5. The effects of medical Qigong on people with type 2 diabetes

A randomized controlled pilot study was conducted at Bastyr University in 2010 on the effects of Qigong on glucose control in type 2 diabetes [3, 27, 31]. In this study, a threearmed, 12-week randomized, controlled clinical trial compared the biological and psychological responses of Yi Ren Medical Qigong (YRMQ) with progressive resistance training (PRT) or standard care in patients with T2DM. The results on blood glucose control [31], perceived stress [27], body weight and insulin resistance [3] in people with T2DM were interesting and intriguing. Fasting plasma glucose, body weight, body mass index (BMI), insulin and perceived stress levels were recorded before and after the 12-week intervention. As shown in Figure 2, the plasma glucose levels indicated significant reductions in the Qigong group. In contrast, the plasma glucose levels showed an increase in both the PRT group and the control group, respectively [31].

The results of the preliminary study showed a very interesting phenomenon as shown in Figure 3: the PRT group participants demonstrated significant body weight loss and BMI decrease, but their insulin resistance increased; in contrast, the YRMQ group showed a smaller loss in body weight and BMI, but their insulin resistance decreased [3]. These results suggested that medical Qigong works with a different mechanism for the management of type 2 diabetes compared with PRT [3].

Figure 2. Changes in fasting blood glucose during a 12-week intervention [3, 31].

Figure 3. Changes in insulin resistance during a 12-week intervention [3, 31].

Insulin resistance plays a major role in the pathogenesis of metabolic syndrome and T2DM and yet the mechanisms responsible for it remain poorly understood. Current studies have shown that mitochondria may be a major factor in the development of T2DM [32–34]. Mitochondria are known as the powerhouses of the cell. They convert energy from the food that we eat into an energy substance called adenosine triphosphate (ATP) through the process of oxidative respiration. A potential mechanism linking mitochondrial dysfunction to insulin resistance is seen when decreases in substrate oxidation affect electron flow through the electron transport chain (ETC) and lead to the formation of superoxide which damages mitochondria [35]. Mitochondrial superoxide shows evidence of a being a cellular reaction to nutrient excess, leading to insulin resistance with body tissues [36]. Exercise is also known to have a major impact on both mitochondrial function and insulin sensitivity in skeletal muscle [37–40]. Exercise increases energy expenditure and insulin sensitivity. Studies suggest that aerobic exercise may be useful in reversing insulin resistance in prediabetic individuals, possibly preventing the development of type 2 diabetes [34].

One possible explanation for the outcome in the abovementioned study [3] of the YRMQ participants who experienced a reduction in insulin resistance is that in medical Qigong practice, specific Qi-energy breathing exercises that are uniquely recharging might enhance the mitochondrial oxidative respiration process and provide energetic support to mitochondria for preventing ETC electron leakage thereby restoring the functions of the mitochondria for reversing insulin resistance. This possible relationship needs further study.

In addition, it is widely accepted that the etiology of T2DM involves pancreatic β-cell dysfunction and insulin resistance [41]. In molecular genetics studies, the most common mutation leading to mitochondrial diabetes is the A3243G mutation in the mitochondrial encoded tRNA (Leu, UUR) gene [42, 43]. Researchers have found that the A3243G form of mitochondrial diabetes is related to decrease glucose-induced insulin release but is not characterized by insulin resistance, indicating that the major pathology occurs within mitochondria of pancreatic β cells [41]. In the abovementioned study [3], YRMQ group participants practiced, among other Qigong exercises, a specific medical Qigong exercise for empowering the pancreas, which might be beneficial for restoring the functions of the mitochondria of pancreatic β cells. Further studies are needed to investigate these possible benefits.

#### 5.1. Mechanisms of managing type 2 diabetes with medical Qigong

Insulin resistance plays a major role in the pathogenesis of metabolic syndrome and T2DM and yet the mechanisms responsible for it remain poorly understood. Current studies have shown that mitochondria may be a major factor in the development of T2DM [32–34]. Mitochondria are known as the powerhouses of the cell. They convert energy from the food that we eat into an energy substance called adenosine triphosphate (ATP) through the process of oxidative respiration. A potential mechanism linking mitochondrial dysfunction to insulin resistance is seen when decreases in substrate oxidation affect electron flow through the electron transport chain (ETC) and lead to the formation of superoxide which damages mitochondria [35]. Mitochondrial superoxide shows evidence of a being a cellular reaction to nutrient excess, leading to insulin resistance with body tissues [36]. Exercise is also known to have a major impact on both mitochondrial function and insulin sensitivity in skeletal muscle [37–40]. Exercise increases energy expenditure and insulin sensitivity. Studies suggest that aerobic exercise may be useful in reversing insulin resistance in prediabetic individuals, possibly

preventing the development of type 2 diabetes [34].

Figure 2. Changes in fasting blood glucose during a 12-week intervention [3, 31].

76 Chinese Medical Therapies for Diabetes, Infertility, Silicosis and the Theoretical Basis

Figure 3. Changes in insulin resistance during a 12-week intervention [3, 31].

From a medical Qigong perspective, the main cause of T2DM is the imbalance of yin and yang. Another way to look at this is excess sugar intake is too yin and a lack of exercise leads to deficiency of yang. T2DM is largely preventable and many cases could be avoided by lifestyle changes such as eating less and getting appropriate exercise such as walking for 40–60 min/day.
