Evidence-Based Clinical Decision Making Mind-Body Therapies in Diabetes Management

cases using an evidence-based practice framework presented with “PICO ” components: population, intervention, comparison, and outcome; a description of the search strategy employed for the integra-tive review; a summary of the results and critical appraisal of the search; and an evaluation of the scientific and medical evidence base for recommendations. Background and Clinical Problem Practitioners of meditation have long believed in its ability to treat stress and chronic disease. The physi-ological basis of this belief has never been fully described, but as current research continues to reveal the intri-cacies of neuro-endocrine pathways, meditation, yoga, and other mind-body therapies are considered to be promising options in the treatment of diabetes. The prevalence of diabetes is increasing dramatically worldwide.1 Negative effects of physiological and emotional stress on blood glucose control have been described in the lit-erature.2,3 Mind-body therapies, such as meditation, yoga, qi-gong, and other relaxation techniques, have been studied in diabetes as a means of decreasing stress-related hyper-glycemia.4–8 The objective of many mind-body therapies is to facilitate attainment of a physiological state that counteracts the stress response and develops into a permanent set of traits among practitioners. Physiological and emotional stress activate neuro-endocrine and sympathetic pathways via the hypothalamic-pituitary-adrenal axis and medullary adrenal sym-pathetic system.9,10 Circulating catecholamines and glucocorticoids affect the structure and function of a variety of tissues and induce inflammatory cytokines that lead to increased glucagon production and decreased uptake and disposal of glucose in peripheral muscles.11 Cytokines, primarily interleukin 6, have been strongly implicated in oxidative stress and inflammatory processes that lead to insulin resis-tance and vascular complications.11–13 The relaxation response promotes regulation of cortisol and other stress hormones.14 Structured programs of meditation, such as Transcendenta