Accepted Manuscript

Title: Effect of cold hip baths on blood glucose levels in

patients with type 2 diabetes mellitus: a pilot study

Authors: A Mooventhan MD (Naturopathy), Sharad

Shivajirao Chaudari, V Venugopal

PII: S1262-3636(19)30063-1
DOI: https://doi.org/10.1016/j.diabet.2019.04.003
Reference: DIABET 1087

To appear in: Diabetes & Metabolism

Received date: 4 January 2019

Please cite this article as: Mooventhan A, Chaudari SS, Venugopal V, Effect of cold hip
baths on blood glucose levels in patients with type 2 diabetes mellitus: a pilot study,
Diabetes and Metabolism (2018), https://doi.org/10.1016/j.diabet.2019.04.003

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Effect of cold hip baths on blood glucose levels in patients with type 2 diabetes mellitus: a
pilot study

Running head: Cold hip baths in type 2 diabetes

A. Mooventhan,1 Sharad Shivajirao Chaudari,2 V. Venugopal3

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MD (Naturopathy), Assistant Medical Officer/Lecturer-II, Department of Naturopathy, Govt.

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Yoga and Naturopathy Medical College and Hospital, Arumbakkam, Chennai, Tamil Nadu,
India

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Intern, Division of Yoga and Life Sciences, The School of Yoga and Naturopathic Medicine, S-
VYASA University, Bengaluru, Karnataka, India

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Assitant Medical Officer/Lecturer-II, Department of Yoga, Govt. Yoga and Naturopathy

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Medical College and Hospital, Arumbakkam, Chennai, Tamil Nadu, India
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*Corresponding author:
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A. Mooventhan, MD (Naturopathy)
Assistant Medical Officer/Lecturer-II, Department of Naturopathy, Govt. Yoga and Naturopathy
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Medical College and Hospital, Arumbakkam, Chennai 600106, Tamil Nadu, India
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Email: dr.mooventhan@gmail.com
Mobile tel: +91 98 4445 7496
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Received 4 January 2019; Accepted 7 April 2019

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The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide. Although

conventional medicine is the first line of management, complementary therapies are being

increasingly used in the management of T2DM [1]. Cold hip baths (CHBs) are commonly

employed by naturopathic hospitals in India to treat T2DM. However, there is a lack of scientific

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reports on their effect on blood glucose levels (BGLs) [2]. For this reason, the present pilot study

was conducted to evaluate the effect of CHBs on BGLs in patients with T2DM.

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Eight T2DM patients (five men, three women) aged 51.25 ± 5.44 years were recruited for the

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study. Men and women with a history of T2DM on stable medication over the past month who

were willing to participate were included. Participants with a history of type 1 diabetes, T2DM

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complications, psychiatric problems and aversion to cold water were excluded.
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The study protocol was approved by the relevant institutional ethics committee, and informed
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consent was obtained from all participants.

A single-group repeated-measures design was used for this pilot study. All subjects underwent
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one CHB session and one control session (CS), both on the same day. All CHBs were taken
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using a specially designed tub called a ‘hip bathtub’ made of fibre. Participants were advised to
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sit in a tub of water (15o–16o C) filled to a level that allowed immersion of the area between the

umbilicus and mid-thigh. They were also advised to rest their feet on a footrest (outside the tub),
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while resting their hands (not touching the water) on the sides of the tub [2]. During the CS,

participants were asked to sit comfortably in a chair with no hydrotherapy intervention. The
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CHB and CS each lasted for 20 min.

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Random BGLs were measured using a continuous glucose-monitoring sensor (FreeStyle Libre

Pro Flash Glucose Monitoring System; Abbott Diabetes Care, Witney, UK) at baseline (just

before), during and after (immediately, at 15 min and at 30 min) each interventional session.

Statistical analyses of data collected within and between sessions were performed using repeated

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measures of analysis of variance (ANOVA) and post-hoc analyses with Bonferroni adjustment

for multiple comparisons, using SPSS version 16.0 software (SPSS Inc., Chicago, IL, USA).

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There were no significant differences in BGLs at baseline in the between-session analysis.

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However, there was a significant reduction in BGLs after 30 min with CHBs compared with

CSs. Likewise, the within-session analysis showed a trend towards a gradual reduction of BGL

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with the CHB, but not the CS. None of the participants reported any adverse events either during

or after the interventions.

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These results suggest that a 20-min CHB is effective for reducing BGL in patients with T2DM

compared with a simple rest. Thus, CHBs could be considered a complementary treatment
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modality when treating patients with T2DM. Also, the trend towards a gradual reduction in
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BGLs with CHBs suggests that the glucose-lowering effect begins during the intervention itself,

then gradually accelerates over a period of time (particularly after the intervention) to produce a
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significant reduction a half-hour after the intervention.

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The following possible mechanisms may explain the BGL reduction with CHB sessions. (i)

Cold-induced thermogenesis is the ability to generate heat by increasing metabolism in response

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to cold to maintain a stable core body temperature, a basic property of endothermic

thermoregulation [2,3]. According to a previous study, immersion in cold water (20° C) nearly

doubles the metabolic rate and, at 14° C, more than quadruples it. Thus, the CHB could have
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gradually increased metabolic rates by utilization of blood glucose [2]. (ii) The transient receptor

potential melastatin 8 (TRPM8) ion channel plays a crucial role in detecting cool-to-cold

temperatures in vivo. TRPM8 activation is associated with ‘browning’ of white adipose tissue

and acceleration of energy utilization [4]. Cold exposure is associated with an increase in

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metabolic heat production (shivering and non-shivering thermogenesis) to prevent a fall in core

body temperature. Shivering is a major source of heat production. However, during mild cold

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exposures, non-shivering thermogenesis, primarily mediated by metabolically active brown

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adipose tissue [5], has a vital role in producing a physiological response. Thus, CHBs are also

believed to reduce BGLs by triggering energy utilization and non-shivering thermogenesis

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through activation of the TRPM8 ion channel. (iii) CHBs are reported to prompt parasympathetic

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activation [2] which, in turn, is known to promote insulin secretion [6], and (iv) there is also
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evidence to suggest that exposure to cold (14–15o C) induces a 43% increase in insulin
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sensitivity [7] and improves glycaemic control in T2DM [5].

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Ours is the first study to report on the effects of CHBs on BGLs in patients with T2DM. All
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assessments were done using standard equipment. In addition, although the interventions took

place at different times during the same day (CHBs were between 0900–1000 h in the morning;
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CSs were between 1700–1800 h in the evening), the mean difference in BGL at baseline between

the CHB and CS was 0.62 mg/dL, with no significant difference at baseline according to
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between-session analysis (P = 1.000; Table I).

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As this experiment was conducted as a pilot study, our sample size could not be calculated based

on any previous study. Therefore, although the results of this preliminary study are encouraging,

the difficulty in generalizing these data in the absence of an adequate sample size limits the

applicability of our findings. Thus, a randomized controlled trial involving a larger sample size is
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now required to substantiate these results. However, based on our present data, it may be

concluded that a 20-min CHB could be effective in lowering BGLs in patients with T2DM.

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SOURCE OF FUNDING: None

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CONFLICT OF INTEREST: None declared

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REFERENCES

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Abdominal Pack on Blood Glucose Level and Cardiovascular Functions in Patients with

Type 2 Diabetes Mellitus. J Clin Diagn Res 2018;12:KC01-04.

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doi: 10.7860/JCDR/2018/29561.11328.

2. Shrestha RL, Sujatha KJ. Effect of cold hip bath on autonomic variables in healthy

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individuals: A randomized control trial. J Res Educ Indian Med 2017;23:1-4.

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doi.10.5455/JREIM.82-1502188415.

3. Brychta RJ, Chen KY. Cold-induced thermogenesis in humans. Eur J Clin Nutr

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2017;71:345-52. doi: 10.1038/ejcn.2016.223. Epub 2016 Nov 23.
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4. Kenny GP, Sigal RJ, McGinn R. Body temperature regulation in diabetes. Temperature
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(Austin) 2016;3:119-45. doi: 10.1080/23328940.2015.1131506.
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5. Wang H, Siemens J. TRP ion channels in thermosensation, thermoregulation and

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nervous system is necessary for normal meal-induced insulin secretion in rhesus

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7. Hanssen MJ, Hoeks J, Brans B, van der Lans AA, Schaart G, van den Driessche JJ, et al.
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Table

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Table I

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Study results at baseline, during and after cold hip bath (CHB) and control sessions

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Parameters CHB session (n = 8) Control session (n = 8) P (between sessions)
Baseline 165.88 ± 59.48 166.50 ± 58.53 1.000
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During 160.00 ± 57.29 165.13 ± 54.70 1.000
Blood glucose Post-1 (immediately 145.13 ± 48.62 167.13 ± 51.75 0.203
levels (mg/dL) after)
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Post-2 (after 15 min) 137.75 ± 45.21 168.75 ± 53.74 0.077

Post-3 (after 30 min) 134.88 ± 45.62* 164.63 ± 55.85 0.025**
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Within-session analysis F (1.179, 8.256) = 14.282, F (1.640, 11.477) = 0.186, –

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P = 0.004 P = 0.791
* P < 0.05 for within-session analyses (vs respective baseline); ** P < 0.05 for between-session analyses (by repeated measures of analysis
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of variance and post-hoc analysis with Bonferroni adjustment for multiple comparisons)