• RAMAM SRIPADA Department of Pharmacy Practice, GIET School of Pharmacy, Rajahmundry, Andhra Pradesh, India.
  • HEMANTH KUMAR VANGALA Department of Pharmacy Practice, GIET School of Pharmacy, Rajahmundry, Andhra Pradesh, India.
  • SUDEEPTHI PADALA Department of Pharmacy Practice, GIET School of Pharmacy, Rajahmundry, Andhra Pradesh, India.
  • DASARATHA DHANARAJU MAGHARLA Department of Pharmacy Practice, GIET School of Pharmacy, Rajahmundry, Andhra Pradesh, India.


Diabetes can be defined as a metabolic disorder characterized by resistance to the action of insulin, insufficient insulin secretion, or both. In this article, we reviewed about the non-pharmacological approaches in the management of diabetes mellitus that includes diet and stress management programs such as Pranayama, meditation, and exercises along with the lifestyle modification which has to be followed by the diabetics for the better management of diabetes in natural ways. By following, these approaches besides regular usage of medications one can lead a healthy life with very less complications. The quality of life can be increased in the patients who follow these methods when compared to those patients who do not consider any of these methods in their daily life. Not only the patient, a healthy individual but can also prefer these methods to prevent chronic diseases and make their day to day life happy and healthy.

Keywords: Diabetes, Diabetic diet, Diabetic yoga, Meditation, Pranayama

Author Biography

RAMAM SRIPADA, Department of Pharmacy Practice, GIET School of Pharmacy, Rajahmundry, Andhra Pradesh, India.




1. American Diabetic Association. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997;20:1183-97.
2. van Tilburg J, van Haeften TW, Pearson P, Wijmenga C. Defining the genetic contribution of Type 2 diabetes mellitus. J Med Genet 2001;38:569-78.
3. American Diabetes Association. Standards for medical care in diabetes 2010. Diabetes Care 2010;3:S11-61.
4. Zipitis CS, Akobeng AK. Vitamin D supplementation in early childhood and risk of Type 1 diabetes: A systematic review and meta-analysis. Arch Dis Child 2008;93:512-7.
5. Defronzo RA. Banting lecture. From the triumvirate to the ominous octet: A new paradigm for the treatment of Type 2 diabetes mellitus. Diabetes 2009;58:773-95.
6. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. p. 1257-8.
7. Vijayan V, Jayachandran E, Sumanth MH, Brahma T, Naidu D, Rao S. Diabetes a historical perspective. J Pharm Res 2011;4:1-3.
8. DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, editors. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. p. 1268-75.
9. Bivens L. Basic Health Care Series: Diabetes. Delhi: VIJ Books Indiapvt Ltd.; 2017.
10. Lindeberg S, Jönsson T, Granfeldt Y, Borgstrand E, Soffman J, Sjöström K, et al. A palaeolithic diet improves glucose tolerance more than a mediterranean-like diet in individuals with ischaemic heart disease. Diabetologia 2007;50:1795-807.
11. John S, Karthiga S, Parimalam SR, Chellappa AR. Nutrition and Diabetes. Coimbatore: Tamil Nadu Textbook Corporation; 2005. p. 119-31.
12. Michael Moore Classification of Foods. Available from: https:// search?q =cache: LjXX_2yekR4J: https:// connecticut/woodbury-middlebury/how-to-minimize-your-risk-for-type-ii-diabetes-or-manage-it_260b710d+&cd=15&hl=en&ct=clnk&gl=in.
13. Abraham N, Balagopal P, Batheja R, Bhargava N, Chatterjee S, Deshpande K, et al. Indian Foods: AAPI’S Guide to Nutrition, Health and Diabetes. The Subcommittee of the Public Health Committee of AAPI. Chennai: Allied Publications Pvt. Ltd.; 2002.
14. Lung NH. Blood Institute. Your Guide to Lowering Your Cholesterol with TLC (Therapeutic Lifestyle Changes) National Institutes of Health. Bethesda, MD, USA: US Department of Health and Human Services; 2006.
15. Trumbo P, Schlicker S, Yates AA, Poos M, Food and Nutrition Board of the Institute of Medicine, The National Academies. Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein and amino acids. J Am Diet Assoc 2002;102:1621-30.
16. Sylvetsky A, Rother KI, Brown R. Artificial sweetener use among children: Epidemiology, recommendations, metabolic outcomes, and future directions. Pediatr Clin North Am 2011;58:1467-80, 11.
17. Garg A, Bantle JP, Henry RR, Coulston AM, Griver KA, Raatz SK, et al. Effects of varying carbohydrate content of diet in patients with non-insulin-dependent diabetes mellitus. JAMA 1994;271:1421-8.
18. Kiehm TG, Anderson JW, Ward K. Beneficial effects of a high carbohydrate, high fiber diet on hyperglycemic diabetic men. Am J Clin Nutr 1976;29:895-9.
19. Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, et al. Nutrition recommendations and interventions for diabetes--2006: A position statement of the american diabetes association. Diabetes Care 2006;29:2140-57.
20. Nielsen JV, Joensson E. Low-carbohydrate diet in Type 2 diabetes. Stable improvement of bodyweight and glycemic control during 22 months follow-up. Nutr Metab 2006;3:22.
21. Science Daily. Original Human Stone Age Diet Is Good for People with Diabetes, Study Finds; 2007.
22. Bernstein, Richard K. Dr Bernstein’s Diabetes Solution. New York: Little, Brown and Company; 1997.
23. Widanagamage RD, Ekanayake S, Welihinda J. Carbohydrate-rich foods: Glycemic indices and the effect of constituent macronutrients. Int J Food SciNutr. 2009; 60. 215-223.
24. Fenugreek Seed Importance in Diabetes. Available from:
25. Kim HY. Nutritional intervention for a patient with diabetic nephropathy. Clin Nutr Res 2014;3:64-8.
26. Dixit AA, Azar KM, Gardner CD, Palaniappan LP. Incorporation of whole, ancient grains into a modern Asian Indian diet to reduce the burden of chronic disease. Nutr Rev 2011;69:479-88.
27. Asif M. The prevention and control the Type-2 diabetes by changing lifestyle and dietary pattern. J Educ Health Promot 2014;3:1.
28. Nuttall FQ. Dietary fiber in the management of diabetes. Diabetes 1993;42:503-8.
29. John AJ, Cherian R, Subhash HS, Cherian AM. Evaluation of the efficacy of bitter gourd (Momordica charantia) as an oral hypoglycemic agent a randomized controlled clinical trial. Indian J Physiol Pharmacol 2003;47:363-5.
30. Modak M, Dixit P, Londhe J, Ghaskadbi S, Devasagayam TP. Indian herbs and herbal drugs used for the treatment of diabetes. J Clin Biochem Nutr 2007;40:163-73.
31. Rai V, Iyer U, Mani UV. Effect of tulasi (Ocimum sanctum) leaf powder supplementation on blood sugar levels, serum lipids and tissue lipids in diabetic rats. Plant Foods Hum Nutr 1997;50:9-16.
32. Tiwari AK, Sahana C, Zehra A, Madhusudana K, Kumar DA, Agawane SB, et al. Mitigation of starch-induced postprandial glycemic spikes in rats by antioxidants-rich extract of Cicer arietinum Linn. Seeds and sprouts. J Pharm Bioallied Sci 2013;5:270-6.
33. Perera PK, Li Y. Mushrooms as a functional food mediator in preventing and ameliorating diabetes. Funct Foods Health Dis 2011;1:161-71.
34. De DD, Rapior S, Hyde KD, Bahkali AH. Medicinal mushrooms in prevention and control of diabetes mellitus. Fungal Divers 2012;56:1-29.
35. Landsberg L, Young JB. Sympathoadrenal system: The regulation of metabolism. In: Ingbar SH, editor. Contemporary Endocrinology. Vol. 2. New York: Plenum; 1985. p. 217-46.
36. Surwit RS, Schneider MS. Role of stress in the etiology and treatment of diabetes mellitus. Psychosom Med 1993;55:380-93.
37. Inui A, Kitaoka H, Majima M, Takamiya S, Uemoto M, Yonenaga C, et al. Effect of the kobe earthquake on stress and glycemic control in patients with diabetes mellitus. Arch Intern Med 1998;158:274-8.
38. Viner R, McGrath M, Trudinger P. Family stress and metabolic control in diabetes. Arch Dis Child 1996;74:418-21.
39. Lane JD, McCaskill CC, Ross SL, Feinglos MN, Surwit RS. Relaxation training for NIDDM. Predicting who may benefit. Diabetes Care 1993;16:1087-94.
40. Lustman PJ, Griffith LS, Clouse RE, Freedland KE, Eisen SA, Rubin EH, et al. Effects of alprazolam on glucose regulation in diabetes. Results of double-blind, placebo-controlled trial. Diabetes Care 1995;18:1133-9.
41. Lehrer PM, Woolfolk RL. Are all stress reduction techniques equivalent or do they have differential effects? A review of the comparative empirical literature. In Principles and Practices of Stress Management Techniques. New York: Academic Press; 1984. p. 404-47.
42. Lichtstein KL. Clinical Relaxation Strategies. New York: Wiley; 1988.
43. Surwit RS, van Tilburg MA, Zucker N, McCaskill CC, Parekh P, Feinglos MN, et al. Stress management improves long-term glycemic control in Type 2 diabetes. Diabetes Care 2002;25:30-4.
44. Schmidt NB, Richey JA, Zvolensky MJ, Maner JK. Exploring human freeze responses to a threat stressor. J Behav Ther Exp Psychiatry 2008;39:292-304.
45. Borghouts LB, Keizer HA. Exercise and insulin sensitivity: A review. Int J Sports Med 2000;21:1-2.
46. Singh RB, Singh S, Fedacko J, Pella D, De Meester F. Pranayam Yoga Breathing Practices Modulate the Mind-Body Connection. Int J Disabil Hum Dev 2009;8:141-53.
47. Bal BS. Effects of short term practice of anuloma viloma pranayama on components of health-related fitness. Educ Prac Innov 2015;2:10-8.
48. Srivastava S, Goyal P, Tiwari SK, Patel AK. Interventional effect of bhramari pranayama on mental health among college students. Int J Ind Psychol 2017;4:29-33.
49. Nivethitha L, Mooventhan A, Manjunath NK. Effects of various Pr?n?y?ma on cardiovascular and autonomic variables. Anc Sci Life 2016;36:72-7.
50. Singh RB, Wilczynska-Kwiatek A, Fedacko J, Pella D, De MeesterF. Pranayama: The power of breath. Int J Disabil Hum Dev 2009;8:141-53.
51. Raveendran AV, Deshpandae A, Joshi SR. Therapeutic role of yoga in Type 2 diabetes. Endocrinol Metab (Seoul) 2018;33:307-17.
52. Khedikar SG, Erande MP. Management of diabetes mellitus through aasana and pranayama. Int J Curr Med Pharm Res 2018;4:3656-60.
53. Srivastava A, Tiwari RK. Effect of yoga asanas and pranayama on diabetic adults. Int J Yoga Allied Sci 2015;4:95-101.
54. Mondal S, Kundu B, Saha S. Yoga as a therapeutic intervention for the management of Type 2 diabetes mellitus. Int J Yoga 2018;11:129-38.
55. Jindal N, Joshi NP. Comparative study of vamana and virechanakarma in controlling blood sugar levels in diabetes mellitus. Ayu 2013;34:263-9.
56. Shalinee, Mishra D, Kamal K, Gupta AK, Sharma KK. Shankha prakshalana: A yogic karma for purification. Int J Ayurvedic Herb Med 2012;2:578-81.
57. Skoro-Kondza L, Tai SS, Gadelrab R, Drincevic D, Greenhalgh T. Community based yoga classes for Type 2 diabetes: An exploratory randomised controlled trial. BMC Health Serv Res 2009;9:33.
58. Jyotsna VP, Joshi A, Ambekar S, Kumar N, Dhawan A, Sreenivas V, et al.Comprehensive yogic breathing program improves quality of life in patients with diabetes. Indian J Endocrinol Metab 2012;16:423-8.
59. Miller CK, Kristeller JL, Headings A, Nagaraja H, Miser WF. Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with Type 2 diabetes: A pilot study. J Acad Nutr Diet 2012;112:1835-42.
60. Ricard M, Lutz A, Davidson RJ. Mind of the meditator. Sci Am 2014;311:38-45.
61. Chung SC, Brooks MM, Rai M, Balk JL, Rai S. Effect of sahaja yoga meditation on quality of life, anxiety, and blood pressure control. J Altern Complement Med 2012;18:589-96.
62. Keyworth C, Knopp J, Roughley K, Dickens C, Bold S, Coventry P, et al. A mixed-methods pilot study of the acceptability and effectiveness of a brief meditation and mindfulness intervention for people with diabetes and coronary heart disease. Behav Med 2014;40:53-64.
63. Singh S, Kyizom T, Singh KP, Tandon OP, Madhu SV. Influence of pranayamas and yoga-asanas on serum insulin, blood glucose and lipid profile in Type 2 diabetes. Indian J Clin Biochem 2008;23:365-8.
64. Thangasami SR, Chandani AL, Thangasami S. Emphasis of yoga in the management of diabetes. J Diabetes Metab 2015;6:613.
65. Youngwanichsetha S, Phumdoung S, Ingkathawornwong T. The effects of mindfulness eating and yoga exercise on blood sugar levels of pregnant women with gestational diabetes mellitus. Appl Nurs Res 2014;27:227-30.
66. Sreedevi A, Gopalakrishnan UA, Karimassery Ramaiyer S, Kamalamma L. A randomized controlled trial of the effect of yoga and peer support on glycaemic outcomes in women with Type 2 diabetes mellitus: A feasibility study. BMC Complement Altern Med 2017;17:100.
67. Malhotra V, Singh S, Tandon OP, Sharma SB. The beneficial effect of yoga in diabetes. Nepal Med Coll J 2005;7:145-7.
68. 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 2009;53:97-101.
69. 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 2007;4:469-86.
70. Aswathy S, Unnikrishnan AG, Kalra S. Effective management of Type 2 DM in India: Looking at low-cost adjunctive therapy. Indian J Endocrinol Metab 2013;17:149-52.
71. Mahajan AS. Role of yoga in hormonal homeostasis. Int J Clin Exp Physiol 2014;1:173-8.
72. Innes KE, Bourguignon C, Taylor AG. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: A systematic review. J Am Board Fam Pract 2005;18:491-519.
73. Kosuri M, Sridhar GR. Yoga practice in diabetes improves physical and psychological outcomes. Metab Syndr Relat Disord 2009;7:515-7.
74. Ross A, Thomas S. The health benefits of yoga and exercise: A review of comparison studies. J Altern Complement Med 2010;16:3-12.
75. Gordon L, Morrison EY, McGrowder D, Penas YF, Zamoraz EM, Garwood D, et al. Effect of yoga and traditional physical exercise on hormones and percentage insulin binding receptor in patients with Type 2 diabetes. Am J Biochem Biotechnol 2008;4:35-42.
76. Sahay BK. Yoga and diabetes. J Assoc Physicians India 1986;34:645-8.
77. Sahay BK. Role of yoga in diabetes. J Assoc Physicians India 2007;55:121-6.
78. McDermott KA, Rao MR, Nagarathna R, Murphy EJ, Burke A, Nagendra RH, et al. A yoga intervention for Type 2 diabetes risk reduction: A pilot randomized controlled trial. BMC Complement Altern Med 2014;14:212.
79. Cui J, Yan JH, Yan LM, Pan L, Le JJ, Guo YZ, et al. Effects of yoga in adults with Type 2 diabetes mellitus: A meta-analysis. J Diabetes Investig 2017;8:201-9.
80. Hagins M, States R, Selfe T, Innes K. Effectiveness of yoga for hypertension: Systematic review and meta-analysis. Evid Based Complement Alternat Med 2013;2013:649836.
81. Sahay BK, Murthy KJR, Raju PS, Madhavi S. Effect of yogic practices on exercises tolerance in diabetes. Diabetes 1991;40:398.
82. Madhavi S, Raju PS, Reddy MV, Annapurna N, Sahay BK, Kumari DG, et al. Effect of yogic exercises on lean body mass. J Assoc Physicians India 1985;33:465-6.
83. Chong S, Ding D, Byun R, Comino E, Bauman A, Jalaludin B, et al. Lifestyle changes after a diagnosis of Type 2 diabetes. Diabetes Spectr 2017;30:43-50.
84. Khan MU. Lifestyle modification in the prevention of Type II diabetes mellitus. Oman Med J 2012;27:170-1.
85. Sanghani NB, Parchwani DN, Palandurkar KM, Shah AM, Dhanani JV. Impact of lifestyle modification on glycemic control in patients with Type 2 diabetes mellitus. Indian J Endocrinol Metab 2013;17:1030-9.
86. Liu AY, Silvestre MP, Poppitt SD. Prevention of Type 2 diabetes through lifestyle modification: Is there a role for higher-protein diets? Adv Nutr 2015;6:665-73.
87. Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on Type 2 diabetes mellitus: A review. Int J Health Sci (Qassim) 2017;11:65-71.
88. Knutson KL. Impact of sleep and sleep loss on glucose homeostasis and appetite regulation. Sleep Med Clin 2007;2:187-97.
89. Bhatia V, IAP National Task Force for Childhood Prevention of Adult Diseases. IAP national task force for childhood prevention of adult diseases: Insulin resistance and Type 2 diabetes mellitus in childhood. Indian Pediatr 2004;41:443-57.
112 Views | 18 Downloads
How to Cite
Review Article(s)