considered 77 type 2 diabetic patients to investigate the impact of Hatha yoga and
conventional physical training (PT) exercise regimens on biochemical, oxidative stress
indicators and oxidant status in patients with type 2 diabetes. Results revealed that the
concentrations of FBG in the Hatha yoga and conventional PT exercise groups after six
months decreased by 29.48% and 27.43% respectively (P < 0.0001) and there was a
significant reduction in serum TC in both groups (P < 0.0001). The concentrations of
13
VLDL in the managed groups after six months differed significantly from baseline values
(P = 0.036). This study concludes that the efficacy of Hatha yoga exercise on fasting blood
glucose, lipid profile, oxidative stress markers and antioxidant status in patients with type 2
diabetes and suggest that Hatha yoga exercise and conventional PT exercise may have
therapeutic preventative and protective effects on diabetes mellitus by decreasing oxidative
stress and improving antioxidant status.20
A study was conducted in Madhya Pradesh, India to evaluate the effect of Yoga-
Nidra on blood glucose level in diabetic patients. This study was conducted on 41, middle
aged, type-2 diabetic patients, who were on oral hypoglycemic. These patients were
divided in to two groups: 20 patients on oral hypoglycemic with yoga-nidra and 21 were
on oral hypoglycemic alone. Yoga-nidra practiced for 30 minutes daily up to 90 days,
parameters were recorded every 30th day. Results of this study showed that most of the
symptoms were subsided (P < 0.004, significant), and fall of mean blood glucose level was
significant after 3-month of Yoga-nidra. This fall was 21.3 mg/dl, P < 0.0007, (from 159
+/- 12.27 to 137.7 +/- 23.15,) in fasting and 17.95 mg/dl, P = 0.02, (from 255.45 +/- 16.85
to 237.5 +/- 30.54) in post prandial glucose level. This study suggest that subjects on
Yoga-nidra with drug regimen had better control in their fluctuating blood glucose and
symptoms associated with diabetes, compared to those were on oral hypoglycaemics alone. 21
A study was conducted in Ontario, Canada to analyze the effect of practicing yoga
for the management of type II Diabetes. Total sample of 363 participants were included in
this study. The results show improvement in outcomes among patients with diabetes type
II. These improvements were mainly among short term or immediate diabetes outcomes
and not all were statistically significant. No adverse effects were reported in any of the
included studies. Short-term benefits for patients with diabetes may be achieved from
practicing yoga. Further research is needed in this area. Factors like quality of the trials and
other methodological issues should be improved by large randomized control trials with
allocation concealment to assess the effectiveness of yoga on diabetes type II. A definitive
recommendation for physicians to encourage their patients to practice yoga cannot be
reached at present. 22
14
A study was conducted in Delhi, India to see the effect of 40 days of Yoga asanas
on the nerve conduction velocity. Yoga asanas included Suryanamskar. Tadasan, Konasan,
Padmasan Pranayam, Paschimottansan Ardhmatsyendrasan, Shavasan, Pavanmukthasan,
Sarpasan and Shavasan. Study showed that yoga asanas have a beneficial effect on
glycaemic control and improve nerve function in mild to moderate Type 2 diabetes with
sub-clinical neuropathy while control group nerve function parameters deteriorated over
the period of study. 23
A comprehensive literature search done in Charlottesville, USA. Identified 25
eligible studies, including 15 uncontrolled trials, 6 non-randomized controlled trials and 4
randomized controlled trials (RCTs). Overall, these studies suggest beneficial changes in
several risk indices, including glucose tolerance and insulin sensitivity, lipid profiles,
anthropometric characteristics, blood pressure, oxidative stress, coagulation profiles,
sympathetic activation and pulmonary function, as well as improvement in specific clinical
outcomes. Yoga may improve risk profiles in adults with DM 2, and may have promise for
the prevention and management of cardiovascular complications in this population.
However, the limitations characterizing most studies preclude drawing firm conclusions.
Additional high-quality RCTs are needed to confirm and further elucidate the effects of
standardized yoga programs in populations with DM 2. 24
A study was conducted in New Delhi, India to analyze the short-term impact of a
brief lifestyle intervention based on yoga on some of the biochemical indicators of risk for
cardiovascular disease and diabetes mellitus. The study is based on data collected on 98
subjects (67 male, 31 female), ages 20-74 years, who attended one of our programs. The
subjects were a heterogeneous group of patients with hypertension, coronary artery
disease, diabetes mellitus, and a variety of other illnesses. Results showed that fasting
plasma glucose, serum total cholesterol, low-density lipoprotein (LDL) cholesterol, very-
LDL cholesterol, the ratio of total cholesterol to high density lipoprotein (HDL)
cholesterol, and total triglycerides were significantly lower, and HDL cholesterol
significantly higher, after the prescribed intervention. The changes were more marked in
subjects with hyperglycemia or hypercholesterolemia. This study concludes that a short
lifestyle modification and stress management education program leads to favorable
metabolic effects within a period of 9 days. 25
15
A study was conducted in New Delhi, India to see the role of pranayama and yoga-
asana on P300 latency and amplitude in type 2 diabetic patients. A sample of 60 patients of
type 2 diabetes were recruited from diabetic clinic and divided into two groups - control
group on only conventional medical therapy and yoga-group on conventional medical
therapy along with pranayama and yoga-asana. Basal recordings of P300 and blood
glucose were taken at the time of recruitment and second recordings repeated after forty
five days for both the groups. Study showed a statistically significant improvement in the
latency and the amplitude of N200, P300 in the yoga group as compared to the control
group. Investigators suggested that yoga can be incorporated along with the conventional
medical therapy for improving cognitive brain functions in diabetes. 26
A study was conducted in New Delhi, India to evaluate the effect of different
yogasanas on 20 mild to moderate type II diabetic patients. Total of 20, NIDDM subjects
(mild to moderate diabetics) in the age group of 30-60 years were selected from the out
patient clinic of G.T.B. hospital. They were on a 40 days yoga asana regime under the
supervision of a yoga expert. 13 specific Yoga asanas < or = done by Type 2 Diabetes
Patients included. Surya Namaskar, Trikonasana, Tadasana, Sukhasana, Padmasana,
Bhastrika Pranayama, Pashimottanasana, Ardhmatsyendrasana, Pawanmuktasana,
Bhujangasana, Vajrasana, Dhanurasana and Shavasana are beneficial for diabetes mellitus.
The results indicate that there was significant decrease in fasting glucose levels from basal
208.3 +/- 20.0 to 171.7 +/- 19.5 mg/dl and one hour postprandial blood glucose levels
decreased from 295.3 +/- 22.0 to 269.7 +/- 19.9 mg/dl. The exact mechanism as to how
these postures and controlled breathing interact with somatoendocrine mechanism
affecting insulin kinetics was worked out. A significant decrease in waist-hip ratio and
changes in insulin levels were also observed, suggesting a positive effect of yoga asanas on
glucose utilization and fat redistribution in NIDDM. Yoga asanas may be used as an
adjunct with diet and drugs in the management of Type 2 diabetes. 27
7. MATERIAL AND METHODS OF STUDY:-
7.1 SOURCES OF DATA:-
16
The data will be collected from the diabetic patients of SDM Ayurveda Medical
College Hospital, Hassan, Karnataka.
7.1. METHOD OF DATA COLLECTION:-
7.1.1. Research design:- Quasi experimental, pre-test post-test, control group
design.
PRETEST INTERVENTION POSTTEST
EO1 X O2
CO1 - O2
Key words:-
E=Experimental group. (40 diabetes mellitus patients)
O1 =Observation in pre test
X = VAT on Yoga as a complementary therapy in the management of diabetes
mellitus
O2 =Observation in post test
C= Control group. (40 diabetes mellitus patients)
7.1.2. Research setting:-
Study will be conducted in SDM Ayurveda Medical College Hospital, at Hassan
Karnataka.
7.1.3. Population:-
Accessible population:
17
The Diabetic patients of SDM Ayurvedic Medical College Hospital, at Hassan
who meets the inclusion criteria.
Target population:
The patients who all are in the SDM Ayurvedic Medical College Hospital, at
Hassan.
7.1.4. Sample:-
All the selected diabetic patients who fulfill the inclusive criteria formulate the
sample of this study
7.1.5. Sample size:-
The study will include 40 participants in experimental group and 40 participants in
control group.
7.1.6. Sampling technique:-
Non-probability convenient sampling method
7.1.7. Collection of data:-
Collection of data is done by using semi structured questionnaire
7.2.8 Selection of Tool:-
Part A: Socio demographic Profile
Part B: Data collection through semi structured questionnaire
7.2. Research approach:-
Evaluative approach
8. VARIABLES:-
Independent variable: Video assisted teaching regarding Yoga as a
complementary therapy in t he management of diabetes mellitus
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Dependent variable: Knowledge of diabetic patients regarding Yoga as a
complementary therapy in the management of diabetes mellitus.
Extraneous variables: Demographic variables of diabetic patients namely age,
sex, religion, marital status, residence, educational qualification, occupation,
family income, number of years after diagnosis of diabetes mellitus, previous
exposure to the information resources, etc.
9. PLAN FOR DATA ANALYSIS: -
The data will be analyzed by using descriptive and inferential statistics.
Descriptive Statistics: Frequency, Percentage Distribution, Mean and Standard
Deviation will be used.
Inferential Statistics :
1. Paired “t” test will be used to analyze the significant difference between
the mean pre test and post test knowledge score.
2. Chi squire test will be used to analyze the association of the post test level
knowledge and attitude with selected demographic variables.
10. PILOT STUDY
Pilot study will be planned with 10% of the sample and that was excluded in the main
study.
11. ETHICAL CONSIDERATION:
1. Has ethical clearance being obtained from your institution?
---Yes. Ethical clearance will be obtained from ethical committee of the Nisarga
College of Nursing, Hassan.
2. Has ethical clearance being obtained from the hospital?
---Yes. Ethical clearance will be obtained from ethical committee of the SDM
Ayurvedic medical college and Hospital, Hassan.
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12. LIST OF REFERENCES:-1. Suzanne C Smeltzer, Brenda G Bare, Janice L Hinkle, Kerry H Cheever. Brunner
and suddharth’s text book of medical surgical nursing.12th ed. Newdelhi: Wolters
Kluwer Health; 2009.pp1149-71.
2. Sahay BK . Role of yoga in diabetes. J Assoc Physicians India. [serial online] 2007
Feb [cited 2011 Nov 25];55:121-6. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/17571741.
3. Diabetic facts. Available from URL
http://www.worlddiabetesfoundation.org/composite-35.htm.
4. Nirmala Vaze , Sulabha Joshi Yoga and menopausal transition. Journal of midlife
health; [serial online]: 2010[cited 2011 Nov 25]; 1(2); 56-58. Available from URL
http://www.jmidlifehealth.org/article.asp.
5. India to spend $32bn on diabetes care in '10: Study.TNN Aug 10, 2010, 04.33am
IST. Available from URL
http://articles.timesofindia.indiatimes.com/2010-08-10/india/28311470_1_diabetes-
treatment-financial-burden.
6. ABC of Yoga, 2003-2008, Maxlifestyle International. [cited on 2009 Oct 11].
Available from: http://www.abc-of-Yoga.com/Yoga-and-health/Yoga-lifestyle.asp .
7. Cohen BE , Kanaya AM, Macer JL, Shen H, Chang AA, Grady D. Feasibility and
acceptability of restorative yoga for treatment of hot flushes: a pilot trial. Maturitas.
2007 Feb 20;56(2):198-204. Epub[serial online] 2006 Sep [cited 2011 Nov
25];18. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/16979311.
8. Suzanne C Smeltzer, Brenda G Bare, Janice L Hinkle, Kerry H Cheever. Brunner
and suddharth’s text book of medical surgical nursing.12th ed. Newdelhi: Wolters
Kluwer Health; 2009.pp1149-71.
9. Dennis L. Kasper, Eugene Braunwald, Anthony S. Fauci, Stephen L. Hauser, Dan
L. Longo, J. Larry Jameson. J. Harrison’s Principles of Internal Medicine;16th
edition, Mcgraw-Hill Medical Publishing Division, New York, 2005.pp2152-79.
20
10. Suzanne C Smeltzer, Brenda G Bare, Janice L Hinkle, Kerry H Cheever. Brunner
and suddharth’s text book of medical surgical nursing.12th ed. Newdelhi: Wolters
Kluwer Health; 2009.pp1149-71.
11. Patel M, Patel IM, Patel YM, Rathi SK. A hospital-based observational study of
type 2 diabetic subjects from Gujarat, India. J Health Popul Nutr. (serial online)
2011 Jun [cited on 08 DEC 2011];29(3):265-72. Available from
http://www.ncbi.nlm.nih.gov/pubmed?term=A%20hospital-based%20observational
%20study%20of%20type%202%20diabetic%20%20subjects%20from%20Gujarat
%2C%20India.
12. Boffetta P, McLerran D, Chen Y, Inoue M, Sinha R, He J, et al. Body mass index
and diabetes in Asia: a cross-sectional pooled analysis of 900,000 individuals in the
Asia cohort consortium. PLoS One. (serial online) 2011[cited on 08 DEC
2011];6(6):e19930. Epub 2011 Jun 22. Available from
http://www.ncbi.nlm.nih.gov/pubmed/21731609.
13. Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al.
Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis
incidence. BMC Public Health. (serial online) 2007 Sep 6[cited on 08 DEC
2011];;7:234. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/17822539.
14. Singh RB, Singh V, Kulshrestha SK, Singh S, Gupta P, Kumar R, Krishna A,
Srivastav SS, Gupta SB, Pella D, Cornelissen G. Social class and all-cause
mortality in an urban population of North India. Acta Cardiol. (serial online) 2005
Dec[cited on 08 DEC 2011];;60(6):611-7. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/16385922.
15. Agarwal AK, Jain V, Singla S, Baruah BP, Arya V, Yadav R, et al. Prevalence of
non-alcoholic fatty liver disease and its correlation with coronary risk factors in
patients with type 2 diabetes. J Assoc Physicians India.(serial online) 2011
Jun[ cited on 8 Dec 2011];59:351-4. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/21751587.
21
16. Agarwal N, Sengar NS, Jain PK, Khare R. Nephropathy in newly diagnosed type 2
diabetics with special stress on the role of hypertension. J Assoc Physicians India.
(serial online) 2011 Mar[ cited on 8 Dec 2011];59:145-7. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/21751621de.
17. Viswanathan V, Kumpatla S. Pattern and causes of amputation in diabetic
patients--a multicentric study from India. J Assoc Physicians India.(serial online)
2011 Mar[ cited on 08 Dec 2011];59:148-51. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/21751622.
18. Shiekh GA, Ayub T, Khan SN, Dar R, Andrabi KI. Reduced nitrate level in
individuals with hypertension and diabetes. J Cardiovasc Dis Res. (serial online)
2011 Jul[cited on 08 DEC 2011];2(3):172-6. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/21968508.
19. Malhotra V , Singh S, Singh KP, Gupta P, Sharma SB, Madhu SV, Tandon OP.
Study of yoga asanas in assessment of pulmonary function in NIDDM patients.
Indian J Physiol Pharmacol. [serial online] 2002 Jul[cited 2011 Nov
25];46(3):313-20. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/12613394.
20. Gordon LA , Morrison EY, McGrowder DA, Young R, Fraser YT, Zamora EM,
Alexander-Lindo RL, Irving RR. Effect of exercise therapy on lipid profile and
oxidative stress indicators in patients with type 2 diabetes. BMC Complement
Altern Med. [serial online] 2008 May 13[cited 2011 Nov 25];;8:21. Available
from URL http://www.ncbi.nlm.nih.gov/pubmed/18477407.
21. Amita S , Prabhakar S, Manoj I, Harminder S, Pavan T. Effect of yoga-nidra on
blood glucose level in diabetic patients. Indian J Physiol Pharmacol. [serial online]
2009 Jan-Mar[cited 2011 Nov 25];53(1):97-101. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/19810584.
22. Aljasir B , Bryson M, Al-Shehri B. Yoga Practice for the Management of Type II
Diabetes Mellitus in Adults: A systematic review. Evid Based Complement Alternat
Med. [serial online] 2010 Dec[cited 2011 Nov 25];7(4):399-408. Epub 2008 May
7. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/18955338.
22
23. Malhotra V , Singh S, Tandon OP, Madhu SV, Prasad A, Sharma SB. Effect of
Yoga asanas on nerve conduction in type 2 diabetes. Indian J Physiol Pharmacol.
[serial online] 2002 Jul [cited 2011 Nov 25];46(3):298-306.
24. Innes KE , Vincent HK. The influence of yoga-based programs on risk profiles in
adults with type 2 diabetes mellitus: a systematic review. Evid Based Complement
Alternat Med. [serial online] 2007 Dec[cited 2011 Nov 25];;4(4):469-86.
Available from URL http://www.ncbi.nlm.nih.gov/pubmed/18227915.
25. Bijlani RL , Vempati RP, Yadav RK, Ray RB, Gupta V, Sharma R, Mehta N,
Mahapatra SC. A brief but comprehensive lifestyle education program based on
yoga reduces risk factors for cardiovascular disease and diabetes mellitus. J Altern
Complement Med. [serial online] 2005 Apr;11[cited 2011 Nov 25]; (2):267-74.
Available from URL http://www.ncbi.nlm.nih.gov/pubmed/15865492.
26. Kyizom T , Singh S, Singh KP, Tandon OP, Kumar R. Effect of pranayama & yoga-
asana on cognitive brain functions in type 2 diabetes-P3 event related evoked
potential (ERP). Indian J Med Res. [serial online] 2010 May[cited 2011 Nov
25];;131:636-40. Available from URL
http://www.ncbi.nlm.nih.gov/pubmed/20516534.
27. Malhotra V , Singh S, Tandon OP, Sharma SB. The beneficial effect of yoga in
diabetes. Nepal Med Coll J. [serial online] 2005 Dec[cited 2011 Nov 25];7(2):145-
7. Available from URL http://www.ncbi.nlm.nih.gov/pubmed/16519085.
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