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.”

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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,

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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

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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

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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.

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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

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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:-

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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

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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:-

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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:

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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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