Diabetes mellitus (DM), particularly type 2 diabetes mellitus (T2DM), stands as a predominant global health challenge and a leading cause of mortality worldwide, driven by chronic hyperglycemia stemming from defects in insulin secretion, action, or both(1).This metabolic disorder encompasses a spectrum of etiologies, intertwining genetic susceptibilities with environmental triggers such as obesogenic diets and sedentary lifestyles, culminating in widespread vascular, neuropathic, and renal complications(2). In India alone, epidemiological data from 2019 indicate approximately 77 million affected individuals, with projections estimating a surge to 134 million by 2045—a trajectory that underscores the escalating socioeconomic burden in low- and middle-income settings(3). Contemporary paradigms increasingly recognize T2DM's psychosomatic dimensions, wherein protracted emotional distress, mental fatigue, and physical inactivity exacerbate insulin resistance; notably, physical inactivity triples T2DM risk while amplifying coronary artery disease incidence by 2.4-fold(4). Core management strategies for T2DM and its triad of comorbidities—obesity, hypertension, and dyslipidemia—rely on non-pharmacological pillars: caloric moderation and structured physical activity(5). Yet, adherence falters amid urban sprawl, nutrient-dense yet calorie-replete diets, spatial limitations for exercise, temporal constraints from modern exigencies, and motivational lapses, particularly among diabetic cohorts(6). Compounding these are T2DM-intrinsic hurdles to mobility, including adiposity-induced mechanical strain, deconditioning, restricted arthromobility, and sequelae like ischemic cardiopathy, peripheral neuropathy, and podiatric vulnerabilities, which collectively erode exercise feasibility(7).Empirical syntheses affirm that such non-compliance profoundly curtails the therapeutic yield of lifestyle interventions, often necessitating escalated pharmacotherapy and heightening complication risks(8).Emerging as a venerable antidote, yoga—rooted in ancient Indian ethos over 5,000 years ago—espouses an integrative paradigm for equilibrating somatic, cognitive, and affective realms(9).Far transcending kinesiological exercise, yoga's salubrious imprint manifests through multifaceted psycho-physiological cascades, as evidenced by burgeoning interventional audits(10-12). Deriving from the Sanskrit "Yuj" (to yoke or unite), this discipline fosters mind-body-spirit synergy, equipping practitioners with augmented physiological resilience and psychosocial buoyancy amid stressors that precipitate T2DM and hypertension.(13) Within Patanjali's Ashtanga octad, therapeutic emphases converge on asanas (postural stabilizations) and pranayama (modulated respirations), modalities routinely harnessed for metabolic stewardship(14). Bibliometric overviews corroborate yoga's prophylactic and ameliorative prowess against psychosomatic afflictions, including T2DM(15). Infusing yogic tenets into quotidian routines elicits profound cardiometabolic recalibrations, fortifying prophylaxis against lifestyle-mediated pathologies.(16) Extant trials illuminate yoga's modulatory effects on T2DM risk constellations—glycemic excursions, adiposity indices, and hemodynamic profiles—while attenuating trait anxiety, thereby potentiating holistic glycemic governance(17,18).Despite this momentum, lacunae persist in exhaustive appraisals of yoga's modulatory breadth on human physiological-biochemical continua. Bridging this void, our inquiry chronicles pre-post yogic evolutions in T2DM phenotypes. Primordially, it interrogates yoga's efficacy in ameliorating body mass index (BMI), systolic/diastolic pressures, postprandial glycemia, fasting glycemia, and HbA1c, probing prospective metabolic reprogramming via adjunctive yogic praxis.

This prospective, observational, cross-sectional comparative study was conducted at Department of Physiology, Government Medical college, Nandyal. The study design adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational research, focusing on pre- and post-intervention assessments in a non-randomized cohort to evaluate the effects of a structured yoga program on physiological and biochemical parameters in patients with type 2 diabetes mellitus (T2DM)(20). The current study was in clearance with ethical approval with the guidelines of the Indian Council of Medical Research (ICMR), New Delhi, India(21). All participants provided written informed consent after a comprehensive explanation of the study objectives, procedures, potential risks, and benefits. No incentives were offered, and participants retained the right to withdraw at any time without prejudice to their medical care. Participants were recruited from the outpatient endocrinology and general medicine Government Medical college, Nandyal. lnclusion criteria encompassed adults aged 40-60 years with a confirmed diagnosis of T2DM (duration 0-10 years) based on World Health Organization (WHO) criteria: fasting plasma glucose ≥126 mg/dL, 2-hour postprandial glucose ≥200 mg/dL, or HbA1c ≥6.5% on at least two occasions, in the absence of ketoacidosis or autoimmune markers.(1) Exclusion criteria included type 1 diabetes, gestational diabetes, acute infections, malignancy, severe cardiovascular events within the prior six months, uncontrolled hypertension (>160/100 mmHg), pregnancy, or any contraindication to yoga (e.g., recent surgery, severe retinopathy, or neuropathy limiting mobility)(22). A total of 100 eligible T2DM outpatients were enrolled consecutively from August 2024 onward, stratified by age and gender to ensure demographic balance, yielding two groups of 50 participants each: an experimental group (intervention with yoga; 23 males, 27 females) and a control group (standard care; 19 males, 31 females). Sample size was determined a priori using G*Power software (version 3.1), assuming a medium effect size (Cohen's d=0.5), alpha=0.05, power=0.80, and accounting for 10% attrition, based on prior yoga-T2DM studies reporting significant glycemic changes(23).The experimental group underwent a 24-week structured yoga intervention in addition to standard medical management (oral antidiabetic agents and dietary counselling per American Diabetes Association guidelines)(24). Yoga sessions, lasting 30 minutes daily (five days/week), were supervised by a certified yoga instructor (RYT-200 accredited) in a dedicated hospital wellness centre. The protocol incorporated a sequence of asanas (postures) including Surya Namaskar (sun salutation), Mandukasana (frog pose), Vakrasana (twisted pose), Ardha Matsyendrasana (half spinal twist), Hamsasana (swan pose), Mayurasana (peacock pose), and Dhanurasana (bow pose), followed by pranayama techniques such as Anulom Vilom (alternate nostril breathing), as adapted from established T2DM-specific protocols(25).Participants maintained a diabetic diet (1500-1800 kcal/day, low glycemic index) and continued prescribed medications without dose adjustments unless clinically indicated. Adherence was monitored via weekly logs and attendance records (>85% compliance required for inclusion in final analysis). The control group received routine care, including quarterly clinic visits, pharmacotherapy, and basic nutritional advice, without yoga or additional lifestyle coaching. Key outcome variables included physiological parameters (body mass index [BMI], systolic and diastolic blood pressure) and biochemical markers (fasting blood glucose [FBG], 2-hour postprandial plasma glucose [PPG], and HbA1c). These were selected based on their established prognostic value in T2DM progression and cardiovascular risk(26).BMI was calculated as weight (kg)/height² (m²) using a calibrated digital scale and stadiometer. Blood pressure was measured in the seated position (right arm, after 5-minute rest) using an automated oscillometric device (Omron HEM-7120), with three readings averaged (discarding the first)(27). Biochemical assessments occurred at baseline (pre-intervention) and endpoint (post-24 weeks). Venous blood (5 mL) was drawn after overnight fast (8-10 hours) into EDTA-coated tubes for HbA1c and plain tubes with gel separator for glucose. Samples were centrifuged at 3000 rpm for 10 minutes and analyzed within 2 hours using a fully automated clinical chemistry analyzer (COBAS c 311, Roche Diagnostics) for FBG and PPG (enzymatic hexokinase method; inter-assay CV <2%)(28). HbA1c was quantified via indirect enzyme-linked immunosorbent assay (ELISA; Bio-Rad D-10 system; certified NGSP-traceable; intra-assay CV <1.5%)(29).All measurements were performed by blinded laboratory technicians to minimize observer bias. Potential confounders (e.g., medication adherence, physical activity via IPAQ-short form, dietary intake via 3-day food diary) were assessed at baseline and endpoint but not adjusted in primary analyses due to the observational design. Data were double-entered into a secure Microsoft Excel database and analysed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA)(30). Continuous variables were expressed as mean ± standard error of the mean (SEM). Normality was verified via Shapiro-Wilk test. Between-group differences (pre- vs. post-intervention) were evaluated using independent-samples t-tests for normally distributed data or Mann-Whitney U tests otherwise; within-group changes employed paired-samples t-tests(31). Categorical variables (e.g., gender, age groups) were compared via chi-square tests. Statistical significance was set at P<0.05 (two-tailed). No interim analyses were performed, and missing data (<5%) were handled via last-observation-carried-forward.

The study cohort comprised 100 participants with type 2 diabetes mellitus (T2DM), evenly distributed across experimental (n=50) and control (n=50) groups, with assessments conducted at baseline and following a 24-week intervention period. Demographic characteristics revealed a balanced representation, with a slight female predominance in both arms and a skew toward older age subgroups (51-60 years), reflective of typical T2DM epidemiology in this region (Table 1). No significant baseline intergroup disparities were noted in age, gender, or T2DM duration (P>0.05), ensuring comparability. Table 1: Demographic Profile (Age and Gender) of Study Cohorts Variables Control (n=50) Experimental (n=50) Gender Male 23 (46%) 19 (38%) Female 27 (54%) 31 (62%) Age Group 40-50 years 24 (48%) 17 (34%) 51-60 years 26 (52%) 33 (66%) Pre-and post-intervention physiological and hepatological parameters are summarized in Table 2. In the control group, minimal fluctuations were observed across metrics, with negligible changes in BMI (25.34 ± 1.52 kg/m² to 25.49 ± 1.41 kg/m²), fasting blood glucose (FBG; 124.21 ± 2.18 mg/dL to 123.09 ± 2.94 mg/dL), systolic blood pressure (SBP; 130.45 ± 2.34 mmHg to 131.23 ± 2.76 mmHg), diastolic blood pressure (DBP; 85.67 ± 1.89 mmHg to 84.91 ± 1.52 mmHg), postprandial plasma glucose (PPG; 229.12 ± 4.78 mg/dL to 226.78 ± 3.69 mg/dL), and HbA1c (7.41 ± 0.42 mmol/mol to 7.29 ± 0.65 mmol/mol). Conversely, the experimental group exhibited substantial improvements post-yoga intervention: BMI decreased markedly (25.12 ± 1.68 kg/m² to 22.34 ± 1.35 kg/m²), alongside reductions in FBG (124.67 ± 1.23 mg/dL to 109.45 ± 3.21 mg/dL), SBP (132.18 ± 3.72 mmHg to 120.92 ± 2.34 mmHg), DBP (85.42 ± 1.56 mmHg to 81.78 ± 1.18 mmHg), PPG (229.34 ± 3.21 mg/dL to 146.23 ± 3.21 mg/dL), and HbA1c (7.41 ± 0.63 mmol/mol to 6.82 ± 0.52 mmol/mol). Table 2: Pre- and Post-Intervention Physiological and Hematological Parameters Groups BMI (kg/m²) FBG (mg/dL) SBP (mmHg) DBP (mmHg) PPG (mg/dL) HbA1c (mmol/mol) Pre-test Control 25.34 ± 1.52 124.21 ± 2.18 130.45 ± 2.34 85.67 ± 1.89 229.12 ± 4.78 7.41 ± 0.42 Experimental 25.12 ± 1.68 124.67 ± 1.23 132.18 ± 3.72 85.42 ± 1.56 229.34 ± 3.21 7.41 ± 0.63 Post-test Control 25.49 ± 1.41 123.09 ± 2.94 131.23 ± 2.76 84.91 ± 1.52 226.78 ± 3.69 7.29 ± 0.65 Experimental 22.34 ± 1.35 109.45 ± 3.21 120.92 ± 2.34 81.78 ± 1.18 146.23 ± 3.21 6.82 ± 0.52 Table 3: Paired Differences in BMI (Pre- vs. Post-Intervention) Parameter Mean SD SEM 95% CI of Diff. t df 2-tailed Sig. BMI Control 0.15 1.95 0.28 -0.41 to 0.71 0.54 49 0.59 Experimental -2.78 2.41 0.34 -3.47 to -2.09 -8.17 49 0.000 Analogous patterns emerged for hematological parameters (Table 4). Within-group analyses revealed non-significant changes in controls for FBG (-1.12 mg/dL; P=0.036, borderline), SBP (0.78 mmHg; P=0.125), and HbA1c (-0.12 mmol/mol; P=0.235), with marginal significance for DBP (-0.76 mmHg; P=0.029) and PPG (-2.34 mg/dL; P=0.011). In contrast, the experimental group demonstrated robust, significant decrements across all domains: FBG (-15.22 mg/dL; P<0.001), SBP (-11.26 mmHg; P<0.001), DBP (-3.64 mmHg; P<0.001), PPG (-83.11 mg/dL; P<0.001), and HbA1c (-0.59 mmol/mol; P<0.001). Between-group contrasts post-intervention confirmed superiority of yoga-augmented care (all P<0.05), with effect sizes ranging from moderate (DBP, HbA1c) to large (FBG, PPG). Table 4: Paired Differences in Hematological Parameters (Pre- vs. Post-Intervention) Parameter Mean SD SEM 95% CI of Diff. t df 2-tailed Sig. FBG Control -1.12 3.71 0.52 -2.17 to 0.93 -2.15 49 0.036 Experimental -15.22 3.48 0.49 -16.21 to -14.23 -31.06 49 0.000 SBP Control 0.78 3.52 0.50 -0.23 to 1.79 1.56 49 0.125 Experimental -11.26 4.41 0.62 -12.51 to -10.01 -18.12 49 0.000 DBP Control -0.76 2.39 0.34 -1.44 to -0.08 -2.24 49 0.029 Experimental -3.64 1.92 0.27 -4.19 to -3.09 -13.48 49 0.000 PPG Control -2.34 6.28 0.89 -4.13 to -0.55 -2.63 49 0.011 Experimental -83.11 4.78 0.68 -84.47 to -81.75 -122.51 49 0.000 HbA1c Control -0.12 0.71 0.10 -0.32 to 0.08 -1.20 49 0.235 Experimental -0.59 0.74 0.10 -0.80 to -0.38 -5.90 49 0.000 Overall, these findings affirm the yoga intervention's efficacy in eliciting favorable metabolic and hemodynamic adaptations in T2DM patients, with no adverse events reported and high adherence (>85%) in the experimental arm.

The present investigation elucidates the salutary effects of a 24-week structured yoga intervention on physiological and hematological indices in adults with type 2 diabetes mellitus (T2DM), manifesting as pronounced intergroup divergences in body mass index (BMI), blood pressure (systolic and diastolic), fasting blood glucose (FBG), postprandial plasma glucose (PPG), and HbA1c across pre- and post-intervention epochs (all P<0.05). In the experimental cohort, BMI regressed from 25.12 ± 1.68 kg/m² to 22.34 ± 1.35 kg/m², FBG from 124.67 ± 1.23 mg/dL to 109.45 ± 3.21 mg/dL, systolic blood pressure (SBP) from 132.18 ± 3.72 mmHg to 120.92 ± 2.34 mmHg, diastolic blood pressure (DBP) from 85.42 ± 1.56 mmHg to 81.78 ± 1.18 mmHg, PPG from 229.34 ± 3.21 mg/dL to 146.23 ± 3.21 mg/dL, and HbA1c from 7.41 ± 0.63 mmol/mol to 6.82 ± 0.52 mmol/mol—contrasting negligible control-group fluxes. These ameliorations intimate yoga's adjunctive prowess in mitigating T2DM's cardiometabolic encumbrances, aligning with its psycho-neuro-endocrine modulatory paradigm. Adiposity metrics evinced yoga's targeted efficacy, with experimental BMI abatement exceeding controls (mean differential: -2.78 kg/m²; P<0.001). This resonates with Mohan et al.'s 2016 prospective audit, wherein 12-week yogic immersion eroded body fat percentage in high-altitude sojourners, imputing enhanced lipolytic cascades(12).Analogously, Braunstein's 2004 integrative paradigm yielded BMI-glucose synergies in T2DM cohorts, underscoring postural-respiratory synergies in metabolic recalibration(13). More contemporaneously, a 2025 RCT by Hegde et al. documented yoga-naturopathy-induced BMI decrements (mean -2.1 kg/m² over 24 weeks) alongside neuropathic pain alleviation in T2DM inpatients, attributing gains to amplified insulin sensitivity via asana-mediated vagal tonus. Sahay et al. further corroborated fat-to-lean mass transpositions post-yogic stewardship, mirroring our -2.78 kg/m² flux and intimating sustained volumetric reductions(8).Hemodynamic profiles similarly contracted in the experimental arm (SBP: -11.26 mmHg; DBP: -3.64 mmHg; both P<0.001), evoking Subramanian et al.'s 2011 community-based crossover, wherein yogic non-pharmacologic infusions lapsed BP sans control flux(14). Rao et al.'s 2011 naturopathy-yoga hybrid regressed SBP/DBP from 139.6/91.2 to 129.6/86.1 mmHg, paralleling our decrements and implicating pranayamic baroreflex augmentation(15). A 2025 multi-site feasibility trial by Anderson et al. extended these yields, reporting SBP/DBP reductions (-10.2/-3.8 mmHg) in remote yoga versus standard exercise for T2DM management, with high fidelity across sites. Cohen et al.'s 2011 Iyengar RCT affirmed 12/24-week hypotensives, while Wolff et al.'s 2013 primary-care trial spotlighted home-yoga DBP gains versus controls(21,23).Glycemic axes—FBG (-15.22 mg/dL), PPG (-83.11 mg/dL), and HbA1c (-0.59 mmol/mol; all P<0.001)—underwent robust curtailments, befitting Kumar's 2012 yogic serum glucose audit and Singh et al.'s pranayama-asana lipid-insulin synergies(16,17). Chimkode et al. echoed PPG/FBG dips, while Raveendran et al. imputed HbA1c homeostasis to pharmacoreductions(18,19). Manjunatha et al. ascribed beta-cell sensitization, a mechanistic tether(20).Recent meta-analytic scrutiny by Li et al. (2025) privileged yoga's glycemic primacy over conventional exercise in RCTs, with HbA1c deltas (-0.65%) surpassing our -0.59 mmol/mol, potentially via hypothalamic-pituitary-adrenal attenuation. A 2025 community-based RCT by Wang et al. further evidenced HbA1c lapses (-0.7%) and lipid profile improvements in T2DM via structured hatha yoga, augmenting our findings with cognitive enhancements. Exertional comparatives diverge: some exalt yoga's FBG/PPG yields;(18) others parity(21). Agte et al. lauded diastolic primacy(22). Yet, methodological frailties plague yogic audits: modest n, brevity, lax Controls, and pharmacotherapeutic confounders obfuscate attribution—though protocol stasis herein permits yogic accrual. Concurrent antidiabetics, while standardizing care, temper causal inference; our observational bent, sans randomization, invites selection skew. In sum, this inquiry affirms yoga's integrative valence in T2DM stewardship, potentiating parametric homeostasis sans adversities (adherence >85%). Futurity mandates multicenter RCTs, dissecting subtype efficacies and mechanistic nexuses via longitudinal neuroimaging or metabolomics, to forge evidence-based paradigms.

Findings indicate yoga's potential as an adjunctive modality for optimizing T2DM-related outcomes. Rigorous, expanded inquiries are warranted to delineate modality-specific efficacies.

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