Role of Yoga in Distinctly Targeting Modifiable Risk Factors in Type 2 Diabetes to Improve Immuno-Metabolic Axis.

Modifiable and non-modifiable risk factors in Type 2 Diabetes (T2D) contribute to chronic inflammation characterized by elevated pro-inflammatory mediators and constitutively activated immune cells. Chronic inflammation in T2D leads to perturbations in metabolism, resulting in altered immuno-metabolic axis and further vascular complications. Hence, reducing inflammation by targeting modifiable risk factors such as adiposity, sedentary lifestyle and psychological stress in T2D may facilitate efficient clinical management. Yoga has been shown to improve glucose metabolism, reduce psychological stress, and decrease obesity, hence we sought to review the role of Yoga on cellular mechanisms regulating the immuno-metabolic axis in T2D. Elevated levels of inflammatory mediators such as IL-1b, IL-6, TNF-a, and CRP contributing to insulin resistance are reduced upon practicing Surya Namaskara, Pranayama, and meditation and further improved glycemic index in T2D individuals. Specific Asanas and Pranayama significantly decreased adipokines including leptin, adiponectin, and vaspin in subjects with high BMI, triglycerides and HOMA-IR values, and concomitantly reduced inflammation. Bidirectional activation of inflammatory mediators and stress hormones including epinephrine, catecholamines and cortisol manifesting in diabetes are also reduced upon practising meditation and Yoga. Yoga practices such as Pranayama, Asanas and Mudras improve insulin sensitivity, contribute to weight management, mitigate stress levels in T2D, and maintain immuno-metabolic homeostasis.